Practical Nursing Theory Test 1 Questions and Answers, Exams of Nursing

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Practical Nursing Theory Test 1 Questions With Complete Solutions ______ has been credited with being the first person in what is now Canada to provide nursing care to the sick (arrived toQuebec around 1617, assisted her husband - a surgeon) Correct Answer Marie Rollet Hébert "Nurses are the largest group of health care professionals in the country. Harnessing their full capacity offers the best possibility for transforming our healthcare system. Ensuring that nurses are in work environments that enable them to practice at their full scope will accelerate nursing innovation and better quality patient care". (Canadian Nurses Assoc., 2013, page 5) Correct Answer Nurses and our Health Care System "The promotion of health and the assessment of, the provision of care for, and the treatment of health conditions by supportive, preventive, therapeutic, palliative and rehabilitative means in order to attain or maintain optimal health" (College of Nurses of Ontario, 2012) Correct Answer CNO Definition: the practice of nursing is:

• is the study of good conduct, character, and motives •It is concerned with determining what is good or valuable for individuals and/or society at large •all healthcare professionals have codes of ethics that offer guidelines about responding to practice situations •ethics are rules of conduct that have been agreed to by a particular group

•these rules are agreed to be morally right or proper for that group •ethics are different from laws, in that they are voluntary Correct Answer Ethics

• values are found at the heart of ethics •formation: in childhood and learned from family, culture, peer groups, workplace •some values are fixed for life, some change (are not static) •values clarification: know yourself and your biases in order to help others ** what happens when your values clash with a patient's values? Correct Answer Values •Aboriginal status, gender, disability, housing, early life, income and income distribution, education, race, employment and job security, working conditions, social exclusion, food insecurity, social safety net, health services Correct Answer Social Determinants of Health ("The Canadian Facts" by Mikkonen & Raphael, 2010) •approx. 2,000 Canadians were infected with HIV and approx. 30,000 Canadians were infected with Hepatitis C •Royal Commission Inquiry conducted by the Honourable Commissioner Judge Horace Krever of the Canadian Blood System known as the 'Krever Inquiry' (approx. 1,200-page report that declared this to be a "nationwide public health calamity" with multiple errors and not just from the Canadian Red Cross Society; the inquiry also provided 50 recommendations) Correct Answer Early 1980's - Tainted Blood Scandal in Canada

•Canada spent approximately $253.5 billion on health care in 2018, an average of $6,839 per Canadian •3rd highest spender, but ranks 30th (out of 100 peer countries) in the world as the best health care system •ranks 10th in health status among 17 peer countries; Canada gets a "B" for health status Correct Answer Healthcare Spending •Gains a deeper understanding of the subject and sometimes at the end helps to develop a hypothesis •No ambiguity in the definitions; describes & explains concepts & specific variables that may be identified in the study •Starts with specific observations & ends with broad generalizations •New theory is often created by the researcher & is commonly supported by an existing theory Correct Answer Inductive Research: Qualitative Studies •growing number of infectious diseases (e.g. TB rise, VRE, MRSA, C.Diff) •medicare vs. private-funded healthcare •increasing gap between rich and poor •changing demographics •Indigenous populations had a decreased rate of population in past/ but now rising •increasing multiculturalism •inadequate sanitation continues for some people: food and water; pollution on the rise •worldwide nursing numbers are cyclical changing between shortage to too many nurses

•increased use of Unregulated HC Providers •rising healthcare costs •increase in evidence-based practice (basing nursing practice on research) •advances in technology •rise in complex care (multiple health problems) •shorter stays in the hospital •customer-service approach Correct Answer Trends in Health Care Today •in 1984 the Federal gov't created the CHA which consisted of the Principles of Medicare: universal access to all for hospital and medical (doctor) coverage •Medicare does not cover all health care services, treatments and medications •current controversy: expensive + +,? sustainable Correct Answer Canada Health Act (CHA) •in training schools staffing hospitals, 2 hr class/week •2-year diploma from college starting in the 1960s •BScN programs started in the 1940s •RNs remained majority diploma trained until 2005 when a degree became the entry-to-practice requirement Correct Answer RN Education in Ontario •Inter-professional collaboration/education •more chronic disease at all ages due to: obesity, hypertension, type 2 diabetes, opioid addictions, poverty, and mental illness •Medicinal Cannabis (must comply with the "Smoke Free Ontario Act" passed July 1, 2018)

•Medical Assistance in Dying (MAID) - Bill C14 amended and passed in 2017 Correct Answer Current Trends & Reforms in Health Care •Is not as well developed as a theoretical framework and has a narrower scope •Is derived from concepts and specific variables that are identified in the research •Is the end result of bringing together a # of related concepts to explain or predict a phenomenon •When no existing theory fits the concepts that the researcher wishes to study the researcher may construct a conceptual framework Correct Answer Conceptual Framework •Katharine Kolcaba: Theory of Comfort •Nola Pender: Health-Promotion Model •Hildegard Peplau: Interpersonal Relations in Nursing Theory •Patricia Benner: From Novice to Expert Theory •Blanche Mikhail: Health Belief Model •Dorothy Johnson: Behavioral Systems Model Correct Answer Examples of Middle-range Nursing Theories •Myra Estrin Levine: Conservation Model •Betty Neuman: Health Care Systems Model •Sister Callista Roy: Adaptation Model •Dorthea Orem: Self-Care Deficit Theory •Martha Roger: Science of Unitary Human Beings Theory •Rosemary Parse: Theory of Human Becoming Correct Answer Examples of Grand Nursing Theories •nursing is both an art and a science

science: is the application of nursing knowledge and the technical aspects of practice art: is the establishment of a caring relationship •both focus on the whole person holistically: physical, psychological, emotional, spiritual, and cultural (no longer just focusing on one problem) Correct Answer Nursing Today •Organize patient data •Understand patient data •Analyze patient data •Make decisions about nursing interventions •Plan patient care •Predict outcomes of care •Evaluate patient outcomes Correct Answer How Do Nurses Use Theory In Everyday Practice? •Provides a broad explanation of relationships that exist between concepts •Is general, less structured, loosely defined •Is based on one theory that already exists •Provides a basic foundation for a research study & the concepts of the study relate back to the theory •Starts out as a conceptual framework & with much research, develops into a research-based theoretical framework Correct Answer Theoretical Framework •Starts with a generalized hypothesis and ends with a conclusion (rejects or confirms the hypothesis)

•Aims at testing an existing theory •Uses a theoretical framework as a foundation/structure to guide the research study Correct Answer Deductive Research: Quantitative Studies •to guide nursing practice, support and generate knowledge •it helps to describe &/or explain nursing •it enables nurses to know What they are doing & WHY they are doing it Correct Answer The Purpose of Theory •Traditional Nursing Care •Functional nursing •Team and Modular nursing •Total patient care •Primary nursing •Case management Correct Answer Canadian Health Care Dollars Delivery Models

1. Primordial
2. Primary
3. Secondary
4. Tertiary
5. Rehabilitation (not always included)
6. Quaternary Correct Answer Future of Preventative Medicine (PHC): 1)Promotive: Health Promotion 2)Preventative: Disease & Injury Prevention 3)Curative: Diagnosis & Treatment 4)Rehabilitative Care 5)Supportive Care Correct Answer Levels of Health Care Settings and Services

1840's - 1880's: Establishment of "Insane/LunaticAsylums" in Upper Canada (Ontario) ex. Correct Answer Provincial Lunatic Asylum, Queen Street Toronto a set of concepts, definitions, relationships, and assumptions that project a systematic view of a phenomenon it may consist of one or more concrete or generalized concepts or a hypothesis that describes, accounts for, or organizes a phenomenon Correct Answer Theory also called morality Correct Answer Ethics are Comprehensive, Universality, Portability, Public Administration, and Accessibility Correct Answer The 5 Main Principles of Medicare (Canada's Health Act - CHA) as of ____, baby boomers are between 54 and 72 years of age - (*largest cohort of Canadian's entering the system; approx. 9. million) Correct Answer 2018 as training schools grew, nursing students staffed hospitals and took classes led by doctors until the ____ Correct Answer 1950s aspect of reality that can be consciously observed or experienced; focus for the theory Correct Answer Phenomenon autonomy, beneficence, nonmaleficence, justice Correct Answer 4 principles: of Bioethics

broadest in scope & complexity; abstract concepts; non-specific to settings; provide a general framework and nursing ideas; further research is often needed for clarification Correct Answer Grand Theories Canadian Confederation -Provincial gov'ts - responsible for establishing, maintaining and managing hospitals, asylums, charities and charitable institutions Correct Answer July 1, 1867 Canadian Red Cross Correct Answer 1896 Caregiver, Communicator, Collaborator, Co-ordinator, Colleague, Teacher, Leader, Advocator, Lifelong learner Correct Answer Nursing Roles in All Settings Children's Aid Society Correct Answer 1891 CHR/EMR/EHR, CPOE, PDA's, Bar code scanning with med's, ADU's Correct Answer changing technology cities had high mortality rates due to epidemics for example: Correct Answer (e.g., typhoid fever, small pox, TB, measles, flu, maternal mortality deaths, wars, immigration, trauma, lack of health care) cities received the homeless, sick, immigrants, unemployed/poor, abandoned women and children Correct Answer Threats to Health in 1700's to 1800's

concrete; situation-specific that has a narrow scope & focus (certain group or setting); provide frameworks for nursing (including specific goals, interventions & desired outcomes); least complex; have a direct effect on nursing practice Correct Answer Low/Micro-range Theories (practice level): courses became 35 weeks long Correct Answer 1968 Deductive Research Correct Answer Quantitative Studies describe the general meaning of the concepts Correct Answer Definitions do no harm Correct Answer Nonmaleficence doing good for others Correct Answer Beneficence During the ____________ to ____________ century, the federal government established racially segregated "Indian hospitals" for the treatment of First Nations and Inuit peoples in Canada. With the coming of medicare in the late 1960s, the government began to close them. A 50-bed Saskatchewan "Indian Hospital" built in 1936 Correct Answer early to mid-20th century entry to practice requires a 2-year diploma Correct Answer 2002 explains the relationships between the concepts; is a hypothesis (may or may not have this) Correct Answer Propositions

fairness. (related to resources and social justice) Correct Answer Justice first Canadian hospital established & directed by _______ ________ mid-1600s in Montreal (30 bed hospital, called Hôtel- Dieu); **Mance also co-founded Montreal Hospital Correct Answer Jeanne Mance first community nursing order, visited both settlers &Indigenous Peoples (1700's) Correct Answer Greys Nuns Florence Nightingale Correct Answer Leader of The Industrial Revolution in Nursing For most of history, health care was delivered in the Correct Answer community given jurisdiction over marine hospitals and quarantine Correct Answer Federal gov't Grand Theories Middle-range Theories Low/Micro-range Theories (practice level): Correct Answer Types of Nursing Theory hospitals and long term care facilities Correct Answer Institutional Hospitals were a new development in North America in the Correct Answer 1900's

Humber River Hospital Correct Answer •Robots will deliver non-narcotic drugs and other supplies; diagnostic images (e.g., MRI) will be charted immediately so specialists can review them sooner; and patients will check in on self-serve kiosks that will automate patient records and notify the relevant care teams that the patient has arrived Humber River Hospital (opened in Toronto Oct. 2015) Ontario's gov't is investing up to $2.13 billion in this project Correct Answer North America's First Fully Digital Hospital: ideas, mental images, and experiences that help to describe the phenomenon; the building blocks of the theory Correct Answer Concepts Indian Act Correct Answer 1867 (first passed) Indigenous Peoples have been in the Americas for Correct Answer 15,000 - 30,000 years Inductive Research Correct Answer Qualitative Studies internal and external factors that affect the person Correct Answer Environment is a strong personal belief and an ideal that an individual strives to uphold about a given idea, attitude, custom, or object that set standards that influence behavior Correct Answer Values Is more than a job or occupation because:

1. it provides services that require specialized knowledge, skill, and judgement
2. It requires extensive higher education
3. it is guided by a code of ethics
4. it has been self-regulated since 1963 by the College of Nurses of Ontario (CNO)
5. it has professional groups: the Registered Practical Nurses Association of Ontario (WeRPN) and the Registered Nurses Association of Ontario (RNAO) Correct Answer Nursing Profession is thought to be the most abstract view of a discipline and is made up of essential concepts that define the discipline functions as a generalized theoretical framework in which the more restricted/specific structures of the theory developed Correct Answer Metaparadigm Kingston General Hospital Correct Answer 1849 make decisions for oneself; self-determination Correct Answer Autonomy Medicare: hospital and medical insurance for all Correct Answer Not Free more limited in scope & less abstract compared to grand theories; address a specific phenomenon in nursing and reflect nursing practice; maybe generalized/applied to multiple settings Correct Answer Middle-range Theories

most programs moved into colleges, a certificate program with 3 semesters after grade 12. RPN title created. Correct Answer 1990s mostly responsible for health care of Ontario Citizens Correct Answer Provincial and Territorial nurses have the responsibility of being Correct Answer altruistic (unselfish, humanitarian, and compassionate) Nursing Superintendent at the Toronto General Hospital Training School for Nurses, 1884- •created the largest, and one of the most prestigious, nursing schools in Canada and appealed to TGH for a nurses' residence, which was built in 1887 •introduced regular lectures by physicians; expanded course content; and advocated for nurses to become registered •in 1907 helped found and served as president of the Canadian National Association of Trained Nurses (name changed in 1924 to Canadian Nurses Association) Correct Answer Mary Agnes Snively one form of ethical theory to guide all health care providers (not just nurses) Correct Answer Principles of Bioethics Ontario created LHIN's (2019 -starting to be dismantled by the provincial government) Correct Answer regionalization

Ottawa Heritage Hospital Correct Answer 1845 (now known as the Ottawa Hospital) patchwork health care coverage (some coverage from Federal and some from Provincial/Territorial) Correct Answer Indigenous peoples Patient, Client, Resident, Nurse Correct Answer Words Matter

• Choose the Correct Terminology Phenomenon Concepts Definitions Assumptions Propositions Correct Answer Components of a Theory Physicians, personal support workers, social workers, dieticians, respiratory technicians, pharmacists, occupational therapists, physiotherapists, chaplains, ward secretaries, housekeeping, porter, paramedic, etc... Correct Answer Inter-professional Health Care Team Members Provincial and Territorial Insured -health care services: Ontario = OHIP •Examples of OHIP Coverage (insured services paid through taxes): basic out-patient and in-patient services; public ward room, blood tests; x-rays; prescription medications (anyone not covered by private insurance who is 24 or under and 65 or older) •Examples of OHIP not Covering (uninsured services): dental services; if you miss an MD appoint.; cosmetic surgery;

prescription glasses/contact lenses; infertility treatment Correct Answer Health Care Covered by Canada's Health Act Provincial Lunatic Asylum Correct Answer for the mentally ill opened in 1850 (now known as the Centre for Addiction and Mental Health on Queen St., Toronto) public health, doctor's and nurse practitioner's offices, home care (Community Care Access Centre), adult day care services, respite care, hospice care, community agencies (eg., Canadian Diabetes Association; Canadian Mental Health Association) Correct Answer Community Sector recipient of care; can be more than one person e.g., clients, groups, friends, families, communities Correct Answer Person responsible for the health care coverage of RCMP, Military, Veterans, Federal Inmates Correct Answer Federal RPNs now give meds (except IV push meds); administer blood transfusions; change dressings (including packings); insert foley catheters; count narcotics; call the physician on the phone for Dr.'s orders; initiate IV's •Some agencies may have policies restricting/allowing certain nursing skills ** always check with your facilities policy as to what RPN's are allowed to do and not to do •an RPN is no longer 'under the supervision of an R.N' however can always collaborate and ask for guidance with the RN whenever needed Correct Answer Changing Scope of Practice

Scope of Practice Correct Answer (means the work a nurse does) Social Safety Net: started in the 1960s •Social Safety Net refers to the programs and policies in place by the Federal and Provincial governments meant to alleviate the effects of poverty •Social Safety Net programs allow ALL people to receive income, health care and other Correct Answer Evolution of the Canadian Health Care System statements that describe the concepts based on the theorist's values & beliefs (may not always have both assumptions and propositions - may only have one or the other) Correct Answer Assumptions The "Sanatorium Age" in Canada -1897-1950's ex. Correct Answer Canada's 1st TB hospital was the Muskoka Cottage Sanatorium, opened in 1897 at Gravenhurst, a location chosen for its clear air the degree of wellness; this is subjective - what the person reports about his/her health Correct Answer Health The Maintaining Hope in Transition Model

• a specific theoretical, practical framework that utilizes evidence-based research & practice
• developed to specifically address the needs and vulnerability for patients living with heart failure & their families

-provides a structure for health care professionals to support and guide this particular group of patients and their families (specific goals, interventions & desired outcomes) Correct Answer Example of a Low-range Nursing Theory The Metaparadigm of Nursing consists of Correct Answer 4 central concepts among nursing theories the nurse's attributes, characteristics and actions; including how the nurse interacts with the person Correct Answer Nursing Theories adopted from other disciplines (other than nursing) such as psychology & sociology to try to empirically describe, explain, or predict a nursing phenomenon •Example: Critical Social Theory

• shifts the lens from the majority political, socio-economical, cultural, spiritual and intellectual views to the minority, voiceless, oppressed groups; promotes human liberation & equality through exposing mainstream domination & providing the tools needed to empower vulnerable groups to improve their situation Correct Answer Borrowed Theories These are all current issues for who? •aging nurses •high retirement rate of nurses •less fulltime positions for nurses •increased number of Unregulated HC Providers •lack of resources •meeting 'target times' •adapting to frequent changes

•increased complexity of patients •increased number of nurses and patients suffering from mental illness and/or addiction problems •nurses suffering from a work-related physical injury Correct Answer Current Issues for Nurses traditional medicine was and is the approach that Indigenous Peoples use: Correct Answer physical, spiritual, emotional and mental well-being Victoria Hospital for Sick Children Correct Answer 1865 (now known as the Hospital forSick Children) Victorian Order of Nurses Correct Answer 1897 Visions for? •Self-care/patient-led care will be the norm with a "shared-care" delivery model of responsibility and accountability for health and illness care •More financial and human resources will be directed to health and communities; less focus will be placed on illness and hospitals •Every Canadian will have a secure, portable and accessible electronic health record •Nurses will act as health "shepherds", coordinating care, delivering direct services, and helping patients to understand options and navigate the health system •Nurses will not carry out any tasks that can be accomplished safely by patients themselves (e.g. medication administration), by nonhuman care partners (e.g. robots) or by other human supports (e.g. PSW's)

•70 % of nurses in all categories will have access to full-time positions or the equivalent •More nurses will be certified specialists in institutional and community settings •Nurses will Correct Answer Toward 2020: Visions for Nursing What 4 things does nursing Metaparadigm include? Correct Answer Health Person Environment Nursing What year? first school of nursing in Canada was created in St. Catherines, Ontario Correct Answer 1874 When •Post WWII (1945 war ended): the creation of modern public health approach •focus on illness prevention and health education •Provincial gov'ts: set up public health units Correct Answer 1940s When? •1990's - shift from hospital to out-patient clinics, and home care nursing due to hospital budgets cuts, hospital closures, and hospital merges

•2003 - Canada saw approx. 438 SARS (Severe Acute Resp. Syndrome) cases, with 44 deaths Correct Answer Canadian Healthcare (1990's to 2000's) When? •antibiotics: focus on infectious diseases to chronic conditions •by 1950s -1980's hospital focus (increase number of hospital beds and budgets) •1979: 1st patient diagnosed with AIDS in Canada and by 1987 there were 1,011 Canadians diagnosed with AIDS in Canada Correct Answer Canadian Healthcare (1950's to 1980's) When? Canadian Confederation (self-governing colony created: British North American Act) Correct Answer 1867 When? first nursing assistant programs began- 9 months long Correct Answer 1946 When? population became more urban, crowded living conditions, poor housing and sanitation Correct Answer 1867 When? Frederick Banting and Charles Best discovered insulin under the directorship of John Macleod at the University of Toronto Correct Answer the Early 1920s Who:

• Founder/Pioneer of modern nursing (globally)
• born in England, family wealthy

• set up a military hospital during the CrimeanWar (1854); reduced soldier's deaths by improving sanitation
• published 'Notes on Nursing' and started the first nursing school
• established nursing as a discipline distinct from medicine
• stressed need for lifelong learning
• brilliant with statistics
• believed in the basics: clean water and air, to reduce disease
• called the 'Lady with the Lamp' Correct Answer Florence Nightingale Written history about nursing begins in Correct Answer the 1600s York General Hospital Correct Answer 1812 (changed to Toronto General Hospital and now known as University Health Network)