question

Regarding Historical Perspective Highlights Nurses:

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-Respond to needs of clients - Actively participate in policy - Respond and adapt to challenges

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-Established first nursing philosophy

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Florence Nightingale (1860)

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- Health maintenance - Restoration

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Florence Nightingale (1860)

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• Role of nursing: - "charge of somebody's health" - "how to put the body in such a state to be free of disease or to recover from disease

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Florence Nightingale (1860)

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Civil War to the Beginning of the Twentieth Century -Red Cross

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Clara Barton

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Civil War to the Beginning of the Twentieth Century

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Dorothea Dix and Mother Bickerdyke

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Civil War to the Beginning of the Twentieth Century -Led slaves to freedom

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Harriet Tubman

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Civil War to the Beginning of the Twentieth Century -First colored nurse -Respect

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Mary Mahoney

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In the Twenty‐First Century what was put in place

answer

• Nursing Code of Ethics • Changes in curriculum • Nursing in multiple care settings • End of Life Care

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What are the Societal Influences on Nursing

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• Demographic changes • Woman's health care issues • Human rights • Medically underserved • Threat of bio terrorism

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Influence of Today's Health Care Delivery System

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• Rising health care costs • Evidence‐based practice • Nursing and biomedical research • Nursing shortage

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What are the needs of the Consumers

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• Cultural diversity • Safety • Health promotion and wellness

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Nursing as a Profession

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- Requires an extended education - Requires a body of knowledge - Provides a specific service - Has autonomy - Incorporates a code of ethics

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• Nursing: Scope and Standards of Practice - 1960: Documentation began - Standards of Practice - Standards of Professional Performance • Goal - To improve the health and well‐being of all individuals, communities, and populations through the significant and visible contributions of registered nursing using standards‐based practice

answer

Scope and Standards of Practice

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Nursing: Scope and Standards of Practice Goal

answer

- To improve the health and well‐being of all individuals, communities, and populations through the significant and visible contributions of registered nursing using standards‐based practice

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ANA Standards of Nursing Practice

answer

Nursing standards provide the guidelines for implementing and evaluating nursing care. • Assessment • Diagnosis • Planning • Implementation • Evaluation

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ANA Nursing standards provide

answer

guidelines for implementing and evaluating nursing care.

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Standards of Professional Performance

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Ethics Quality of Practice Professional Practice Evaluation Education Communication Resources Evidence-Based Practice and Research Leadership Environment allied Health Collaboration

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Code of Ethics

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• Philosophical ideals of right or wrong that define principals. • Incorporate your - Ethics - Values - Worldview

question

Nursing is defined as a profession because nurses

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Practice autonomy.

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Nursing Education

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• Professional Registered Nurse Education - Diploma - ADN - BSN • Graduate Education - MSN • Doctoral Preparation - DSN or DNP - PhD • Continuing and In‐Service Education

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Nursing Practice

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Nurses practice in a variety of settings. • Nurses: - Protect, promote, and optimize our patients' health - Prevent illness and injury - Alleviate suffering through the diagnosis and treatment of human responses - Advocate for the care of our patients

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Nurse Practice

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• Nurse Practice Acts • Licensure and Certification • Science and Art of Nursing Practice

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Nursing Practice Benner: From Novice to Expert

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• Novice • Advanced Beginner • Competent • Proficient • Expert

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Novice

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New Grad nurse

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Advanced beginner

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2-3 years experience

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Professional Responsibilities and Roles

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• Nurses are responsible for obtaining and maintaining specific knowledge and skills. • In the past: - To provide care and comfort • Now: - To provide care and comfort and to emphasize health promotion and illness prevention

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• Nurses are responsible for obtaining and maintaining specific knowledge and skills. • In the past:

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- To provide care and comfort

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• Nurses are responsible for obtaining and maintaining specific knowledge and skills. Now:

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- To provide care and comfort and to emphasize health promotion and illness prevention

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Professional Responsibilities and Roles "The making of a Nurse"

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• Caregiver • Advocate • Educator • Communicator • Manager

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Career Development

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Nursing provides an opportunity for you to commit to lifelong learning and career development.

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Career Development

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• Clinician • Advanced Practice Nurse - Clinical Nurse Specialist - Nurse Practitioner - Certified Nurse Midwife - Certified Registered Nurse Anesthetist • Nurse Educator • Nurse Administrator • Nurse Researcher

question

Ming is particularly drawn to the idea of becoming an advanced practice registered nurse (APRN). - Ming's career options for becoming an APRN include which of the following? (Select all that apply.)

answer

Clinical nurse specialist (CNS) Certified nurse midwife (CNM) Certified RN anesthetist (CRNA)

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Professional Nursing Organizations

answer

• National League for Nursing • American Nurses Association • International Council of Nursing • National Student Nurses Association

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If Ming decides to pursue a career as an APRN, which patient populations may he serve?

answer

Neonatology Psychiatric mental health Adult‐gerontology

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Quality and Safety Education for Nurses (QSEN)

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Competency Patient‐Centered Care Teamwork and Collaboration Evidence‐Based Practice Quality Improvement Safety Informatics

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Additional Nursing Trends

answer

Genomics • Public perception of nursing • Impact of nursing on politics and health policy • Future trends

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You practice using nursing code of ethics for professional registered nurse. This code:

answer

Defines the principals by which nurses provide care to their clients

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A Case for Evidence

answer

• A response to societal forces • A problem‐solving approach to practice • Challenge to obtain: - The very best information - The most current information - Information at the right time, when you need it for patient care

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Steps for Evidence‐Based Practice

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EBP achievement of best practice: • Five steps: - Ask the clinical question. - Collect the best evidence. - Critique the evidence. - Integrate the evidence. - Evaluate the practice decision or change.

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EBP achievement of best practice: • Five steps:

answer

- Ask the clinical question. - Collect the best evidence. - Critique the evidence. - Integrate the evidence. - Evaluate the practice decision or change.

question

Developing a PICO question P

answer

Patient population of interest Identify pts by age, ethnicity , disease of health problems

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Developing a PICO question I

answer

Intervention of interest What is the intervention that is worthwhile to use in practice (ex. Tx, Dx test, Prognostic factor)

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Developing a PICO question C

answer

Comparison of interest What is the usual standard of care or current intervention used now in practice?

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Developing a PICO question O

answer

Outcome: What result do you wish to achieve or observe as a result of an intervention (ex. Change in client behavior, physical finding, client perception)

question

Gathering Evidence

answer

• The more focused a PICOT question is, the easier it will become to search for evidence in the scientific literature. • Expert clinicians are a rich source of evidence because they use it frequently to build their own practice and to solve clinical problems. • The critique or evaluation of evidence includes determining the value, feasibility, and usefulness of evidence in making a practice change.

question

The more focused a PICOT question is

answer

the easier it will become to search for evidence in the scientific literature.

question

Expert clinicians are a rich source of evidence because they use it frequently to

answer

build their own practice and to solve clinical problems.

question

Reviewing Studies • Evidence-based articles include the following:

answer

- Abstract - Introduction - Literature review or background - Narrative (clinical or research) • Purpose • Methods or design - Results and/or conclusion • Clinical implications

question

Analysis of Evidence

answer

• After critiquing all articles for a PICOT question, - Synthesize or combine the findings - Consider the scientific rigor of the evidence and - Whether it has application in practice

question

After critiquing all articles for a PICOT question

answer

- Synthesize or combine the findings - Consider the scientific rigor of the evidence and - Whether it has application in practice

question

Integration of Evidence When you decide to apply evidence, consider:

answer

- The setting - Whether support is provided from staff and available resources • Evaluate the change. • Share the information.

question

Nursing Research

answer

• A way to identify new knowledge, improve professional education and practice, and use resources effectively • The International Council of Nurses (ICN) supports the need for nursing research as a means of improving the health and welfare of people.

question

The International Council of Nurses (ICN) supports the need for

answer

nursing research as a means of improving the health and welfare of people

question

Outcomes Management Research

answer

• Designed to assess and document the effectiveness of health care services and interventions • A response of the health care industry to demands from policy makers, insurers, and public • Care delivery outcomes are the observable or measurable effects of some intervention or action

question

Outcomes Management Research Examples of Nursing‐Sensitive Outcome Measures

answer

• Central line bacteremia rate • Compliance/adherence to actions (diet, meds, activity restriction) • Failure to rescue • Fall rate • Functional status • Nosocomial (health‐care associated) infection rate • Nosocomial (health‐care associated) ulcer rate • Symptom reduction

question

Which of the following is the first step of the research process?

answer

Identify problem.

question

Human Research Terminology

answer

• Institutional Review Board (IRB) • Informed consent means - Participants receive full and complete information - They can understand the information - They have free choice to participate - They understand how their confidentiality will be kept • Confidentiality

question

Quality and Performance Improvement

answer

• Every health care organization gathers data on health outcome measures as a way to gauge the quality of care. • Quality improvement • Performance improvement • A thorough analysis of QI data leads clinicians to understand work processes and the need to change practice.

question

QI Program

answer

• Plan—Review available data to understand existing practice conditions or problems to identify the need for change. • Do—Select an intervention on the basis of the data reviewed and implement the change. • Study—Study (evaluate) the results of the change. • Act—If the process change is successful with positive outcomes, act on these practices by incorporating them into daily unit performance.

question

QI Program Plan

answer

Review available data to understand existing practice conditions or problems to identify the need for change.

question

QI Program Do

answer

Select an intervention on the basis of the data reviewed and implement the change.

question

QI Program Study

answer

(evaluate) the results of the change.

question

QI Program Act

answer

If the process change is successful with positive outcomes, act on these practices by incorporating them into daily unit performance.

question

Every health care organization gathers data on health outcomes. Examples of data include

answer

Infection rates.

question

An operating room nurse is talking with colleague during a meeting and asks, "I wonder if we would see fewer wound infections if we used chlorhexidine instead of povidone‐iodine to clean the skin of our surgical client? In this example of a PICO question, the P is?

answer

Surgical Clients

question

The nurse involved in scientific research effectively analyzes the information collected and determines a course of nursing action by:

answer

Using critical thinking

question

The Domain of Nursing

answer

- Is the perspective of a profession - Provides the subject, central concepts, values and beliefs, phenomena of interest, and central problems of a discipline -provides both practical and theoretical aspects of the discipline.

question

Paradigm

answer

- Links science, philosophy, and theories accepted and applied by a discipline

question

Nursing paradigm

answer

Links person, health, environment/situation, and nursing

question

Terminology

answer

• Person • Health • Environment/situation • Nursing • Nursing process: Method of applying the theory or knowledge • Integration of theory and nursing process is the basis for professional nursing.

question

Theory

answer

contains a set of concepts, definitions, and assumptions or propositions that explain a phenomenon.

question

Theories

answer

guide the design of nursing interventions.

question

Nursing Theory

answer

- Is a conceptualization of some aspect of nursing - Describes, explains, predicts, and/or prescribes nursing care

question

Components of a Theory

answer

Concepts,Definitions,Assumptions or propositions *Phenomenon*

question

Types of Theory

answer

• Grand - Broad in scope, complex, require specification • Middle‐range - More limited in scope and less abstract • Descriptive - Describe phenomena, speculate on why phenomena occur, and describe the consequences of phenomena. • Prescriptive - Address nursing interventions for a phenomenon, and predict the consequence of a specific nursing intervention.

question

Grand

answer

Broad in scope, complex, require specification

question

Middle‐range

answer

More limited in scope and less abstract

question

Descriptive

answer

Describe phenomena, speculate on why phenomena occur, and describe the consequences of phenomena.

question

Prescriptive

answer

Address nursing interventions for a phenomenon, and predict the consequence of a specific nursing intervention.

question

Theory‐Based Nursing Practice • Theories

answer

- Generate nursing knowledge for use in practice - Can direct how to use nursing process - Are adaptable to different patients and all care settings

question

The goal of nursing knowledge is to

answer

explain the practice of nursing as different and distinct from the practice of medicine, psychology, and other health care disciplines.

question

Interdisciplinary Theories

answer

Explain systematic views of phenomena specific to the discipline of inquiry: - Basic human needs - Developmental - Psychosocial - Systems

question

Nursing theories provide nurses with perspectives from which to

answer

Analyze patient data.

question

Systems Theories

answer

Input,System,Feedback,Output

question

Systems Theories Input

answer

Pateints interaction with environment including interactions from the following domains: Psychological Physiological Developmental Socioculture Environmental Spiritual

question

Systems Theories Output

answer

Patients health status for returning to the environment

question

Systems Theories Feedback

answer

Patient successfully or unsuccessfully functions in the environment

question

Selected Nursing Theories Nightingale (mid‐1800s)

answer

- Environment as the focus of nursing care - Descriptive theory

question

Peplau (1952)

answer

- Focus on interpersonal relations between nurse, patient, and patient's family - Development of nurse‐patient relationship

question

Henderson (1955, 1966)

answer

- 14 basic needs of the whole person - Framing nursing care are the needs of the individual.

question

Orem (2001)

answer

- Focuses on patient's self‐care needs - Goal is for patient to manage his or her health problems.

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Leininger (2010)

answer

- Theory of cultural care diversity and universality - Considers social structure factors

question

Neuman (2010)

answer

- Based on stress and the patient's reaction to the stressor - Role of nursing is to stabilize the patient or situation.

question

Roy (1989)

answer

- Views the patient as an adaptive system - When patient cannot adapt to stressors, nursing is needed.

question

Watson (1996)

answer

- Defines the outcome of nursing activity with regard to the humanistic aspects of life - Purpose is to understand the interrelationships among health, illness, and human behavior.

question

Benner and Wrubel (1989)

answer

- Caring is central.

question

The Link Between Theory and Knowledge Development

answer

• Nursing knowledge is theoretical and practical. • The goals of theoretical knowledge are to stimulate thinking and create a broad understanding of the "science" and practices of the nursing discipline. • Experiential knowledge, or the "art" of nursing, is based on nurses' experiences in providing care to patients.

question

The goals of theoretical knowledge are to

answer

stimulate thinking and create a broad understanding of the "science" and practices of the nursing discipline

question

Experiential knowledge, or the "art" of nursing, is based on

answer

is based on nurses' experiences in providing care to patients.

question

Nursing process is central to nursing practice. Nursing practice

answer

is derived from a theory.

question

Theories provide

answer

direction for nursing research.

question

Nursing theory and nursing research build the

answer

knowledge base for nursing, which is then applied to practice.

question

Theory‐generating or theory‐testing research refines the

answer

knowledge base of nursing.

question

Nurses incorporate research‐based interventions into

answer

theory‐based practice.

question

Health and Wellness

answer

• Healthy People: The Surgeon General's Report on Health Promotion and Disease Prevention, 1979 • Healthy People 2000: National Health Promotion and Disease Prevention Objectives • Healthy People 2010 • Healthy People 2020

question

Healthy People 2020 Goals

answer

• Attain high-quality, longer lives free of preventable disease, disability, injury, and premature death • Achieve health equity, eliminate disparities, and improve the health of all groups • Create social and physical environments that promote good health for all • Promote quality of life, healthy development, and healthy behaviors across all life stages.

question

Definition of Health

answer

• Health is more than the absence of disease! • A state of complete physical, mental, and social well‐being, not merely the absence of disease or infirmity (WHO, 1947) • A state of being that people define in relation to their own values, personality, and lifestyle

question

Models of Health and Illness

answer

• Health Belief Model - Addresses the relationship between a person's beliefs and behaviors • Health Promotion Model - Directed at increasing a patient's level of well‐being • Basic Human Needs Model - Attempts to meet the patient's basic needs • Holistic Health Model - Attempts to create conditions that promote optimal health

question

Maslow Hierarchy of Needs

answer

1.Self Actualization 2. Self esteem 3.Love and belonging needs 4.Physical Safety/Psychological safety (safety and security) 5.Physiological: O2,Fluids,Nutrtion,Bod temp,Elimination,Shelter,Sex

question

Three levels of prevention

answer

• Primary - Health promotion - Educational programs - Immunization programs - Nutritional programs • Secondary - Health screenings - Treating earlier stages of disease to decrease further complications - Nursing care in hospital, home, and skilled care • Tertiary - Disease process is permanent - Prevention of further complication - Promote independent level of function

question

levels of prevention: Primary

answer

- Health promotion - Educational programs - Immunization programs - Nutritional programs

question

levels of prevention: Secondary

answer

- Health screenings - Treating earlier stages of disease to decre

question

levels of prevention: Tertiary

answer

- Disease process is permanent - Prevention of further complication - Promote independent level of function

question

Risk Factors

answer

• Variables that increase the vulnerability of an individual or a group to an illness or accident • Risk factors include: - Genetic and physiological factors - Age - Environment - Lifestyle

question

Risk Factor Modification and Changing Health Behaviors

answer

• Precontemplation - Not intending to make changes within the next 6 months • Contemplation - Considering a change within the next 6 months • Preparation - Making small changes in preparation for a change in the next month • Improvement in health may involve a change in health behaviors. • Action - Actively engaged in strategies to change behavior; lasts up to 6months • Maintenance stage - Sustained change over time; begins 6 months after action has started and continues indefinitely

question

Risk Factor Modification and Changing Health Behaviors, Prcontemplation:

answer

Not intending to make changes within the next 6 months

question

Risk Factor Modification and Changing Health Behaviors, Contemplation:

answer

Considering a change within the next 6 months

question

Risk Factor Modification and Changing Health Behaviors, Preparation:

answer

Making small changes in preparation for a change in the

question

Risk Factor Modification and Changing Health Behaviors, Improvement in health may involve a change in health behaviors, Action:

answer

Actively engaged in strategies to change behavior; lasts up to 6months

question

Risk Factor Modification and Changing Health Behaviors, Maintenance stage:

answer

Sustained change over time; begins 6 months after action has started and continues indefinitely

question

Illness

answer

• A state in which a person's physical, emotional, intellectual, social, developmental, or spiritual functioning is diminished or impaired • Acute Illness - Short duration and severe • Chronic Illness - Persists longer than 6 months

question

Acute Illness

answer

Short duration and severe

question

Chronic Illness

answer

Persists longer than 6 months

question

Illness Behavior

answer

• Involves how people monitor their bodies and define and interpret their symptoms • Influenced by many variables and must be considered by the nurse when planning care • Internal variables - Perception of illness and nature of illness • External variables - Visibility of symptoms, social group, cultural background, economics, and accessibility to health care

question

Illness Behavior, Internal variables:

answer

Perception of illness and nature of illness

question

Illness Behavior, External variables

answer

Visibility of symptoms, social group, cultural background, economics, and accessibility to health care

question

Impact of Illness on the Patient and Family

answer

• Behavioral and emotional changes • Impact on body image • Impact on self‐concept • Impact on family roles • Impact on family dynamics

question

Levels and Settings of Care

answer

• Primary Care: health promotion • Preventive Care • Community Based Care • Home Care • Secondary and tertiary care • Long term acute care • Assisted Living • Restorative • Rehabilitation • Extended care • Palliative care • Hospice • Respite

question

In Patient Hospital Nursing

answer

• Levels of care - ED - Intensive Care Units - Medical Surgical units • Delivery models - Team nursing - Total client care - Primary nursing - Case management - Nurse Manager

question

Delivery System Challenges

answer

• Regulatory agencies - Joint Commission - Centers for Medicare/Medicaid - OSHA • Utilization review • Diagnostic related groups (DRG) • Capitation • Managed Care

question

Regulatory agencies

answer

• Joint Commission • Accredits and Certifies • Recognizes an organization commitment to meeting certain performance standards • National patient safety goals

question

Regulatory agencies

answer

• Centers for Medicare • Funded national insurance program for people 65years and older - Medicare health plans - Medicare financial management - Medicare fee for service operations • Center for Medicaid • Federally funded state operated program - Low income families - People with long term disabilities - Supplemental coverage to older adults

question

Regulatory agencies, Funded national insurance program for people 65years and older

answer

- Medicare health plans - Medicare financial management - Medicare fee for service operations

question

Regulatory agencies,, Federally funded state operated program

answer

- Low income families - People with long term disabilities - Supplemental coverage to older adults

question

Regulatory agencies, OSHA

answer

• Covers employers and their employee's • Assure safe and healthful working conditions for working men and women • Authorize enforcement of the standards developed under the Act

question

Health Care Focus

answer

• Wellness and prevention • Evidenced based practice • Safety and quality • Technology • Patient satisfaction

question

Items Influencing Med/Surg Nursing

answer

• National Patient Safety Goals • Institute of Health initiatives • Institute of Medicine Core Competencies • Patient Centered Care • Collaboration Initiatives • Quality Improvement

question

Magnet: 14 Forces of Magnetism

answer

- Quality of Nursing Leadership - Organizational structure - Management style - Personnel Polices and Programs - Autonomy - Community and Healthcare Organization - Nurses as teachers - Image of Nursing - Interdisciplinary Relationships - Professional Development

question

Nursing Care Decision Making

answer

• Autonomy • Responsibility • Accountability • Authority • Collaborate • Delegate

question

Nursing Care Skills

answer

• Good Communicator • Priority Setting - Highest - Intermediate - Lowest • Organization Time Management • Utilization of Resources • Evaluate Outcomes

question

Disciplines

answer

• Physical Therapist (PT) - PTA • Occupational Therapist (OT) - OTA • Speech language pathologists (SLP) - SLPA • Recreational therapist • Nutritionist • Nursing assistant • Social worker • Case manager

question

Admission Procedure

answer

• Admitting a patient to the nursing unit • Meet and Greet • Orient patient • Physician's orders • Patient History and Physical Assessment • Specimens • Clarify Patient Questions and Expectations • Document • History and Physical • Time of arrival on the unit • How they arrived (wheelchair, stretcher)

question

Requirements

answer

• Nursing Admission Assessment - Check institution policy on timing (JCAHO suggests 24 hours) • Screening patients for multidisciplinary needs - Institutions have policies in regards to the time frame in which the referral needs to be completed • Medication Reconciliation • Plan of Care • Patient Education record must begin • Discharge Planning must begin

question

Plan of Care

answer

• Requires patient/caregiver input • Can take many formats - Standardized care plan - Individualized care plan - Problem list - Clinical/Critical pathway

question

Styles of Physician's Orders

answer

• Written orders - Secretaries must transcribe exactly as written, they cannot assume they know what the order is supposed to say • Computerized entry • Verbal orders - Should be reserved for emergency purposes only - Must be cosigned within 24 hours • Telephone Orders - Must be read back and have a verification procedure - Must be cosigned within 24 hours • All orders must be checked with the original by an RN

question

Medication Orders

answer

• Components of medication orders - Month, date, year order written - Time the order was written - Client Name - Medication name - Dose - Route - Frequency - Signature of physician, APN, or PA - Some medication orders may have parameters associated with them • Orders must be complete, or they must be verified

question

Other Orders

answer

• Treatments, diet, activity etc. • Lab values, diagnostic tests‐fill out appropriate requisitions • Medication reconciliation • Recheck for accuracy • Designate that the transcription process is complete by writing the date & time the orders were transcribed, sign your name and title in a specific color of ink

question

Referrals

answer

Need a physician's order for referrals to social workers, PT, meals on wheels, reach to recovery, etc. for services to be covered by insurance

question

Discharge Planning

answer

• Crucial due to prospective payment system • Patient must be involved - Identification of strengths, limitations, and resources • Medication Reconciliation must occur again

question

The Joint Discharge Requirements

answer

• Information on safe, effective use of medications • Information on safe, effective use of equipment • Food‐drug interaction information • Techniques/Rehabilitation planned for any functional limitations • Access to community resources • When/how to access future treatment • Client/caregiver responsibilities • Hygiene/grooming

question

Discharge Summaries

answer

• Concise and in the client's own language • Step by step instructions • Precautions • Signs and symptoms of complications and what to do about them • Names and phone numbers of healthcare providers • Unresolved problems and follow up needed • Actual time of discharge, mode of transportation, and with whom the patient left - Make sure the patient has all of their belongings!!

question

Discharge Against Medical Advice (AMA)

answer

• There are times when pts leave the hospital against medical advice • Patient must sign a form releasing the hospital and physician from any responsibility • Pt has the right to terminate healthcare, but the nurse has an obligation to discuss the possible outcomes of this decision • There maybe health consequences of their decision

question

Intake and Output

answer

• Provides important data about client's fluid and electrolyte balance • Some facilities measure I&O only if ordered by the physician • Accurate measurement of I&O is essential • I&O is always measured and recorded in cc's

question

Intake and Output GOAL:

answer

of course, is to have intake equal output as closely as possible in a 24 hour period • "Concern" output: greater than 2,500cc in 24° or less than 30cc per hour for more than 2 consecutive hours • For clients requiring extremely close fluid and electrolyte monitoring, I&O alone is not accurate enough. Daily weights (same time, same scale) & labs will be part of the regimen

question

Patients Who Should Be on I&O

answer

Post op Burns/trauma Electrolyte issues Acute renal failure Oliguria Heart failure Increased loss of body fluids Nephron necrosis Diuretics Steroids Poor nutritional intake

question

Intake

answer

Oral fluids Food (liquid at room temperature) IV Subcutaneous Irrigation Tube feed Water flushes

question

Output

answer

Urine Vomitus Diarrhea Fistulas Suction Perspiration Lesions

question

Common Errors with I&O

answer

Communicating who is on I&O Explanation to patient and family Recording/promising to later Guessing amounts Lack of designated measurements of utensils Measuring devices unavailable for small amounts Ice/ice melting Over filled IV bags Assuming "empty" means the patient drank it

question

Common Errors in I&O, continued

answer

Failure to consider perspiration "uncaught" emesis Unmeasured liquid feces Wound exudate difficulty to quantify Not checking catheter patency Lack of a urometer Not matching irrigant correctly with results

question

Nursing Implications

answer

Must do accurate I&O including routes -Must watch totals over consecutive days -Use a urometer for small amounts -If the patient takes in a high solute load, they need to increase their intake of free water -If they have poor urine concentration ability, must increase intake to keep up with the output

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