NR 222 Exam Review One (Nursing, Ethics, Health Promotion, SMART GOALS)

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Definition of Nursing
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Nursing encompasses autonomous & collaborative care of individuals of all ages, families, groups & communities, sick or well settings. Nursing includes the promotion of health, prevention of illness, and the care of ill, disabled & dying people. Advocacy, promotion of a safe environment, research, participation in shaping health policy & in patient & health systems management, and education are also key nursing roles. http://www.icn.ch/who-we-are/icn-definition-of-nursing/
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Definition of Nursing as a Profession
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The Nursing profession is self-governing and as members of the Nursing profession, nurses provide a service to society, are accountable for their actions and abide by the ANA Code of Ethics. Professional Responsibility of the Nurse is to provide care and comfort and emphasize health promotion and illness prevention through education.
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General Description of Nursing
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Nursing involves the diagnosis and treatment of human responses to health and illness.
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Nursing Assessment
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gathering of objective and subjective data about a patients physiological, psychological, sociological and spiritual status
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Objective data
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is information that the nurse perceives, such as via observation, hearing, smiling, feeling. Objective data includes data such as vital signs and lab results.
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Subjective data
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is information provided to the nurse by the patient. For example, a patient tells you they have a pain in their leg. The nurse cannot ‘see’ the pain; however, the nurse can see a grimace on the face of someone in pain. This grimace on their face would be an objective observation.
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Nursing Diagnosis
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a clinical judgement about individual, family, or community responses to actual or potential health problems. A nursing diagnosis provides the basis for a selection of nursing interventions to achieve positive patient outcomes.
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Nursing Process (Standards of Practice)
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1. Assessment 2. Diagnosis (Nursing) 3. Planning 4. Implementation 5. Evaluation
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Assessment
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RN collects comprehensive data pertinent to the patient’s health and situation
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Diagnosis (Nursing)
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RN analyzes assessment data to determine diagnoses
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Planning
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RN develops a plan of care that involves interventions to attain expected outcomes for the patient; Outcomes Identification- RN identifies expected outcomes for the patient.
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Implementation
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RN implements interventions identified in the plan based on the nursing diagnosis
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Evaluation
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RN evaluates progress toward attainment of outcomes
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Professional Nurse Roles (ACCEM)
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Advocate Caregiver Communicator Educator Manager
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Advocate
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Ie. Nurse acts as the “voice” for the patient. Our first loyalty is to the patient.
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Caregiver
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Ie. Nurse provides care on all levels: Physical, psychosocial, developmental, cultural & spiritual
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Communicator
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Ie. Nurse communicates with patient/family and healthcare team
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Educator
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Ie. Nurse provides education on all aspects of care, such as heart healthy diet.
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Manager
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Ie. Nurse guides patient care across the continuum (admission to discharge)
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Nurse Autonomy
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respecting parent’s decision to make a child ‘no code blue’ or ‘do not resuscitate’
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Nurse Accountability
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‘owning up to one’s actions’ or being answerable to one’s own actions.
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Patient Self-Determination Act
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Competent patients have the right to make their own decisions.
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Health Insurance Portability and Accountability Act (HIPAA)
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“Privacy Rule” – Upholds confidentiality of patients’ protected health information
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Behavior-Specific Cognition
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Nurse must assess the PATIENT’S PERCEIVED benefits of action to evaluate the potential for success in improving health. In other words, for the patient to be successful in improving health, he/she must perceive the actions or interventions to be helpful or beneficial.
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ANA Code of Ethics
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identifies 9 provisions that emphasize the primary goals, values, and obligations of the nursing profession. *Foundation Sets standards of nursing practice
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Ethical Principles
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Autonomy Beneficence Fidelity Justice Nonmaleficence Veracity
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Ethical dilemmas
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occur as a result of conflicting values. Important for the nurse to understand own personal values.
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** General steps in resolving ethical dilemmas
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Gather relevant information Identify actions to be taken Negotiate a plan Evaluate the plan
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*Ethical Issues
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Discuss details with patient Determine if ethical issue exsits Assess everyone’s ethical beliefs Determine if there is an ethical conflict Take decided actions Discuss results of actions
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Health Promotion
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Assessment of strengths, not only deficits. Important to make true assessments while involving patient in his/her care. AVOID making suggestions before consideration of patient and family concerns.
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Healthy People 2020 – Overarching Goals
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1. Advance the access to care for all 2. Eliminate health disparities 3. Increase the quality and years of healthy life
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Tobacco
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smoking cessation is important health promotion issue
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Definition of Health
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Dynamic and holistic process in a person’s perceived state of being (Always changing)
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Illness can be ACUTE or CHRONIC
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ACUTE illness=short duration and severe CHRONIC illness=persists longer than 6 months. For example, people normally make lifestyle changes which are the best way to manage their long-term disease or chronic illness.
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Models of Health and Illness
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HEALTH BELIEF MODEL- Addresses the relationship between a person’s beliefs and behaviors. People’s health beliefs can put them at risk for illness. EXAMPLE: Some people seek medical attention only when they are sick. This puts them at risk because they may be seeking care too late. Some illnesses can be detected early and serious disease can be prevented. HEALTH PROMOTION MODEL- Directed at increasing a patient’s level of well-being (prevention & education)
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Risk Factors
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Variables that increase the vulnerability of an individual or a group to an illness or accident. It is important FIRST identify problems that may develop (prevention). Examples: Genetic and Physiological Factors Age Environmental Lifestyle Behaviors If patient smokes, then smoking is a RISK FACTOR for diseases such as Chronic Obstructive Pulmonary Disease (COPD), lung cancer, etc. Risk factors can be MODIFIABLE or NON-MODIFIABLE. In the examples above, modifiable risk factors include, environmental and lifestyle behaviors such as smoking. Age, genetics, developmental level are examples of non-modifiable risk factors.
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Modifiable Risk Factors
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environmental and lifestyle behaviors- smoking
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Non-modifiable Risk Factors
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age, genetics, developmental level
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Levels of Prevention
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Primary Secondary Tertiary
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Primary Prevention
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True prevention that lowers the chances that a disease will develop Ie. Immunizations, use of seat belts, use of infant car seats. EDUCATION is a great example of primary prevention and nurses provide education frequently. Also, keep in mind that screening for risk factors rather than disease is considered primary prevention. For example, let’s say a person is screened for risk factors related to Diabetes. They find that they are obese and lack exercise. This is considered primary prevention because the actual disease ( Diabetes) can be prevented by diet and exercise.
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Secondary Prevention
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Focuses on those who have or are at risk to develop a disease. Ie. Screening for breast cancer ( actual disease). If disease is detected during screening mammogram or cardiac catheterization, for example, the disease may be treated early and managed before disease becomes more serious or life threatening. In the previous example, if a screening is done to detect high blood glucose, then Diabetes may be detected. This is secondary prevention because the actual disease is detected and can be treated early.
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Tertiary Prevention
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Occurs when a defect or disability is permanent or irreversible. Disease is already present, so in this stage, we treat and manage the disease. (chronic or long term)
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SMART Goals
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Specific Measurable Attainable Relevant Time-Frame
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Specific
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“What has to be done?”
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Measurable
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“What will be the end result?”
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Attainable
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“Is the goal feasible or reachable?”
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Relevant
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“Is the goal applicable?”
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Time-Frame
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“What is the target date?”

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