Foundations Exam – Flashcards
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A peer reviewed journal
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has a structured reviewing system in which at least two reviewers, EXCLUDING IN HOUSE EDITORS, evaluate each unsolicited manuscript and advise the editor as to acceptance or rejection", also called a "refereed"
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Warning! theses are not peer reviewed
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news items, letters to the editor, single page article, regular columns, editorials or opinion pieces, meeting or poster abstracts
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Google
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Not peer reviewed
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CINAHL
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High quality info, access through Baylor libraries, covers non journal sources such as dissertations, theses, books, book chapters, reports, symposia, conference proceedings, audiovisuals
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CINAHL Subject Headings
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Standardized Terminology, nose bleeds=epistaxis, AIDS=acquired immunodeficiency syndrome, Elderly=aged, Sprains=sprains and strains
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Time Saving tip
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gather more references than you need to end up with
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References before 2010
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still in 5th edition APA style
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Refworks
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a web-based service, upgraded to 6th edition as of May 2010
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LRC website
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go to APA style Resources
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Journals LRC owns
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bearcat, CINAHL(full text links, and explanatory locator notes)
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If LRC doesn't own it
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check bearcat first, try PubGet, interlibrary loan, or go to UT southwestern Medical Library
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Baylor University
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chartered in 1845 by the Republic of Texas and affiliated with the Baptist General Convention of Texas, Baylor is the oldest institution of higher learning in the state and the largest Baptist university in the world.
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Mission of Baylor University
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to educate men and women for worldwide leadership and service by integrating academic excellence and Christian commitment with a caring community.
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Revised Honor Code in 2007
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Baylor University students, staff, and faculty shall act in academic matters with the utmost honesty and integrity, established the office of academic integrity, added reporting responsibility for faculty, changed quorum and selection procedures, changed reporting lines
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Academic Appeals
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For students who feel they have been treated unfairly by a professor, handled by professor, and if necessary, chair, dean, and provost's office
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Linda Cates
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Director of the Office of Academic Integrity
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What happens when the OAI receives a report
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1. report has been received 2. procedure (21 days to refer to Honor council) 3. copy of violation report is enclosed, then it is either referred to the honor council or accepted by student (the dec. of the faculty member), finally the OAI maintains the reports and files
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Reporting Process for cases to get to the Honor Council
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cases are referred by faculty to the Honor Council, cases are referred by STUDENTS when the situation has not been resolved to their satisfaction, Automatic referral by OAI to Honor Council on second or subsequent violation
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When matters are referred to the honor council
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a student will attend a honor council hearing. It is coordinated by OAI, must be within 21 days of the referral, in the Quorum there are 3 faculty and 3 students, provost determines the situation
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typical cases seen by the honor counsel
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plagiarism, altering documents, unauthorized collaboration, obtaining information, exam notes, other's work
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REMEMBER THIS!
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the faculty sanctions are given GREATER weight than a students appeal! DUH.
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Plagiarism
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Incorporating into one's work offered for course credit passages taken either word for word or in substance from a work of another, identifies the original author's work with quotation marks, footnotes, or another appropriate written explanation
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Appropriate and consistent sanctions of the reporting process
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faculty has discretion in sanctions, including but not limited to 1. Failure/grade penalty on assignment, 2. Re-writing the assignment, failure/grade penalty on test, failure/grade penalty in course
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the Honor Council recommends sanctions based on
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PRECEDENT; sanctions faculty send, plus probation, suspension, expulsion, etc.
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Sanctions are issued by
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PROVOST! think Lindsey's cousin Tiffany= who is the Provost adminis. at Baylor
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Expungement Process
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Records involving a suspension or expulsion may not be expunged. Student files petition with OAI in last semester. Must use the form obtained from the OAI, matter is decided by the Honor Council chair and TWO member on the Honor Council(from the school where the violation occurred), unanimous decision is necessary, decision is final and MAY NOT BE APPEALED
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class room conduct policy
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students are expected to always conduct themselves in a mature manner that does not distract from or disrupt the educational pursuits of others
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Misconduct
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actions or conduct that include, but are not limited to falsifying reports, client documentation, agency records or other documents
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Philosophy
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expression of what the community of an institution believe to be true about central elements of the institution: existence, knowledge, values, reason or logic, mind, language
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Mission statement of LHSOBN
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to prepare baccalareate and graduate level nurses within a Christian community, for professional practice, health care leadership, and service to society
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Philosophy of Nursing school
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developed from the mission statement, written by the faculty of the nursing school, divided into paragraphs stating what the faculty BELIEVES is most important to the school's work based on the school's intentional mission statement
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Human Needs Framework
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Model, Foundation for the curriculum, focus is on maintaining optimal health by assisting the client to meet human needs, simple to complex
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A nurse generalist
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has the knowledge, skills, and competencies necessary for assuming the responsibility of entry-level professional nursing positions and for graduate study in nursing
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Graduate-specialization
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the faculty believes specialization occurs at the Masters level in the: refinement of existing skills, expansion of knowledge, dev. of competencies in a specific area of nursing practice,
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baylor faculty: def. of health
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Basic Human condition which is uniquely perceived by individuals and groups, health is a dynamic state of human functioning wherein clients exist with varying degrees of wellness and illness, the higher level of human need fulfillment, the more optimal the state of wellness of the client, ind. have the right to pursue that level of health perceived by them to be optimal, taking into account their social and cultural def. of health. The level of health individuals can attain is influenced by the levels of health of families and communities of which they are a part and with whom they coexist
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faculty def of Professional Nursing
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the caring for ind, families, groups and communities and society through the diagnosis and treatment of the responses to actual or potential threats to health and through facilitating human need fulfillment.It is a practice of discipline which has evolved from a rich, unique heritage
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Proffesional nursing encompasses
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the arts, sciences, ethics, and politics.
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Nursing has a dynamic...
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body of knowledge based on nursing research and on the application of theories and concepts from the physical and behavioral sciences and the humanities
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Florence Nightingale
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The role of the nurse is to put the patient in the best condition for nature to act upon him? (she was concerned about the environment, hygiene, and nursing not as a cure but as help)
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Birth of modern nursing
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started with Florence Nightingale, she wrote notes of nursing in 1860
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Virginia Henderson 1958
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Nurse theorist, worked in comm. for public health, she wanted to stand in the GAP for the patient (remember the continuum of healing- illness to wellness)
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Model Nurse Practice Act 1988
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Defined nursing around currently accepted concepts of the nursing process
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American Nurses Association Social Policy Statement (1998)
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Nursing is the diagnosis and treatment of human responses to actual or potential health problems.
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Board of Nurse Examiners-Senate Bill 1,000
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Defined term, "professional nursing"
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Nursing diagnosis
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according to Senate Bill 1,000. As generalists we do not have this, we cannot write orders for medicine or therapy
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BULHSON definition of nursing
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Caring for individuals, families, groups and communities through the diagnosis and treatment of responses to actual or potential threats to health and through facilitating human need fulfillment.
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Bixler and Bixler 1959
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Wrote Criteria of a Profession
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Criteria of a profession first point
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1. Possesses a well defined and well organized body of knowledge that is on an intellectual level and can be applied to the activities of the group, Nursing has both borrowed and biological knowledge
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Nurses knowledge includes (based on criteria of a profession)
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Biological sciences Social sciences Medical sciences-occupational therapists, we must know the system Nursing research- nurses add new knowledege Code of Ethics Standards- national standard Peer review- unique, Bufton is a director of peer review, where a nurse is found to not be meeting standards, nurses monitor nurses
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2. Enlarge a systematic body of knowledge and improve education and service through the use of the scientific method.
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2nd point of criteria of a profession
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Nursing Process
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problem solving process that helps us learn about our patient
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Nursing research
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using a systematic way to find out what is wrong to determine new knowledge or evaluate if a change is necessary.
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Criteria pt. 4
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4. Function autonomously in the formulation of professional policy and in the control of professional activity. Dependent versus collaborative practice Care vs. cure- caring is more emphasized, we can help the patient continue down the continuum Planning and Accountability- We are accountable for our own practice, we are practicing under our license Nursing Diagnosis- depends on the patient Prescriptive Authority Third-party reimbursement
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Criteria pt. 5
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4. Function autonomously in the formulation of professional policy and in the control of professional activity. Dependent versus collaborative practice Care vs. cure- caring is more emphasized, we can help the patient continue down the continuum Planning and Accountability- We are accountable for our own practice, we are practicing under our license Nursing Diagnosis- depends on the patient Prescriptive Authority Third-party reimbursement
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criteria pt. 6
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6. Attract to the profession individuals who recognize this occupation as their life work and who desire to contribute to the good of the society through service to others. Longevity vs. burnout or short term- most people come in for the long term in nursing Stepping-stone vs. articulation- nursing is not a stepping stone, our profession is a profession in itself Service vs. Self-preservation- we do our work because we want to give out our service
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7. Strive to compensate its practitioners by providing autonomy, continuous professional development, and economic security. Appropriate remuneration and dedication Collective bargaining- unions is where this takes place
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criteria pt. 7
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occupations
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Training may occur on job Length of training varies Values, beliefs, and ethics are not prominent features of preparation Accountability rests with employer
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Proffesions
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Education takes place in college or university Education is prolonged Values, beliefs, and ethics are an integral part of preparation Accountability rests with the individual
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Diploma Way of becoming a Nurse
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Based in the hospital First type of nursing education in the US Height of popularity in 1920's and 1930's One of few avenues for women to have career
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Bacc. Education to become Nurse
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4 year programs with 2 pre-req years and 2 yrs nursing courses Continues to be debate about entry level into practice
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Associate Program Degree for Nursing
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Located in Community Colleges 2 year programs-but most students cannot finish in 2 years as curriculum has changed Most common program in US
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Excelsior (formerly Regents) College
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most well known program.- clinical testing weekend
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External Degree Program
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Learning is independent Assessed through highly standardized and validated exams Students responsible for arranging own clinical experiences
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To become an RN one must
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-Graduate from an accredited school of nursing -Be accepted by the BNE for candidacy -Pay fee for licensure CE- continuing education; -Pass the NCLEX -Receive registration and license to practice -Must renew license every 2 years with 20 hours of mandatory CE in Texas
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Art form usually includes
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medium (nurse), Process (Nurse-client interaction) and Product (client outcome)
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Nursing as an art is referred to as
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"the conscience of health care system"
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Nursing as a science
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systematic approach to knowledge with information categorized and organized within a clearly defined frame work, nurses use research, theories and facts to understand human needs and the pathologic processes that block the satisfaction of needs
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Theory
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a systematic explanation of an event in which constructs and concepts are identified and relationships are proposed and predictions made, consists of concepts that describe a pattern of reality
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Theory arranges
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a group of related statements so that they make sense
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Theories can be...
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tested, changed, used to guide research, or provide the basis for evaluation
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How one arrives at a theory
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deductive reasoning (Roy's Adaption Model), and inductive reasoning (build from specific ideas to form generalizations)
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Purpose of Nursing Theories
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to differentiate nursing from other disciplines, provides a means of testing knowledge through research and expanding our knowledge base
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Nursing Theories
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It is the unique theories and perspectives used by a discipline that distinguish it from other disciplines
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Paradigm
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an organizing framework that contains concepts, theories, assumptions, beliefs, values and principles. A discipline may have a number of paradigms
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Assumptions
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beliefs one must accept about phenomena in order to accept a theory about the phenomena
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Construct
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The MOST complex type of concept; more general than a concept. Constructed by the theorist to fit a purpose
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Four major concepts of nursing
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1. systems, 2. person, 3. Environment, 4. Health
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Wagner (1986)
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sampled 160 deans of BSN programs. 94-98 % agreed that the concepts that comprise the nursing paradigm are person, health, nursing, and environment; He concluded there is a consensus in nursing that these are the dominant phenomena within the science of nursing
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System
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(von Betalanffy 1968) Set of interrelated parts that come together to form a whole. Each part is necessary or integral to make a meaningful while
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example of input
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students,faculty, ideas, desire to learn, knowledge
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example of output
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educated graduates
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Evaluation example
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standardized exam of reading comprehension, math, and analytical skills would be used
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Feedback example
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patient satisfaction, patient outcomes, staff retention, etc
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Homeostasis
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Internal stability that is the goal or the dynamic balance for systems is this, this is the GOAL of systems theory
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Maslow's Hierarchy of Human Needs
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1970- All humans are born with instinctive needs, grouped into 5 cat's, arranged in order of importance; Humanistic Theory broken down in intrinsic vs extrinsic factors
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Maslow's landmark book
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MOTIVATION AND PERSONALITY 1954, looked at positive psychology, focused on strengths
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Change Theory
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Involves a modification or alteration and may be planned or unplanned, KURT LEWIN (1962) developed classic theory of change, with 6 components
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6 components of change theory
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1. recognition of where change is needed 2. analysis of a situation to determine what forces exist to maintain the situation and what forces are working to change it 3. identify what methods by which change can occur, 4. Recognition of the influence of a group mores or customs upon the change 5. id of the methods that the references group uses to bring about change 6. the actual process of change
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3 states of lewin's change
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1. unfreezing 2. movement 3. Refreezing
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What Nightingale stressed these things
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significance of trained powers of observation and reflection, record observations, develop knowledge about factors that promoted healing, this knowledge should be distinct from medical knowledge
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Hildegard Peplau (1952)
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Described an interpersonal process between the nurse and the client. Nursing is a therapeutic, interpersonal and goal-oriented process "I started a revolution!"
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Virginia Henderson (1955)
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"the patient is an individual who requires help to reach independence"
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1968 Roy's Adaption Model
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Nurse theorist sr. CALLISTA ROY, peds nurse specialty, began as an investigation of nursing as a service to society, started looking at person and family as adaptive systems
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Focus of Roy Adaption model
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Focuses on the interrelatedness of 4 adaptive systems, deductive theory based on nursing practice, this model guides the RN who is interested in physiologic adaption as well as the one who is interested in psychosocial adaptation as well as the one who is interested in psychosocial adaptation
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Martha Rogers(1970)
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Emphasis on the science and art of nursing with the unitary human being central to the discipline of nursing. Nursing assists the patient in mobilizing inner resources. Energy fields
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The Nurse-client relationship
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the relationship is focused on the client, is goal directed and has defined parameters, utilizes nurse self-assessment
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Phases of the Nurse client relationship
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1. orientation phase, 2. working phase, 3. Termination Phase
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Orientation Phase
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Introductions, agreement about mutual roles and responsibilities, *Remember patient turn over and hopefully they will be discharged by the time you're there next week
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Working Phase
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nurse and client participate together, client uses nurse's expertise and abilities, nurse functions as caregiver, advocate, problem solver around behavioral and interpersonal issues
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Termination Phase
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Closure of the relationship, review patient responses, discharge planning, clarity is key
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AIDET acronym
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A=acknowledge, I=Introduce, D=Duration, E= Explanation, T=Thank you
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A=Acknowledge
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eye contact, make patient feel that you expected them, use their name
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I=Introduce
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First Generation: name, School of Nursing Next Generation: Self,Skill, Set, Experience, and Certification, co workers, other departments, physicians
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D=Duration
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How long will the TEST, procedure, appointment, or admission actually take?, How long BEFORE THE TEST, procedure visit or admission take place?, How long until the RESULTS are available
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E=Explanation
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Why are we doing this?, What will happen and what should you expect? What questions do you have?
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T=Thank you
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THANK THEM FOR CHOOSING BAYLOR AND THANK THEM FOR ALLOWING YOU TO BE THEIR STUDENT NURSE FOR THE DAY
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When you are closing the relationship...
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It is IMPORTANT to ask them if there is anything you can do before you leave? It's a polite and appropriate way to close the relationship
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Process of Communication
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Message sent verbally and or non-verbally to another person, message is received, communication stimulus is sent to the brain where it is perceived, perceiver processes results in some type of response from the receiver
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The Nurses role in patient Communication
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Includes monitoring the tone of your voice, changes in mood of the patient, uses therapeutic communication to identify needs that can be met. Always follow the dr. into the room: the patient might have talked to you and wants to talk to the dr. you can remind the Dr. of the questions the patient might previously have.
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Nurse vital communication tip
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WE interpret to the patient what the Dr. said, it is CRITICAL that the nurse is in the room with the Dr. if at all possible
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Techniques for Therapeutic Communication
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#1- Encourage conversation: #2 Reflecting, #3- Sharing Observations, #4 Acknowledging the patients feelings, #5- Giving Info
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TFTC #1- Encourage conversation
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Conveys willingness to listen; use broad opening statements to initiate conversation
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TFTC #2 Reflecting
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Encourages the patient to expand on her statement by restating the patient's statement (partially or completely)
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TFTC #3 Sharing Observations-
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Conveys concern and interest in further discussion
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TFTC #4 Acknowledging the patient's feelings
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Allows the patient to feel understood and accepted, thus encouraging the patient to express further feelings. THINK OF THIS AS AVOIDING CONFUSION!
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TFTC #5 Giving Information
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Helps the patient to correctly assess information that may help the patient resolve the problem
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Ingredients for Therapeutic Communication
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Empathy, Positive Regard, Comfortable sense of self
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ITC 3. Comfortable sense of self
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Awareness of one's personality, values, cultural background and style of communication
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When developing Helping Relationships, and listening actively,make sure to:
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Pull your chair up to the bedside, ask the questions, nod your head etc. We have a short amount of time with these patients, so when your with them REALLY be there, 9. Be creative
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Developing Helping Relationships
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1. Listen Actively 2. Help Identify what the person is feeling 3. Put yourself in the other's shoes 4. Be honest 5. Do not tell a person WHAT to feel 6. Do not tell a person HOW to feel 7. Do not make excuses for the other person 8. Be genuine 9. Use your ingenuity 10. Know your role and limitations
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Characteristics of Effective Verbal Communication
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1. simplicity, 2. clarity, 3. timing and relevance, 4. Flexibility 5. Feedback 6. Adaptability and Appropriateness 7. Credibility
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Hey Brett...For some reason I feel like you'd be good at this aspect of Effective Verbal Communication, What is it?!
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Humor :)
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Blocks to Therapeutic Communication
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Making stereo-typed comments, Requesting the explanation, Defending, Giving Approval, Belittling the patient's feelings, disagreeing with the patient, using reassuring cliches, agreeing with the patient, giving advice, expressing disapproval, changing the subject
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BTC: Giving advice
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this is different than a suggestion or an alternative solution, Giving advice crosses a line "Oh if I were you.." is not helpful
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What should a nurse always do first in regards to their personal information?
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ALWAYS validate info with the patient first
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Anticipatory guidance
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we always want to be looking ahead to what's their potential problem
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Part of our planning process as a nurse
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Outcome ID
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What does maslows hierarchy of needs have to do with?
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Planning
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What the nurses rule of thumb when it comes to documentation?
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If its not documented, its not done!
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What are nurses continually doing to our patients?
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Assessing. It is only by observation that we will recognize subtle changes
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How many steps of the nursing process are there?
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5!
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Characteristics of a Non-helping Attitude
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1. Condescension, 2. Diminished Concentration, 3. Lack of Spontaneity, 4. Stereotyping
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In terms of a patient wanting to walk as their goal, what should a nurse check to see?
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If we want to walk the patient for 10 minutes, at the end of the day- see how they did!
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Unrealistic expectations must be what?
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modified and documented
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How are nursing care plans mainly instituted now?
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electronically
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The nursing process is a version of what?
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the scientific method
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Professional Boundaries
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The spaces btw the nurses power and the client's vulnerability. The nurse's power comes from the professional position and the access to private knowledge about the client. Establishing boundaries allows the nurse to control this power differential and allows a safe connection to meet the client's needs.
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Boundary Crossings
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Brief excursions across boundaries that may be inadvertent, thoughtless or even purposeful if done to meet a special therapeutic need. This type of crossing results in a return to established boundaries but should be evaluated by the nurse for potential client consequences and implications
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Boundary Violations
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Can result if there is confusion btw the needs of the nurse and those of the client. Such violations are characterized by EXCESSIVE personal disclosure by the nurse, SECRECY, or even a REVERSAL or roles.
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What can Boundary violations cause?
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Delayed distress for the client, which may not be recognized or felt by the client until harmful consequences occur.
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Whats the extreme form of boundary violation?
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Professional Sexual Misconduct
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What does Professional Sexual Misconduct include?
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any behavior that is seductive, sexually demeaning, harassing or reasonably interpreted as sexual by the client. This is an extremely serious violation of the nurse's professional responsibility to the client. It is a breach of trust.
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How many Guiding Principles for the Nurse are there?
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there are 7 guiding principles for the nurse
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GPFTN #1: THIS IS IMPT
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The nurse is responsible to delineate and maintain boundaries
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GPFTN #2
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The nurse should work within the zone of helpfulness
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GPFTN #3
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The nurse should examine any boundary crossing, be aware of its potential implications and avoid repeated crossings
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GPFTN #4
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Variable such as the care setting, community influences, client needs and the nature of therapy affects the delineation of boundaries
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GPFTN #5
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Actions that overstep established boundaries to meet the needs of the nurse are boundary violations
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GPFTN #6
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The nurse should avoid dual relationships where the nurse has a personal or business relationship, as well as a professional one
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GPFTN #7
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Post-termination relationships are COMPLEX (duh) bc the client may need additional services (uh?), and it may be difficult to determine when the nurse-client relationship is truly terminated
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A nurse should use this rather than changing the subject
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direct communication
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Should nurses use the word should?
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Absolutely not. We can't project our feelings on our patient.
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In terms of a conversation, should a nurse assume the relationships of the support person?
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Absolutely not.
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Being this kind of nurse is being a good nurse
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an assertive nurse
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A nurse should use this kind of speech
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persuasive speech
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Boundary crossing on a continuum should be
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inadvertent and unintentional, if at all
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Assessment Techniques
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Observation, Interview, Examination, Medical Record Review
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Dimensions for Gathering Data for Health History
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Physiological and Developmental, psychological, sociological, spiritual
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Physiological and Developmental Dimension
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Perception of health status, past health problems and therapies, present health therapies, risk factors, activity and coordination, review of systems, developmental stage, effect of health status on dev. stage, growth and maturation, occupation, ability to complete ADL's
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Psychological Dimension
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Behavioral and Emotional status, support systems, self concept, body image, mood, sexuality, coping mechanisms, (reason why we took pre reqs)
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sociological Dimension
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Financial Status, Recreational Activities, Primary Language, Cultural Heritage, Cultural Influences, Community Resources, Environmental Risk Factors, social relationships, family support and structure (what are your pt's community resources? coping becomes key, family dynamics need to be looked at so we can better care for our pt)
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Spiritual Dimension
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Beliefs and meaning, Religious experiences, Rituals and practices, Fellowship, Courage
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Knowing this will change the nurses approach of care
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the developmental stage of the patient
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What cannot be validated?
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Nausea, bc its subjective which is the MOST CRITICAL PART OF DATA
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6 phases of Assessment
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collecting data, id'ing cues and making inferences, validating the data,organizing, Iding patterns and testing first impressions, reporting and recording data
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Validating Data Helps the Nurse Avoid
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Making assumptions, missing key information, misunderstanding the situation, jumping to conclusions or focusing in the wrong direction, making errors in problem identification
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Nursing Data is utilized using
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the human needs framework and nursing process format, *Use maslow for deciding about priorities
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Reporting and Recording Data
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check for continuity, accuracy, and use critical thinking
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6 phases of assessment guidelines
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when in doubt, ask your instructor or nurse. Report abnormal finding as soon as possible. Before reporting make sure you have all necessary info at hand. Write down your report, give precise information, use SBAR!
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Initial Assessment
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Admission, purpose is to evaluate health status and ID health needs that are un met
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Focus Assessment
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To collect data about a problem already Identified. Also includes the appraisal of any new, overlooked, or misdiagnosed problem
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Mrs. Prater recommends:
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using a jot sheet, to keep a timely record. You may give recommendations, use SBAR (situation, background, action, recommendation)
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REMEMBER: administration
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must be documented by RN, not tech. tech can take vital signs if the RN feels confident in the person
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Time lapsed re-assessment
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more likely to see this in clinic patients than hospital settings, this is used to evaluate any changes in client's human needs. Performed when long periods of time have elapsed between assessments (3-12 months)
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Emergency Assessment
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life-threatening situations-ABC, suicidal thoughts, social conflict leading to violent acts
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Seating arrangement of the interview
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45% of angle of the bed, 3-4 feet away
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Stages of the Interview
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Opening, Body of the Interview, and Closing
