ULL Nurs 100 Units 5 – Flashcards

Addresses the humanistic and holistic needs of patients, families, and environment and provides responses to patterns and/or needs of patients, families, and communities to actual and potential health problems

Problems, changes, and concerns that are current fo the present time

Essential cluster of abilities and skills required for competent nursing practice

The results, or end products, of planned study and experience that are focused on specific abilities required for practice

Progressive movement from one type or level of education to another, often based on flexible, self-directed, or advanced placement options. RN to BSN or MSN; BSN to doctoral degree, or non-nursing degree to BSN, MSN, or doctoral degree

Shifts in conditions and concerns that emerge from and influence various aspects of society; broad changes is the United States and the world that influence the education and practice of nurses and other providers.

Standardized evaluation based on objective demographics of specific required competencies Used in conjunction with written tests of knowledge about those abilities May require performance in actual or simulated situations, related to physical pyschomotor skills or the observable evidence of other skills such as critical thinking, communication, teaching, planning, writing, or analysis and integration of data

Certification requirement Increasing competency assessment in the work place High stress from competing demands of school, home, meeting competency requirements

Common master's specialty in the 60's

causes limited access for nursing students

Commission on Collegiate Nursing Education accredits Master's programs

National League for Nursing Accredits Associate degree programs

concern of consumers and nurses

Increased after 9/11

New York seeks to make BSN the standard for entry into nursing practice

First BSN in 1924

A type of occupation that meets certain criteria that raise it to a level above that of an occupation.

A person who belongs to and practices a profession.

The demonstration of high-level personal, ethical, and skill characteristics of a member of a profession

specify expected results, the destination the student needs to reach. The outcomes approach requires a mental shift from trying to memorize voluminous readings and class notes to actually learning to think like a nurse, to integrate information in problem solving and decision making and providing competent patient care.

practiced based case studies and simulations for students to engage in problem solving, critical thinking, and integration of concepts, knowledge, and evidence-based practice.

these climates are changing and education must prepare graduates for an ever changing landscape. People are living longer with more chronic diseases, the cultural mix continues to become more and more diverse, there is a rise in domestic abuse and violence, epidemic of obesity, the traditional family has changed (single parent households, same sex couples, singles living with singles, social disrespect). All of these issues affect health care. Nurses work with those all aspects of society, and thus, course content and interactive practice-based learning that incorporates these issues is essential.

The push to change "illness care" to "health care" on a large scale involving families and communities, not just individual patients. Our current health care system focuses on illness, we must change our focus to health promotion and disease prevention.

a change of approach from "giving patient care" to "working with" the patient and families. Prevention of medical errors-2000 IOM study that reported the alarming number of serious medical errors and their consequences. Big emphasis on safety, introduction of QSEN competencies. HIPAA -the 2002 Health Insurance Portability and Accountability act and patient privacy issues.

Multicultural, multiethnic populations and patients who have different ways of responding to illness, treatment, and care providers raise ethical issues of who is "right" and who has the "right to decide". Many ethical dilemmas require students, nurses, and other providers to accept the value of individual choice regarding abortion, organ transplant, stem-cell research, preference in sexual partners, and the patient's right to die a dignified death.

inadequate clinical staff and use of part-time and agency nurses tend to reduce the quality of overall care and increase stress and burnout. Students are assigned to multiple and diverse community clinical settings, some of which may be short staffed, making it difficult for them to find qualified preceptors. An alarming number of qualified applicants to schools of nursing are being denied admission due to the lack of prepared nurse educators, limited space and other administrative constrains. The number of MSN and doctoral prepared faculty are inadequate to meet current demands.

Nurses have always worked in situations emanating from disasters, abuse and violence in families and communities and in military conflicts. Domestic violence, violence in the workplace and in schools has increased resulting in an increased emphasis in nursing education and in state regulations of reporting and responding to violent incidents. Criminal acts and substance abuse have become more common in hospitals and other health care agencies and in schools of nursing threatening the safety of patients and staff. As a consequence, criminal background checks are required for all students and by agencies providing clinical experience.

Students, teachers and nurses confront increasing life responsibilities and associated stressful demands on time and resources. Issues include expansion of information and technology, changing health care systems, more interactive and out-of-class methods of learning, multiple care settings, higher expectations for competence, shortage of nurse preceptors and teacher, multiple cultural, ethical, and legal aspects of an ever-changing society. Many students are responsible for the care of dependent children and aging parents.

Licensed Practical Nurse/Licensed Vocational Nurses (California and Texas) Shortest programs (9 to 18 Months) Most restricted form of practice Must work under the supervision of an RN Cannot perform all skills Limited work in critical care areas Practice focuses on technical skills NCLEX-PN licensing exam [NCLEX=National Council Licensure These nurses can also work under the supervision of an MD - such as in a physician's office

The oldest, most traditional RN programs Modeled after Nightingale programs in Europe Approximately 2-3 years in length 1950-1960 - increase in the number of hospitals led to the increase in the number of diploma programs. More than 1300 programs operational By 2008, only 75 diploma programs remained NCLEX-RN licensing exam Diploma programs now are more similar to associate degree programs. Many have arrangements with colleges so that students can simultaneously earn an associate or baccalaureate degree.

Accounts for largest number of nursing graduates (63% in 2009). Average about 3 years to complete Increased demand for nurses. WWII Hill Burton Act Increased demand for college based education (as opposed to diploma) Intended to be the "technical nurse" NCLEX-RN licensing exam Basic Tech care in RN positions, licensure

The Hospital Survey and Construction Act (or the Hill-Burton Act) is a U.S. federal law passed in 1946 which provided monies for construction of hospitals which in turn created an increase need for hospital based nurses. WWII also created an increase demand for nurses. ADN Programs emerged in the 1950's At the time of development of the ADN program BSN programs graduated only 15% of graduates. There was a push to increase the number of college based graduates. The increase demand for nurses increased the need to graduate nurses in a shorter time period than the traditional 4 year degree. At inception, ADN programs took only 2 years to complete. Today, most ADN programs take about 3 years to complete. The intention was that the ADN would be the technical nurse and BSN would assume the charge nurse and leadership roles. Because of the shortage of BSN graduates and the competence of the ADN graduates, ADNs were quickly put into leadership roles. Because of the periodic nursing shortages, the shortage of BSN graduates, and the fact that they all take the same licensing exam make the expectation of differentiation of roles (ADN vs BSN) unrealistic. Currently, salary for bedside nursing is the same for a BSN or an ADN Graduate There is an ongoing 50 year debate about the entry level for the professional nurse. "With inception of ADN education, nursing took control of nursing curriculum and assumed full responsibility in shaping nurses for a more professional level of practice""Before ADN programs more then 85% of graduating nurses' curriculum was controlled by hospitals and physicians" Orsolini-Hain and Waters, 2009. With the demand for more leadership skills from nurses, ADN programs have added courses and now most programs take a minimum of 3 years to complete.

4 year degree program Intended to be the "professional nurse" More emphasis on leadership and management than ADN Programs First BSN program at Yale University in 1924 BSN degree usually required for admission to graduate programs. NCLEX-RN community course is essential

Nurse leaders from those early years until today believe that nurses provide more comprehensive and competent care when they get a solid foundation in the arts and sciences, in addition to nursing content. As stated in the previous slide, with inception of the Associate degree programs, the ADN was intended to be the "technical" nurse and the BSN was intended to be the "professional" nurse. Because of social and political forces the distinction has never materialized. More hospitals who are seeking "Magnet" status are requiring nurses in management and leadership to have a minimum of a BSN or an MSN. With the increasing demand for APRNs it is advantageous for students to have a BSN as entry level into practice.

Master's degree in nursing Different areas of specialty Nursing education Schools of nursing, staff development, industry for clinical support. Health Care Administration Health care management positions Some choose to also get MBA, or business administration graduate degree concurrently Clinical Nurse Leader (CNL)

Prepared as a master's generalist clinician (not APRN) Master's degree RN who assumes resposibility for client care outcomes through assimilation and application of research based info to design, implement, and evaluate client plans of care Oversees the care coordination of a distinct group of patients, evaluates outcomes, and has the decision - making authority to change care plans when necessary Relatively new specialty, promoted by AACN and other nurse leaders. Expertise in quality improvement and cost-effective resource utilization Master of Science in Nursing degree that prepares students to sit for the certification exam as Clinical Nurse Leaders (CNL).

Master's Prepared Doctoral Prepared Clinical Nurse Specialist Nurse Anesthetist Nurse Mid-Wife Nurse Practitioner Family Adult Pediatric Psychiatric/mental health Women's health Emergency

not an all inclusive list of nurse practitioners. Currently the entry into practice for APRN is a master's degree. In the year 2015, APRN will be required to have doctoral degree for entry into practice (2015 is the planned year but there is still much discussion and deliberation about this issue). This will not be required for current APRNs. Requires certification for practice.

An advanced practice nurse who possesses expertise in a efined area of nursing practice for a selected client population or clinical setting Traditional roles Expert practitioner Educator Consultant Manager Researcher Hospital-based CNSs have faced fewer opportunities due to hospital downsizing

Anesthesia specialists Administer many types of anesthesia Anesthesia -related care Preanesthetic preparations Anesthesia induction, maintenance, emergence Certification Exam required 40% of CRNAs are men

Management of women's health care Primarily: Pregnancy Childbirth Postpartum period Care of the newborn Family planning Gynecological needs Master's level not yet required for nurse-midwifery students. In 5 states, midwifery may be practiced by care givers who are not registered nurses.

Assesses patients and uses independent decision -making skills at an advanced level Has prescriptive authority Functions in collaborative agreement with a physician or dentist http://www.lsbn.state.la.us/documents/scope/apscope.pdf

Master's programs typically take approximately 2 years to complete when attending full time. Many flexible options now available Part-time Distance learning APRNs are required to obtain certification for practice

PhD, DNS, DNP,ND Varies for education program completion Advanced nursing for research, clinical practice, education, and leadership positions Some think introducing another level of education will further the nursing shortage. UL College of Nursing just recently had their DNP program approved!!

A clinical practice focused doctoral degree in Nursing - advanced nurse practitioners - will be entry level in 2015

Research focused

doctor of nursing science - advance clinical nursing practice

ND - doctor of nursing - BS or higher degree in non-nursing field who want to pursue a career in nursing leadership

Specialty certifications are certifications obtained from a certifying board other than the state board of nursing Specialty certifications can further validate a nurse's skill, knowledge and abilities Not required by state boards to practice as a registered nurse Required for APRN Some employers or specialty areas may require certifications.

Flexibility LPN to BSN RN to BSN RN to MSN Accelerated Programs Baccalaureate to Doctoral Career ladder programs 1+1 2+2 Distance Learning Documented needs of students, the nursing shortage, and the expansion and acceptance of electronic learning technology has led to variety of much more flexible education options. UL College of Nursing now has the RN to BSN program all online!!

Classroom without walls. Innovative distance mobility program Developed under New York Board of Regents Provides degree programs for adult learners underserved by traditional programs The nursing programs enroll thousands

Accelerated, fast- track, or second degree programs designed for non-nurses with other degrees - most rapidly growing programs Some programs reaching out to underrepresented groups such as men and minorities

The American Association of Colleges of Nursing [AACN] & other organizations strongly support the BSN as the "entry into practice" & the professionalism of nursing.

"The illiterate of the 21st century will not be those who cannot read and write but those who cannot learn, unlearn and relearn" To practice as a nurse requires continuing education. The rate of change in the health care field is rapid and the recognition of the need for continuing education and the willingness to do so is crucial.

Employment services $68,160 General medical and surgical hospitals $63,880 Offices of physicians $59,210 Home health care services $58,740 Nursing care facilities $57,060

40% of all health care professionals Mean age of 46.8 5.7% are males 49% of CRNAs are men 56% practice in hospitals, 8.6% are APRNs 51% NPs 24% CNSs 13% CRNAs 6% NP-CNS 4% Nurse-midwives

LPN, Diploma, BSN, MSN, CNL, DNP, PhD

Residencies, traineeships, employer reimbursement, scholarships, loan forgiveness and repayment programs, online opportunities

Personal and professional responsibilities, cost, lack of access, lack of technology skills

The organization of leaders in all facets of nursing: practice, education administration, research, organizations, and government; the think tank of the profession; promotes advancement of all aspects of nursing' publishes papers , conference proceedings and documents to advance nursing.

The organization of deans and directors of baccalurate and higher-degree nursing programs'

The major national nursing organization concerned with borad scope of practice issues' standard of practice, scope of practice, ethics, legal, employment; a federation of state nurses associations; publications related to array of practice issues and standards

A subsidiary of AACN with responsibility for establishing and implementing standards and criteria and for accreditation of baccalaureate and graduate degree programs in nursing.

Organization of all state boards; coordinates licensure activities on national level; creates and administers licensure examinations (NCLEX); developed computerized licensure examinations; works with other organizaitons to promote nursing standards and regulation and establish interstate licensure protocols

The national organization of nurse educators, with long-standing commitment to four types of basic programs (LPN, diploma, ADN, and BSN); includes lay citizens concerned with nursing and health care on its board. NLN also has councils for nursing informatics, research in nursing education, wellness centers, and multiple types of print publications. Initiated certification program and examination to certify excellence of nursing educators; also estalished Centers for Excellence for nursign programs that meet designated standards

Formed in 1997 as a subsidiary of NLN with responsibility for establishing and implementing standards and criteria and for accrediting all types of schools of nursing.

Organization of nurse practitioners in multiple specialties; sets national standards and criteria for programs and certification.

National organization of statewide student nurse associations; concerned with education and career issues; provides student perspectives to other national nursing organizations.

Standardized evaluation based on objective demorgraphics of specific required competencies

a broad academic field encompassing human-computer interaction

Rapid Knowledge Expansion;increasing use of technology, informatics in education and practice Practice-based competency: outcomes and evidence-based content Performance-based competency: learning and objective assessment methods Sociodemographics, cultural, diversity, economic, political changes, and global issues Community-focused interdisciplinary approaches Consumer-oriented care: engagement, safety, and privacy Ethics and Bioethical concerns Increasing shortage of nurses and faculty Disasters, violence, and terrorism Increasing professional and personal responsibility

Standardized evaluation based on objective demorgraphics of specific required competencies

Choosing most effective electronic and technology options Information overload; virtually unlimited global research opportunities, issues Identifying current and accurate information; material rapidly outdated Expanded expectations, limited time, rapid response expected; little time for reflection

a broad academic field encompassing human-computer interaction

Learning focused on core practice competencey outcomes, professional skills beyond psychomotor skills Integration of evidence-based standards Emphasis on critical thinking and problem solving

Multiple teaching-learning methods Problem-based learning Accountability for learning and competence Interprofessional learning

Increased aging population Global nursing networks Consequences for access and health care

Diverse alternative health practices, influence of cultures Broad scope of nursing Clincial approach Requires more planning, travel time, expenses, and arrangements Time Constraints

Privacy issues Consumer intiatives for involvement and protection Balance standards and preferences Focused on safe, competent patient care

Alternative solutions to ethical dilemas Standards of quality care Patients rights issues Respect, tolerance for patients decisions, ethical competencies for students

Shortage of staff esults in limitations in clinical learning Heavy work load Student need more clinical learning

New learning skills required for major natural disaster events Preparedness for terroism

Certification requirement Increasing competency assessment in the work place High stress from competing demands of school, meeting competency requirements

Licensed Practical Nurse/Licensed Vocational Nurce Must work under the supervision of a RN or physician Technical nursing procedure focus

2-3 yrs Most traditional type of program for RN license

2yrs Basic Tech care in RN positions, licensure

2-4yrs Basic professional practice as RN

1-2 yrs Advanced clinical practice, management, education, and leadership positions

PhD, DSN, DNP,DNSc Varies for education program completion Advancef nursing for research, clinical practice, education, and leadership positions