Chapter 1

Review

First practicing nurse epidemiologist

Florence Nightingale

Founded the American Red Cross

Clara Barton

____________assisted in the Underground Railroad movement during the__________.

Harriet Tubman, Civil War

___________ was the first professionally trained African American nurses and brought forth an awareness of _________ diversity and respect for the individual.

Mary Mahoney, cultural

Nurses working in the __________ __________ Settlement in _____ were among the first nurses to demonstrate ___________ in practice because those nurses were required to use ________ _______ skills.

Henry Street, 1893, autonomy, critical thinking

The _________ ___________ was an important study that led to the development of the _______ ________ of ___________ in ______.

Goldmark Report, Yale School, Nursing, 1923

The associate degree (___-yr program)nursing program is usually offered by a _______________ of ____________.

2, University, Community college

The associate degree nursing program (ASN) focuses on ____________, ___________, and __________ courses related to the practice of nursing.

basic sciences, theoretical and clinical courses

The baccalaureate degree nursing program (BSN) usually includes ___ yrs of study in a __________ or ______________.

4, college, university

BSN normally focuses on __________ sciences, ________ and ___________ courses, and courses in the __________ science, _________, and ____________ to support nursing theory.

basic, theoretical, clinical, social,art, humanities

According to Benner:
novice nurse

Beginning nursing student or any nurse entering a situation in which there is no previous level of experience (e.g. experienced operating room nurse chooses to practice in home health). The learner learns with specific set of rules or procedures that are usually in steps

According to Benner:
the advanced beginner nurse

a nurse who has had some level of experience with the situation. This experience may only be observational in nature, but the nurse is able to identify meaningful aspects or principles of nursing care.

According to Benner:
the competent nurse

Nurse who has been in the same clinical position for 2-3 yrs. Understands the organization & specific care required by the type of patients (e.g. surgical,oncology, or orthopedic).

According to Benner:
the competent nurse

Is competent practitioner who is able to anticipate nursing care and est long-range goals. usually exp in all psychomotor skills for this group of patients.

According to Benner:
the proficient nurse

a nurse with more than 2-3 years of experience in same clinical position. This nurse perceives a patient's clinical situation as a whole, is able to assess an entire situation, and can readily transfer knowledge gained from multiple previous experiences to a situation. nurse focuses on managing and performing skills.

According to Benner:
expert nurse

nurse with diverse experience who has an intuitive grasp of an existing or potential clinical problems. This nurse is able to zero in on the problem and focus on multiple dimensions of the situation. He or she is skilled at identifying both patient-centered problems and problems related to the healthcare system or needs of the novice nurse.

Professional Responsibilities and Roles of a nurse:
autonomy

essential element of professional nursing that involves the initiation of independent nursing interventions without medical orders. (e.g. you independently implement coughing and deep-breathing exercises for a patient who recently had surgery. or collaborate w/ other hc professions to make tx. plan for patient.

Professional Responsibilities and Roles of a nurse:
accountability

you are responsible, professionally and legally, for the type and quality of nursing care provided. (keep current and competent in nursing and scientific knowledge/technical skills. also accountable through nursing audits and standards of practice.

Professional Responsibilities and Roles of a nurse:
care giver

help patients maintain and regain health, manage disease and symptoms, and attain a maximal level function and independence through the healing process. Provide healing through physical and interpersonal skills. meet all hc needs restore emotional, spiritual, and social well-being. help set goals w/ pt and family.

Professional Responsibilities and Roles of a nurse:
ADVOCATE

protect your patient's human and legal rights and provide assistance in asserting these rights if the need arises. provide additional information to help patient decide whether or not to accept treatment, or find an interpreter to help family members with concerns. sometimes have to speak out against policies that endanger patients or conflict rights

Professional Responsibilities and Roles of a nurse:
educator

explains concepts and facts about health, reason for routine care activities, demonstrate procedures such as self-care activities, reinforce learning or patient behavior and evaluate progress in learning. planned or unplanned. some are general, some are formal like insulin injections.

Professional Responsibilities and Roles of a nurse:
communicator

Have to be effective. Allows you to know your patients, strengths and weaknesses and their needs. communicate with patients, families, other nurses, healthcare professions, resources persons, and the community. assists with rehabilitation or providing patient education.

Professional Responsibilities and Roles of a nurse:
manager

need to establish an environment for collaborative patient-centered care to provide safe, quality care with positive patient outcomes. coordinates activities of members of the nursing staff for nursing care and has personnel, policy and budgetary responsibility for specific nurse units. Creates environment that reflects mission and values of the healthcare organization.

Levels of advanced practice registered nurses: (APRN)

Clinical Nurse Specialist, Nurse Practitioner, Certified Nurse-Midwife, Certified Registered Nurse Anesthetist, Nurse Educator, Nurse Administrator, Nurse Researcher

Acronyms of advanced practice registered nurses:

CNS, NP, CNM, CRNA

CNS

expert clinician in a specialized area of practice. specialty may be identified by a population (e.g. geriatrics), a setting (critical care), a disease specialty (diabetes), a type of care (rehabilitation), or a type of problem (pain). CNS practices in all health care settings.

NP

provides health care to a group of patients, usually in an outpatient, ambulatory care, or community-based setting. provides patient, ambulatory care, or community-based setting. Provides care for complex problems and a more holistic approach than physicians. Provides comprehensive care, manages those with chronic issues. All ages. Acute care, adult, family, pediatric, women's psychiatric, mental health, and geriatric. detects self-limiting acute and chronic like asthma, diabetes mellitus, & hypertension.

CNM

Educated in midwifery, is certified by the American College of Nurse-Midwives. Involves providing independent care for women during normal pregnancy, labor, & delivery and care for newborn. Includes some gynecological services routine Papanicolaou smears, family planning, and treatment for minor vaginal infections. practices with a health care agency that provides medical consuls, collaborative management, and referral.

CRNA

Advanced education in a nurse anesthesia program. provides surgical anesthesia under the guidance and supervision of an anesthesiologist, who is a physician with advanced knowledge of surgical anesthesia.

The Master's prepared RN is also eligible for advanced degrees such as the DNP

practice- focused doctorate

The Master's prepared RN is also eligible for advanced degrees such as the PhD

research and theory oriented

What does acronym APRN stand for

Advanced Practice Registered Nurse

Patient-Centered Care, Teamwork & Collaboration, Evidence-Based Practice, Quality Improvement, Safety, Informatics

Patient-Centered Care-

Recognize the patient or designee as the source of control and partner in providing compassionate and coordinated care based on respect for patient's preferences, values, and needs. EX Involve family and friends in care. Elicit patient values and preferences. Provide care with respect for diversity of the human experience.

What kind of continuing education does an RN need and why

formal, organized educational programs offered by universities, hospitals, state nurses associations, professional nursing organizations, and educational & health care institutions. Ex program caring for adults with dementia. Helps to specialize in a particular area of practice, and teaches you new skills and techniques.

Why do we need continuing education?

knowledge based career field that needs to stay up on nursing skills, gain new knowledge and theory, and obtain new skills, reflecting the changes in the health care delivery system.

What in-service training does an RN need and why

instruction or training provided by a health care agency or institution and is designed to increase the knowledge, skills, and competencies of nurses and other health care professional employeed by the institution.

What is in-service programs normally for

often focuses on new technologies such as how to correctly use the newest safety syringes. many designed to fulfil required competencies of an organization, eg training on administering chemotherapy safely, or cultural sensitivity.

Test that BSN graduate and ASN graduate takes for licensing

NCLEX - National Council Licensure Examination. It is exactly the same in every state.

Factors influencing the nursing profession include:

Demographics, human rights, the threat of bioterrorism, rising healthcare costs, health care costs, health care reform, nursing shortage, and the medically underserved.

Demographics

the characteristics of a human population or part of it, especially its size, growth, density, distribution, and statistics regarding birth, marriage, disease, and death. EG community of elderly different treatments then young adults

Human rights

Basic rights that everyone no matter of sex, race, religion, material status, deserve to have when being treat by a nurse. EG Nurses have to be more sensitive in cases where patient comes from the backwoods of Kentucky.

Threat of bioterrorism

Terroristic acts, nuclear, chemical, or biological attacks. Nurses are active in disaster preparedness. ICN works alongside national nursing associates for best training. EG public health emergency simulation exercises allow nurses to work with community for natural disasters. ranges from vaccine research, decontamination, triage for mass casualty.

Rising healthcare costs

skyrocketing cost, some patients skimp on taking meds due to the inability to afford them. Nurses are responsible for providing best-quality of care in an efficient and economical manner. to use health care and patient resources wisely.

health care reform

Nursing shortage

affects patient care, administration, and nursing education, represents challenges and opportunities in the profession. health care dollars are invested in recruiting well-educated, critically thinking, motivated and dedicated nurses. need to learn to use our patient contact time more efficiently. better time mgmt, therapeutic communication, patient education and compassionate psychomotor skills help patient feeling positive about their quality of care.

Who are the medically underserved

Unemployed, underemployed, low paying jobs, mental illness, and homeless. Global issue, social, political, and economic factors affects access to care and resources to pay for that care. Poor and on Medicaid. Others are part of the working poor, can't afford own insurance. some need home based needs. nurses and schools of nursing are partnering to work in community settings to prevent illnesses.

The goal of the Scope and Standards of Practice is to improve the health and well-being of all _______, ___________, and __________ through the significant and visible contributions of registered nursing using standard procedures.

individuals, communities, and populations

Understand The ANA Standards of Practice: Assessment

The registered nurse collects comprehensive data pertinent to the patient's health and/or the situation.

Understand The ANA Standards of Practice: Performance

RN collects comprehensive data pertinent to the patient's health and/or the situation

Understand ANA Standards of Professional:
Diagnosis

RN analyzes the assessment data to determine the diagnoses or issues.

Understand The ANA Standards of Practice:
Outcomes Identification

RN identifies expected outcomes for a plan individualized to the patient or the situation.

Understand The ANA Standards of Practice:
Planning

The registered nurse develops a plan that prescribes strategies and alternatives to attain expected outcomes.

Understand The ANA Standards of Practice:
Implementation

The registered nurse implements the identified plan.

Understand The ANA Standards of Practice:
Coordination of Care

The RN coordinates care delivery.

Understand The ANA Standards of Practice:
Health Teaching and Health Promotion

The RN uses strategies to promote health and a safe environment.

Understand The ANA Standards of Practice:
Consultation

The graduate level-prepared specialty nurse or advanced practice registered nurse provides consultation to influence the identified plan, enhance the abilities of others, and effect change.

Understand The ANA Standards of Practice:
Prescriptive authority and treatment

The advanced practice RN uses prescriptive authority, procedures, referrals, treatment, and therapies in accordance with state and federal laws and regulations.

Understand The ANA Standards of Practice:
Evaluation

The RN evaluates progress toward attainment of outcome.

Understand ANA Standards of Professional Performance:
Ethics

The RN practices ethically.

Understand ANA Standards of Professional Performance:
Education

The RN attains knowledge and competency that reflects current nursing practices.

Understand ANA Standards of Professional Performance:
Evidence-Based Practice and Research

The RN integrates evidence and research findings into practice.

Understand ANA Standards of Professional Performance:
Quality of Practice

The RN contributes to quality nursing practice.

Understand ANA Standards of Professional Performance:
Communication

The RN communicates effectively in all areas of practice.

Understand ANA Standards of Professional Performance:
Leadership

The RN demonstrates leadership in the professional practice setting and the profession.

Understand ANA Standards of Professional Performance:
Collaboration

The RN collaborates with health care consumer, family, and others in the conduct of nursing practice.

Understand ANA Standards of Professional Performance:
Professional Practice Evaluation

The RN evaluates her or his own nursing practice in relation to professional practice standards and guidelines, relevant statutes, rules and regulations.

Understand ANA Standards of Professional Performance:
Resources

The RN uses appropriate resources to plan and provide nursing services that are safe, effective, and financially responsible.

Understand ANA Standards of Professional Performance:
Environmental Health

The RN practices in an environmentally safe and healthy manner.

Understand the Code of Ethics for Nurses

Is the philosophical ideals of right and wrong that define the principles you will use to provide care to your patients. You also need to incorporate your own values and ethics. Ask how do your ethics, values, and practice compare to the established standards.

The Code of Ethics for Nurses with Interpretive Statements is a guide for

carrying out nursing responsibilities that provide quality nursing care; it outlines the ethical obligations of the profession.

Robert Johnson Wood Foundation initiative:

Quality and Safety Education for Nurses (QSEN)

QSEN competencies encompasses

patient-centered care, teamwork and collaboration, evidence-based practice, quality improvement, safety, and informatics

Patient-centered care targeted Knowledge, skills, and attitudes (KSAs) are:

recognize the patient or designee as the source of control and full partner in providing compassionate and coordinated care based on respect for patient's preferences, values, and needs. EG involve family and friends in care. care with respect for diversity of the human experience.

Teamwork and collaboration targeted Knowledge, skills, and attitudes (KSAs) are:

function effectively within nursing and interprofessional teams, fostering open communication, mutual respect, and shared decision making. EG recognize the contributions of other health team members and patients family members, communicate and resolves conflict. methods to support effective teamwork.

Evidence-based practice targeted Knowledge, skills, and attitudes (KSAs) are:

Integrate best current evidence with clinical expertise and patient/family preferences and values for delivery of optimal health care. EG demonstrate knowledge of basic scientific methods. appreciate strength and weaknesses of science based and reading relevant journals.

Quality improvement targeted Knowledge, skills, and attitudes (KSAs) are:

Use data to monitor the out comes of care processes and use improvement methods to design and test changes to continuously improve the quality and safety of health care systems. eg use tools, flow charts, and diagrams to make process of care explicit. appreciate how unwanted variation in outcomes affects care. identify gaps between local and best practices.

Safety targeted Knowledge, skills, and attitudes (KSAs) are:

minimize risk of harm to patients and providers through both system effectiveness and individual performance. eg examine human factors and basic safety design principles and commonly used unsafe practices. value own role in preventing errors.

Informatics targeted Knowledge, skills, and attitudes (KSAs) are:

use info and technology to communicate, manage knowledge, mitigate error, and support decision-making. eg navigate an electronic health record. protect confidentiality of protected health information in electronic health records.

KSAs are integrated into your nursing _________ program.

prelicensure