NUR 2058 Dimensions Final Study Guide( Complete Solution Rated A)

NUR 2058 Dimensions Final Study Guide NUR 2058 Dimensions Final Study Guide Module 1 (Chapter 2,4,5 Nursing Now!) Chapter 2 • Identify the “father of modern medicine” and key historical persons who advanced the nur ...

NUR 2058 Dimensions Final Study Guide NUR 2058 Dimensions Final Study Guide Module 1 (Chapter 2,4,5 Nursing Now!) Chapter 2 • Identify the “father of modern medicine” and key historical persons who advanced the nursing profession Hippocrates was considered to be the father of modern medicine. His beliefs focused on harmony with the natural law instead of on appeasing the gods. He emphasized treating the whole client-mind, body, spirt, and environment -and making diagnoses on the basis of symptoms rather than on an isolated idea of a disease Florence Nightingale is universally regarded as the founder of modern nursing. Dedicated her life to improving health care and nursing standards. Played a huge part in the Crimean War and helped to improve nursing education, hospital conditions, sanitation, and health care in general. Opened the Florence Nightingale School of Nursing and Midwifery. Isabel Adams Hampton Robb dedicated her life to raising the standards of nursing education in the United States. She was the director of the Illinois Training School for nurses, and some of her ideas were developed and implemented, such as a grading policy for students. She also advocated for the reduction of the long hours involved in training nurses. She headed the John Hopkins Training School for Nurses, and brought together leaders from key nursing schools to for the American Society of Superintendents of Training Schools for Nurses, and served as chairwoman. This group was the precursor to the National League for Nursing. Robb was also the first president of the American Nurses Association. She also helped develop the American Journal of Nursing, the first professional journal dedicated to the improvement of nursing. Lillian Wald opened the Henry Street Settlement, a storefront health clinic in one of the poorest sections in the city of New York. This clinic allowed organization nurses to make home visits, focused on sanitary conditions, and children’s health. Wald became a dedicated social reformer, an efficient fundraiser, and an eloquent speaker. She is also credited with the founding of the American Red Cross’s Town and Country Nursing Service. She founded and became the first president of the National Organization for Public Health Nursing. Many child health and wellness programs in use today are based on her efforts. Lavinia Lloyd Dock contributions as a reformer focused on the professionalization of nursing the equality of women. She wrote the first medication textbook for nurses, and worked along Lillian Wald and Isabel Robb. Spent most of her career dedicated to the pursuit of equal rights. She also believed poverty and squalor contributed to poor health, and dedicated herself to social reform to address these problems. One of the most influential leaders in the early 20th century. Annie W. Goodrich provided nursing care at Lillian Wald’s Henry Street Settlement after receiving her nursing degree. She was known as an outstanding nursing educator and ran a number of nursing schools. She was appointed state inspector of nursing schools, a position that up until that time had only been held by physicians. She was the dean of the US army nursing school and Yale school of nursing. She established a nursing training program at Vassar College. She had demonstrated that teaching theoretical information in a classroom was just as important in training highly skilled nurses in clinical practice. Her many writings about nursing education and her experiences with military nursing have been a great contribution to the nursing profession. Loretta C. Ford is credited with founding the nurse practitioner (NP) practice. She worked with pediatrician, Dr. Henry K. Silver to form the first NP program after noticing a shortage on family physicians. Ford also became the founding dean of the University of Rochester School of Nursing and director of the Nursing Service at the University Hospital in 1972. She was inducted into the National Women’s Hall of Fame for being recognized as an internationally renowned nursing leader who has transformed the profession of nursing and made health care more accessible to the general public. She also won the Blackwell award, which is given to a woman who has shown exemplifying outstanding service to humanity. • Review the evolution of symbols in nursing and significance of these symbols In Modern society, the symbols connect the professions to their historical roots and provide the philosophical basis for the work they do. The significance of the lamp is really the significance of light. For years, lamps were used to push back the darkness. It dispelled fear and allowed people to pursue learning long after the sun went down. It often was used as a religious symbol that represented an eternal flame that dispels darkness and evil. The lamp was first used as a symbol for the nursing profession at the time of Florence Nightingale. The lamp became a sign for caring, comfort, and often the difference between life and death. It retains its significance as a symbol of the ideals and selfless devotion of Florence Nightingale. It also signifies the knowledge and learning that the graduate has attained during their years in the nursing program. The Nursing pin can trace its origins to the heavy protective war shields used by soldiers as far back as the Greek and Roman Empires. The pinning ceremony is part of a long tradition that acknowledges nursing graduates as belonging to a unique group and identifies them as new members of the health-care community. It is a symbol of their legal authority as licensed professionals. It’s a medal of honor. The Cap can be traced back to an early Christian era group of women called deaconesses. They were set apart from other women of the period by the white head covering, which indicated their primary service was to care for the sick. The white covering eventually evolved into a white cap that signified “service to others.” It is a sign of service to those in need, and is a reminder of the unchanging values of wisdom, faith, honesty, trust, and dedication of nursing. Chapter 4 • List the QSEN competencies and relationship to nursing education 1.Client-Centered care 2.Teamwork and Collaboration 3.Evidence-Based Practice (EBP) 4.Quality Improvement (QI) 5.Safety 6. Informatics • Identify and discuss the importance of interpersonal education for nurses Two or more students from different professions learning about, from and with each other to enable effective collaboration and improve health outcomes. Interdisciplinary learning helps to improve the real-world outcomes for the well-being of clients. Poor communication and lack of teamwork among health-care professionals were major contributions to the increased number of medicine and other errors in the hospital setting. In conjunction with other health-care disciplines, could integrate teaching and learning to improve health-care outcomes. Four key competences found in interprofessional education: ➢ Values and Ethics for interprofessional practice ➢ Roles and responsibilities ➢ Interprofessional communication ➢ Teams and Teamwork They recommend that these competences be emphasized throughout nursing and other professional health-care curriculums. Chapter 5 • Identify the purpose and needs for nursing licensure Licensure is conducted by the state through the enforcement powers of its regulatory boards to protect the public’s health, safety, and welfare by establishing professional standards. Licensure for nurses, as for any other professional who deals with the public, is necessary to ensure that everyone who claims to be a nurse can function at a minimal level of competency and safety. It helps to set the standards of care. • Review examples of ways a nursing license may be revoked ➢ Conviction of a serious crime ➢ Demonstration of gross negligence or unethical conduct in the practice of nursing ➢ Failure to renew a nursing license while still continuing to practice nursing ➢ Use of illegal drugs or alcohol during the provision of care for clients or use that carries over and affects the client’s health ➢ Willful violation of the state’s nurse practice act Revocation of the license to practice nursing is one of the most severe punishments that a nurse can experience. The nursing profession is responsible for monitoring and enforcing its own standards through the state licensing board. • Identify why it is important for nurses to join professional organizations The establishment of a professional organization is one of the most important defining characteristics of a profession. An association is a group of people banding together to achieve a specific purpose. By working together for a specific purpose, an association or organization amplifies its impact, and by developing a strategic plan, it focuses that impact to achieve certain results. Nurses need and use power in every aspect of their professional lives. An individual nurse probably does not have much influence, but for nurses as a group, the potential is increased exponentially by the organization. The dedications to high-quality nursing standards and improved methods of practice by the major nursing organizations has led to improved care and increased benefits to the public as a whole. Nurses need power for supervising unlicensed personal and negotiating with the administration for increased independent of practice. • Define ways a professional organization can impact nursing The National League of Nursing was the first national nursing organization to provide accreditation for nursing programs at all levels. Its primary purpose is to maintain and improve the standards of nursing education. Its bylaws state that its purpose is to foster the development and improvement of hospital, industrial, and public health. The American Association of Colleges of Nursing was established to help colleges with schools of nursing work together to improve the standards for higher education for professional nursing. It serves the public interest by assessing and identifying nursing programs that engage in effective educational practices. The AACN has developed the guidelines for the education of professional nursing that is widely used as the theoretical basis for baccalaureate curriculum. The International Council of Nurses consists of national nursing organizations, and the ICN serves as the international organizations for professional nursing. The goal of the ICN is to improve health and nursing care throughout the world. The National Student Nurses’ Association is an independent legal cooperation established in 1953 to represent the needs of nursing students. The main purpose of the NSNA is to help maintain high standards of education in schools of nursing, with the ultimate goal of educating high-quality nurses who will provide excellent health care. Sigma Theta Tau is an honors organization that was established in colleges and universities to recognize individuals who have demonstrated leadership or made important contributions to professional nursing. It is international, and candidates are selected from among senior nursing students or graduate or practicing nurses. Together, these organizations help improve nursing education and improve care. These organizations also help to increase benefits for health-care professionals. They help establish nursing standards and help to improve the nursing practice. By having organization, nurse can have a louder voice on concerns and issues within the nursing field Chapter 1 • Define Evidence-Based Practice (EBP) Evidence-Based practice is the practice of nursing in which interventions are based on data from research that demonstrates that they are appropriate and successful. It involves a systematic process of uncovering, evaluating, and using information from research as the basis for making decisions about and providing client care. • Determine the main method in which nurses can gain power in nursing The referent source of power depends on establishing and maintaining a close personal relationship with someone. Nurses often obtain power from this source when they establish and maintain good therapeutic relationships with their clients. The expert source of power derives from the amount of knowledge, skill, or expertise that an individual or group has. This power source is exercised by the individual or group when knowledge, skills, or expertise is either used or withheld in order to influence the behavior of others. The reward source of power depends on the ability of one person to grant another some type of reward for specific behaviors or changes in behavior. The coercive source of power is the flip side of the reward source. The ability to reprimand, withhold rewards, and threaten punishment is the key element underlying coercive source of power. The legitimate source of power depends on a legislative or legal act that gives the individual or organization a right to make decisions that they might not otherwise have the authority to make. The collective source of power is often used in a broader context than individual client care and is the underlying source for many other sources of power. Nurses can increase their power by professional unity, political activity, accountability and professionalism, networking, and future trends in the nursing profession. Professional Unity is the first and most important way in which a nurse can gain power. The most powerful groups are those that are organized and most united. A nurse can gain power through political actions, although this produces some discomfort in many nurses. Showing professionalism and accountability will also help a nurse gain power, as well as establishing a nursing support network. Chapter 17 • Define Civility and examples of civility in nursing education Civility is based on recognizing that all human beings are important. A simple definition of civility is for people to treat others as they would wish to be treated. Civility is one of the underpinnings of caring and can even be considered a moral imperative. Civility in the profession makes caring the focal point of their practice. EXAMPLES of civility in the classroom: ➢ Practice Proper door etiquette ➢ Assume Goodwill ➢ Listen and respect others ➢ Be flexible and open-minded ➢ Keep cell phones on silent and use proper phone etiquette ➢ Use laptop for class work only ➢ Do not have side conversations ➢ Give notice of change in advance ➢ Be present and on time ➢ Have fun! • Describe behaviors that are considered uncivil and civil in the clinical setting Incivility is the lack of civility. It is a very broad term that includes a wide range of what is considered to be unacceptable behavior in a civilized society. Incivility can be viewed as a continuum of impolite behaviors with a lot of overlap between them. EXAMPLES of incivility in a clinical setting: - Workplace hostility - Bullying - Lateral/ Horizontal Violence - Vertical Violence - Workplace Violence - Threatening - Physical harm - Impoliteness/Rudeness - Harassing - Failing to clarify an unreadable order - Lifting or ambulating heavy or debilitated clients without assistance rather than asking for help - Using unfamiliar pieces of equipment without asking for instructions first - Carrying out orders the nurse did not believe were correct EXAMPLES of civility in a clinical setting: - Assume goodwill - Respect and celebrate differences - Communicate respectfully - Listen Carefully - Come to clinical prepared and on time - Share work equally among group members - Resolve conflicts directly and with respect - Have Fun! Module 3 (Chapter 14 Nursing Now!) Objective 1: Contrast the various healthcare delivery settings and the diverse clients they serve • What is healthcare delivery? How does this affect nursing care? What demographic trends are affecting healthcare delivery? What are the 4 systems types in Western Medicine and what are the goals of each system? The delivery of health care is the action or activities of supplying or providing services to maintain health, detect illnesses, and cure those who are ill or injured. Although the US has one of the best healthcare systems, the Nation’s health-care delivery system is mediocre at best. One of the goals of the health-care reform is to bring the high-quality care experienced by some to those who are less fortunate or do not have employer-based insurance plans. Demographics affecting health-care delivery: ➢ Age: Between now and the year 2050, the number of persons 65 years or older is expected to double. Of this number, many will eventually become more dependent on the health-care delivery system as a result of chronic health problems. ➢ Chronicity: Another factor influencing the climate of health-care delivery is the long- term and expensive nature of many health problems. Understanding the approach to health care in comparison with other countries is important in assessing the challenges to and potential health-care delivery. The Four Systems: Type 1 Systems In this system, private approaches to health services predominate. Physicians, other caregivers, and clients have maximum autonomy. In this plan, individuals who can afford private health insurance, or who simply can pay for their health care, choose their care providers can receive health services. Those who cannot pay, do not have choice or benefit. Private insurance, preserve autonomy, acceptance of social differences. Type 4 Systems On the opposite end of the spectrum from type 1 is type 4. This type of health-care system focuses on keeping the general public healthy so that they can continue to contribute to society and the economy. Socialized health system, essential service, physicians as state employees. Type 3 Systems Between the extremes of type 1 and type 4 health-care systems are two types- type 2 and type 3. The type 3 system is funded and operated by the government. With this system, the state- operated and state-funded health services were based on an egalitarian value. National health service, egalitarian, public management. Type 2 Systems This system is a hybrid of the type 1 and type 3 systems. Egalitarian values are given high priority, but so are practitioner and client autonomy. This system uses tax dollars to pay for health services through health insurance available from a nonprofit agency (E.g. government). National health insurance, egalitarian, preserve autonomy. • What is prospective payment system? What is a capitated payment system? The prospective payment system is one of the most significant factors that has influenced cost control. This system required facilities providing services to Medicare clients to be reimbursed using a fixed-rate system and included monetary incentives to reduce the length of hospital stays. Medicare clients are classified using a diagnosis-related group, and the facilities are reimbursed a predetermined amount. Capitation, or a capitated payment system, was introduced to encourage cost-effectiveness in a growing health-care system. In this system, participants pay a flat rate, usually through their employer, to belong to a managed care organization (MCO) for a specified period of time. The health-care providers who serve the participants receive a fixed amount for each participant in the health-care plan. • Have an understanding of each health-care model listed in boxes 14.1-14.5 Managed Care Organizations (MCOs): Provide comprehensive, preventive, and treatment services to a specific group of voluntarily enrolled persons - Staff Model: Physicians are salaried employees of the MCO - Group Model: MCO contracts with single group practice - Network Model: MCO contracts with multiple group practices and/or integrated organizations Characteristics: Focus on health maintenance and primary care Medicare MCO: Program same as MCO but designated to cover health-care costs of senior citizens. Characteristics: Premium generally less than supplemental plans. Traditional Private Insurance: Traditional fee-for-service plan, payment, computed after services are provided, is based on number of services used. Characteristics: Policies typically expensive; most policies have deductibles that clients must meet before insurance pays. Long-Term Care Insurance: Supplemental insurance for coverage of long-term care services. Policies provide a set number of dollars for an unlimited time or for as little as 2 years. Characteristics: Very expensive, good policy, has a minimum waiting period for eligibility, payment for skilled nursing, intermediate or custodial care, and home care. Preferred Provider Organization (PPO): One that limits an enrollee’s choice to a list of “preferred” hospitals, physicians, and providers. An enrollee pays more out of pocket expenses for using a provider not on the list. Characteristics: Contractual agreement exists between a set of providers and one or more purchasers Exclusive Provider Organization (EPO): One that limits an enrollee’s choice to providers belonging to one’s organization. Enrollee may or may not be able to use outside providers at additional expense. Characteristics: Limited contractual agreement; less access to specialists Medicare: Federally funded national health insurance program in the united states for people older than 65 years. Part A provides basic protection for medical, surgical, and psychological care costs based of diagnosis-related groups (DRGs). Part B is a voluntary medical insurance plan that covers physician and certain outpatient services. Part D is an unfunded insurance for medications. Characteristics: Payment for plan deducted from monthly social security check; covers services of nurse practitioners (varies by state); does not pay full costs of certain services; supplemental insurance is encouraged Medicaid: A federally funded, state-operated medical assistance program for people with low incomes. Individuals states determine eligibility and benefits Characteristics: Finances a large portion of maternal and child care for the poor; reimburses for nursing midwifery and other advanced practice nursing; reimburses long-term facility care • What are the 3 levels of service in health care? Primary Care: In nursing, primary care refers to health promotion and preventive care, including programs such as immunization campaigns. Primary care focuses on health education and on early detection and treatment. Maintaining and Improving health is the overriding goal. Secondary Care: In secondary care, the focus shifts toward emergency and acute care. Secondary services are frequently provided in hospitals and other acute care settings, with an emphasis on diagnosis and the treatment of complex disorders. Tertiary Care: Emphasizes rehabilitative services, long-term care, and care of the dying. Nursing services are essential in all three levels of health care, in both the hospital and community settings. • Review all of the healthcare settings Public Health departments are government agencies that are established at the local, provincial, or state, and federal levels to provide health services. The goal is to prevent and control communicable diseases. Has expanded to different areas of the health field, ex. pregnancy, pediatrics. Nurses continue their role as the first line of defense against pandemics that can potentially kill thousands of citizens. Home Health Care is care of the ill and injured in the home. The goal is to make it possible for clients to remain at home rather than use a hospital, residential, or long-term care facilities. School Based Services are services from nurses within local school systems. These services include screenings, health promotion and illness prevention programs, and treatment of minor health problems. Emphasis is placed on physical, social, and psychological well-being. Community Health Services are being more frequently used in many areas. Most centers use a team approach involving physicians, nurse practitioners, and community nurses working together to provide health services to the community. Physicians’ office, or general clinic, continues to be the location where most north Americans access primary health care. Services range from routine health screenings to illness diagnosis and treatment, and even some minor surgical procedures. Occupational Health Clinics maintain the health of workers in their workplaces to increase productivity. Many of these companies provide wellness programs and encourage or ever require their employees to participate. These services range from providing exercise facilities and fitness programs to health screenings and referrals. Hospitals are the traditional provider of health-care services, and are essential part of the health- care system and still provide the majority of nurses with employment. Provide a variety of services, such as medical, surgical, obstetric, pediatric, and psychiatric care. Long-Term Care facilities provide care in a homelike atmosphere and base programs on the needs and abilities of the clients, or residents as they are commonly called. Many of these residents require bathing and assistance with activities of daily living. Tube feedings and catheter management are some services provided. Rehabilitation center or units are similar to some extended care facilities, where the client goal is to restore health and function at an optimum level. Often clients are submitted to rehabilitation units after recuperating from the acute stage of an injury or illness. These centers provide services to complete recovery and restore high degree of independence. Assisted Living Centers are increasing in popularity because they allow clients, or residents, to maintain the greatest amount of independence possible in a partially controlled and supervised living environment. These centers consist of separate apartments or condos for the residents and provides amenities such as meal preparation and laundry services. Nurses help residents navigate their way through complex paperwork usually involved in obtaining required services Day-Care centers can be used by any age group, traditionally used for children. Adult day-care centers provide services for elderly adults who cannot be left at home alone but do not require institutionalization. Services provided by an adult day-care centers include health maintenance classes, socialization, an exercise programs, physical or occupational therapy, rehabilitative services, and recreational activities. Rural Primary Care: Clients living in rural areas face some different health issues than people who live in large cities. Access to health care is difficult when a client is located in a remote area. Rural areas often have fewer family practice physicians and often have no specialists at all. Chronic disease is notably higher in clients who live in rural areas. Hospice care emphasizes physiological and psychological support for clients who have terminal diseases. Hospice care provides a variety of services in a caring and supportive environment to terminally ill patients, their families, and other support persons. The central concept of hospice is not saving life, but improving and maintain the quality of life until death occurs. Telehealth, or telephone health, advice services have experience major growth. These services are generally available 24 hours a day, 7 days a week. Nurse answer phone calls, supply answers to health related questions, and advise callers on how to handle nonurgent health situations E-health, or electronic health, similar to telehealth, but advice is given through the computer. Parish Nurses are attempting to meet the needs of individuals who are without adequate primary care or who are expecting escalating health-care costs. They serve as health educators and counselors, they do health assessments and referrals, organize support groups, visit parishioners who are sick or elderly, serve as client advocates or case managers, and organize and manage parish health clinics. Voluntary Health agencies provide many valuable services, including fund-raising in support of cutting-edge research and public education. Ex. American Cancer Society Independent Nurse-Run Heath Centers are nurse-run health centers that focus on health promotion and disease prevention. Primary care services are generally offered to the medically underserved, and these centers are typically funded by public and private sources. Wellness and health-promotion clinics are another type of nurse-run clinic. Module 4 (Chapter 3 Nursing Now!) • What is a model? What is a theory? What is evidence based practice? Theories and Models help explain and direct nursing actions. A theory refers to a speculative statement involving some element of reality that has not been proved. For example, a theory of relativity has never been proved, although the results have often been observed. Theory is a mental viewing, a plan or idea, and a formulation (statement) of a relationship that helps explain some observable phenomenon A model is a theoretical representation of something that exists in reality. The purpose of a model is to explain a complex reality in a systematic and organized manner. For example, a hospital organizational chart is a model that attempts to demonstrate the interrelationships of the various levels of the hospitals administration. • A generalized hypothetical description often based on an analogy used to explain something; A representation that helps explain the concept or object it represents. Theories are used to explain apparent relationships between observed behaviors and their effects on the client’s health; The goal is to describe and explain a particular nursing action to make a hypothesis, which predicts the effect on the client’s outcome, such as improved health or recovery from an illness. For example, action of turning an unresponsive client from side to side every 2 hours should help to prevent skin breakdown and improve respiratory function. • What are the 4 concepts common to all nursing theories? Be able to define them in relation to each theory listed in Chapter 3 (Nursing Now!). The four key concepts are client, health, environment, and nursing. The concepts of nursing explain the function and role of nurses in their relationships with clients that affects the client’s health. Know the Orem Self-Care Model The Dorothea E. Orem’s model of nursing is based on the belief that healthcare is each individual’s own responsibility. The aim of this model is to help clients direct and carry out activities that maintain or improve their health. The central element of this model is the client, who is biologically, psychological, and social being with the capacity for self-care. Self-care is defined as the practice of activities that individuals initiate and perform on their own behalf to maintain life, health, and well-being. Universal Health-Care – Includes elements used in everyday life that support and encourage normal human growth, development, and functioning. Health Deviation Self-Care – When the individual is unable to conduct one or more of the six self-care activities. Individuals with diseases, injuries, physiological or psychological stress. Six Self-care activities: • Air, water, and food • Excretion and waste • Activity and rest • Solitude and social interactions • Avoiding hazards to life and well-being • Being normal mentally under universal Wholly compensated care is a person who is able to carry out a few or no self-care activities. In this care, the nurse must provide for most or all of the client’s self-care needs. Ex. Comatose patients. Partially compensated care are clients who can meet some to most of their self-care needs, but still have certain self-care defects that require nursing interventions. Ex. Patients who can do basic things, but need help with catheters and dressing. Supportive developmental care are clients who are able to meet all of their basic self-care needs and require very few to no nursing interventions. Client is seen as a human being, biological, psychological, social being with the ability for self- care. Health is being able to live life to the fullest through self-care. Environment is the medium through with the client moves. Nursing is assistance in self-care activities to help the client achieve health. 1. Know the King Model The current widely accepted practice of establishing health-care goals for clients, and directing client care to meet these goals, has its origins in the King Model of Goal Attainment developed by Imogene M. King. The King Model also notes that nursing must function in all 3 system levels found in the environment: Personal, interactional, and social. Primary function of nursing is at the personal systems level. Nursing is a dynamic process that identifies and meets the client’s health care needs The focal point of King Model is the person or client. The client is viewed as a person system with physical, emotional, and intellectual needs that change and grow during the course of life. Environment is an important concept in the Kings model, and personal systems, such as client- nurse relationship. The client exchanges energy and information with the environment to meet needs. Health is viewed as a dynamic process that involves a range of human life experiences, health exists in people when they can achieve their highest level of functioning. Health is a dynamic process to achieve the highest level of functioning. (1) Personal Systems (basic level) is where an interchange takes place between two individuals who share similar goals, such as a client-nurse relationship. (2) Interpersonal Systems (intermediate level) are typically involve small groups of individuals who share like goals. For example, a formal weight-loss program in which members have a common goal of losing weight. (3) Social systems (Highest level) include the large, relatively homogeneous elements of society. The health-care system, government, and society in general are some important social systems. 2. Know the Watson Model of Human Caring The Watson model of human caring defines caring in a detailed and systematic manner. Used to balance impersonal aspects of nursing care that are found in the technological and scientific aspects of practice with the personal and interpersonal elements of care that grow from a humanistic belief in life. Philosophical approach. This model views the client as someone who has needs, who grows and develops throughout life, and who eventually reaches a state of internal harmony. To be healthy, an individual must be in a dynamic state of growth and development that leads to reaching full potential as a human. Emphasizes that the total person is more important to nursing care than the individual’s injury or disease process that produced the need for care. Watson recognized the client’s and family’s spiritual beliefs as an essential elements of health. The client is an individual that has needs, grows, and develops to reach a state of inner harmony. Health is a dynamic state of growth and development leading to full potential as a human being. In the environment, the client must overcome certain factors to achieve health. Nursing is the science of caring that helps clients reach their greatest potential. Watson makes a clear distinction between the science of nursing and the practice of curing (medicine). She defined nursing as the science of caring in which the primary goal is to assist the client to reach the greatest level of personal potential. The practice of curing involves the conduct of activities that have the goal of treatment and elimination of disease. 3. Know the Neuman Health-Care Systems Model As envisioned by Betty Neuman, the Health-Care Systems Model focuses on the individual and his or her environment and is applicable to a variety of health-care disciplines apart from nursing. This model also includes elements from stress theory with an overall holistic view of humanity and health care The client is viewed as an open system that interacts constantly with internal and external environments through the system’s boundaries. The client-systems boundaries are called the lines of defense and resistance in Neuman Model. The model is defined as the relatively stable internal functioning of the client. Optimal health exists when the client is maintained in a high state of wellness and stability. Illness exists when the clients core structure becomes unstable through the effects of environmental factors that overwhelm and defeat the lines of defense and resistance. These environmental factors, whether internal or external, are called stressors in this model. Stressors produce change or response in the client; can be bad or good. Interpersonal stressors arise from interactions with other individuals. Intrapersonal stressors arise within the client, and include, involuntary physiological responses, psychological reactions, and internal thought processes. Nursing’s main concern in this model is either to identify stressors that will disrupt a defensive boundary in the future (prevention) or to identify a stressor that has already disrupted a defensive boundary, thereby producing instability (illness). Identifies 3 levels of intervention: primary, secondary, and tertiary. Primary Intervention is to prevent possible symptoms that could be caused environmental stressors. Teaching clients about stress management, giving immunizations, and encouraging aerobic exercise to prevent heart disease are examples of primary interventions Secondary Intervention is aimed at treating symptoms that have already been produced by stressors. Ex. Pain medications or teaching a client about heart disease. Tertiary Intervention seeks to restore the client’s systems to an optimal state of balance by adapting to negative environmental stressors. Ex. Teaching a client how to care for a colostomy bag at home after being discharged from the hospital. Occurs after the client has received a secondary intervention and offers support to the client so that he/she can continue to recover or prevent further deterioration in health. Client is an open system that constantly interacts with internal/external environment. Health is when an individual has a relatively stable functioning of a high state of wellness. The environment is when internal and external stressors produce change in the client. Nursing identifies boundary disruption and helps clients in activities to restore stability. • The Roy Adaption Model As developed by sister Calista Roy, the Roy adaption model of nursing is very closely related to systems theory. The main goal of this model is to allow the client to reach his or her highest level of functioning through adaption. Client is seen as a human being a dynamic system with input and output. Health is a continuum with the ability to adapt successfully to illness. Environment is both internal and external stimuli that affect behaviors. Nursing is a multistep process that helps the client adapt and reach the highest level of functioning. In this model, the client is constantly being affected by stimuli, adaption is a continual process. Inputs are called stimuli and include internal stimuli that arises from within the client’s environment and stimuli coming from external environment factors such as physical surroundings, family, and social. The output in this model is the behavior that the client demonstrates as a result of stimuli affecting them. Three stimuli of this theory: (1) Focal Stimuli are the environmental factors that most directly affect the client’s behavior and require most of his or her attention. (2) Contextual Stimuli form the general physical, social, and psychological environment from which the client emerges. (3) Residual Stimuli are factors in the client’s past, such as personality characteristics, past experiences, religious beliefs, and social norms, that have an indirect effect on the client’s health status. Difficult to identify because they may remain hidden in the person’s memory or may be an integral part of the client’s personality. • Johnsons Behavior System By integrating systems theory with behavioral theory, Dorothy E. Johnson developed a model of nursing that considers client behavior to be the key to preventing illness and to restoring health when illness occurs. Johnson holds that human behavior is really a type of system in itself that is influences by input factors from the environment and has output that in turn affects the environment. A client is a behavioral system; an organized, integrated, whole composed of seven subsystems. Health is when a behavioral system able to achieve a balanced, steady state. Environment is all the internal and external elements that affect the client’s behavior. Nursing is activities that manipulates the environment and helps client achieve the balanced state of health. 1. Definition of terms Values are ideals or concepts that give meaning to an individual’s life. Values are derived most commonly from societal norms, religion, and family orientation and serve as the framework for making decisions and taking action in daily life. Values tend to change as a person grows, and life situations change. Morals are the fundamental standards of right and wrong that an individual learns and internalizes, usually in the early stages of childhood development. Often based on religious beliefs, although societal influence plays an important part in this development. Moral behavior is often manifest as behavior in accordance with group norms, customs, or traditions. Ethics are declarations of what is right and wrong and of what ought to be. Ethics are usually presented as systems of value behaviors and beliefs; they serve the purpose of governing conduct to ensure the protection of an individual’s rights. Can exist in small groups to a society; a system of morals. Laws can generally be defined as rules of social conduct made by humans to protect society, and these laws are based on concerns about fairness and justice. The goals of laws are to preserve the species and promote peaceful and productive interactions between individuals and groups of individuals by preventing the actions of one citizen from infringing on the rights of another. Two important aspects: should be enforceable through police force and applied equally to all persons Ethical dilemma is a situation that requires an individual to make a choice between two equally unfavorable alternatives. The basic, elemental aspects of an ethical dilemma usually involve conflict of one individual’s rights with those of another, conflict of one’s individual obligation with the rights of another, or combined conflict of one group’s obligations and rights with those of another group. A Code of Ethics is generally defined as a written statement or list of the ethical principles that govern a particular profession. They are presented as general statements and thus do not give specific answers to every possible ethical dilemma that might arise. Ethical code: a framework for decision-making, usually for an identified group; should be action oriented and usable on a daily basis. Guides the conduct of a professional. Euthanasia is defined as the act or practice of killing, for reasons of mercy, individuals who have little to no chance of recovery by withholding or discontinuing life support or by administering a lethal agent. Passive Euthanasia usually refers to the practice of allowing an individual to die without any extraordinary intervention. Active euthanasia usually describes the practice of hastening an individual’s death through some act or procedure; poison, gun, knife, or pain medication. Ethical Accountability is when each person is responsible for his or her own actions. It is one of the key elements of being a professional, and the individual must be willing to accept the consequences for their own decisions. A responsibility to perform the activities and duties of the profession according to established standards. Accountability is answerability. Nurses are accountable to clients, the public, the profession, facility administration, physicians, and other nurses. Autonomy is the right of self-determination, independence, and freedom. It refers to the client’s right to make health-care decisions for himself or herself, even if the health-care provider does not agree with those decisions. Client has the right to refuse treatment. Under certain circumstances, rights can be imposed on, such as an individual being a threat to society. Beneficence is one of the oldest requirements for health-care providers, views the primary goal of health care as doing good for clients under their care. An ethical principal based on beliefs that the health-care provider should do no harm, prevent harm, remove existing harm, and promote the good and well-being of the client. Good care requires the provider to take a holistic approach to the client, including the client’s beliefs, feelings, and wishes, as well as those of family and significant others. Problem: determining what is best for the client. Nonmaleficence is the requirement that health care providers do no harm to their clients, either intentionally or unintentionally. Requires health-care providers to protect those who cannot protect themselves; evident in groups of children, the mentally incompetent, the unconscious, and the weak. Obligations to report child-abuse. Justice is the obligation to be fair to all people. Individuals have the right to be treated equally, regardless of race, gender, marital status, medical diagnosis, social standing, economic level, or religious belief. Underlines the first statement in the ANA’s code of ethics. Fidelity is the obligation of an individual to be faithful to the commitment made to himself or herself and to others. Fidelity also includes the professional’s faithfulness or loyalty to agreements and responsibilities accepted as part of the practice of the profession. It is the main support for the concept of accountability, although conflicts may arise from obligations owed to different individuals/groups. Veracity is the principle of truthfulness. It requires the health-care provider to tell the truth, and not to intentionally deceive or mislead clients. The primary limitations occur when telling the client, the truth would seriously harm the client’s ability to recover or would produce greater illness. Veracity is the basic foundation for a trusting relationship between nurse and client. Advance directives are decisions made by competent individuals about their future health care. It is essential that the clients wish about health care be followed, and all client communication to the nurse about desires for future care should be documented. This is a form of self- determination. Should designate an individual to act as moral surrogate, if client becomes unable to make their own decisions. Legal Requirement. Living Will is a signed legal document in which an individual makes known their wishes about the care they are to receive if they should become incompetent at a future date; it usually specifies what types of treatments are permitted and what types are to be withheld. Ethical difficulties include moral conflict, lack of clarity, and the lack of client knowledge on disease and conditions. Should be updated, as life situations change. Often poorly written and too general. The Durable Power of Attorney for Health Care (DPOAHC) refers to a person who is legally designated to make health-care decisions for an individual who is no longer able to make those decisions for himself or herself. The Omnibus Budget Reconciliation Act (OBRA) of 1990 made it mandatory for all health-care facilities, such as hospitals, nursing homes, and home health-care agencies, to provide information to clients about the living will and DPOAHC. The DPOHAC, in consultation with medical professionals, should consider the client’s cognitive abilities, the level of pain, loss of dignity and humiliation, life expectancy, treatment options, and risk/benefits to treatment options. Abandonment is leaving a client without the client’s permission; terminating the professional relationship without providing for appropriate continued or follow-up care by another equally qualified professional. The relationship between client and nurse continues till mutual termination. Key phrase: “without adequate notice.” Leaving after your shift is not considered to be abandonment on your part, but by the hospital. Going on strike with an adequate notice is not considered abandonment. 4. Know the General Systems Theory (Open/Closed systems) The General Systems Theory is a set of interrelated concepts, definitions, and propositions that describe a system. Generally understood as an organized unit with a set of components that interact and affect each other, a system acts as a whole because of the interdependence of its part. When part of the system fails, it interrupts the function of the whole system rather than affecting one part. Ex. Humans, plants, cars, governments, health-care system, the profession of nursing. • Open systems are those in which relatively free movement of information, matter, and energy into an out of the system exists. In a completely open system, there would be no restrictions on what moves in and out of the system, thus making its boundaries difficult to identify. Often works under a semipermeable nature regarding boundaries, which allows some things in and keeps some things out. The control of input and output leads to a dynamic equilibrium found in most well-functioning systems. • Theoretically, a closed system prevents any movement into and out of the system. In this case, the system would be totally static and unchanging. Probably, no absolutely closed systems exist in the real world, although some systems tend to be closed to outside elements. The process by which a system interacts with elements in the environment are called input and output, Input is defined as any type of information, energy, or material that enters the system from the environment through its boundaries. Output is defined as any information, energy, or material that leaves the environment through the systems boundaries. Throughput is a third term sometimes used in relationship to the systems dynamic exchange with the environment. It is the process that allows the input to be changed so that it is useful to the system. • Know the Process used in ethical decision making An ethical decision-making process provides a method for nurses to answer key questions about ethical dilemmas and to organize their thinking in a more logical and sequential manner. The chief goal is to determine right and wrong in situations in which clear demarcations are not readily apparent. Step 1: Collect, Analyze, and Interpret the Data - Obtain as much information as possible concerning a particular dilemma, which includes patient’s wishes, family’s wishes, the extent of physical/emotional problems causing the dilemma, the physician’s beliefs about health care, and the nurse’s own orientation to issue concerning life and death. The nurse should also collect information on the patient’s mental competency, a living will, or DPOAHC. Step 2: State the Dilemma - After collecting/ analyzing information, the nurse needs to state the dilemma as clearly as possible. It is important to identify whether the problem is one that directly involves the nurse or is one that can be resolved only by the client, the client’s family, the physician, or DPOAHC. Recognizing the key aspects of the dilemma helps focus attention on the important ethical principles. Step 3: Consider the Choices of Action - After stating the dilemma, the next step is to list, without consideration of their consequences, all possible courses of action that can be taken to resolve the dilemma. This brainstorming activity may require input from outside sources such as colleagues, supervisors, or even experts in the ethical field. Step 4: Analyze the Advantages and Disadvantages of Each Course of Action - The identification of these actions becomes readily evident during this step in decision- making process, when the advantages and the disadvantages of each action are considered in detail. Along with each option, consequences of taking each course of action must be thoroughly evaluated. A major factor would be choosing an appropriate code of ethics. The ANA Code of Ethics should be part of many client-care decisions affected by ethical dilemmas. Step 5: Make the Decision and Act on It - The hardest part of the process is making a decision, following through with an action, and then living with the consequences. • Understand the Nursing Code of Ethics and its purpose A code of ethics is generally defined as a written statement or list of the ethical principles that govern a particular profession. Code of ethics are presented as general statements and thus do no give specific answers to every possible ethical dilemma that might arise, however, these codes do offer guidance to the individual practitioner in making decisions. Was written by Lystra E. Gretter • Be able to Identify invasion of privacy and law around HIPPA including when it is appropriate for a nurse to breech confidentiality Confidentiality is the right of the client to expect the communication with a professional to remain unshared with any other person unless a medical reason exists or unless safety of the public is threatened. Confidentiality of information concerning the client must be honored. A breach of confidentiality results when a client’s trust and confidence are violated by public revelation of confidential or privileged communications without the client’s consent. Privileged communication is protected by law and exists in certain well-defined professional relationships, such as physician-client, priest-client, and lawyer-client. Privileged communication ensures that the professional who obtains any information from the client cannot be forced to reveal that information, even in court of law under oath. Nurses do not have privileged communication, but are bound by extension. It is only appropriate to breech confidentiality when the safety of the public is at risk, medical reason exists, or legal requirements to report certain conditions or circumstances Because Health Insurance Portability Act (HIPPA) of 1996, health providers have become more aware than ever of the issue of confidentiality in the health care setting. The HIPPA policies covering the collection, development, and use of client data are based on issues of confidentiality and security. The primary objectives of HIPPAA include: - Ensuring health insurance portability - Reducing health-care fraud and abuse - Guaranteeing security and privacy of health information - Enforcing standards for health information Health care providers and facilities must obtain client consent before using and disclosing client information for treatment, payment, or health care operations. An invasion of privacy is a type of quasi-intentional tort that involves (1) an act that intrudes into the seclusion of the client, (2) intrusion that objectionable to a reasonable person, (3) an act that intrudes into private facts or published as facts or pictures of a private nature, and (4) public disclosure of private information. It is a violation of a person’s right to keep information about self, family, and property from public scrutiny. It is not an absolute right—can and may be required by law to be breached in certain situations such as child, spousal, or elder abuse; gunshot wounds; knife wounds; rape; communicable diseases; suspected crimes. Different examples include, giving out client’s name, information, intruding into their private affairs, showing photos of the client, or information that misrepresents the client. • Know about the laws and the responsibility to the healthcare provider related to Domestic Violence and Child Abuse There is a general legal requirement in most states that suspected child abuse must be reported by health-care providers and by anyone who suspects that child-abuse has occurred. Abuse is more obvious when the child has physical injuries that do not fit the medical history or are atypical for the age group. A conflicting ethical principle that is sometimes forgotten in the reporting of suspected child abuse is the family’s right to privacy and self-determination. Decisions about reporting suspected child abuse or neglect rest on the underlying ethical principles of beneficence and protection of the best interests of the child. One important difference between adults and children that always needs to be included in ethical decisions about child health issues is that children are dependents. As dependents, children generally are not attributed the right to self-determination that is fundamental to adult decision-making. • Review the Steps of the Nursing Process and the order of priority of the steps. If provided an example, be able to identify which stage of the nursing process it represents (A) (D)elicious (P)(I)(E) Assessment Phase The first step of the nursing process is assessment. During this phase, the nurse gathers information about a patient's psychological, physiological, sociological, and spiritual status. This data can be collected in a variety of ways. Generally, nurses will conduct a patient interview. Physical examinations, referencing a patient's health history, obtaining a patient's family history, and general observation can also be used to gather assessment data. Patient interaction is generally the heaviest during this evaluative phase. Diagnosing Phase The diagnosing phase involves a nurse making an educated judgment about a potential or actual health problem with a patient. Multiple diagnoses are sometimes made for a single patient. These assessments not only include an actual description of the problem (e.g. sleep deprivation) but also whether or not a patient is at risk of developing further problems. These diagnoses are also used to determine a patient's readiness for health improvement and whether or not they may have developed a syndrome. The diagnoses phase is a critical step as it is used to determine the course of treatment. Planning Phase Once a patient and nurse agree on the diagnoses, a plan of action can be developed. If multiple diagnoses need to be addressed, the head nurse will prioritize each assessment and devote attention to severe symptoms and high risk factors. Each problem is assigned a clear, measurable goal for the expected beneficial outcome. For this phase, nurses generally refer to the evidence- based Nursing Outcome Classification, which is a set of standardized terms and measurements for tracking patient wellness. The Nursing Interventions Classification may also be used as a resource for planning. Implementing Phase The implementing phase is where the nurse follows through on the decided plan of action. This plan is specific to each patient and focuses on achievable outcomes. Actions involved in a nursing care plan include monitoring the patient for signs of change or improvement, directly caring for the patient or performing necessary medical tasks, educating and instructing the patient about further health management, and referring or contacting the patient for follow-up. Implementation can take place over the course of hours, days, weeks, or even months. Evaluation Phase Once all nursing intervention actions have taken place, the nurse completes an evaluation to determine the goals of the patients wellness have been met. The possible patient outcomes are generally described under three terms: patient's condition improved, patient's condition stabilized, and patient's condition deteriorated, died, or discharged. In the event the condition of the patient has shown no improvement, or if the wellness goals were not met, the nursing process begins again from the first step. • Review definitions of critical thinking, critical reasoning, and critical judgement Clinical reasoning can be defined as thinking through the various aspects of patient care to arrive at a reasonable decision regarding the prevention, diagnosis, or treatment of a clinical problem in a specific patient. Clinical judgement is the conclusion or enlightened opinion at which a nurse arrives following a process of observation, reflexion and analysis of observable or available information or data. Critical thinking clarifies goals, examines assumptions, uncovers hidden values, evaluates evidence, accomplishes actions, and assesses conclusions. Critical thinking involves asking questions, defining a problem, examining evidence, analyzing assumptions and biases, avoiding emotional reasoning, avoiding oversimplification, considering other interpretations, and tolerating ambiguity • Definition of EBP Module 7 (Chapter 24 Nursing Now!) Evidence based practice, or EBP, is the practice of nursing in which interventions are based on data from research that demonstrates that they are appropriate and successful. It involves a systematic process of uncovering, evaluating, and using information from research as the basis for making decisions about and providing client care. • Know the role of AHRQ in EBP The Agency for Healthcare Research and Quality (AHRQ) was given the task of improving the quality of health care and client safety and improving the efficiency of the system. One solution to speed up the process of incorporating EBP into client care was developed by AHRQ. It created the framework that used the following steps: (1) Knowledge creation, (2) Diffusion of the evidence, and (3) Dissemination and adoption (institutionalizing) of the change. This framework creates a multidisciplinary map for education and practice to establish parallel paths whose ultimate goal is to improve client outcomes. Barriers we have to overcome before EBP can be fully used to improve outcomes is the traditional trial-and-error method of developing new nursing knowledge. • Define Nursing Research Nursing Research can be defined as a systematic process for answering questions through the discovery of new information with the ultimate goal of improving client care. It is also considered to be a complex process in which knowledge, in this case in the form of discovery, is transformed from the findings of one or more studies into possible nursing interventions, with the ultimate goal of being used in clinical practice. Research shows which approaches to nursing care are more effective and which do not work. • The goal of nursing research & scientific inquiry A major goal in nursing research is to expand and clarify the body of knowledge unique to the discipline of nursing. Scientific inquiry is the tool of choice for achieving the goals of professional clarification, justification, extension, and collaboration. The purpose of nursing research is “to test, refine, and advance the knowledge on which improved education, clinical judgement, and cost-effective, safe, ethical nursing care rests.” • Origin of nursing research (Florence) In her first book, Notes on Nursing (1859), Florence Nightingale introduced the concept of research to the profession and expanded it in her subsequent publications. Nightingale believed in the importance of “naming nursing” through the collection and use of objective data. She also used this data to prove that there was a need for wide-ranging health-care reforms, including clinical practices, treatment of injured soldiers, and nursing education. Nightingale recognized the positive impact of combining strong logical thinking and empirical research in developing a sound scientific bases of which to the practice of the nursing profession. • Quantitative vs. Qualitative Research Qualitative Research: The purpose of qualitative inquiry is to gain an understanding of how individuals construct meaning in their world, visualize a situation, and make sense of that situation. Because of the nature of nursing and the usual subject matter (human beings), qualitative designs are best suited to answer questions that interest nurses. - Semi structured interviews using open-minded questions and observations are the most commonly used data collection methods in qualitative studies. Quantitative Research uses approaches that seek to verify data through prescriptive testing, correlation, and sometimes description. These designs imply varying degrees of control over the research material or subjects. In quantitative experimental design, a comparison of two or more groups is required. The groups under study must be as similar as possible. In tradition of scientific inquiry, quantitative experimental research designs were the most highly respected. However, the past 15 years have shown a growing interest in, and respect for qualitative approaches in research, especially in social sciences. • Barriers to research practice A challenge to the use of research in practice is that research skills are often taught to nursing students in isolation from other nursing subjects. Learning in this way seems to broaden the division between research and practice by separating the two elements early in the nurse’s professional development and education. There is also a lack of understanding within research practice. Some researchers do not understand practice issues from the bedside nurse’s point of view. Entrenched practices also present another challenge. A few nursing traditions remain so widely accepted as fact that they are never questioned and therefore evade the scrutiny of testing. Lack of incentive is a barrier in research practice. Many of the barriers to implementation of research practice is the lack of insufficient authority and insufficient time. There is also budget limitations. There is also resistance of managers, given some of them view an environment of updates and change as unfavorable to maintaining a committed and cohesive staff. • Associate Degree Nurse roll in research (1) Demonstrates awareness of the value or relevance of research in nursing (2) Assists in identifying problem areas in nursing practice (3) Assists in collection of data within an established structured format Associate degree nurses are expected to demonstrate an awareness of the value of research in nursing by becoming knowledgeable consumers of research information and by helping identify problems within their scope of nursing practice that may warrant exploration. • Ethical issues in research (consent needed) The Nuremburg Code, a code of ethics, was developed by the American Medical Association for research that would serve as a standard for judging the Nazi War crimes. Ethical issues are critical to all research, and researchers from all disciplines are bound by ethical principles that protect the rights of the public. The National Research Act established the National Commission for protection of human subjects in biomedical and behavioral research. Informed consent is both an ethical and legal requirement in the research process. An individual has the right to be fully informed, not only about the care they receive, but also any research in which they participate. Module 8 (Chapters 12,21, 22 Nursing Now!) Chapter 12 • Encoding definition, what can interfere with the encoding process The encoding process occurs when the receiver thinks about the information, understands it, and forms an idea based on the message. There are several factors that can interfere with the encoding process. On the sender’s side, there can be factors such as unclear speech, convoluted and confused message, monotone voice, poor sentence structure, inappropriate use of terminology or jargon, or lack of knowledge on the topic. On the receiver’s side, factors that may interfere with encoding include lack of attention, prejudice and bias, preoccupation with another problem, or even physical factors such as pain, drowsiness, or impairment of senses. • Communication Style assertive, nonassertive, aggressive Assertive communication is the preferred style in most settings. It involves interpersonal behaviors that permit people to defend and maintain their legitimate rights in a respectful manner that does not violate the rights of others. Assertive communication is honest and direct and accurately expresses the person’s feelings, beliefs, ideas, and opinions. Disagreement and discussion are considered to be a healthy part of the communication process, and negotiation is the positive mechanism for problem-solving, learning, and personal growth. Nonassertive communication is also referred to as submissive communication. When people display submissive behavior or use a submissive communication style, they allow their rights to be violated by others. Their requests and demands are surrendered to others without regard to their own feelings and needs. Many experts believe that submissive behavior and communication patterns are a protective mechanism that helps insecure people maintain their self-esteem by avoiding negative criticism and disagreement from others. There is a very fine line between assertiveness and aggressive behavior and communication. Aggressive communication strongly asserts the speaker’s legitimate rights and opinions with little regard or respect for the rights and opinions of others. This communication is used to humiliate, dominate, control, or embarrass the other person or lower that person’s self-esteem – creates an “I win, you lose” situation. Some experts believe it is a mechanism used to compensate for the individual’s insecurities. • Conflict resolution tips (1) Improve your conflict management skills – seminars, books, mentors (2) Change your Paradigm – Focus on the positive, not the negative. Realize that appropriate confrontation is a risk-taking activity. (3) Achieve better Communication – Improve relationships, improve teamwork, mentoring (4) Understand your Values – Focus on win-win, be willing to negotiate and compromise, be direct and honest, focus on the issues, do not attack the person, do not make judgements, do not become the third person; encourage peers to go direct, and do not spread rumors (5) Set Personal Guidelines – Confront in private, never in front of anyone else, confront the individual; do not report him or her to the supervisor first, do not confront when you are angry, start with an “I” message, express your feelings and opinions, allow the other person to talk w/o interruptions, listen attentively, set goals and future plans of action, let it go, and keep it private and confidential. • Nonverbal Builders and blockers Anything done or said that interferes with communication is called a communication blocker. Actions and speech that encourage and build communication are called communication builders. Nonverbal communication builders are eye contact, stopping what you are doing, nodding of the head, positive facial expressions, sitting/standing in close proximity, open posture, directly facing, listening empathically, and light touching. Nonverbal communication blockers are eye rolling, arm/leg folding, slouching, hunching, turning away, fidgeting, deep/loud signs, multiple watch or clock checks, continuing with an activity while the other person is speaking, failure to make eye contact, turning out or failing to pay attention. • Verbal Builders and Blockers Verbal communication builders include the use of encouraging words, asking open-ended questions, using “I” rather than “you” messages, asking clarification messages, reflecting feelings or emotions, repeating what was just said, never interrupting, reviewing what was said, and acknowledging what was said. Verbal communication blockers include automatic defensiveness, asking closed-ended questions, accusing or blaming, using sarcasm, constant interruptions, judging, name calling, diagnosing, stating opinions as proven facts, making generalizations, being patronizing, offering vague reassurances, telling people how they should feel, changing the subject, expecting mind reading, shaking or pointing a finger while speaking, or walking away. • Environmental Blockers Experiencing change is considered to be an environmental blocker. Change can be a communication blocker in various ways. Some individuals may be afraid to ask questions about procedures in fear of looking “stupid.” Other blockers include grief experiences, stressful situations, policy change, and tension and anxiety. • Resolving conflict strategies and how approached by different personalities Strategy 1: Ignore the Conflict Submissive Personality: Person avoids bringing the issue to the other through fear or retaliation or ridicule if he or she confront and expresses honest feelings or opinions Assertive Personality: Ignoring the conflict is never an option. They will almost always use strategy 2. Aggressive Personality: Person has decided not to pursue the conflict because the other person is “too stupid to understand” or it would just be a “waste of time.” Strategy 2: Confront the conflict Submissive Personality: Person does not handle the situation directly but refers the problem to a supervisor or to another person for resolution Assertive Personality: Person sets up a time and place for a one-on-one meeting. At the meeting, the two parties focus on issues that caused the conflict and negotiate to define goals and problem-solve. Aggressive Personality: Person confronts the other loudly, in front of an audience, and attacks the other’s personality rather than the issue. The communication is strictly one-sided. Strategy 3: Postpone the Conflict Submissive Personality: Person keeps track of the issues until they reach a critical point, then dumps all the issues at one time on the offender on a highly aggressive manner. Assertive Personality: Hardly ever uses this method except to allow the other person to “cool down” and become more receptive to what others have to say Aggressive Personality: Person waits until he or she can either use the incident as a threat or blackmail or express the conflict in front on an audience. Chapter 21 • Define Spirituality Spirituality is often defined as integrative energy, capable of producing internal human harmony, or holism. It is regarded as the driving force that pervades all aspects of and gives meaning to an individual’s life. Spirituality also entails a sense of transcendent reality, which draws strength from inner resources, living fully for the present, and having a sense of inner knowledge. Solitude, compassion, and empathy are important components of spirituality for many individuals. Spirituality creates a set of beliefs and values that influence the way people conduct their lives. Traditionally, it has been defined as a sense of meaning in life associated with a sense of inner spirit. • Distinguish between spirituality and religion From the religious perspective, spirituality can be defined as encompassing the ideology of the image of God, or soul, that exists in everyone. The soul makes the person a thinking, feeling, moral, creative being, able to relate meaningfully to a supreme being and to others. This being or force may be called God, Allah, the divine creator and sustainer of the universe, the divine mystery, or other names that convey a profound sense of transcendence and awe. A religious perspective often entails a set of beliefs, or creeds, that helps explain the meaning of life, suffering, health, and illness. Most religions also incorporate and promote a set of positive values, such as charity to others, faith in a supreme being, and a requirement for a lifestyle that involves honesty, truth, and virtuous living. • Be familiar with the developmental stages of human spirituality In the context of a person’s spiritual growth and development, a series of four developmental stages have been proposed for human spirituality. Stage 1: The chaotic (antisocial) stage, with its superficial belief system Stage 2: The formal (Institutional) stage, with its adherence to the law. Stage 3: The skeptic (individual) stage, with its emphasis on rationality, materialism, and humanness Stage 4: The mystical (communal) stage, with its “unseen order of things” • Identify the principle upon which Nightingale’s spirituality was based For Nightingale, spirituality involved a sense of a divine intelligence that creates and sustains the cosmos, and she had an awareness of her own inner connection with this higher reality. The universe, for Nightingale, was the embodiment of a transcendent God. She came to believe that all aspects of creation are interconnected and share the same inner divinity. Spirituality for her entailed the development of courage, compassion, inner peace, creative insight, and other “Godlike” qualities. • Describe the Characteristics defining “spiritual distress” as a nursing diagnosis Spiritual Distress is defined as the disruption in the life principles that pervades a person’s entire being and integrates and transcends one’s biological and psychological nature. Defining characteristic of spiritual distress include: - Concerns with and questions about the meaning of life and death - Anger toward God, - Concerns about the meaning of suffering - Concerns about the person’s relationship to God - The inability to participate in preferred religious practices - Seeking spiritual help - Concerns about the ethics of prescribed medical regimens - Preoccupation with illness and death - Expressing displaced anger toward clergy - Sleep disturbances - Altered Mood Swings Spiritual distress may occur in relation to separation from religious or cultural supports, challenges to beliefs and values, or intense suffering • Describe the different spiritual practices Nurturing the Spirit: Caring for their spirits or souls require nurses to pause, reflect, and take in what is happening within and around them, to take time for themselves, for relationships, and for other things that animate them. Spiritual Assessment Questions: Nurse may have some difficulty assessing the spirituality status of a client. Some questions that facilitate gathering this info include, “What is strength for you?” or “Who gives you strength?” Prayer and Meditation are spiritual disciplines practiced in many traditions, both cultural and religious. Relief through imagery: When a person is confined to a hospital room, the practice of imagery may enable him or her to experience another space. Imagery can take a person to a temple, an ocean, a place of religious worships, a breakfast nook, or any “sacred place.” Relaxation response and prayer have been demonstrated to affect illnesses. The ability of people to participate in their own healing through prayer and meditation may use a source of healing power called remembered wellness, sometimes called the placebo effect. It is based on the belief that all people have the capacity to “Remember” the calm and confidence associated with emotional and physical health and happiness. Other practices include peace through awareness, quiet focus, and the Nocebo effect, which is the fulfillment of an expectation of harm (Contrast with placebo effect). • Define Therapeutic Touch Therapeutic touch is an active alternative healing modality that involves redirecting the human energy systems. In recent years, TT has been retrieved from ancient traditions, studied, and refined. Module 8 (Chapter 22 Nursing Now!) • U.S Demographics and Ethnic Trends now and in the future The population of working and young people in the US is increasing even as the baby boomer generation ages. This trend is due to the US’s relatively high birth rate, with nearly 4.3 million births in 2007. This was the highest birth rate in over 45 years, due in part to the influx of new immigrants, who tend to have more children than those who have been living in the US for more than one generation. Another trend is a population shift. In 2010, Approx. 120 million, or 38%, of the entire US population was composed of minority groups, up from 33% in the year 2006. If this trend continues, it is expected by 2043, the Caucasian population will be a minority group, constituting 48.9% of the total US population. The percentage of minority nurses does not reflect the national population trends. In past 10 years, the number of minority nurses has only been risen slightly to approx. 13% from 10.7%. (Answer to Next question) The Medicare and Medicaid laws that evolved out of the social programs of the 1960s have increased the number of culturally diverse clients with whom nurses come in contact. • What is happening to the US population shift? Read Above in Red. In some states, such as California, the white population may be a minority as early as 2030. These shifts will require a redefinition or rethinking of the term minority, as it is currently defined as a racial or ethnic groups that compose less than 50% of the population. Contributing to the rapid growth in minority populations is the number of immigrants coming to the US, however, from 2002 and 2012, the numbers have actually decreased by over a million. The largest number of immigrants are from Asia, Mexico, and Central and South America. • Discuss and Define Culture Culture is not a monolithic concept. Any individual probably belongs to several subcultures within his or her major culture. Subcultures develop when members of a group accept outside values in addition to those of their dominant culture. Many variations may exist within any culture. Ex. An American County Girl vs. An American City Girl Culture can be envisioned as a flawed photocopy machine that makes duplicates of the original document with minor modifications. As a society attempts to preserve itself by passing down its values, beliefs, and customs to the next generation, slight variations in the practices inevitably occur. • Define Diversity and the characteristics that define diversity. Diversity is a term used to explain the differences between cultures. The characteristics that define diversity can be divided into two groups: primary and secondary - Primary Characteristics tend to be more obvious such as nationality, race, color, gender, age, and religious beliefs - Secondary Characteristics include socioeconomic status, education, occupation, length of time away from country of origin, gender issues, residential status, and sexual orientation. These may be more difficult to identify, yet they have an even more profound effect on the individual’s cultural identity than the primary characteristics When individuals make generalizations about others on the obvious primary characteristics or the less evident secondary characteristics, they are stereotyping, which is an oversimplified belief, conception, or opinion about another person, or group, based on a limited amount of information. • Define the “Melting Pot” and “Salad Bowl” theories as they relate to multiculturalism The US has traditionally been considered a melting pot of world cultures. Early in history of the US, most people who came from distant lands were eager to assimilated into American culture. Many people Americanized their names, shed their traditional dress, learned American manners, and customs as quickly as possible, and made valiant efforts to learn English without the benefits of formal schooling – all so they could “fit in” with their new homeland. Until recently, most immigrants to the US were very willing to acculturate (to alter their own cultural practice in attempt to become more like members of their new culture). The end result was a blending, or MELTING POT, of cultures. Since the early 1970s, the practice of intentional acculturation seemed to have fallen by a wayside. Many individuals who migrate to the US from other countries now cling to their traditional cultural practices and languages, resulting is multiculturalism. The modern immigrants maintain their own unique flavors and mixtures, much like the ingredients in a large tossed salad. There are drawbacks and benefits to both approaches. In the melting pot era, Individuals who try to maintain their native beliefs were often scorned, ridiculed, or made to feel like outsiders. Those who Americanized themselves were accepted as equals. The current salad bowl trend has the advantage of allowing individuals in a dominant culture to gain an appreciation of other cultures. The drawback is that it tends to create pockets of culturally different individuals who live in but have only minimal interaction with mainstream American Society. It also gives rise to cultural relativism. • Define Culturally Competent Care Despite the relatively low number of minority nurses, it is expected that nurses from one culture should be able to give culturally competent care to individuals from any other culture. Health- care is considered to be culturally competent when health-care providers and institutions are able to provide care for clients that meet the clients’ culture needs. Cultural Competency care leads to high-quality care to every client regardless of language, race, or ethnic background. • List the Skills necessary of the nurse to provide culturally competent care Providing culturally competent care requires the development of certain interpersonal skills that allow nurses to work with individuals and groups in the community. The primary skills required form cultural competence care, include communication, understanding, and sensitivity. The development of cultural competencies not a one-time skill to check off on a skills checklist; rather, it is an ongoing process that continues throughout the nurses’ career. • How do you assess culture? Obtaining accurate cultural assessments can be time-consuming and difficult. However, the only way nurses can avoid imposing their cultural values and practices on others and develop plans of care based on their knowledge about others’ beliefs and customs is to make a concerted effort to obtain this information. One of the most thorough cultural assessments developed to date is based on Purnell’s Model of Cultural Competence. 12 competences: 1. Overview/heritage 2. Communications/ Dominant language 3. Family Roles and Organizations/ Head of House 4. Workforce Issues/ Culture in Workplace 5. Biocultural Ecology/ Skin Color 6. High-Risk Behaviors/ Health-care practices 7. Nutrition/ Meaning of Food or Dietary Practices 8. Pregnancy and Childbearing Practices 9. Death Rituals 10. Spirituality/ Religious Practices 11. Health-Care Practices/ Health-seeking beliefs and behaviors 12. Health-Care Practitioners/ Traditional vs. Biomedical Care • Why are biological/physical cultural variations important? Physical Assessments made on individuals from other cultures require a certain level of cultural awareness and competence. Although the assessment techniques used for different individuals may be identical, the nurse needs to know the basic biological and physical variations among ethnic groups. The interpretation of assessment finding may be affected by ethnic variations. Ex. Children from Asian cultures may fall below the normal growth level on a standardized American growth chart because of their genetically smaller stature. Changes in skin color may also affect the interpretation of assessment findings • Why is heritage consistency important? Some cultural groups manage to blend the melting pot and the salad bowl together through a complex process called heritage consistency. They may Americanize themselves by wearing business suits, speaking English, or eating American food, but at home they speak their native language, wear traditional clothes, and eat their native foods. This approach to acculturation has the advantages of allowing them to fit in and advance within the larger culture, while retaining many of the cultural elements they feel like home, which provides a sense of stability in their lives. It does, however, create in some individuals a type of cultural confusion that may lead to increase tension and anxiety. • Developing Cultural Awareness starts where? Developing cultural awareness is the first step in becoming a culturally competent nurse. A nurse develops cultural awareness only when he or she is able to recognize and value all aspects of a client’s culture, including beliefs, customs, responses, methods of expressions, language, and social structure. Cultural awareness begins with an understanding of one’s own cultural values and health-care beliefs. Cultural awareness basically begins at home. Module 9 (Chapters 15,16,18 Nursing Now!) Chapter 15 • Define Quality of Care Quality of care can be defined as the degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge. Its three accepted elements are structure, process, and outcome, while care should be safe, effective, client-centered, timely, efficient, and equitable. • How many deaths per year were reported and for what reason? The Institute of Medicine estimated 98,000 people die each year due to adverse events and medical errors. The report focused on fault systems, processes, and conditions that led to mistakes. • What are the six aims for improvement of quality of care according to IOMS 2nd report? The IOM’s second report focuses on developing a new health-care system that improved the quality of care. It identified six aims for improvement, concluding that care should be: 1. Safe. Avoiding injuries to clients from the care that is intended to help them 2. Effective. Providing services based on scientific knowledge to all who could benefit, and refraining from providing services to those not likely to benefit 3. Patient-Centered. Providing care that is respectful of and responsive to individual patient preferences, needs, values, and ensuring that patient values guide all clinical decisions 4. Timely. Reducing waits and sometimes harmful delays for both those who receive and those who give care 5. Efficient. Avoiding waste, including waste of equipment, supplies, ideas, and energy 6. Equitable. Providing care that does not vary in quality because of personal characteristics such as gender, ethnicity, geographic location, and socioeconomic status • Define Quality assurance, CQI and what it is known by, benchmarking, dashboards Quality assurance initiatives are essential when efforts are being made to cut costs and, at the same time, maintain high standards of care. It is an activity conducted in healthcare facilities that evaluates the quality of care provided to ensure that it meets pre-established quality standards. To ensure high-quality care, the healthcare industry borrowed the philosophy of Continuous Quality Improvement, or CQI. CQI is a type of total quality management whose primary goal is the improvement of the quality of health care. Benchmarking is a written outcome standard used to classify acceptable levels of performance to maintain high quality of care. These may be written for outcomes, processes, or for structures. Dashboards are electronic tools that act as a scoreboard. They can provide retrospective or real- time data to assess quality. These informatics technologies assist the process of quality improvement. • Define client satisfaction and what is HCAHPS? Why is HCAHPS important to nursing? Client satisfaction is another way to measure the quality of care. The Hospital Care of Quality Information from the Consumer Perspective (HCAHPS) initiative began in 2008 and provides a standardized survey instrument and data collection method to obtain client satisfaction data on eight key topics: communication with doctors, communication with nurses, responsiveness of hospital staff, pain management, communication about medications, discharge information, cleanliness of environment, and quietness of hospital environment. This standardized survey instrument allows healthcare organization to monitor, compare, and improve their performance. • How to Identify Quality Care and Providers? See page 379, box 15.1 • What is the leapfrog program and what is it referred to as now? The Leapfrog was officially launched by larger healthcare facilities that worked together to improve the quality and safety of health care and to make it more affordable. The resulting movement now serves as the gold standard for comparison of hospital performance on national standards of safety, quality, and efficiency, thereby facilitating transparency and easy access to health care information. Leapfrog founders realized that they could take leaps forward in quality of health care for their employees, retirees, and families by rewarding hospitals that implement significant improvements in quality and safety. Its main goal is to promote high quality health care through incentives and rewards. • Define Root Cause Analysis, sentinel events, six-sigma, AHRQ, QSEN Root Cause Analysis is a type of assessment that tracks events leading to error, identifies faulty systems, and processes and develops a plant to prevent further errors Sentinel Events are unexpected occurrences involving death or serious physical or psychological injury, or the risk thereof including loss of limb or function. Relatively infrequent, occurring independently of a client’s condition, that commonly reflect hospital system and process deficiencies and result in negative outcomes for clients. Sentinel Events are not the same as medical errors. Indicate the need for immediate investigation and response. Six Sigma is a business management strategy that has been adapted to the healthcare industry to identify wasteful practices and lower costs while improving the overall quality of life. It has been seen as a way to identify problems to health care delivery and find effective solutions. The traditional Six Sigma process comprises of five distinct phases: 1. Define. The problem is identified. Why are the consumers dissatisfied? 2. Measure. Data is collected to pinpoint the exact issue. Is reviewed in detail and time. 3. Analyze. The root cause of the problem is identified, and the external/internal influences 4. Improve. Strategies, based on the previous 3 stages, are developed to correct the problem. 5. Control. Systems are put in place to continuously monitor the changes in the process. The goal is to detect errors before they affect the whole system. Quality and Safety Education for Nurses, or QSEN: Nursing Education curriculum designed to prepare future nurses with the knowledge, skills, and attitudes (KSAs) necessary to continuously improve the quality and safety of the healthcare system in which they work. The five competencies that were initially developed by IOM: 1. Client Centered Care 2. Teamwork and Collaboration 3. Evidence-Based Practice (EBP) 4. Quality Improvement (QI) 5. Safety A sixth competency, INFORMATICS, was later added as the model developed and was revised because of the important role technology now plays in health care. The Agency for Healthcare Research and Quality (AHRQ) is 1 of 12 Departments of Health and Human Services agencies that supports research that improves the quality of health care and helps people make more informed health-care decisions. This agency is charged with developing partnerships that create long-term improvement in American health care. The research goal is to measure those improvements in terms of client outcomes, deceased mortality, improved quality of life, and cost effective quality care. Its overall focus is in three areas: Safety and quality, effectiveness, and efficiency. • How many competencies were developed by IOM (define IOM) – what are the competencies? The Institute of Medicine, or IOM, developed five key competencies that nursing students must be able to achieve upon graduation: 1. Client-Centered Care 2. Interdisciplinary Teamwork 3. Evidence-Based Practice 4. Quality Improvement 5. Informatics • Define NEVER events A list of reasonably preventable medical errors that occur in hospitals that will no longer be paid for by Medicare in an attempt to control costs. Subsequently, hospitals now have to cover costs for “never events” that do occur. The purpose of this is to control Medicare costs and improve the quality of care. • What are the key factors to high-quality care? - Evidence-Based Practice/ Research - Client Centered Care - Teamwork and Collaboration - Lifelong Learning - Informatics Scholarship, research, and evidence-based practices is very important in ensuring the quality and safety in health care. • Define Cultural Organization Environment Nursing cultures need to make quality and safety a priority rather than focusing on what went wrong after an adverse event happens and trying to blame someone for the error. Other characteristics of blame-free or just culture organization include positive working environments, commitment to safety and quality, transparency, and using errors as learning opportunities, and allowing employees to report errors and near misses voluntarily and anonymously. Chapter 16 • Know the important factors an RN must consider when assigning unit staff assignment Assess the client - Before delegating any task, RN should give careful consideration to the condition of the client and the client’s health-care needs. Assessing clients is a designated responsibility of RNs. Without a thorough assessment, it is likely that critical needs will remain unidentified by less trained personnel, leading to potential error in care. Task must be uncomplicated and routine, must be performed without variation from policy or procedure, and should not require the use of nursing judgement while being performed. Know Staff Availability – The delegating nurse needs to know the availability of staff and the education and competency levels of the personnel to be delegated. These factors must be matched with the level of care required by the client. It is important to keep the team informed of who is delegated which tasks and when changes are made. Know the Job Description – One large group of health care workers to whom RNs delegate is generally called unlicensed assistive personnel(UAP). This group includes individuals who have been through some type of training program ranging from a few hours to several months. They may receive a certificate of completion, but do not have any type of licensure. The RN needs to know the institution’s official position description for the UAP as well as the UAP’s abilities. When the RN determines that the client’s needs match the skills and abilities of the UAP or LPN, only then should that person be assigned. Educate the Staff Member – RNs who delegate are also responsible for educating the UAP about the task to be done. If the UAP is unfamiliar with the task, the RN is required to demonstrate how the task or procedure is to be performed and then document the training. Education also includes telling the UAP what is expected in the completion of the tasks and what complications to watch for and report to the RN. The RN must always be available to answer questions and help the UAP. • Know and be able to identify what the scope of practice is for an RN, LPN, along with what tasks a CNA/UAP can do RNs have the ability to do admission assessments, give IV medications, blood products, care plans, client teaching, care of unstable clients, and treating actuate diseases. RNs typically make assignments and delegate tasks, however, not all RN functions can be delegated to assistive staff, such as admission assessments and Iv medications. LPNs can check vital signs, have uncomplicated skills, work with stable clients, deal with chronic diseases, and can give oral and IM medications. They cannot do admission assessments, IV push medications, write nursing diagnoses, do most teaching skills, do complex skills, take care of clients with acute conditions, and they cannot take care of unstable clients. CNAs, UPAs assist in feedings, basic hygiene, basic skills, stable clients, chronic diseases, and ambulation. Regarding this level, RNs need to look for the lowest level of skill required for the task. They also need to look at the least complicated task and look for the most stable client. LPNs and CNAs look for clients with chronic illnesses. • Know and be able to identify what tasks a RN can delegate to an LPN or CAN/UAP Read the previous answer for the different tasks. The nurse is responsible and accountable for individual nursing practice and determines the appropriate delegation of tasks consistent with the nurse’s obligation to provide optimum patient care. RNs have an obligation to refuse assignments that they are not competent to carry out and to refuse to delegate particular nursing tasks to individuals who they believe are unable or unprepared to perform them. • Know the Role and Scope of practice of a RN, LPN, and CAN/UAP, and who could perform a history and physical on a new patient Read the above passage on the scope of practice. Performing admission assessments, developing care plans, and making nursing diagnoses are activities generally restricted to RNs only. • Know and be able to identify what tasks can be delegated to a LPN/LVN is a patient is stable The NCLEX uses strict parameters for determining delegation. Although LPN/LVNs can do most skills, for the NCLEX, they cannot do admission assessments, IV treatments, nursing diagnoses, most teaching, complex skills, care of patients with acute conditions, or unstable patients. However, an LPN can check the vital signs of a patient, work on cases that involve uncomplicated skills, work with stable patients, help treat chronic illnesses, and can give oral and IM medications. • Know the Steps of Delegation Step one is to determine which tasks to delegate. Step two is to define the task clearly in your own mind. Step three is to select the right person for the job. Step four is to explain the task thoroughly and clearly. Step five is to monitor progress and provide support. Step six is to follow up and make sure the task has been successfully completed. • Know and be able to identify the characteristics of a task that warrants a task to be assigned by an RN. Delegation is an essential component of client care and management of nursing units in today’s healthcare systems. Delegation is recognized as designating ancillary personnel for the responsibility of carrying out specific group of nursing tasks in the care of certain clients. An RN must assign appropriate tasks that fall under the scope of practice of the assigned individual. Ex. Feeding, bathing, checking vital signs, giving medication. • Who can an RN delegate? An RN can delegate task to ancillary personnel that falls under their own scope of practice according to the facility policies, position descriptions, and, if applicable, state practice act. When RNs delegate to task to non-nurses, the RNs must always supervise those individuals to ensure that the care given meets the standards of care, and must only give tasks the individual is trained for. It is common for RNs to delegate certain aspects of care to LVNs, LPNS, UAP, monitory technicians, and other levels of assistive personnel. Module 9 (Chapter 18) • How has technology changed communication? Technology has changed the way everyone in the world communicates. Before the use of a telephone, people communicated through written word. Before television and the computer, people gathered together in neighborhoods and developed a sense of community. Today, the whole world is in the community, and every corner can be reached from a home computer or wireless device. Individuals can use their computers to chat and to organize get together, while at the same time using their cell phones to text friends and to call them. Technology has given us a better way of communication, and allows us to stay connected to the people in our lives. • Define Nursing Informatics Two definitions of informatics are commonly used in health care. The term medical informatics includes all the informational technologies that deal with the medical care of the client, medical resources, and the decision making process. Health informatics is a more comprehensive term, defined as the use of information technology with information management concepts and methods to support health care delivery. Health informatics includes the medical field but also encompasses nursing, dental, and pharmacy informatics as well as all other healthcare disciplines. The definition of health informatics focuses attention on the recipient of care rather on the discipline of the caregiver. • Define data, information, and knowledge. Describe examples of each. Data are defined as raw and unstructured facts. For example, the number 102 and 104 are raw data: by themselves, these numbers have little meaning because they lack interpretation. Information consists of data that has been given form and has been interpreted. If the numbers 102 and 104 are given additional descriptors, so that they become a 25-year-old man with an oral temperature of 102F and a heart rate of 104 beats per minute (bpm) taken on admission to the ER, they become information that has meaning to the nurse. Knowledge takes the process one step further because it is a synthesis of data and information. Knowing that an oral temperature of 102 is higher than normal, and a heart rate of 104 bpm is faster than normal for a 25-year-old man, and combining that information with an understanding of human physiology and pharmacology, the nurse is able to decide what treatment should be given. • Define technology, theory, and function in nursing informatics Technology. The earliest attempts to define nursing informatics focused solely on the use of technology. A commonly used early definition of nursing informatics stated that it existed whenever the nurse used any type of information technology in delivering nursing care or in the process of educating nursing students. The use of technology to store, process, retrieve, or communicate health information include: - Administer nursing services and resources - Manage the delivery of client and nursing care - Link research resources and findings to nursing practice - Apply educational resources to nursing education Nursing Theory. As nursing informatics evolved, it began to combine nursing theory and informatics. Without a well-articulated theoretical basis to guide the gathering of data, nurses soon become overwhelmed with meaningless data and information. Function. An additional step in the evolution of nursing informatics is the inclusion of the concept of function. The function of nursing informatics is to manage and process data to help nurses enter, organize, and retrieve needed information. Technology is then developed to achieve specific purpose related to client-care needs. • Definition and purpose of unified nursing language and taxonomy Because a standardized nursing language is needed to name and communicate what nurses do, nursing classifications, schemes, taxonomies, and vocabularies have come to the forefront with the evolution of nursing informatics. The UNLS, or unified nursing language, maps concepts by identifying common terms from different vocabularies and acknowledging them as synonyms of the same concept. Taxonomy is a type of classification system. Twelve classification systems that are recognized by the ANA as uniquely developed to documenting nursing care. They are designed to record and track the client care process for an entire episode of client care in the acute, home, or ambulatory setting. • What is nursing minimum data set and what is its purpose? The Nursing Minimum Data Set is a list of data elements necessary in any computerized client record system or national database. The NMDS is considered to be the umbrella for other nursing process schemes. The purpose of it is to: 1. Describe the nursing care of clients and their families in various setting, both institutional and noninstitutional 2. Establish comparability of nursing data across clinical populations, settings, geographical areas, and time 3. Demonstrate or project trends regarding nursing care provided an allocation of nursing resources to clients according to their health problems or nursing diagnoses 4. Stimulate nursing research through linkages of detailed data existing in nursing information systems and in other health care information systems 5. Provide data about nursing care to influence health policy and decision-making The NMDS focuses on 16 elements divided into three main categories; nursing care, client demographics, and service elements. • Describe the human factor. What areas need to be addressed when developing technology? When information tools, machines, and systems are developed, they must include recognitions of human factors, including knowledge about human capabilities, limitations, and characteristics that may affect the use of the system. The study of human factors examines how to make the interaction of people and equipment safe, comfortable, and effective. “User-friendly” systems are intuitive, self-evident, and logical, even if they are complicated. • Compare advantage/disadvantages of electronic health record with paper health record Electronic health records have many advantages. Multiple care providers can access them simultaneously from remote sites. They can provide reminders about completing information or carrying out protocols as well as warning of incompatibilities of medications or variances from normal standards. It is portable, unbreakable, and accepts multiple data types, such as graphs, photographs, drawings, and text. Information is captured once and then transmitted to every record requiring the information. Electronic health records have some obvious disadvantages. There Is a high front-end cost in buying an electronic system and converting from a paper system. Employees may have problems adapting to the new system because of the steep learning curve involved. They can be subject to glitches and decisions must be made about who can enter into the system and when entries should be. Information can be lost and is often illegible and incomplete. It can only by accessed by one person at a time and is often disorganized. It can also make research difficult. • What are characteristics of the ideal electronic health record? The ideal EHR would be a lifelong continuous record of all the care the client has received, rather than the episodic, piecemeal data that it now provides. This one record would reflect an individual’s current health status and lifelong medical history. It would be unique to the person and not to the institution. This record would reside in multiple data sites and would accept multiple data types (ex. Graphs, pictures, x-rays, text) and would be accessible worldwide. • Discuss different threats to security in electronic health systems In the new electronic world, confidential information has become a commodity that bought and sold in the electronic marketplace. Although the HIPPA laws have tried to deal with the issue, people who use the internet or e-mail quickly realize that their personal information is no longer so personal. Unauthorized sharing of health-care information is generally unethical and now is always illegal. Threats to information security can either be accidental or intentional and can affect both paper and electronic systems. Intentional threats to the security of information involve actions of an individual or individuals to damage, destroy, or alter the records. • What is telehealth/telemedicine and what are the uses/purposes Telehealth and telemedicine are often used interchangeably. Telehealth is the use of electronic information and communications technologies to provide and support health care when distance separates the physician and the client. Telemedicine is just one of the services provided by the overall telehealth systems that primarily involves consultation with a physician. Telehealth is being used in emergency departments across America. The telehealth system allows access to centralized specialists who can support primary care providers in outlying areas, such as rural or urban areas. Telehealth services has helped save lives and prevent disabilities by assisting and answering concerns of clients. Chapter 10 (Chapters 20, 23, 25, 27 Nursing Now!) Chapter 23 • What is the Silver Tsunami? The rapid growth in the older population has been coined “silver tsunami” as it increases the demand for health services focused on chronic disease, comorbid status, and the unique health promotion needs for older adults. • How does chronic disease and co-morbid status impact elderly clients? Since the older population is living longer, chronic disease has become a major problem and a leading cause of death. Chronic disease accounts for more than 36 million deaths globally per year. Older adults are at a much higher risk for chronic illness, which includes diseases and conditions such as obesity, diabetes, coronary artery disease, chronic obstructive pulmonary disease. Arthritis, dementia, coronary vascular disease, cancer, osteoarthritis, and depression. Individuals with chronic disease and comorbidity require longer stays in the hospital, require mo re specialists visit, and primary care visits. Medicare, in an attempt to cut costs, has lowered compe nsation to doctors caring for Medicare patients, which causes a lot doctors to not accept Medicare patients. • What is the focus of the current health care systems? Impact of Baby boomers on this system? The health care system currently used in the US was designed primarily to treat acute illness and injury. Today, the system is evolving to provide high-quality care for chronic illnesses and adapt to behaviors and personal issues of the aging population. Its main focus is on the chronic disease process. Nurses in today’s health care system are dealing with a rapidly aging population as the first “baby boomers” (adults born between 1946-1964) become 65 and older. Over 37 million people in this group, will have one or more chronic illness by 2030. The older population has more hospitalization, more admissions to nursing homes, and is the most likely to lose freedom of living in their own home; therefore, the possibility of experiencing low-quality care increases simply because they are participating in the health-care system more frequently. • How are clients impacted by Health-Care Coverage? Medicare and Medicaid account for a large portion of the growth in health expenditures. Medicare is a federal government-sponsored health program developed primarily for senior citizens over the age of 65, those with end-stage renal disease, and disabled persons who are eligible to receive Social Security benefits because of their contribution to the Social Security System during their working years. Medicare is split into 3 parts: (A) covers hospital care, (B) covers medical insurance, and (D) covers prescription drugs. Participants in the program may be required to pay a deductible and a small co-pay for medical services Medicaid is primarily for low-income families and low-income individuals. Medicaid is managed by individual states, which receive matching funds from the federal government, so there is much variability in who qualifies. Self-Care. In Dorothea Orem’s model of nursing, individuals are responsible for their own care. As people age, the ability to perform activities of daily living often decrease if any type of illness occurs that impinges on their physical and/or mental function. States that invest in home support services for the elderly have reduced the number of clients receiving long-term institutional care and overall spending in their Medicare programs. • Trends in recent years to reduce reimbursement The trend in recent years is to reduce reimbursement to hospitals and health care providers such as physicians and nurse practitioners for the Medicare clients they are seeing. Some state legislatures have attempted to further decrease reimbursement to health care providers. Reducing Medicare reimbursement has caused some providers to stop accepting new Medicare clients and increases the number of elderly clients of providers – who are still willing to accept Medicare clients – must see. • What is the Impact of aging populations? The growing elderly population in the US is having major economic consequences for the country, especially for the federal and state programs that help support the health care of the elderly. Women statistically account for 74% of poor elders whose only source of income is Social Security. As more of the elderly seek health care, the nursing shortage will only become more pronounced, as many nurses are approaching retirement age. An aging population will place an increased burden on an already stressed health care system. As the shortage becomes worse, nurses will need to work back to back shifts, which increase more mistakes and medication errors. There is also a lack of practitioner specialist for elderly care and nurses need to educate the elderly on health. • What is long-term economic impact The long-term economic impact that results from an aging population includes a shortage of nurses, elder specialist, an increase need for education, and a higher risk of mistakes and medication errors. The average age for nurse is 46, which indicates that over 50% of the nursing workforce is reaching retirement age. It is projected there will be a shortage of 200,00-800,000 RNs by 2025. As the shortage becomes worse, nurses will be expected to work multiple shifts under highly stressful conditions. This causes long-term fatigues, accidents, and injury, and increase in job dissatisfaction. As the aging population enters the health care system, there is an increasing need for practitioners who specialize in elderly care. It is also very important for nurse to educate the clients on how to live a healthy lifestyle. • What are the long-term effects on geriatric specialists and how is the healthcare system impacted? As mentioned above, as the aging population moves into the health care system, these is an increase need for practitioners who specialize in elderly care. Almost all nursing programs today have a course on the care for the elderly. The reality of the future health-care systems is that almost all nurses, except those is pediatrics and obstetrics, will be providing care for older clients. With the projected shortage of primary care physicians, NPs are in the perfect positions to fill this need. The cut backs on reimbursement from Medicare may also affect these specialists, as many other physicians may refuse to see Medicare patients. • How has the Affordable Care Act (ACA) impacted care to elderly? The ACA has made health care more easily assessable, and helps to keep insurance companies from declining pre-existing conditions. It has also helped to lower the income of elderly care. • What Impacts the ability of self-care and managing at care home? When people age, the ability to perform activities of daily living often decrease if any type of illness occurs that impinges on their physical and/or mental function. States that invest in home support services for the elderly have reduced the number of clients receiving long-term institutional care and overall spending in their Medicare programs. • How do we manage special education needs? To provide better holistic care, nurses today must educate the older population. This education is important in improving the health of the community and the everyday lives of the elderly. The goal of all education is to change behavior. Repetition combined with positive reinforcements such as praise, a pleased look, or another type of reward, can become a motivator to change behavior. Any health teaching must acknowledge and build up the experiences, values, and beliefs of the client. Adding excitement and interest will also help better learning environments and sessions. • How do nurses address the Older Population’s Spirituality? What is spirituality? By understanding their own belief systems, nurses may feel more comfortable in addressing their client’s spiritual needs. The needs the nurses respond to and assist with include psychological, physical, spiritual, or emotional support. A nurse should address the client with empathy and open-ended questions, and allow the client to vent religious or spiritually oriented concerns. The nurse should also support the need for prayer and scripture, and encourage the family to participate. And help clients understand and work through their spiritual distress. Spirituality may be regarded as the driven force that pervades all aspects of and gives meaning to an individual’s life. • How does Joint Commission on Accreditation of Healthcare Organization (JACHO) measure healthcare organizations spiritual of elderly? The Joint Commission on Accreditation of Healthcare Organization has established a standard of client care that includes spiritual and emotional care for clients. JCAHO states that the client’s spiritual assessment is to include identification of spiritual practices important to them. Chapter 25 • Define the terms healing, medicine, holism, alternative, complimentary, and integrative Holism refers to treatment of the whole person, mind, body, and soul, in that person’s environmental context, such as spiritual, cultural, social, physical, or biological. Healing is the process of becoming sound or healthy again. The reintegration of the physical with the spiritual. The process by which a patient can make changes in their lives to reach their full potential in wellness. Healing is preferred to medicine. Medicine can be defined as either the science or practice of the diagnosis, treatment, and prevention of disease, or it can be described a compound used for the treatment or prevention of a disease. The use of Western Medicine or practices to treat illness. Complementary and Alternative Medicine (CAM) Defined as the understanding and use of healing therapies not commonly considered part of Western Biomedicine. The focus here is mainly on methods of self-care, wellness, self-healing, health promotions, and illness prevention. Therapies and practices are called alternative when used alone and complementary when used in conventional therapies. The Integrative Approach to health is based on the belief that clients, after an illness or injury, have the capability to regain their overall health and maintain wellness during their lifespans. The work of the practitioner using integrative health practices is to become familiar with each client’s particular health needs and then personalizes their care using the full range of elements that affect health, including physical, mental, spiritual, social, and environmental factors. This approach is client focused. • Why has the use of integrative health practices increased? Three general theories have been advanced to explain the growing use of integrative healing: 1. Dissatisfaction with conventional health care 2. A desire for greater control over one’s health 3. A desire for cultural and philosophical congruence with personal beliefs about health and illness. Many other client-specific reason have also been postulated, such as belief in the effectiveness of integrative therapies and the individual’s health status. • Difference between integrative medicine (therapy from within) and conventional medicine (therapy from outside) Conventional Medicine focuses on the physical or material part of the person, the body. It is concerned with the structure, function, and connections or communication between material elements that compose the body, such as bones, muscles, and nerves. Conventional medicine consists of chemotherapy, curing/treating, disease category, end-stage, illness treatment, specialist care, science is the only source of knowledge. Individual is viewed as a disease category and is a patient or client. Treatments tends to be technological and invasive. Integrative and alternative approach views the person-body as consisting of multiple, integrated elements that incorporate both the materialistic and nonmaterialistic aspects of existence. Integrative approach includes plants and other natural products, healing/ministering care, client is viewed as a person and unique individual, there hope/hopefulness, health promotion and illness prevention, holistic approach, self-care, multiple sources of knowledge and truth, and natural/noninvasive. • Physical Manipulation Technologies/Ingested or Applied substances/energy therapies Manipulative and body-based methods include body manipulation, body movement, or both. Chiropractic care specializes in adjustments and manipulation of the spine, returning the body to its optimal alignment. Energy therapies are based on manipulation of biofields with bioelectromagnetically based therapies. Biofields include energy systems and energy fields internal and external to the body that are used for medical purposes. In Therapeutic Touch, there is no actual contact with the body or only very light touch. The use of TT is believed to redirect energy flow and treat pain and disease. It has been shown to be effective on wound healing, pain, and anxiety. Ingested or Applied substances. A number of substances, including herbs, vitamins, and other nutritional supplements, and dietary regimens have the goal of helping the body heal itself, rid itself of toxins, and promote general health and wellness. • Define Wellness and Holism Wellness is often used interchangeably with good health, generally meaning an absence of disease or illness. Wellness tends to focus on individuals who are seen as being at risk for illness. Holism is often defined as the totality or entirety of a system that is more than the sum of its parts. The system being looked at in health care is the human person. • The Placebo Response In conventional medicine, the term placebo has come to signify a type of sham treatment instituted to please difficult or anxious clients, or a sugar pill given when health care professionals have nothing more to offer the client. A placebo is an inactive or non-treatment given to the control group under the assumption that it will not change any physiological responses and will therefore prove the effectiveness of the active treatments. It is the belief that healing only takes place because the individual believes the treatment is effective. • Energy: Conventional use, alternative use Conventional health care has long used various types of energy systems for screenings, diagnosis and some types of treatments. Commonly used modalities include electrocardiograms, magnetic resonance imaging, electroencephalograms, electromyograms, x-rays, radiation treatments for cancer, low-frequency electric current to stimulate growth of bone cells to accelerate healing of fractures, electric shock therapy, cardioversions, and pacemakers. Conventional health care also uses bioenergy to determine the degree of injury and estimate recovery times through the study of cells. Alternative therapies refer to energy systems as fields, vital essences, balance, and flow that clients can use to prevent illness, promote health, and health themselves. The basic concept is that external forces are not able to cause harm if the person is in the well state. Treatment magnet and light therapy, relaxation of the muscles, acupuncture, acupressure, and chiropractic. • Supplements: regulation of supplements The Dietary Supplement Health and Education Act created a special category of 20,000 protected substances previously sold as supplements. The DSHEA defined supplements as including vitamins, minerals, amino acids, herbs, botanicals, etc. The FDA can remove supplements from the market if it receives reports of their adverse effects and then proves that they are dangerous to consumer’s health. The DSHEA also gave the FDA authority to improve and enforce product labeling, package inserts, and accompanying literature. The US postal service and the federal trade commission also helps regulate nutritional supplements and herbal products. • Plants as medicine Both alternative and conventional health care use plants as medicine. Herbalism is the study and use of herbs or crude-based plant products for food, medicine, or prophylaxis. They can also be used to heal, treat, or prevent illness and improve the spiritual and physical quality of life. Chapter 27 • Define the roles of nurses and practice settings The profession of nursing is dynamic and ever changing. Nursing roles evolve and develop in response to the needs of society. Hopes for the affordable care act is that it will open even more doors for professional nurses and provide opportunities for expanding practice. • Forensic Nurses, Legal Nurse Consultant, examiner, psychiatric, correctional, SANE Forensic nursing is defined by the application of nursing science to public or legal proceedings; the application of the forensic aspects of health care combined with the bio-psycho-social education of the registered nurses (RN) in the scientific investigation and treatment of trauma and/or death of victims and perpetrators of abuse, violence, criminal activity, and traumatic accidents. These nurses provide a continuum of care to victims and their families, beginning in the ER or crime scene and leading to participation in the criminal investigation and the courts of law. A SANE is an RN trained in the forensic examination of sexual assault victims. This person has an advanced education and clinical preparation specialized in this area. Clients who have been sexually assaulted have unique medical, legal, and psychological needs. The care provided by the SANE has been designed to preserve the victims’ dignity and reduce psychological trauma. Their responsibilities include interviewing the victim, completing the physical examination, collecting specimen for forensic evidence, and documenting the finding. They also provide emotional support to the victim and their families. The Legal Nurse Consultant is a licensed RN who critically evaluates and analyzes health care issues in medically related lawsuits. Their responsibilities include drafting legal documents, interviewing witnesses, educating attorneys and involved parties on health-care issues and standards, researching nursing literature, standards, and guidelines, reviewing and analyzing medical records, identifying and conferring with expert witnesses, assessing causation and issues of damages, developing case strategies, providing support, and educating/mentoring other RNs in the practice of legal nurse consulting. Forensic psychiatric nurses work with individuals who have mental health needs and who have entered the legal system. These nurses generally practice in state psychiatric institutions, jails, and prisons. The assist clients with self-care, administer medical care and treatment, and monitor the effectiveness of the treatment. They also help to treat individuals with psychiatric disorders. Forensic correctional nurses provide health care for inmates in correctional facilities such as juvenile centers, jails, and prisons. They manage acute and chronic illness, develop health care plans, dispense medications, and perform health screenings and health education. They also conduct psychiatric assessments and respond to emergency situations. An examiner can also be related to a forensic death investigator. They are called upon when law enforcement suspects a death did not result from natural causes. They are qualified for forensic training. • The need for many more certified RN-coders and certified RN- auditors. Because of the new changes in the coding system, it presents challenges for hospitals and other health care providers to master. Because the changes are much more complicated and difficult, nurses will need to gain knowledge and expertise on these systems. • The roles of nurse navigator, case manager, and safety officer. Case management is a collaborative process of assessment, planning, facilitating, and advocacy for options and services to meet an individual’s health needs through communication and available resources to promote quality, cost-effective outcomes. Effective collaboration among all members of the health care team is essential to meet the needs of clients in today’s complex health care system. The Nurse Navigator’s role is similar to the case manager, it tends to be more focused on only one specialty area, such as cancer clients. The role revolves around clients and families to help them deal with complex care issues. The nurse navigator attempts to eliminate barriers and serves an as advocate for the client to make moving through treatment easier. Ex. Helping with Insurance forms, transportation, providing knowledge about disease and treatment, and providing knowledge on side effects of the medications. Client safety officer, also known as client safety nurse, is an RN who works to lower the risk factors that cause poor and adverse client outcomes. Focuses primarily on satisfying the joint commission and the requirements of other regulatory bodies, client safety officers plan and implement protocols and procedures to eliminate health-care errors. These nurse provide a more comprehensive approach to safety, including reporting and analyzing adverse events. They also educate other nurses on the causes of errors and how to eliminate them using evidence based safety strategies.