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Florence Nightingale

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First nursing theorist - sanitation, Health promotion Environmental Theory - fresh air, pure water, efficient drainage, cleanliness & light Theory of Practice - environmental adaptation theory

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Harriet Tubman

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civil war - slaves - underground railroad "moses"

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Clara Barton

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American Red Cross

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Linda Richards

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First American trained nurse Introduced doctor's orders and nursing notes

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Mary Mahoney

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1st African American professional RN

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Lillian Wald

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public health nursing (preventable measures)

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Lavinia Dock

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Training Schools for Nurses of the United States

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Margaret Sanger

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planned parenthood

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Mary Breckinridge

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1st midwifery training schools in the United States

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Julie O. Flikke

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Superintendent of the Army Nurse Corps

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nursing theories?

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Guide research and practice, basic ingredients are concepts explain existing phenomena and predict future events

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nursing theories required criteria

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1. Inclusiveness- include all concepts related to area of interest 2. Consistency- add new entities without the founding assumptions being changed 3. Accuracy- predicts future outcomes 4. Relevance- relate to scientific foundation 5. Fruitfulness- generate new directions for future research 6. Simplicity- can be replicated, makes sense

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Peplau's Interpersonal Theory

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relations model - clients feelings as a predictor of positive outcomes, and how nurses can influence this. 4 phases: 1. Orientation 2. Identification 3. Exploitation 4. Resolution

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Roger's Science of Unitary Human Beings (Broad in Scope)

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energy fields, openness, pattern- between human beings and universe or environment.

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Orem's General Theory of Nursing

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self-care deficit - nurse can evaluate these in client and match with appropriate intervention 4 concepts: 1. self-care 2. self-care agency 3. self-care requisites 4. therapeutic self-care demand

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King's Goal Attainment Theory

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Conceptual framework of the relationship of personal systems (individuals), interpersonal systems (groups such as nurse-client), and social systems (educational systems/health care system).

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Newman's Systems Model

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health and consciousness followed by concepts of movement, time, and space

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Roy's Adaptation Model (Grand Nursing Theory)

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focus of the individuals "biopsychosocial adaptive system" - response to stimuli

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Leininger's Cultural Care Diversity & Universality Theory

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Transcultural nursing and caring nursing; concepts are aimed toward caring and the components of a culture care theory; diversity, universality, worldview, and ethno history are essential to the four concepts (care, caring, health, and nursing).

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Watson's Human Caring Theory

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Holistic outlook addresses the effect and importance of altruism, sensitivity, trust, and interpersonal skills

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Parse's Human Being Theory

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quality of life from each person's individual perspective should be the goal of nursing practice.

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Dorothea Dix

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organize military hospitals and provide medical supplies to the Union Army soldiers

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American Academy of Nursing (AAN)

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Uses credential FAAN. Transform health care policy through nursing knowledge.

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Commission on Collegiate Nursing Education (CCNE)

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accreditation of BSN/MSN

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Diagnosis Related Groups (DRG's)

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reimbursed one amount based on patient's diagnosis

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Hebrew/Palestine

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Mosaic code. Public health laws concerning hygiene. Priests were health inspectors

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Middle Ages

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Women used herbs, men used purging and leeches. Noble and the rich became nurses

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Crusades

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Military "nurses", mostly men

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Colonial American Nursing

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yellow fever, smallpox, plagues. First hospital built.

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Mary Seacole

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Nurse in Cuba and Panama, tried to join nightingale- denied as she was black. Jamaican nurse. Crimean war

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Civil War

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Conditions similar to Crimean war. Numerous epidemics. No army nurse or medical corps when war began

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Prehistoric Period

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health practices that were strongly guided by beliefs of magic, religion, and superstition

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Egypt

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1st to use sutures in repairing wounds and developing community planning that resulted in a decrease in public health problems

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Greece

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sought to understand man and his relationship with the gods, nature, and other men

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India

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earliest cultures were Hindu. The sacred book of Brahmanism (also known as Hinduism), the Vedas, was used to guide health care practices. emphasized hygiene and prevention of sickness and described major and minor surgeries. importance of prenatal care to mother and infant

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Rome

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a military dictatorship, adapted medical practices from the countries they conquered and the physicians they enslaved. The first military hospital in Europe

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Renaissance Period

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Dark ages of nursing new emphasis was given to medical education, but nursing education was practically nonexistent.

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Colonial America

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The first hospital and the first medical school in North America were founded in Mexico—the Hospital of the Immaculate Conception in Mexico City and the medical school at the University of Mexico. individuals with infectious diseases were isolated in almshouses or "pesthouses" Ben Franklin helped found the first hospital, called the Pennsylvania Hospital, was built in the United States in Philadelphia

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The Great Depression

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Franklin D. Roosevelt, "new deal", 1935 Social Security Act to provide (1) a national old-age insurance system, (2) federal grants to states for maternal and child welfare services, (3) vocational rehabilitation services for the handicapped, (4) medical care for crippled children and blind people, (5) a plan to strengthen public health services, and (6) a federal-state unemployment system

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Edith Cavell

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Savior of Allied soliders

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Shifrah

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Stood up against authority to save the lives of infants

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Faye Abdellah

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Twenty-one nursing problems. Client-centered interventions

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Ida Jean Orlando

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Theory of the nursing process

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Dorothy E. Johnson Behavioral system model for nursing

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separates physiologic and psychologic aspects of illness. Nurse provides support and comfort to aid in healing.

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conceptual model

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A group of concepts that are associated because of their relevance to a common theme

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Schematic models

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visual representations of ideas

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Nursing Research Process

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Conceptualization—Identify what needs to be done Planning—Decide how to proceed Implementation—Put your plan into action Communication—Make sure others know about it

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Clinical Practice Guidelines

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"Systematically developed statements to assist practitioner and patient decisions about appropriate health care for specific clinical circumstances."

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Deontological

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considers a decision to be right only if it conforms to an overriding moral duty, such as preserving life at all costs, and wrong only if it violates that moral duty.

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Mishel's Uncertainty in Illness Theory

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Uncertainty in illness is stress-producing and capable of contributing to negative physical and/or psychologic outcomes

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Nurse Practice Act

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Governs nursing practice in each state

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American Nurse's Association

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Represents the nations rn population. develops standards of care in nursing

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Patricia Benner Primacy of Caring Model

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five practice areas (novice, advanced beginner, competent, proficient, and expert) in the seven domains of nursing practice

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Altruism

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a concern for the welfare and well-being of others

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social justice

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upholding moral, legal, and humanistic principles

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Science vs. theory

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--Science- facts brought together by systematic method of inquiry and organized by general principles so we can understand natural phenomena. -- Theory- organizes concepts and ideas (rather than facts) to help us understand natural phenomena in new ways.

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What is the difference between a nursing theory and a nursing model?

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Theories help guide research- explain, predict, control: health, stress, adaptation and other concepts. Models are more loosely structured than theories. Broad: examples nursing, person, health, environment.

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What are the three levels of theory and how do they differ?

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Grand theory, often broad in scope; describe and explain large segments of human experience. (Rogers's theory of unitary man describes the entire nursing process). Middle- range and Practice theory, smaller in scope and simpler to understand, may refer to a specific population or situation, and used to guide nurses daily practice (Jacob's - grief of older women, Sousa and Zauszniewski's - diabetic self-care management, or Tsai and colleagues' - chronic pain). Middle-range theory (Lenz and Pugh's - theory of unpleasant symptoms and Mishel's - uncertainty in illness).

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What is the purpose of a model in describing nursing phenomena?

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to provide an illustration of a theory

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Grand Nursing Theories

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have broadest scope and present general concepts. Not designed for empirical testing. Intended to be pertinent to all instances of nursing. Consist of conceptual frameworks defining broad perspectives.

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Mid-range nursing theories

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steps or actions that are meant to lead to a specific outcome or result Narrower in scope than grand nursing theories. Concepts at a lower level of abstraction. Hold great promise for increasing theory-based research and nursing practice strategies.

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Utilitarianism vs. Deontology

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utilitarianism- an action or practice is right if it leads to the greatest possible balance of good consequences or the least bad consequences. Example: distributing health resources to those who would most benefit from them (90 year old Alzheimer's patient vs. healthy adult). -- Deontology- the act that is determined not by the consequences it produces, but by the moral qualities intrinsic to the act itself (resuscitating a viable neonate even if the family cannot pay for care or there are not enough ICU beds). UNIVERSAL AND CONSISTENT BINDING PRINCIPLES

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6 phases of nursing process

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AADPIE assessment analysis and diagnosis planning implementation evaluation

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nursing diagnosis is

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a clinical judgement about an individual to actual health problems or life processes derived from assessment

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5 steps of evaluation

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review outcomes collect data compare actual outcomes to see if goals are met record conclusion relate nursing plans and interventions to outcomes

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4 outcome indicators

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patient focused provider focused organized focused population focused

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what are clinical pathways?

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provides a means of standardizing care for patients with similar diagnoses

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clinical pathway vs. clinical practice

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clinical pathways define key processes and patient goals in the day-to-day management of care, whereas clinical practice guidelines guide broader decision making and focus on the decisions to perform a procedure or service.

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Descriptive Theories

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describe phenomena speculate why and consequences

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Prescriptive Theories

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addresses nursing interventions ("prescription") for a phenomenon and predicts the outcome of intervention

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Statutory law

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Laws written and enacted by legislative bodies Violations are criminal offenses and are punishable by fines or imprisonment

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Emergency Medical Treatment and Active Labor Law (EMTALA)

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"All persons presenting for care must receive the same medical screening examination and be stabilized, regardless of their financial status or insurance coverage, before discharge or transfer." Prohibits refusal of care for indigent and uninsured patients seeking medical assistance in emergency departments Prohibits transfer of unstable patients, including women in active labor, from one facility to another Applicable to non-emergency facilities, i.e., urgent care clinics

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Patient Self-Determination Act of 1990:

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requires federally funded hospitals (Medicare, Medicaid) to inform adult patients in writing about their right to make treatment choices and to ask patients if they have a living will or durable power of attorney

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Child Abuse Prevention and Treatment Act and reporting statutes

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Laws mandating reporting of specific health problems and suspected or confirmed abuse

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"affirmative duty"

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the duty that nurses exercise independent judgment to prevent harm to patients

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Intentional Tort

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Direct violation of a person's legal rights

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Libel (Intentional Tort)

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defamation caused by written work nurses subject to libel for subjective comments written in the medical record

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Slander (Intentional Tort)

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defamation caused by spoken word; nurses subject to slander when they repeat subjective comments about patients in public places

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False imprisonment (Intentional Tort)

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Nurse has no authority to detain a patient even if there is likelihood of harm or injury

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Clinical Indicators

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Measurable aspects of care that show the degree to which clinical care is carried out (e.g., administer correct IV solution at prescribed rate)

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Standardized core measures are referred to as

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National Hospital Quality Measures

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Institute for Healthcare Improvement (IHI)

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a framework for change on hospital medical/surgical units by engaging front-line nurses and leaders to: Improve quality and safety of patient care Increase the vitality and retention of nurses Engage and improve the patient's and family members' experience of care Improve the effectiveness of the entire care team

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Advanced practice nursing

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basic nursing education, with licensure as a registered nurse (RN) and graduate education and experience Includes: nurse practitioners (NPs), certified nurse-midwives (CNMs), certified registered nurse anesthetists (CRNAs), clinical nurse specialists (CNSs)

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Total Patient Care

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responsible for planning, organizing, and performing all care, including personal hygiene, medications, treatments, emotional support, and education required for their assigned group of patients during the assigned shift critical care areas, such as intensive care units and postanesthesia care units, where continuous assessment and a high degree of clinical expertise are required at all times

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Functional Nursing

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method of patient care delivery, staff members are assigned to complete certain tasks for a group of patients rather than care for specific patients. operating room

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Team Nursing

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the RN functions as a team leader and coordinates a small group (no more than four or five) of ancillary personnel to provide care to a small group of patients inpatient and outpatient health care

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Primary Nursing

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the RN, or "primary" nurse, assumes 24-hour responsibility for planning, directing, and evaluating the patient's care from admission through discharge home health nursing, hospice nursing, and long-term care

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Partnership Model

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RN is partnered with an LVN, LPN, or NAP, and the pair work together consistently to care for an assigned group of patients.

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State Nurse Practice Act

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defines the scope and limitations of professional nursing practice

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Patient Self Determination Act

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competent people could make their wishes known regarding what they wanted in their end of life experience, when they were possibly not competent. durable power of attorney

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Beneficence

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compassion taking positive action to help others desire to do good core principle of our patient advocacy.

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Nonmaleficence

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avoidance of harm or hurt

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Fidelity-

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loyalty, fairness, truthfulness, advocacy, and dedication keeping a commitment and is based upon the virtue of caring

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Justice-

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an equal and fair distribution of resources

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Paternalism

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Healthcare professionals make decisions about diagnosis, therapy, and prognosis for the patient. what is in the best interest of the patient

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Ethical Relativism

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This theory holds that morality is relative to the norms of one's culture no "universal truth."

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Feminist Theory

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it does not support universal acts requires examination of context of the situation in order to come to a moral conclusion

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Deontology-

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judges the morality of an action based on the action's adherence to rules. examines a situation for the essential moral worth of the intention of act, or rightness or wrongness of the act. ex. Many religious traditions are based upon deontology

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Utilitarianism-

answer

supports what is best for most people. ex. public health policies, Medicare for all citizens over age 65

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Patricia E. Benner's theory of Novice to Expert 5 levels of nursing experience

answer

Novice Advanced beginner Competent Proficient Expert

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Nurse as Detective

answer

The nurse uses clinical imagination coupled with nursing science to detect subtle changes and deviations from expected patterns of being to prevent or control adverse outcomes.

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Nurse as Scientist

answer

The nurse participates in scientific inquiry to inform healthcare decisions; and critiques, disseminates and implements evidence to influence practice

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Nurse as Manager of the Healing Environment

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the nurse creates, coordinates, and advocates for a respectful, interdisciplinary environment that promotes optimal well-being and affirms the dignity of the human experience

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