Fundamentals of Nursing: Chapter 1-4 Study Guide, Exams of Advanced Education

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FUNDAMENTALS OF NURSING (POTTER &

PERRY) CHAPTER 1-

American Nursing Association - develops and publishes scope and standards of practice guidelines for nursing: ANA DEFINES NURSING Nurse Practice Act (NPA) - regulates the scope of nursing practice for the state and protects public health, safety, and welfare Why is there a nursing shortage? - exacerbated by an aging workforce, an aging population in need of care, fewer nurses being prepared What are the five levels of proficiency when acquiring and developing nursing skills? - According to Benner:

1. Novice- beginner nursing student (no experience)
2. Advanced Beginner- nurse with some observational experience
3. Competent- nurse in the same clinical position for 2-3 years; understands the organization and specific care required
4. Proficient- nurse has more than 2-3 years of experience; able to assess and manage care
5. Expert-a nurse with diverse experience ANA Standards of Nursing Practice - 1. Assessment
6. Diagnosis
7. Outcomes Identification
8. Planning
9. Implementation
10. Evaluation ANA Standards of Professional Performance - 1. Ethics

2. Education
3. Evidence-Based Practice and Research
4. Quality of Practice
5. Communication
6. Leadership
7. Collaboration
8. Professional Practice Evaluation
9. Resources
10. Environmental Health Professional Roles and Responsibilities - Autonomy and Accountability Caregiver Advocate Educator Communicator Manager APRN - Advanced Practice Registered Nurse -the most independently functioning nurse -has a master's degree of doctor of nursing practice (DNP) degree in nursing CNS - Clinical Nurse Specialist -an APRN who has graduate preparation in nursing and expert clinician in a specialized area of practice -ie. population, setting, disease, type of care CNM - certified nurse midwife -masters degree focuses on midwifery-pregnancy and delivery NP - nurse practitioner

-provides primary, acute, and specialty health care to patients of all ages CRNA - Certified Registered Nurse Anesthesiologist -Nurse who is trained and certified in the administration of anesthesia -most often working under the supervising doctor of Anesthesiology Nurse Educator - works primarily in schools of nursing, staff development departments of health care agencies, and patient education departments Nurse Administrator - manages patient care and the delivery of specific nursing services within a health care agency Nurse Researcher - conducts evidence-based practice and research to improve nursing care and further define and expand the scope of nursing practice Historical influences on nursing - Florence Nightingale- 1st practicing epidemiologist; 1st nursing philosophy based on health maintenance & restoration Lillian Wald & Mary Brewster- initiated control for the spread of TB; public health nurses on east side of NYC ("Henry St. Settlement") Harriet Tubman- influence nursing during civil war; freed slaves in the underground railroad movement Mary Nutting-1st nursing professor at Columbia college 1906 Clara barton- found of American red cross for soldiers Mary Mahoney- 1st professionally prepared black nurse Discuss how advances in nursing science and evidence-based practice improve patient care - reduced healthcare errors and improved patient safety

Explain how professional nursing organizations affect both the profession and standards of care - Professional organizations and associations in nursing are critical for generating the energy, flow of ideas, and proactive work needed to maintain a healthy profession that advocates for the needs of its clients and nurses, and the trust of society What is referred to as the critical thinking model? - The nursing process What is the nursing process? - Assessment Diagnosis Planning Implementation Evaluation compassion fatigue - -A state of exhaustion experienced by medical and psychological professionals, as well as caregivers, which leaves the individual feeling stressed, numb, or indifferent -may contribute to what is called "lateral violence" Burnout - -the condition that occurs when perceived demands outweigh perceived resources -a state of physical and mental exhaustion NCSBN (National Council of State Boards of Nursing) - not-for-profit organization through which nursing regulatory bodies act and counsel together on matters of common interest and concern affecting public health, safety and welfare, including the development of nursing licensure examinations. QSEN (Quality and Safety Education for Nurses) - -a project for preparing future nurses with the knowledge, skills, and attitudes (KSAs) necessary to continuously improve the quality and safety of the health care systems within which they work -focus on competency needed to continuously improve quality of care in their work environment: Patient-centered Teamwork and Collaboration Evidence-Based Practice

Quality Improvement Safety Informatics-Electronic charts Identify four challenges facing nursing this upcoming years - -aging baby boomers -shortage/uneven distribution of healthcare providers -accelerating rate of nurses retirement due to an aging nursing workforce -uncertainty of healthcare reform 6 levels of care in healthcare system - 1. preventative

2. primary
3. secondary
4. tertiary
5. restorative
6. continuing care Levels of care is not the same as levels of? - Prevention Levels of Prevention - Primary: prevent/promotion Secondary: screen-early detection Tertiary: treat- to prevent further deterioration, rehab True or false: There is no single model for an integrated health care system - True What are the 2 types of integrated health care delivery? - -organizational structure that follows economic imperatives (combining financing with all providers) -structure that supports an organized care delivery approach (coordinating care activities and services into seamless functioning)

Hospitals provide what kind of care? - Secondary and Tertiary Preventative and primary care services - - School Health

• Occupational Heath
• Physicians' Offices
• Nurse-manages clinics
• Block and parish nursing
• Community health centers Discharge planning starts when? - admission Factors that affect a person's access to healthcare - -economic factors (poverty) -cultural/social differences -educational short comings -lack of recognition of problem by legislators -isolation of living in remote rural areas Barriers to effective discharge planning - -ineffective communication -lack of role clarity among healthcare team -lack of resources patients discharged too quickly (quicker and sicker) STEEEP - Safe- preventing injuries Timely- reducing waits and delays Effective- services to those who benefit Efficient- preventing waste Equitable- providing unvaried care based on personal characteristics Patient centered- individual patient needs, values, preferences

"Pay for value" - ties reimbursement to quality; if hospitals perform poorly in quality scores, they receive lower payments for services Quality Chasm - Through the ______ reports the IOM has sustained the emphasis on the imperative to transform the U.S. health care system in order to address inconsistent outcomes and prevent errors. Resident Assessment Instrument (RAI) - A comprehensive tool that includes the minimum data set, resident assessment protocols, and guidelines for functional assessment of the resident home care - Provision of medically related professional and paraprofessional services and equipment to patients and families in their homes for health maintenance, education, illness prevention, diagnosis and treatment of disease, palliation, and rehabilitation Rehabilitation - the process aimed at enabling people with disabilities to reach and maintain their optimal physical, sensory, intellectual, psychological, and social function levels extended care facility - provides intermediate medical, nursing, or custodial care for patients recovering from acute illness or those with chronic illnesses or disabilities Nursing Centers or Facilities - Provide 24-hour intermediate and custodial care Nursing, rehabilitation, diet, social, recreational, and religious services Residents of any age with chronic or debilitating illness assisted living - residences for people who do not need skilled, 24-hour care, but do require some help with daily care respite care - planned short-term care, usually for the purpose of relieving a full-time informal caregiver Adult Day Care Centers - provide a variety of health and social services to specific patient populations who live alone or with family in the community

palliative care - hospice care; taking care of the whole person—body, mind, spirit, heart and soul—with the goal of giving patients with life-threatening illnesses the best quality of life they can have through the aggressive management of symptoms Inpatient Prospective Payment System (IPPS) - system in which Medicare reimburses hospitals for inpatient hospital services according to a predetermined rate for each discharge. Diagnosis-related groups (DRGs) - System that categorizes into payment groups patients who are medically related with respect to diagnosis and treatment and statistically similar with regard to length of stay Affordable Care Act (ACA) - A federal law passed in 2010, which prohibits insurers from denying coverage to individuals with pre-existing conditions, sets minimum standards for health insurance policies, includes an individual mandate for individuals to have a health insurance policy, and expands Medicaid eligibility for many individuals and families.

HCAHPS - Survey: Hospital Consumer Assessment of Healthcare Providers and Systems Measures:

• Environment cleanliness*
• Environment quietness*
• Nurse communication
• Physician communication
• Communication about pain*
• Communication about medications
• Responsiveness of hospital staff*
• Discharge information*
• Transition of care
• Overall hospital rating
• Likely to recommend

Magnet Recognition Program - recognize organizations that achieve excellence in nursing practice Healthy People - A set of national health promotion and disease prevention objectives for the U.S. population. NDNQI (National Database of Nursing Quality Indicators) - developed by ANA; measure and evaluates nursing-sensitive outcomes with the purpose of improving patient safety and quality care explain the relationship between public health and community health nursing - -public health = population-related -community health = community-oriented -While both disciplines serve the same demographics, their purposes are distinct. Public health nurses provide healthcare to people and communities who are unable to seek assistance. Community health nursing involves advocacy and policy development to eliminate healthcare disparities. Community-oriented nursing - -focus is on health promotion, disease prevention, and improving quality of life community-based nursing - provides direct illness care to individuals and family within a community setting (home or clinic) Role as a community health nurse - to preserve, protect, promote, and maintain health social determinants greatly affect - health disparities Characteristics of patients from vulnerable populations - immigrants, poverty, homelessness, abused, mental health illnesses, elderly Competencies important for success in community-based nursing practice: - caregiver, case manager, change agent, patient advocate, collaborator, counselor, educator, epidemiologist (similar to standard nursing practice)

Community Assessment Components - people, place, social systems How is theory used in nursing practice? - nurses use theory to describe, explain, predict, or prescribe nursing care What are the components of a theory and what does it provide? - -set of concepts, definitions, assumptions, to explain a phenomenon -it provides a foundation of knowledge for nurses to direct and deliver nursing care Nursing Metaparadigm - allows nurses to understand and explain what nursing is, what nursing does, and why nurses do what they do Nursing Metaparadigm Concepts - person- patients, groups, communities environment health nursing- care for individuals of all ages Summarize the evolution of nursing theory - went from vocation to profession in 21st Century Types of Theories - Grand, Mid-range, Descriptive, Prescriptive grand theories - abstract, broad in scope, and complex; therefore they require further clarification through research so they can be applied to nursing practice middle-range theories - more limited in scope and less abstract; address a specific phenomenon and reflect practice practice theories - Situation-specific theories, bring theory to the bedside Descriptive theories - First level of theory development. They describe phenomena and identify circumstances in which the phenomena occur.

Prescriptive theories - address nursing interventions and predict their consequences Theorists and their focus - Henderson- principles and practice of nursing (assists patient in 14 activities) Johnson- behavioral system (help patient attain balance, function, stability in each subsystem) Neuman- systems (stabilize a patient/wellness and prevention of disease) Abdellah- patient centered care (uses knowledge from previous experience to care for patient) King- goal attainment (help patients attain goals/acheivements) Roy- adaptation (cope) Watson- caring (understand the interrelationship among patients health, illness, and behavior) Rogers/Parse/Newman- unitary beings/human becoming/experiencing consciousness (helps patients use their own potential) Middle range theorists and their focus - Benner- skills acquisition (nurses progress through 5 stages) Kolcaba- comfort (strive to relieve) Pender- health promotion AACN- synergy (matching nursing competencies to patient needs) Meleis, Sawyer, Messias, Schumacher- transitions (interventions specific to each patient)

Nightingale's Environmental Theory - The focus is a patient environment, so nature is able to restore a patient to health. Through observation and data collection she linked the patient's health status with environment factors. GRAND THEORY Peplau's Theory - focuses on the interpersonal relationships between the nurse, the patient and the patient's family. It seeks to develop the nurse-patient relationship (mother of psychiatric nursing) Orem's Theory - known as self-care deficit theory which focuses on the patient's self-care needs (commonly used: rehabilitation centers) Leininger's Theory - to provide culturally specific nursing care National Council of State Boards of Nursing - -was developed to help guide nursing educators in evaluating student nurses ability to make the clinical judgements necessary when providing competent nursing care -a model with multiple layers that help explain the cognitive process nurses use to make clinical judgements -increases sophistication from top to bottom and left to right Relationship between nursing theory and nursing research - The relationship between nursing theory and nursing research builds the scientific knowledge base of nursing, which is then applied to practice Theory is essential to nursing practice because it: - 1. contributes to nursing knowledge

2. predicts patients behavior in situations
3. guides nurse practicing
4. explains relationships between concepts A nursing is caring for a patient who recently lost a leg in a motor vehicle accident. The nurse best assists the patient to cope with this situation by applying which theory? - Roy- adaptation (cope)

the public health nurse is working with the local city/county health department during a pandemic that has created a crisis within the community. What are the responsibilities of the PH nurse during the pandemic? - -educate the public on disease prevention -serve as a liaison between patients and health care services and providers -investigate cases as they arise a community health nurse is working in a clinic with a focus on asthma and allergies. What is the primary focus of the community health nurse in this clinic? - -decrease the incidence of asthma -increase patient's ability to self-manage their asthma -provide asthma education programs for the teachers in the local schools a nurse is providing restorative care to a patient following an extended hospitalization for an acute illness. Which of the following is the most appropriate outcome for this patient's restorative care? - patient will be able to walk 200 feet without shortness of breath What describes characteristics of an integrated health care system - the focus is holistic, the system coordinates a continuum of services, members of the health care team link electronically to use the EHR to share the patient's health care records A nurse newly hired at a community hospital learns about intentional hourly rounding during orientation. Which of the following are known evidence-based outcomes from intentional rounding? (Select all that apply.)

1. Reduction in nurse staffing requirements
2. Improved patient satisfaction
3. Reduction in patient falls
4. Increased costs
5. Reduction in patient call light use - 2, 3, 5 The nurse is assigned to care for an 82-year-old patient who will be transferred from the hospital to a rehabilitation center. The patient and her husband have selected the rehab center close to their home. The nurse learns that the patient will be discharged in 3 days and decides to make the referral on the day of discharge. The nurse reviews the recommendations for physical therapy and applies the

information to fall prevention strategies in the hospital. What discharge planning action by the nurse has not been addressed correctly?

1. patient and family involvement in referral
2. timing of referral
3. incorporation of referral discipline recommendations into plan of care
4. determination of discharge date - 2 a nursing student is giving a presentation to a group of other nursing students about the needs of patients with mental illnesses in the community. Which statement by the student indicates that the nursing professor needs to provide further teaching?
5. "many patients with mental illness do not have a permanent home"
6. "unemployment is a common problem experienced by people with mental illness"
7. "the majority of patients with mental illness live in long term settings"
8. "patients with mental illnesses are often at a higher risk for abuse and assault" - 3