Introduction to Nursing: History, Workforce, and Professionalism, Exams of Nursing

Download Introduction to Nursing: History, Workforce, and Professionalism and more Exams Nursing in PDF only on Docsity! 1 INTRO TO NURSING FINAL STUDY GUIDE 2023 QUIZ Nursing Today (Chp 1) - Nurses comprise the largest segment of the health care workforce in the United States and have increasing opportunities to practice in enormous variety of settings. o RNs are the largest group of healthcare providers in US (more than 4 mil RNs) - Nursing care originated and was practiced informally in home and community settings and moved into hospitals only within the past 150 years - Nursing in the Workforce - NSSRN (National Sample Survey of Registered Nurses): comprehensive survey of nursing workforce every 4 years o Gender ▪ Dominated by women ▪ 2014 – Men comprised 11.7% of students in entry level BSN in nursing o Age ▪ The rise in the number of nurses under the age of 30 is attributed to the increase in the number of BSN Grads! ▪ 25% will be older than 55 by 2020 o Race & Ethnicity ▪ Issue with cultural competency due to 83.2% of nurses being white, non- Hispanic o Education ▪ Graduating from nursing w/in your state qualifies you to take the NCLEX (National Council Licensure Examination)- pass to be RN ▪ Evidence based practice (EBP) refers to nursing care that is based on best available research evidence, clinical expertise, and patient preference. • Knowing to turn your patient every 2 hours to decrease constipation, muscle atrophy, etc. • Research has shown patient outcome is higher with BSN o Practice Setting for Professional Nurses ▪ Hospitals – primary work site ; most common setting for nurses ▪ Earliest forms of education was Hospital based to get students working in hospitals ▪ Nursing in community: Ambulatory clinics, Health departments, Hospices, Homes, Community based settings o Opportunities ▪ Nursing from a Distance: Telehealth (using technology) - Employment outlook in nursing o Nurses can expect employment opportunities to grow “much faster than average”- above 19% thru year 2022 Nursing History (Chp 2) - Evidence of nursing began in biblical times - Reformation (1500s) *Biggest issue in nursing today is aging population 2 INTRO TO NURSING FINAL STUDY GUIDE 2023 QUIZ o Low period for nursing- public image of nurse was not respectable o Monks and nuns disappeared as caregivers o Men disappeared (don’t come back till 20th century-1900s) o Daughter of charity : established during reformation. Charitable nursing order continues today - Medical knowledge revolution (late 1800s)- Curiosity of Renaissance influenced advances in scientific investigation of illness & causes: effective medications, thermometer, syringe, stethoscope, x-ray, anesthesia, etc. - The Nightingale Era (1820-1910) o Florence nightingale was a pioneer who is the founder of modern nursing o Nightingale’s influence today extends beyond her undeniable impact on the field of modern nursing to the areas of infection control, hospital epidemiology, and hospice care o Used applied statistics to develop policy proving that death rate was related to sanitation issues o Introduced women into British army o Crimean War (1850s) ▪ She recruited nurses. MDs did not like her. She told them to wash their hands ▪ Cleaned up conditions- mortality rate was 60%- within 6 month was 2% ▪ Left Crimean war with 2 goals: Reform army sanitary practices & Establish a school for nurses - The Rise of modern Nursing (1860) o Nightingale established the 1st formal educational program for nurses o Nightingale Training School - St Thomas Hospital , London (1860) ▪ Only accepted women of high moral character and ability (explicit standards) ▪ High demand for the “Nightingale Nurse” - Civil War (late 1800s) o No organized system for medical care (no professional nurses to tend to wounded)- “a call for nurses” ▪ Dorothea Dix - superintendent of women nurses of the union army • Created month long training program for women- African American women could train also ▪ Clara Barton - tended to union soldiers • “angel of the battlefield” • Founded supplies- later founded American Red Cross ▪ Superintendent Sally Tompkins - only woman in confederacy to hold military rank o Overall civil war demonstrated dramatic improvements in care and moved toward formal education & training - Formal Education & Training (late 1800s) o New England Hospital (AFTER civil war) *First 3 Nursing schools were applied using nightingale model 5 INTRO TO NURSING FINAL STUDY GUIDE 2023 QUIZ o Hurricane Katrina- Nursing as a profession has responded by increasing preparedness for human catastrophes and natural disasters o Affordable Care Act (ACA): cannot be denied for a preexisting condition ▪ The ANA supported the bill – signed in March 2010 ▪ Insurance companies could NOT deny someone for having preexisting condition - Technology (electronic health records, increase public knowledge, etc) - Nursing Image o Not very good (examples- Sairey Gamp, Nurse Ratched, The Woodhull Study) - Nursing Shortage- A perennial problem o Shortage of nurses due to shortage of nursing faculty o Attempted solutions ▪ Increase the number of nurses • Import nurses from other countries ▪ Create a less trained worker to supplement nurses • Licensed practical nurse (LPN) (WWII) • Associate Degree programs (ADN) (1950s) • EMTs, respiratory therapists (1970s) - Minorities in Nursing o Jesse Sleet Scales ▪ A visionary African American nurse, was among the first to bring community health nursing Principles to the tenants of NYC 1900 - Mary Breckinridge o Nurse and midwife o Founder of Frontier Nursing Service in 1925 (FNS)- delivered babies, provided prenatal and postnatal care, educated families on nutrition, hygiene and care of the sick. Nursing Pathway to Professionalism (Chp 3) - Characteristics of a profession Flexner Report called for medical schools to implement high standards for admission and graduation. o List of criteria that he believed to be characteristic of a PROFESSION: ▪ Intellectual (as opposed to physical) and is accompanied by a high degree of individual responsibility ▪ Is based on a body of knowledge that can be learned and is developed and refined through research ▪ Is practical, in addition to being theoretical ▪ Can be taught through a process of highly specialized professional education ▪ Has strong internal organization of members and a well-developed group consciousness ▪ Has practitioners who are motivated by altruism (the desire to help others) and who are responsive to public interests - *HALL’s* 5 Attributes of a profession : (KNOW) 6 INTRO TO NURSING FINAL STUDY GUIDE 2023 QUIZ 1. Use a professional organization as a primary point of reference 2. The Belief in the value of public service 3. Belief in self-regulation 4. Commitment to a profession that goes beyond economic incentives 5. Sense of autonomy in practice - Among different people 3 things always appear o Service, Specialized knowledge, & Autonomy (control over one’s own practice and ethics) - Occupation-Profession Continuum o Houle identified characteristics that indicate that an occupation moves along the continuum toward professional status. OccupationProfession ▪ Step 1: Defining the group’s mission and foundations of practice ▪ Step 2: Mastery of theoretical knowledge, development of the capacity to solve problems, use of practical knowledge, and self-enhancement (continued learning and development) ▪ Step 3: Development of a collective identity as an occupation evolves into a profession • Collective Identity: Connection and feeling of similarities that individuals in a group feel with one another - WYND: A study of 774 Registered Nurses- “Professionalism was significantly related to years of experience as an RN, having higher degrees, memberships in professional organizations, serving the organization of employment as an officer, and holding professional certification.” - Professionalism is different from an occupation in2 major ways: 1. Professional Preparation: Begins in college. Intense preparation enables practitioners to act in a logical, rational manner using scientific knowledge and prescribed ways of thinking through problems rather than relying on simple problem solving, custom, intuition, or trial and error. Example: nursing process 2. Professional Commitment: Personal identification is derived from the profession. Profession as a “calling.” Commitment transcends expectation of material reward. Strong professional identity – it is less common to change careers than an occupation. - Comparing Occupations & Professions **KNOW** Occupation Profession Training occurs on the job Education take place in college/university Length of training varies. Work is manual. Decision making is guided by experience or trail/error Education is prolonged. Work involved mental creativity. Decision making is based largely on theoretical constructs (evidence- based practice) Values, beliefs, & ethics are not prominent features of preparation Values, beliefs, & ethics are an integral part of preparation Commitment & personal identification vary Commitment & personal identification are strong 7 INTRO TO NURSING FINAL STUDY GUIDE 2023 QUIZ Workers are supervised Workers are autonomous People often change jobs People are unlikely to change profession Material reward is main motivation Commitment transcend material reward Accountability rests primarily with employer Accountability rests with individual - Interprofessionality o WHO: “It is no longer enough for health workers to be professional. They also need to be interprofessional.” ▪ Definition: Inter-professionality is a process by which professionals reflect on and develop ways of practicing that provides an integrated and cohesive answer to the needs of the client/family/population. - Kelly’s: 8 Characteristics of a Profession (KNOW) o 1st The services provided are vital to humanity and the welfare of society . ▪ Become a nurse to HELP people o 2ndThere is a special body of knowledge that is continually enlarged through research. ▪ Example: Evidence-based practice study proved that if we turn a patient every 2 hours it will improve blood flow, circulation, etc. o 3rd The services involve intellectual activities; individual responsibility (accountability) is a strong feature. ▪ Critical and creative thinking serves as basis for providing nursing care. Example: Nursing process ▪ ANA defines accountability is firmly rooted in the ethical principles of “fidelity (faithfulness), loyalty, veracity, beneficence, and respect for the dignity, worth, and self-determination of patients.” ▪ Accountability: Being answerable to someone for something someone has done o 4th Practitioners are educated in institutions of higher learning . ▪ 1909: University of Minnesota – first university-based nursing ▪ 1965: ANA Position Paper – All nursing education should take place in institutions of higher education. Debate: Entry level into Practice o 5th Practitioners are relatively independent and control their own policies and activities (autonomy). ▪ Autonomy – control over one’s practice. ▪ Licensure and autonomous practice ▪ Groups that control nursing practice: collective professional bodies that are the voice speaking for the interest of their professions • Organized nursing: ANA o 6th Practitioners are motivated by service (altruism) and consider their work an important component of their lives. ▪ Altruism – ideal of service to others ▪ Nurses’ altruism is sometimes questioned when they demand higher compensation and better working conditions= Collective bargaining 10 INTRO TO NURSING FINAL STUDY GUIDE 2023 QUIZ ▪ Ex impaired gas exchange, impaired mobility, alteration in comfort (nurses scope does not allow them to diagnose a patient with heart failure) - North American Nursing Diagnosis Association (NANDA): Standardized Nursing Languages o Mission: To “facilitate the development, refinement, dissemination and use of standardized nursing diagnostic terminology” with the goal to “improve the health care of all people” o 235 diagnoses approved for clinical testing - Steps In Nursing Process: Assessment, Diagnosis, Planning, Implementation (Intervention), Evaluation o Phase 1: Assessment- gather information or data about the individual, family, or community. ▪ Types of data – subjective (symptoms- comes from patient ex: pain, shortness of breath, cough) and objective (signs-ex: bowel noise present in 4 quadrants, non-productive cough, fever) ▪ Methods of collecting data – interview, physical examination (inspection (eyes), auscultation (listening), percussion (illicit certain sounds with fingers), and palpation (feeling), and consultation ▪ Organizing patient data ▪ Confidentiality of patient data and HIPAA of 1996: Federal law that protects patients’ privacy o Phase 2: Analysis & Identification of the Problem (Diagnosis) ▪ Data analysis includes validating and clustering. ▪ Nursing diagnosis – identifies the problems the patient is experiencing as a result of the disease process (not the disease process itself). Human response to illness, injury, or threat. ▪ The use of nursing diagnosis does not have universal support among various constituencies of the discipline and profession. • Critics believe that the language of nursing diagnosis obscures rather than clarifies patient problems. ▪ Diagnostic Accuracy: Effective interventions depend on an accurate diagnosis. • Paans and colleagues: found 4 domains of factors that affect nurses’ accurate documentation of diagnoses: o Nurses themselves as effective diagnosticians o How nurses are educated about nursing diagnoses o Complexity of a patient’s situation o Degree to which a hospital’s policy and environment supports the use of nursing diagnosis ▪ Writing Nursing Diagnosis: • P = Problem (NANDA-I diagnostic label ex: fluid overload) • E = Etiology (causal factors ex: what is causing fluid volume overload) 11 INTRO TO NURSING FINAL STUDY GUIDE 2023 QUIZ • S = Signs and symptoms (defining characteristics- ex: fluid volume overload related to as evidence by leg swelling, edema, etc.) ▪ Prioritizing Nursing Diagnosis • Relative danger to the patient o Life-threatening versus overall general health • Maslow’s Hierarchy of Needs o High priority needs –> Basic physiological needs • Nurses should involve patients in identifying priority diagnoses. • Socio-cultural factors must be considered in planning care. o Phase 3: Planning ▪ Bloom’s Taxonomy and domains of learning (cognitive, psychomotor, and affective domains): used to help address patient’s needs ▪ Goals should be agreed on by both nurse and patient . ▪ Goals or objectives are statements of what is to be accomplished and are derived from the diagnoses. ▪ Bloom’s Taxonomy : • (1) Psychomotor domain: Involves physical movement and increasingly complex activities in the motor-skill arena. Learning in this domain can be assessed by measures such as distance, time, and speed. (Ex: The patient will move from the bed to the chair 3 times today without assistance) • (2) Cognitive domain: Involves knowledge and intellectual skills. Cognitive skills range from simple recall to complex tasks such as synthesis and evaluation. (Ex: the patient will list 5 signs of illness in her newborn by the date of discharge) • (3) Affective domain: Involves the emotions, such as feelings, values, and attitudes. (Ex: The patient will describe feeling more accepting of new colostomy within one week of providing ostomy self-care) ▪ Goals & Outcomes • The goal begins with the words “the patient will” or “the patient will be able to.” • The goal sets a general direction, includes an action verb, and should be both attainable and realistic for the patient. • Outcome criteria define the terms under which the goal is said to be met, partially met, or unmet. o Short-term: hours-days o Long-term: over the course of a few months • Cultural congruent intervention – is developed within the broad social, cultural, and demographic context of the patient’s life. ▪ Selecting Interventions & Plans of Care • Every goal has a specific intervention, which may be carried out by a registered nurse (RN) or delegated to other members of the 12 INTRO TO NURSING FINAL STUDY GUIDE 2023 QUIZ nursing staff. 15 INTRO TO NURSING FINAL STUDY GUIDE 2023 QUIZ o Sets the minimum educational qualifications and other requirements for licensure o Determines the legal titles and abbreviations nurses may use o Provides for disciplinary action of licensees for certain causes o In many states, NPA is a statutory law affecting nursing practice within the bounds of the state - The Nurse Practice Act o Nurse Practice Act : laws written by LSBN to provide safe, competent nursing for citizens ▪ ▪ This law authorizes the LSBN to establish administrative rules and regulations to implement the Nurse Practice Act in accordance with the Administrative Procedure Act. ▪ Serves as an example of statutory law - ANA & NCSBN (National Council of State Board of Nursing) have developed suggested language for the content of state Nurse Practice Acts . - Disciplinary Theory: LSBN has complete nursing POWER o They can subpoena anything- even Governors gold pardon seal - Practice of Nursing o Requires specialize knowledge and skills: Biological sciences, Physical sciences, Behavioral sciences, Nursing science o Prohibits medical diagnosis and medical prescriptions (out of our scope) - Resume vs CV o Difference is focused on content, length, and purpose - Resume o Purposes: Gain entrée, Secure interview o Brief – one or two pages o Summarizes: Contact information, Education, Experience, Skills, Licensure and certification o Types ▪ Chronological: List in reverse chronological order, Preferred type ▪ Functional: Used when there are gaps in employment history and career changes, Focuses on skills and experience ▪ Targeted: Customized with focus on job ▪ Mini: One page, Used for networking - Curriculum Vitae (CV) o Purpose: Detailed synopsis of your credentials and expertise o Typically used for applications that are academic, educational, scientific positions, or international Conceptual & Philosophical Foundation of Professional Nursing Practice (Chp 8) - Foundation of Nursing o Person The practice of the RN and APRN is set by the Nurse Practice Act as well as other statutory laws including administrative, criminal and civil. 16 INTRO TO NURSING FINAL STUDY GUIDE 2023 QUIZ ▪ Unique, adaptable ▪ Open systems with subsystems ▪ Influenced by genetics & environment ▪ Motivated by needs ▪ Seeks homeostasis o Environment ▪ Affects well-being ▪ Physical (air, water, etc.) ▪ Nonphysical (family, culture, social structures) o Health ▪ On a continuum ▪ Dynamic ▪ Holistic ▪ Affect by health beliefs & behaviors - The best way to asses a patient’s social support system is by patients perception of their social support NOT by influence of their family members - Components of Systems o Input/raw material - 1st component- info, energy, matter entering system ▪ Nursing students, faculty o Throughput/process -2nd component ▪ Learning experiences o Output/product - end result ▪ graduates o Evaluation - mean measuring the success ▪ NCLEX o Feedback - final component ▪ First time pass rate - Implication of Systems to Nursing o Key Concepts about SYSTEMS (from book, Pg 153): ▪ A system is a set of interrelated parts ▪ The parts form a meaningful whole ▪ The whole is different from and greater than the sum of its parts ▪ Systems may be open/closed • Open: exchange • Closed: no exchange/interaction ▪ All living systems are open ▪ Systems strive for homeostasis (internal stability) ▪ Systems are part of supra-systems ▪ Systems have subsystems ▪ A change in one part of the system creates change in other parts o Subsystems o Synergy: subsystem working together o Homeostasis: internal stability 17 INTRO TO NURSING FINAL STUDY GUIDE 2023 QUIZ o Human needs - (1) Person: each individual woman, man, and child o Marslow’s Hierarchy of Needs ( KNOW): is based on several basic assumptions about human needs. One assumption is that basic needs must be at least partially satisfied before higher order needs can become relevant to the individual ▪ Physiological Needs (most basic needs) ▪ Safety needs (physical and psychological safety & security) ▪ Social needs (love and belonging) ▪ Esteem needs (self-worth, respect & reliance) ▪ Self-Actualization (max potential, peak experiences of using talents, skills & abilities). “Self-actualized people have realized their maximum potential; they use their talents, skills, abilities to the fullest extent possible and are true to their own nature” o Assumptions about needs ▪ Assumption: is all humans meet their needs in different ways ▪ Assumption: is that humans needs change and grow- adaption: people tend to regress slightly and to become more concerned with basic needs and less focus on higher needs when placed in a hospital setting ▪ Assumption: homeostasis is threatened when needs are not met (change in systems causes disruption in homeostasis) - (2) Environment: includes circumstances, influences and conditions that surround and affect individuals, families, and groups o Environmental Systems ▪ Family • Most direct environmental influence on a person is their family • Types, trends • There are more single-parent home in the US than ever before. (In the late 20th century thre was increase in single-parent homes) • As of 2008, 30% of all household were with single- parents compared to in 1980, which was 20% ▪ Cultural • Increase # of diverse groups • Ethnocentrism : making judgements (usually negative) about another culture • When communicating with a foreigner use professional translator ▪ Social • Increased illness following social change • Support, social networks (emotional support, informational support, companionship) ▪ Community, Nation, & World • Most Impact for nurses, hospitals • National, global 20 INTRO TO NURSING FINAL STUDY GUIDE 2023 QUIZ ▪ Termination Phase: activities that allow patient and nurse to end the relationship in a therapeutic manner - Key elements impacting communication & collaboration o Self-awareness: When you recognize your own emotions, prejudices, and biases ▪ is basic to effective interpersonal relationships and is especially important in the nurse-patient relationship o Professional Boundaries: Runs along a continuum of underinvolvmenthelpfulness overinvolvment o Reflective Practice: when you take time to reflect on your own thoughts, feelings, actions, and beliefs. In doing so you are also developing your self-awareness o Stereotypes o Non-judgmental acceptance: means that nurses acknowledge all patients’ rights to be who they are and to express their uniqueness (does not convey approval/disapproval of patients beliefs, habits, feelings, lifestyles) o Patient centered care: Caring is key - Communication theory o Verbal: consist of all speech and represents the most obvious aspect of communication o Nonverbal: consists of clothing, gestures, posture, facial expressions, eye contact, tone, etc. o Congruence: when verbal and nonverbal communication matches - 5 Major Elements of the Communication Process o (1) Sender: person sending message o (2) Message: what is said plus nonverbal message o (3) Receiver: person acquiring the message o (4) Feedback: a response to a message o (5) Context: the setting in which an interaction occurs - Operations in communication process  Individualized and impacted by gender, age, culture, interest, mood, value, clarity, length of message, feedback, intellect, sociocultural conditioning….very complex o Perception : the selection, organization, and interpretation of incoming signal into meaningful messages o Evaluation : the analysis of received information o Transmission : the expression of information, verbal or nonverbal. - 4 major criteria for Successful Communication o (1) Feedback: when a receiver relays to a sender the effect of the sender’s message o (2) Appropriateness: refers to the correct “fit” of a reply, and the size of the reply is neither too lengthy nor too brief o (3) Efficiency: means using simple, clear words that are timed at a pace suitable to participants o (4) Flexibility: bases messages on the immediate situation rather than preconceived expectations 21 INTRO TO NURSING FINAL STUDY GUIDE 2023 QUIZ - Communication skills: Active listening, Open posture, Empathy, Open ended questions, Giving information, Reflection, Silence, Language barriers Professionalism: Educational Levels & Roles, Socialization into Practice (Chp 4 & 5) - Development of Nursing Education in the United States o Early Studies of the Quality of Nursing Education ▪ Goldmark Report: Recommended separation of education from hospital service (bring nursing into university setting) • Increase admission standards • Strengthen collegiate nursing schools • Focused on clinical learning experience of students, establish university school of nursing, lack of funds for nursing education, lack of prepared teachers - Reports & Papers o Lysaught Report: An Abstract for Action- sponsored by Kellogg Foundation ▪ Role clarification needed for health care professionals ▪ Increased research in practice & education needed o 1985 Resolution Position Paper- sponsored by ANA ▪ By 1985, professional nurses should be prepared at baccalaureate level & technical nurses prepared at associate degree level o The NLN Position Paper: Scope & Preparation for Nursing Role- sponsored by National League for Nursing ▪ Called for baccalaureate educational preparation for professional nursing status - What is a Nurse? VN, RN, APRN, or Non-APRN (masters, doctorate) o Vocational Nurse - Licensed Practical Nurse(LPN)/Licensed Vocational Nurse(LVN) ▪ LPN/LVN license ▪ Pass NCLEX-PN o Registered Nurse (RN) ▪ RN license ▪ Pass NCLEX-RN o Advanced Practice Registered Nurse - Certified Registered Nurse Anesthetist (CRNA), Nurse Midwife, Nurse Practitioner (NP), Clinical Nurse Specialist (CNS) ▪ APRN license ▪ Pass specialty certification exam - Vocational Nurse: Educational Programs LPN/LVN License (PN scope of practice) ▪ Graduate from an approved school (Louisiana State Board of Practical Nurse Examiners) ▪ High school, vocational schools, community college, independent schools ▪ 1-1.5 years o Responsibilities ▪ Direct patient care • Bathing/feeding/certain treatments/certain medications (cannot do narcotics or blood transfusions) 22 INTRO TO NURSING FINAL STUDY GUIDE 2023 QUIZ ▪ Under the Supervision of physician or RN - Registered Nurse Diploma, ADN, BSN o All 3: diploma, ADN, BSN RN license (RN scope of practice), pass NCLEX-RN, graduation from an approved program (LSBN) o (1) Diploma: ▪ Education: 3 years w/in a SON, no college credit for SON courses ▪ Responsibilities: plans & gives direct care in structured settings: acute, long-term, ambulatory care ▪ Issues: this was the basic preparation for the “professional” nurse based on the “nightingale model” primary source of graduates until 1960s o (2) Associate Degree (ADN): ▪ Education: 2 years w/in Junior college & SON (credits apply toward BSN) • “Technical Nurse” ▪ Responsibilities: provider and manager of care: acute care, long- term care, home health care, & other community settings ▪ Issues: idea was to designate the AD nurse as “technical” and BSN nurse as “professional”- yet the distinction b/w technical and professional was never supported by nursing profession and today AD and BSN take the same licensing exam (NCLEX) to become “RN” ▪ ADN compromises majority of nurses w/in healthcare system- many hospitals are requiring/encouraging these nurses to acquire a BSN or higher degree for professional advancement o (3) Baccalaureate Degree (BSN): ▪ Education: 4 years w/in university & SON (other program credits can apply towards BSN) ▪ Responsibilities: all nursing function & supervision of care w/in a variety of environments, leadership, public/community health- health promotion, illness prevention, rehabilitation, etc, research - Articulation Programs: LPN ADN, LPNBSN, RNBSN, RNmasters o provides for direct movement from a program at 1 level to another w/o significant loss of credit o responsibility depends upon the nursing degree awarded o Issues: multiple entry & exit programs are difficult to develop, a change in 1 curriculum requires a change in all, often mandated by states for public institutions - RNBSN o Baccalaureate programs for RNs are most often offered by universities that also offer basic nursing education in baccalaureate programs o Students may be integrated in the traditional BSN program or be enrolled in a separate or partially separate program - Programs for 2nd Degree Students (CARE) 25 INTRO TO NURSING FINAL STUDY GUIDE 2023 QUIZ ▪ In most states, one component of advanced- practice licensure is certification ▪ Licensure and certification, however, are separate processes o Education ▪ Educational program granting diploma/degree ▪ Intertwined with certification and accreditation - Role Socialization o Role: A set of attitudes & behavioral expectations imposed by members of the role o Role Conflict: Occurs when a person’s role expectations conflict with value system (can’t give blood transfusion to Jehovah witnesses) o Role ambiguity: occurs when a person’s role is unclear or there are conflicting expectations o Role commitment: the end point of role socialization (individual internalizes role expectations, no longer questions the value of the role) - Profession of Nursing o TopLegally Defined (Nurse Practice Act) o Middle Professionally Defined (Standards & Codes) o BottomSocially Defined (Public Health) - Role Socialization: in order to be socialized into the profession of nursing, you need to commit to the roles and values that are foundational to nursing o The aims of nursing: promote health, prevent illness, restore health, facilitate coping o Competencies of nursing: cognitive, technical, interpersonal, ethical/legal o Values of nursing - Professional Socialization : acquire the knowledge, skills, and sense of identity that are characteristic of a profession goal (role commitment) o During this process a person acquires the knowledge, skills, and sense of identity that are characteristic of a profession o Goal of socialization is role commitment ▪ To learn the facts, skills, and theory of the profession ▪ To internalize the professional culture, goals/social mission ▪ To find a personally and professionally acceptable version of the role ▪ To integrate this professional role into all other life roles o Professional socialization means that a person thinks, behaves, and has the values of the respective profession o The influence of socialization is long-lasting o Research shows it should begin early and not to left to end of the curriculum o Required to be effective as an individual or as a member of a group o Socialization is an interactive process ▪ influenced by: prior roles and their associated values can be ingrained, preconceived ideas about the role and expected benefits, engagement in the educational experience 26 INTRO TO NURSING FINAL STUDY GUIDE 2023 QUIZ o formal experiences: lectures, assignments, labs, papers, online assignments, writing a patient care plan o informal experiences: unplanned observation (watch child birth) o Agents of socialization: faculty (school)/senior nurses(work), peers - Helen Cohen (1981)- Developmental Model Socialization Through Education o Stage I: Unilateral dependence= reliant on external authority; searches for the one right answer. Limited questioning or critical analysis (doesn’t have knowledge yet to make informed decisions) o Stage II: Negative/Independence= cognitive rebellion; less reliance on external authority. Relies more on his/her own judgment (cocky) o Stage III: Dependence/mutuality= Reasoned appraisal; beginning integration of facts and opinions. Begins to apply knowledge to practice, actively engaged in learning (independent but realize they need help) o Stage IV: Interdependence=collaborative decision making; commitment to professional role; self-concept includes professional identity (out of school process been in clinical care)- work well with others - Patricia Benner (1984) Stages of Nursing Proficiency (Basic Student Socialization) Model o Stage 1: Novice= limited background & skills, needs close supervision (soph I) o Stage 2: Advanced Beginner = Marginally competent, uses theory and principles to make decisions; tends to be task oriented (end of soph II) o Stage 3: Competent= coordinates several tasks at once; plans and sets goals; organized, uses analytic reasoning (senior) o Stage 4: Proficient= views patient holistically, recognizes subtle changes, sets priorities with ease o Stage 5: Expert= Grasps patient needs automatically; uses independent judgment, responses are integrated; decisions come naturally and quickly - From Student to Employed Nurse o New graduate nurses may have unrealistic expectations of themselves & others o Most graduate nurses quickly realized that the ideals taught in school are difficult to achieve in everyday practice o Time management skills are closely related to speed of functioning o New nurses must also adapt to collaborating with other nursing care personnel (nursing assistants, patient care technicians) and delegating duties o Physical fatigue caused by 8-12 hour shifts accompanied by strenuous physical activity (standing, walking, bending, lifting, and stooping) - Reality Shock: “Feelings of powerlessness and ineffectiveness experienced by new graduates” o Causes of Reality shock ▪ Absence of positive reinforcement (only get told when you do something wrong) ▪ Lack of Support ▪ Gap between ideals taught in school and the actual work setting 27 INTRO TO NURSING FINAL STUDY GUIDE 2023 QUIZ ▪ Inability to provide nursing care effectively 30 INTRO TO NURSING FINAL STUDY GUIDE 2023 QUIZ 3. Judicial- authority to deny, suspend, or revoke a license or to discipline a licensee or to deny an application for licensure ▪ RECALL: At both federal and state government levels, the executive branch administers and implements law. The state governor (the executive branch) delegates the responsibility for administering the NPA to the state boards of nursing. o Licensure Powers of State Boards of Nursing ▪ Types of Licensure Laws: • (1) Mandatory Law - requires any person who practices the occupation or profession to be licensed • (2) Permissive Law - protects and limits the use of the title granted in the law but does not prohibit persons from practicing the occupation/profession if they do not use the title (ex- someone could still practice nursing even if they didn’t refer to themselves as a nurse) ▪ All states have a mandatory licensure law for the practice of nursing to safeguard the public. Thus, only licensed nurses- RN or LVN/LPN- can practice nursing o State Boards of Nursing & Nursing Education ▪ The state board of nursing have the authority to set and enforce minimum criteria for nursing education criteria • An applicant for licensure must graduate from a state- approved nursing education program o Schools of nursing must have state-approval to operate. Schools seek accreditation to demonstrate that they meet higher than minimum standards o State-approvals are less stringent than national accreditation standards o Some states are undertaking rule changes to require nursing programs to have national accreditation to achieve state approval o State Boards of Nursing & Sanctions ▪ The state board of nursing has the power to sanction a nurse for performing professional functions that are dangerous to the patient or general publicprobation, suspension, revocation ▪ Most common reason for disciplining nurses: practice while under the influence of alcohol or drugs (diverted from workplace) o Rehabilitation of Nurses who are impaired by mental health issues or substance abuse ▪ ANA 1st published (1990) Nursing Disciplinary Diversion Act ▪ NCSBN then published (2015) Substance Use Disorder in Nursing • A comprehensive resource to assist with evaluation, treatment, and management of nurses with substance problem 31 INTRO TO NURSING FINAL STUDY GUIDE 2023 QUIZ ▪ Nurses misuse drugs and alcohol at approx. the same rate 10-15% as general population ▪ Goal of SBN: Return the nurse with drugs & alcohol misuse to safe practice o National Council of Licensure Examination for Registered Nurse (NCLEX-RN) ▪ The licensure exam is updated regularly and test critical thinking and nursing competence in all phases of nursing process ▪ Computerized adaptive testing: Min # of quest: 75, Max # of quest: 265, Duration: 6 hours o Licensure by Endorsement ▪ Endorsement : the RN may practice in different states w/o having to take another licensing exam ▪ Requirements: • Proof of licensure in another state • Licensure fee o Nurse Licensure Compact (NLC): A Mutual Recognition Model of Licensure ▪ NCSBN (2000) developed the nurse licensure compact • 2015: NLC has been adopted by 24 states (LA is one of them) o 6 states (IL, MA, MN, NJ, NY, OK) with pending legislation o 1 state (MT) has enacted but implementation is pending ▪ Each state that wishes to participate in the compact must pass legislation enabling the board of nursing to enter into the interstate NLC ▪ NCL allows a RN to have 1 license (in state of residency) yet practice in other compact states w/o an additional license in the state employment. Nurse subject to rules and regs of state current practicing • Concomitant reduction of state barriers • Better protection for the public o Nurse tracking o Information sharing ▪ Nurses licensed in a compact state can practice in their own state and in any other compact state without applying for licensure by endorsement ▪ A nurse, who is licensed in a compact state and changes permanent resident, may practice under the license from former state of residence for up to 90 days ▪ 2005: NCSBN began administering licensure exams internationally to recruit nurses from outside the US - Legal Risks in Professional Nursing Practice o 4 Elements of A Cause of Action for Negligence: 1. The professional (nurse) has assumed the duty of care (responsibility for the patient’s care)- Duty has to be established 2. The professional (nurse) breached the duty of care by failing to meet the standard of care- breach of duty must occur 3. The failure of professional (nurse) to meet the standard of care was the proximate cause of the injury- causation 32 INTRO TO NURSING FINAL STUDY GUIDE 2023 QUIZ 4. The injury is proved- resulting damages o Negligence is the central issue in malpractice. It is the failure to act as reasonably prudent person would have acted in the same circumstances o Malpractice: Is negligence applied to the acts of a professional (malpractice=professional negligence) ▪ may occur in 2 ways: (1) commission- doing something that should not have been done (2) omission- failing to do things that should have been done o Nurse gives aspirin instead of Tylenol and patient becomes injured what form or malpractice? (select all) ▪ The nurse did not meet standard of care and this leads to causation o Croke (2003)- review of 350 trail, appellate, and supreme court cases summaries ▪ Criteria: • A nurse was engaged in the practice of nursing as defined by his or her state’s NPA • A nurse was defendant in a civil lawsuit as the result of an unintentional action (no criminal cases were considered) • A trial was held b/w 1995-2001 • 60% occurred in acute care hospitals • 6 major categories of negligence resulted in malpractice lawsuits against nurses (Pg 112 Box 6-3): Failure to (1) follow standards of care (2) use equipment in a responsible manner (3) communicate (4) document (5) assess and monitor (6) act as a patient advocate - an estimated 80% of serious medical errors involve miscommunication between caregivers during the transfer of patients - SBAR : The joint commission has standardized health care communication w/in and across disciplines thru SBAR. 1st developed by US Navy. Used to decrease the # of sentinel events *SBAR will be on TEST* Look at Example in book (Pg 248) o S ituation ▪ Identify the person to whom you are speaking ▪ Identify yourself, occupation, & where you are calling from ▪ Identify the patient by name and reason for admission ▪ Identify what is going on with the patient (chest pain, nausea, etc) o B ackground ▪ Give the patient’s presenting complaint ▪ Give the patient’s relevant past medical history ▪ Brief summary of background o A ssessment ▪ Vital signs: HR, respiratory rate, BP, temp, oxygen saturation, pain scale, levels of consciousness ▪ List if any vital signs are outside of parameters: what is your clinical impression ▪ Severity of patient, additional concern 35 INTRO TO NURSING FINAL STUDY GUIDE 2023 QUIZ 2. Right Circumstances : Is delegation appropriate in this case? Consider the patient’s health status, care delivery setting, complexity of the activity and 36 INTRO TO NURSING FINAL STUDY GUIDE 2023 QUIZ delegates competency, and available resources, and determine any other relevant factors 3. Right Person : Can the nurse verify that the person delegated to do the task is competent to complete this task? 4. Right Direction/Communication : has the RN given clear, specific instruction? These include identifying the patient clearly, the objective of the task time frames and expected results 5. Right Supervision/Evaluation : can the RN or other licensed nurse provide supervision and evaluation of the patient and the performance of the task? - Informed Consent : is a full knowing authorization by the patient for care, treatment, and procedures and must include the risks, benefits, side effects, cost and alternatives. In the state of Louisiana a nurse CANNOT obtain an informed consent for a medical procedure or the administration of blood. o 3 major condition of informed consent: 1. Consent must be given voluntarily 2. Consent must be given by an individual with the capacity and competence to understand 3. The patient must be given enough information - Elements of Informed Consent to be Legally Valid o Completeness refers to the quality of information provided o Competency takes into account the capability of a particular patient to understand the information given to make a choice o Voluntariness refers to the freedom the patient has to accept/reject alternatives ▪ Autonomy ▪ Minors, under the effects of drugs and alcohol, mental deficits, and competency to consent - Informed Consent and the Role of the Nurse o Unless primary providers, nurses collaborate with the primary provider o A nurse may witness a patient’s signing but is NOT responsible for explaining the proposed treatment o The nurse is not responsible for evaluating whether the physician has truly explained the significant risks, benefits, and alternative treatments o The nurse is responsible for determining that the elements for valid consent are in place, providing feedback if the patient wishes to change consent, and communicating the patient’s need for further info to the primary provider - Confidentiality - legal and ethical concern. Protection of private information gathered about a patient during provision of care o The Code of Ethics for Nurses Provision 3.1 states that: “...the nurse has a duty to maintain confidentially of all patient information, both personal & clinical in the work setting and off duty in all venues, including social media and other means of communication… Nurses are responsible for providing accurate, relevant data to members of the health care team and others who have a need to know” (ANA, 2015) 37 INTRO TO NURSING FINAL STUDY GUIDE 2023 QUIZ o The code acknowledges exception to the obligation of confidentiality 40 INTRO TO NURSING FINAL STUDY GUIDE 2023 QUIZ ▪ Threatened someone who doesn’t taking medicine by telling them ou will give them a shot o Battery is the assault carried out; the impermissible, unprivileged touching of one person by another. - Evolving Legal Issues Affecting Nursing o Role changes ▪ NPA is updated periodically (to accurately reflect current nursing practice) ▪ Support the work of professional organizations to advocate for the profession of nursing ▪ Legal nurse consult ▪ Prescriptive authority : legal acknowledgement of prescription writing as appropriate act of nursing practice. Supported by the ANA and American Academy of Nurse Practitioners • Generalist nurses: must know from whom they can accept medication prescriptions • Advanced practice nurses: must stay within their legal scope of practice o Supervision of UAP (nurse tech, EKG tech,CNA, etc) ▪ UAP are being used in place of RNs, increasing risk for patient injury ▪ NCSBN and National Nurse Aide Assessment Program • A test of both cognitive and skill performance to certify nurse aid competency ▪ NCSBN: Medication Aide Certification Examination (MACE) • Certifies competency in administration of simple medications by UAP o Regardless of UAP, it remains the responsibility of professional nurses to know limitations of the particular assistive personal under their supervision o Payment mechanisms ▪ 1997 Balance Budget Act and advanced practice nurse reimbursement • Authorized Nurse Practitioners and clinical specialists to bill the Medicare program DIRECTLY for nursing services furnished in any setting ▪ 2010 Patient Protection and Affordable Care Act (ACA ) • Increasing quality, availability, and affordability of health insurance • Brought healthcare inequities, high costs, and poor access to preventative care into the spotlight - Patient Self-Determination Act (PSDA) o Encourages patients to consider and document life-prolonging treatment options they desire and to document their preferences in case they should later become incapable of participation in the decision-making process ▪ Advance Directives (AD): written instructions that describe preferences should the individual become incapacitated 41 INTRO TO NURSING FINAL STUDY GUIDE 2023 QUIZ ▪ PSDA basic assumption: each person has legal and moral rights to informed consent about medical treatments with a focus on person’s right to choose (the ethical principle of autonomy) o The Act does not create any new rights and no patient is require to execute an advance directive o PSDA applies to acute care & long-term facilities, these facilities must: ▪ (1) Provide written information to all adult patients about their rights under state law ▪ (2) Ensure institutional compliance with state laws on advance directives ▪ (3) Provide for education of staff and the community on advance directives ▪ (4) Document in the medical record whether the patient has an advance directive o Agency for Health Care Policy Research : found advance directives (AD) were not guiding end-of-life care due to several factors: 1. The patients were not considered hopelessly ill; 2. The family members were not available, were too overwhelmed to implement the patient’s wishes, or disagreed with the patient’s wishes; and the advance directive itself was not specific enough or did not cover pertinent clinical issues - Strategies to Limit the Possibility of Legal Action (Protect yourself from legal action) o (1) Practice in safe setting ▪ Qualities of Safe Agencies : ▪ Risk Management : ▪ The Joint Commission & 2005 Patient Safety Goals : these goals identify significant ways in which patient safety can be enhanced thru environmental, educational, practice, and policy changes (have to have 2 identifies to make sure it is right patient: name & DOB) o (2) Communicate with other Health professionals, Patients, and Families ▪ Keeping good patient records/medical records/electronic health record • Written form of communication is called documentation o (3) Meet the Standard of Care ▪ The most important protective strategy for the nurse is to be a knowledgeable and safe practiti`oner and to meet the standard of care with all patients ▪ The best protection a nurse can have is to know the limits of his/her own education & expertise and the provision of the nurse practice act. o (4) Carry and Understand Professional Liability Insurance ▪ Professional liability insurance cover up to $2 mill for single incident and $4 mill total ▪ 2 types of professional liability insurance policies: • (1) Occurrence Policies- covers injuries that occur during the period covered by the policy, whether or not the policy is still in effect at the time the suit is brought (as long as you were covered when incident 42 INTRO TO NURSING FINAL STUDY GUIDE 2023 QUIZ occurred you are fine- if claim is made later on and you do not have insurance anymore they will still cover) • (2) Claims-Made policies- cover injuries only if the injury occurs within the policy period and the claim is reported to the insurance company during the policy period or during the “tail.” A tail is an uninterrupted extension of the policy period and is also known as the extending reporting endorsement. (will only cover you if you still hold insurance policy even if claim is made later on, must still have insurance policy) o (5) Promote Positive Interpersonal Relationships ▪ The professional nurse who is clinically competent and caring, communicates openly with patients, and acknowledges the holism of the patient is likely to prevent most legal problems - 4 Elements of Negligence: (1) Duty Established, (2) Duty Breached, (3) Causation, (4) Damages/Injuries - Guidelines for Preventing Legal Problems in Nursing Practice (Pg 123 Box 6-9) o Practice safely in a safe setting o Communicate with other health professionals, patients, and- with the patient’s permission- family members. Document fully, carefully, and in a timely manner o Delegate wisely, remembering the “five rights” of delegation o Meet or exceed the standard of care by staying on top of new developments and skills o Carry professional liability insurance, and known the specifics of the policy o Promote positive interpersonal relationships and a non-defensive manner while practicing compassionate, holistic nursing care Nursing Theory: The Basis of Professional Nursing (Chp 9) EXAM 2 QUESTIONS will come DIRECTLY from PPWs for this lecture (9 & 10) (don’t worry about book)- she uses her PPW to make test questions - Why is Theory Important? o Nursing as a profession is strengthened when nursing knowledge is built on sound theory o Nursing has knowledge that is distinct from other disciplines o Theory is a useful tool for reasoning, critical thinking, and decision making - Theory o Guides the professional nurse: 1. Clinical judgments based on evidence a. Determining which data are important b. Organizing, analyzing, and understanding connections in patient data 2. Planning appropriate nursing interventions 3. Evaluating outcomes of interventions o Nursing Theory ▪ Nursing as profession has a distinct theoretical orientation to practice ▪ New theories ALWAYS being generated, although some useful for many years ▪ When new knowledge becomes available, theories that are no longer useful are modified or discarded 45 INTRO TO NURSING FINAL STUDY GUIDE 2023 QUIZ the patient’s self-care deficit, which is the extent to which a patient is incapable of providing effective self-care. 46 INTRO TO NURSING FINAL STUDY GUIDE 2023 QUIZ ▪ Orem formalized three interrelated theories: • (1) Theory of self-care: describes self-care in contrast to other forms of self-care • (2) Theory of self-care deficit: central idea of why ppl need nursing • (3) Theory of nursing system: product of nursing, establishing structure and content for nursing practice in nursing role o Appropriate care for the patient is developed through a series of 3 operations: ▪ (1) Diagnostic- Establishment of the nurse-patient relationship. Assessment of patient’s baseline ability to provide adequate self- care ▪ (2) Prescriptive - occur when therapeutic self-care requisites (based on deficits) are determined and the nurse reviews various methods, actions, and priorities with the patient ▪ (3) Regulatory - the nurse designs, plans, and produces a system for care 2. King’s Interacting Systems Framework & Theory of Goal Attainment o The theory focused on people, their interpersonal relationships, & social contexts w/ 3 interacting systems: (1) personal, (2) interpersonal, and (3) social. ▪ W/in these 3 systems, she identified concepts that provide a conceptual structure describing the processes in each system. o The theory provides a view of people from the perspective of their interactions with other people at three levels of interacting systems. ▪ (1) Personal system identifies concepts that provide an understanding of individuals personally, and intrapersonally (within the person) ▪ (2) Interpersonal system deals with interactions and transactions between two or more people ▪ (3) Social system presents concepts that consider social contacts, such as those at school, at work, or in social settings. o The King nurse is guided by concepts at the system levels: ▪ (1) Personal system leads the nurse to pay close attention to the patient’s perceptions. ▪ (2) Interpersonal system guides the nurse to explore the patient’s roles and the stresses in each role. ▪ (3) Social system cues the nurse to consider influences on the patient’s decision making. o The theory emphasized the importance of goal setting by the nurse and the patient (mutuality). The goal of nursing is gaining or regaining health. 3. Roy’s Adaptation Model o The model provides a comprehensive understanding of nursing from the perspective of adaptation. ▪ When demands of environmental stimuli are too high or the person’s adaptive mechanisms are too low, the person’s behavioral responses are ineffective for coping. ▪ Nursing promotes patient’s adaptation and coping (Phillips, 2002). ▪ Effective adaptive responses- promote integrity of the individual by conserving energy and promoting the survival, growth, reproduction and mastery of the human system ▪ Nursing promotes adaption and coping with progress towards adaptation as the goal o The Roy nurse focuses on adaptation of the patient and on the 47 INTRO TO NURSING FINAL STUDY GUIDE 2023 QUIZ environment. 50 INTRO TO NURSING FINAL STUDY GUIDE 2023 QUIZ • when nurses intentionally structure their practice around a particular nursing theory and use it to guide them as they use the nursing process to assess, plan, diagnose, intervene, and evaluate nursing care. ▪ Benefits of Theory-Based Practice • (1) It shapes theoretical orientation to practice. • (2) It facilitates the transmission of nursing knowledge. • (3) It contributes to professional autonomy. It is a nursing- based guide for practice, education, and research. • (4) It helps develop analytical skills, challenges thinking, and clarifies values and assumptions. o (3) Theory- Based Research ▪ Nursing research tests and refines the knowledge base of nursing. • Research findings enable nurses to improve the quality of care and understand how evidence-based practice influences improved patient outcomes. *Practice Question: WILL BE ON TEST* - During a home visit, a nurse assesses the client and attempts to identify factors that prevent attainment of client’s ability to comply with treatment regimen. The nurse most likely uses o King’s interacting systems framework o Orem’s self-care model o Roy’s adaptation model o Watson’s philosophy The Science of Nursing & Evidence Based Practice (Chp 10) EXAM 2 QUESTIONS will come DIRECTLY from PPWs for this lecture (9 & 10) (don’t worry about book)- she uses her PPW to make test questions - Nursing Research : Systematic investigation of phenomena related to improving patient care. o Ideas for nursing research often arise from nurses’ clinical observations. o Although a research topic may be new and innovative, much can be gained from choosing research problems that are connected to work already done, thereby building the body of knowledge of nursing. - Evidence-Based Practice (EBP) o Approach to the delivery of health care that “integrates the best evidence from [research] studies and patient care data with clinician expertise and patient preferences and values” o Awareness of research that supports specific interventions o Basing one’s practice on published work or reliable texts is an element of critical thinking and a good means of improving clinical judgment. o Focuses on patients’ responses amenable to nursing care. ▪ Ex- turning patient, b/c improves circulation and decreases chance of pressure ulcers • Doing this b/c someone did a study and saw that when turning patient improves circulation and prevents pressure ulcers - Sigma Theta Tau International Honor Society of Nursing 51 INTRO TO NURSING FINAL STUDY GUIDE 2023 QUIZ o Leader in the development and dissemination of knowledge to improve nursing practice o Supports the development and implementation of evidence-based nursing (EBN) o The society defines EBN as an integration of the best evidence available, nursing expertise, and the values and preferences of the individuals, families, and communities who are served. o Optimal nursing care is provided when nurses and health care decision- makers have access to a synthesis of the latest research, a consensus of expert opinion, and are thus able to exercise their judgment as they plan and provide care that takes into account cultural and personal values and preferences. o This approach to nursing care bridges the gap between the best evidence available and the most appropriate nursing care of individuals, groups, and populations with varied needs. o Works closely with key partners o Provide information to support nursing research and EBN around the world o Leading source of information on EBN with an integrated cluster of resources, products, and services o Foster optimal nursing care globally o Provide nurses with the most current and comprehensive resources to translate the best evidence into the best nursing research, education, administration, policy, and practice - The Relationship of Research to Theory & Practice o Relationships among nursing research, practice, and theory are circular. o Research ideas are generated from 3 sources: ▪ (1) clinical practice ▪ (2) literature ▪ (3) theory - Advancing the Profession Through the Use of Research o The ANA’s Code of Ethics, Provision 7.3, states: ▪ “The nursing profession should engage in scholarly inquiry to identify, evaluate, refine, and expand the body of knowledge that forms the foundation of its discipline and practice. … ▪ ..All nurses working alone or in collaboration with others can participate in the advancement of the profession through the development, evaluation, dissemination, and application of knowledge in practice.” ▪ ^^ don’t memorize Ethics (Chp 7) Test questions: Who wrote code of ethics? ANA (it is the governing body) # of provisions of code of ethics? 9 Provisions 1-3 about fundamental values and commitments nurses assume Provisions 4-6 address duty and loyalty Provisions 7-9 address duties beyond individual patients Informed consent came out to protect research subject - Introduction to ethics 52 INTRO TO NURSING FINAL STUDY GUIDE 2023 QUIZ o Attitude viewpoint, outlook o Belief  Idea accepted as true o Value Belief that acts as a standard for behavior o Morals Personal Standards of right/wrong o Ethics Systematic study of right/wrong - The law represents minimum standard of ethics - Ethics o The study of rational processes for determining the best course of action in the face of conflicting choices o Application of ethical principles in decision making serves to protect the rights of the individual o Process oriented and involved critical analysis of actions - Entry into a profession o Marked by a public/ceremonial occasion o The professional nurse makes promise to society (we will do this at graduation) ▪ Responsibilities and obligations to those they serve o For the professional nurse, action is not based on personal preference; there is a duty to act ▪ Ethical code provides internal control for the profession & censure of members who act unethically - ANA Code of Ethics (Adorno is obsessed with code of ethics) o Code of ethics timeline: ▪ 1893 The “Nightingale Pledge” is understood as the first nursing code of ethics ▪ 1950 First code adopted by ANA House of Delegates ▪ 1976 modern code written ▪ 1985 the interpretative statements were added, emphasizing the contract between nursing and clients ▪ 2015 revision o The code of ethics is: ▪ Mandatory for the professional nurse ▪ Not an answer to every dilemma guide/framework ▪ Standards (NOT laws) that are not negotiable o Personal and professional values must be integrated (5.3)-Wholeness of Character o Ethical decision making is not a personal choice but an obligation of the professional nurse (5.4)-Preservation of Integrity ▪ Nurses must examine personal values to understand how they fit into the professional code ▪ Understanding our own values is central to the study of ethics o Though NOT law - failure to uphold can result in censure or reprimand - Values & Nursing: “Caring, the basis of good nursing, depends on you knowing more about who you are…because we cannot help other people until we are a bit clearer about ourselves” Bernard, 1992 55 INTRO TO NURSING FINAL STUDY GUIDE 2023 QUIZ ▪ Whenever there is a conflict between the duty and the utilitarian principle, the duty loses its justification - Ethical Dilemma o An individual is compelled to choose between actions ▪ 2 or more moral principles apply but support mutually inconsistent courses of action ▪ Both actions are reasonably justified as “good” ▪ Neither action is readily justified as “good” ▪ The “goodness” of the action is uncertain - Ethical Approaches o (1) Principle-based approach : Combines elements of Deontology and Utilitarianism o (2) Care-based approach : Stresses the centrality of the nurse patient relationship o (3) Feminist approach : Rights and needs of marginalized groups - ANA Code of Ethics: When making clinical judgments, nurses base their decisions on the Code of Ethics o Obligations, values, ideals ▪ Respect for persons: Autonomy, Beneficence, Nonmaleficence, Justice, Fidelity, Veracity, & Confidentiality ▪ Respect for Persons: Considered by as the fundamental principle underlying nursing practice (1.1) - Ethical Principles Pg 134 o (1) Autonomy- ▪ Control over one’s own life ▪ Right to self-determine a course of action ▪ Uniqueness of the individual ▪ Always from patient’s viewpoint ▪ Capacity Individual’s values/goals, communicate and understand info, reason and deliberate about choices ▪ Voluntariness free from coercion ▪ Adequate Information  must be in form patient can use ▪ There are variations in a person’s capacity to make decisions ▪ The ability to use information is acquired gradually in life and can be lost partially or completely, temporarily, or permanently ▪ Ex- Advance Directive- patient chooses end-of-life care o (2) Beneficence- ▪ “Doing of good” ▪ Beneficent acts often conflict with autonomy ▪ Benefit vs Harm: • In nursing there is a constant balancing act with harm and benefit o Preforming some actions may have 2 potential outcomes o Intended effects – Possible adverse effects ▪ But remember autonomy 56 INTRO TO NURSING FINAL STUDY GUIDE 2023 QUIZ • We may know the "medical" benefit vs. harm but only the patient can know the value of these (and remains in a position of self- determination) ▪ Beneficence is a continuum with nonmaleficence o (3) Nonmaleficence- ▪ Duty to do no harm (Hippocratic Oath) • Classic issue to do no harm yet: chemotherapy, bone marrow/stem cell transplant ▪ the concept that justifies risking harm is referred to as “double effect ” • it considers intended foreseen effect, stating that it is okay to produce distressful/undesirable result if intent it produce overall good effect ▪ Relating to patients in ways that will promote health, relieve unnecessary pain and suffering, and prolong life o (4) Justice- ▪ Ex- who to prioritize when you have lots of critically ill patients who need care ▪ Ex-patients with same diagnosis and healthcare needs should receive the same care and those with greater/lesser needs should receive appropriate care for their needs ▪ Ex- is health a right or priveldge ▪ Fairness: Equitable distribution of benefits and burdens ▪ Frameworks for distribution of health care resources, which should it be based on: Merit, Societal contribution, Contribution in the free market, Needs, Least advantaged ▪ Hurricane Katrina- doctors and nurses gave lethal doses of morphine to patients o (5) Fidelity- ▪ Fidelity is faithfulness to the nurse-patient contract (keeping promises) ▪ Fidelity requires that nurses keep promises made to patients ▪ Trust is the cornerstone of the nurse patient relationship ▪ All clinicians must understand and remain within the constraints of their professional practice act (think she meant NPA here…) ▪ Honor the standard of care ▪ Ex- nurse’s failure to carry out prescribed care (patient abdomen or neglect) ▪ Hurricane Katrina- Nurses who decided to stay home instead of going to hospital o (6) Veracity- ▪ Telling the truth, not lying ▪ Ex- some limits on what a nurse can tell a patient. Sometimes having to withhold the truth ▪ It can be hard to know what the truth is • Information may be new, preliminary, and uncertain 57 INTRO TO NURSING FINAL STUDY GUIDE 2023 QUIZ ▪ Protect the patient ▪ Paternalism: occurs when a nurse relates to patient as though they were a child or assumes the duty of a parent ▪ 2 exceptions to withholding: • When the patient asks not to be told • Patient is mentally incompetent ▪ When the family asks not to tellWith whom is the contract? • Not ethical (not an exception) o (7) Confidentiality- (Adorno’s extra principle) ▪ Respecting privileged information (data) ▪ How information will be handled, managed, disseminated ▪ In ethical discussions – includes the patient's privacy (people) • Conversations are private ▪ Ex: with mother who does not tell anyone she is giving baby up for adoption so she can keep baby in room - what ethical principle is a continuum and weighs the benefit and harm? o Beneficence/non-maleficence- relating to patients in ways that will promote health, relieve unnecessary pain and suffering, and prolong life - Sometimes doing no harm and performing certain action may have what? o 2 options - Box 7-2: The Florence Nightingale Pledge (Pg 138) not in notes, from BOOK o I solemnly pledge myself before God and presence of this assembly; to pass my life in purity and to practice my profession faithfully (Fidelity) o I will abstain from whatever is deleterious and mischievous and will not take or knowingly administer any harmful drug (Nonmaleficence) o I will do all in my power to maintain and elevate the standard of my profession (beneficence) and will hold in confidence all personal matters committed to my keeping and family affairs coming to my knowledge in the practice of my calling (confidentiality) o With loyalty will I endeavor to aid the physician in his work (fidelity), and devote myself to the welfare of those committed to my care (justice) ANA Code of Ethics : o Enduring Statement for the ethical core of nursing o o o The “values and obligations expressed in this Code apply to all nurses in all roles and settings" o Non-negotiable o Can only be revised or amended by ANA o Scope and Standards of Practice: Standard 7 – Ethics states, “the registered nurse practices ethically” & uses code of ethics to guide practice ▪ Uses the Code of Ethics to guide practice. o LA Nurse Practice Act: §3915 Standard Number 7 : Professional Performance Framework for decision-making The ethical standard for - 60 INTRO TO NURSING FINAL STUDY GUIDE 2023 QUIZ nurses and the public”  WILL BE QUESTION ON EXAM- know all 4 GOALS 61 INTRO TO NURSING FINAL STUDY GUIDE 2023 QUIZ ^was not on exam 2 but may be on final - Nurses and Unions o Nurses may choose to join unions to: (1) Work collectively, (2) Have control over their practice and workplace, (3) Work to equalize power between management and staff o Unions are defined by rules and regulations under National Labor Act and overseen by National Labor Relations Board o National Nurses United (NNU)- if an affiliation of collective bargaining organizations o Issues in contract negotiations: staffing, work assignments, and shared governance o Nurses wonder whether they should join unions. ▪ Closed shop – the management is required to bargain with the union and union membership is required as a condition of employment. ▪ Open shop – employees are not required to join but in which an individual’s contract will be dependent on what the union and management have negotiated. ▪ “Right to work” states – the value system of work culture is less supportive of union affiliation. - Benefits of Joining a Professional Organization o (1) Developing leadership skills : o (2) Certification and Continuing Education : o (3) Political activism : o (4) Practice Guidelines & Position Statements : ▪ ANA has positions on blood-borne and airborne diseases ▪ ANA Code of Ethics for Nurses (2015): code serves as an ethical standard for all practicing nurses, whether they are ANA members or not, and is therefore of critical importance o (5) Other benefits include: Access to journals, newsletters, and action alerts about particular topics that need immediate response, eligibility for group health and life insurance, networking with peers, continuing education opportunities, and discounts on products and services (car rentals, computers, or books) o (6) Deciding which organizations to join: visit organizations website - How Policy Influences Nursing Practice o Nursing organizations influence legislators to change state nursing practice acts to reflect what nurses are qualified to do o Regulations are developed to guide the implementation of legislation o Laws define nursing practice : Periodic need to influence lawmakers to modify the nurse practice act to reflect current clinical practice (NPs reimbursement, autonomy, and prescription writing), FDA sets rules for administering and documenting the administration of narcotics, Need to influence legislators regarding broader issues like pay equity, staffing ratios, etc. - Becoming Active in Politics o “Personalize the political process” ▪ Women involved in the feminist movement in 1960s coined the phrase “The personal is political” 62 INTRO TO NURSING FINAL STUDY GUIDE 2023 QUIZ ▪ Resulted in people becoming involved in the political process 65 INTRO TO NURSING FINAL STUDY GUIDE 2023 QUIZ dangerous 66 INTRO TO NURSING FINAL STUDY GUIDE 2023 QUIZ - Genetics & Genomics o 2003: Human Genome Project – initial mapping and sequencing of a composite set of human genes o Pharmacogenetics - genetic variants that affect drug metabolism help determine correct drug dosing - (4) Final Challenge: Unite and Act o Collaborative power of nurses o Powerful voice and presence as the largest health care profession o Tolerance of differences and search for common ground o ANA Nursing Agenda for the Future – four beliefs o Margaret Mead: “Never believe that a few caring people can’t change the world. For indeed, that’s all who ever have.” - Four Basic Beliefs (based on ANA Nursing’s Agenda for the Future) 1) Health care is a basic human right , and universal access to a standard package of essential health care services should be provided to all citizens and residents. 2) The development and implementation of health policies should aim for safe, effective, patient-centered, timely, efficient, and equitable care based on outcomes research. 3) The health care system must turn away from the overuse of expensive, technology- driven, acute, hospital-based services and turn toward a more balanced system with emphasis on community-based and preventive services . 4) A single-payer system is the most desirable option for financing a reformed health care system (ANA, 2008). Practice Question: What strategy is considered in keeping with the American Nurses Association (ANA) beliefs on the future of nursing?  Use outcomes research to develop policies Mandatory Requirements - EACH STUDENT IS RESPONSIBLE FOR THEIR ON MANDATORY REQUIREMENTS - ALL REQUIREMENTS MUST BE COMPLETED BY AUGUST 2019 TO PARTICIPATE IN FALL CLINICALS - STUDENTS THAT ARE NON-COMPLIANT STUDENTS WILL HAVE TO DROP ALL THREE COURSES FOR FOUNDATIONS - NO EXCEPTIONS! - How to become compliant: o Positive titers (+ titer) o What is a Titer? ▪ the strength of a solution or the concentration of a substance in solution as determined by titration ▪ It determines if you are immune to measles, mumps and rubella. ▪ It must be in a # w/in a range Results: 145 IgG (range 135-155) - How in my titer measure? o Documented proof of: IgG quantitative serum titer results, a numerical value indicating actual immunity to a disease(s) o IgM is not accepted - What titers must be positive? o MMR – must have number range 67 INTRO TO NURSING FINAL STUDY GUIDE 2023 QUIZ o Varicella – must have number range o Hep B AB – must have number range - What if my titer is negative? o You will require booster shots! o Then another titer drawn! (+) Measles titer; (-) Measles titer requires two (2) vaccinations, at least 28 days apart (+) Mumps titer; (-) Mumps titer requires two (2) vaccinations, at least 28 days apart (+) Rubella titer; (-) Rubella titer requires two (2) vaccinations, at least 28 days apart (+) Varicella titer; (-) Varicella titer requires two (2) vaccinations, at 4 – 8 weeks apart (+) Hepatitis titer; (-) Hepatitis titer requires three (3) vaccinations at 0, 1, and 6 months - Repeat IgG quantitative serum titer - YOU MUST HAVE A + TITER TO CLINICALS - Additional Info o A negative Tb that CANNOT expire during the semester. o TDP within the last 10 years. o Current Flu once a year o Meningococcal vaccine 1 st and 2nd vaccination if before age 16 or one (1) vaccination after age 21 o Physical Examination o Personal Health Insurance Submit annually or every two years; depending on company/coverage Copy of front and back of card o Louisiana Registered Nurse (RN) License Submit annually or every two years Screenshot of LSBN Renewal of License o Health Cover Letter Student to sign letter sent by Student Health Services on healthcare requirements Letter must be signed and dated by student at the bottom of the letter o BLS – current o Personal Liability Insurance o Background check o Urine Drug Screen o Needle stick/Splatter coverage o Compliance training - Everything gets sent to Castlebranch - You must be CLEARED! o It only goes in Castlebranch – Castlebranch does not clear you! o LSU clears you – you must receive verification of clearance via email from Ms. Cheryl Richardson and Dr. Barrier Nurses, Patients, & Families: Caring at the Intersection of Health, Illness, & Culture (Chp 13) - Introduction o Systems Theory – a change in one part of the system results in changes in other parts Ex: Family as a system. A change in one member affects the other members. o Nursing supports health, manages illness, and addresses complex changes and human responses to illness. - Illness is a highly personal experience. Culture plays a significant role in health beliefs and behaviors 70 INTRO TO NURSING FINAL STUDY GUIDE 2023 QUIZ o Dependence and Independence, Coping Ability, Resourcefulness, Resilience, Spirituality/Religion 71 INTRO TO NURSING FINAL STUDY GUIDE 2023 QUIZ o (Benson and Klipper , 2000) Relaxation-response therapy, positive coping strategies, physical activity, good nutrition, and social support (2015). ▪ Dr. Herbert Benson originated the “relaxation-response” therapy to reduce stress in patients with hypertension, chronic pain, and other stress-related illnesses. ▪ Many people use prayer as part of the relaxation response o Meeting the Spiritual Needs (why would a nurse be uncomfortable dealing with spitiual distress?) ▪ Nurses are reluctant to provide spiritual nursing care because they may have • Feelings of inadequacy, Lack of knowledge, Embarrassment, Spiritual uncertainty, Lack of preparation, Lack of privacy, Lack of time, or Failure to see it as a nursing role ▪ Spirituality where do I find meaning?, How do I feel connected? How should I live? ▪ Religion What practices, rights, or rituals should I follow?, what is right/wrong, what is T/F? ▪ When Spirituality & Religion meet belief, comfort, reflection, ethics, awe o Resilience is thought to be a result of: 1) Disposition (i.e., temperament, personality, overall health and appearance, and cognitive style) 2) Family influences (e.g. warmth, support, and organization) 3) Outside support factors, such as a supportive network and success in school or work ▪ Resilience can be developed over the lifetime. It can be taught, modeled, and learned. o Spiritual distress – “impaired ability to experience and integrate meaning and purpose in life through connectedness with self, others, art, music, literature, nature, and/or a power greater than oneself” ▪ Nurses with strong religious faith ▪ Proselytizing - External Influence on Illness Behavior o Past experiences o Culture: It is a pattern of learned behavior and values that are reinforced through social interactions, shared by members of a particular group, and transmitted from one generation to the next - Cultural Competence : It is having the attitudes, knowledge, and skills necessary for providing quality care to diverse populations (AACN, 2008). o It focuses on patient-specific needs shaped by culture. o The culturally competent nurse is more likely attuned to health disparities . o The “non-compliant” patient and the need to understand the patient’s perception of illness (not all patients understand the illness) - Culture and Nursing 72 INTRO TO NURSING FINAL STUDY GUIDE 2023 QUIZ o Transcultural nursing o Cultural shifts in the population o Nursing Implication: Nurses need to deal more effectively with commonalities and differences in patients and Health care disparities o The Joint Commission and revised standards to incorporate diversity, culture, language, and health literacy issues in patient care processes. - Diversity - The Culturally Competent Nurse o Nursing demographic: The nation is more racially diverse than the nursing workforce. o The Joint Commission and The California Endowment: One Size Does Not Fit All: Meeting the Health Care Needs of Diverse Populations. o Cultural competence – guides the nurse in understanding behaviors and planning appropriate approaches to patient needs. ▪ Conversely, culture will guide the patient’s response to health care providers and their interventions. o When nurses work with patients from a culture different from their own, they lack these familiar guidelines for predicting behavior. ▪ This can cause anxiety, frustration, and feelings of distrust in both patient and nurse. ▪ Issues that arise: stereotyping, communication difficulties, misperceptions about personal space, differing values and role expectations, ethno-pharmacologic considerations, and ethnocentrism o Care Issues associated with Culture: Stereotyping refers to prejudgments about patients from different cultures. ▪ Cultural conditioning – people are culture-bound. They are unconscious of their innate values and beliefs. ▪ Nurses are also culturally conditioned. They hold their knowledge and beliefs in high regard and devalue people who do not possess similar knowledge and beliefs. o Ethnocentrism – inclination to view one’s own cultural group as the standard by which to judge the value of other cultural groups ▪ Nursing Implication: A nurse who identifies how personal beliefs and expectations can influence care is better able to recognize and deal with prejudices that may impede patient care. o Cultural Assessment ▪ It begins with self-assessment. ▪ Cultural assessments are used to identify beliefs, values, and health practices that may help or hinder nursing interventions. ▪ Cultural assessment is really as simple as asking patients their preferences, wat they think or believer about their illness, their family structure, etc. ▪ The patient is “a stranger in a strange land” just by virtue of entering the health care setting with its own language, routines, and culture