Advanced Practice Registered Nursing Roles, Health Care Delivery Systems, and Wellness, Exams of Nursing

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NR 222 Exam #1 Chamberlain CHAPTER 1 - Nursing Today Benner's Model of Novice to Expert - Novice Advanced beginner Competent Proficient Expert ANA definition of nursing - the protection, promotion, and optimization of health and abilities, prevention of illness and injury, alleviation of suffering through the diagnosis and treatment of human response, and advocacy in the care of individuals, families, communities, and populations ANA Standards of Nursing Practice - Assessment Diagnosis Outcomes Identification Planning Implementation Coordination of Care Health Teaching + Health Promotion Consultation Prescriptive Authority + Treatment Evaluation ANA Standards of Professional Performance - Ethics Education Evidence-Based Practice Quality of Practice Communication Leadership Collaboration Professional Practice Resources Environmental Health Autonomy - Essential element of professional nursing that involves the initiation of independent nursing interventions without medical orders. Advanced Practice Registered Nurse (APRN) - Most independently functioning nurse; has masters degree in nursing Clinical Nurse Specialist (CNS) - An APRN who is an expert clinician in a specialized area of practice Nurse Practioner (NP) - Are prepared to provide direct client care in primary care settings, focusing on health promotion, illness prevention, early diagnosis, and treatment of common health problems Certified Nurse-Midwife (CNM) - An APRN who is also educated in midwifery and is certified by the American College of Nurse- Midwifes Rural Hospitals - Located in a county that has a low population density Restorative Care - Care that helps persons regain their health, strength, and independence Home Care - Provision of medically related professional and paraprofessional services and equipment to patients and families in their homes for health maintenance, education, illness prevention, diagnosis and treatment of disease, palliation, and rehabilitation Rehabilitation - Restores a person to the fullest physical, mental, social, vocational, and economic potential possible Extended Care Facility - A facility that provides health care and help with the activities of daily living to people who may be physically or mentally unable to care for themselves; this type of care may last from days to years Skilled Nursing Facility (SNF) - Includes administration of IV fluids, wound care, long term ventilator management, and rehab Continuing Care - For people who are disabled, functionally dependent, or suffering a terminal disease Assisted Living - A living arrangement for elderly people that combines privacy and independence with medical supervision Respite Care - A type of care provided for caregivers of homebound ill, disabled, or elderly patients; gives the normal care-takers time off Adult Day Care - A program for impaired adults that attempts to meet their health, social, and functional needs in a setting away from their homes Hospice - Allows patient to live with comfort, independence, and dignity while easing the pains of terminal illness IOM Competencies - Patient Centered Care Work in Interdisciplinary Teams Use Evidence-Based Practice Apply Quality Improvement Use Informatics Ten Rules of Performance in a Redesigned Health Care System - 1. Care is based on continuous healing relationships 2. Care is individualized based on patient needs and values 3. Patient is the source of control, participates in decision-making 4. Knowledge is shared, info flows freely 5. Decision making is evidence-based 6. Safety is a system property and focused on reducing errors 7. Transparency is necessary through sharing info with patients and families 8. Patients needs are anticipated 9. Waste is continuously decreased 10. Cooperation and communication among clinicians are priorities Quality Health Care - The degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge Pay for performance programs - Designed to promote quality, effective, and safe patient care by physicians and health care organizations Quality improvement strategies that reward excellence through financial incentives to motivate change to achieve measurable improvements Six Sigma - A data-driven approach for improving quality by removing defects and variations in processes Patient-Centered Care - 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 Magnet Recognition Program - Recognition by the American Nurses Credentialing Center that an organization provides quality nursing care Nursing-sensitive outcomes - Patient outcomes and nursing workforce characteristics that are directly related to nursing care such as changes in patients' symptom experiences, functional status, safety, psychological distress, registered nurse job satisfaction, total nursing hours per patient day, and costs Nursing Quality Indicators - Outcomes of nursing care, identified by the American Nurses Association, that address patient safety and quality of care Nursing informatics - Health education programs or activities directed toward protecting patients from threats or potential threats to health and minimizing risk factors Passive Health Promotion Strategies - Ex. Fluoride in water, fortified foods Active Health Promotion Strategies - Ex. weight reduction, smoking-cessation Levels of Preventive Care - Primary, secondary, tertiary Primary Prevention - True prevention, precedes disease or disfunction and applied to patients considered physically and emotionally healthy Includes: health education, vaccines, nutritional programs, fitness activities Secondary Prevention - Focuses on individuals who are experiencing health problems or illnesses and are at risk for developing complications or worsening conditions Tertiary Prevention - Occurs when a defect or disability is permanent or irreversible; involves minimizing the effects of long-term disease or disability by interventions directed at preventing complications and deterioration Risk Factor - Any situation, habit, or other variable such as social, environmental, physiological, psychological, developmental, intellectual, or spiritual that increases the vulnerability of an individual or group to an illness or accident Transtheoretical Model of Change - 1. Precontemplation 2. Contemplation 3. Preparation 4. Action 5. Maintenance Illness - A state in which a person's physical, emotional, intellectual, social, developmental, or spiritual functioning is diminished or impaired Acute Illness - A sudden illness from which a person is expected to recover Chronic Illness - Persists longer than 6 months, is irreversible, and affects functioning in one or more systems Illness Behavior - Ways in which people monitor their bodies, define and interpret their symptoms, take remedial actions, and use the health care system. CHAPTER 16 - Nursing Assessment Nursing Process - Assessment Diagnosis Planning Implementation Evaluation Nursing Assessment - Systematic and continuous collection and analysis of information about the client Two Steps: 1. Collect info from primary source (pt) and secondary sources (family, friends, health prof, records) 2. Interpret and validate data to ensure complete database Critical thinking and the assessment process - Cue - Information that you obtain through use of the senses Inference - Your judgement or interpretation of these cues Health perception-health management pattern - Describes patient's self-report of health and well-being; how patient manages health (e.g., frequency of health care provider visits, adherence to therapies at home); knowledge of preventive health practices Nutritional-Metabolic Pattern - Describes patient's daily/weekly pattern of food and fluid intake (e.g., food preferences or restrictions, special diet, appetite); actual weight; weight loss or gain. Elimination Pattern - Describes patterns of excretory function (bowel, bladder, and skin) Activity-Exercise Pattern - Validation of assessment data - is the comparison of data with another source to determine data accuracy CHAPTER 22 - Ethics and Values Autonomy - Refers to the freedom from external control Beneficence - Refers to taking positive actions to help others Nonmaleficence - Refers to the avoidance of harm or hurt Fidelity - Agreement to keep promises Code of ethics - A set of guiding principles that all members of a profession accept Advocacy - Refers to the support of a particular cause Value - A personal belief about the worth of a given idea, attitude, custom, or object that sets standards that influence behavior Deontology - Proposes a system of ethics that comes from the work of an eighteenth century philosopher, Immanuel Kant Deontology defines actions as right or wrong on the basis of their "right-making characteristics" such as fidelity to promises, truthfulness, and justice Utilitarianism - Relies on the application of a certain principle; focuses on outcomes Proposes the value of something is determined by it's usefulness Also known as consequentialism Feminist ethics - Looks to the nature of relationships to guide participants in making difficult decisions, especially relationships in which power is unequal or in which a POV has become ignored or invisible Ethics of care - Strives to address issues beyond individual relationships by raising ethical concerns about the structures within which individual caring occurs (structures such as hospitals or universities) Casuistry - Case-based reasoning, turns away from conventional principles of ethics as a way to determine best actions and focuses instead on an "intimate understanding of particular situations" Key Steps in the Resolution of an Ethical Dilemma - 1) Ask the ? is this an ethical dilemma 2) Gather info relevant to the case 3) Clarify values; distinguish among fact, opinion, & values. 4) Verbalize the problem 5) Identify possible courses of action 6) Negotiate a plan 7) Evaluate the plan overtime CHAPTER 9 - Cultural Awareness Health disparity - A particular type of health difference that is closely linked with social, economic, and/or environmental disadvantage Social determinants of health - The conditions in which people are born, grow, live, work, and age, shaped by the distribution of money, power, and resources at global, national, and local levels Culture - Associated with norms, values, and traditions passed through generations It also has been perceived to be the same as ethnicity, race, nationality, and language Intersectionality - Overlapping of social categories such as race, class, gender as they apply to a given individual or group. Creates interdependent systems of discrimination/ disadvantage Oppression - A formal and informal system of advantages and disadvantages tied to our membership in social groups, such as those at work, at school, and in families Culturally congruent care - Care that fits a person's life patterns, values, and system of meaning Meaning of Disease and Illness - Linguistic competence - The ability of an organization and its staff to communicate effectively and convey information in a manner that is easily understood by diverse audiences Teach Back technique - Have patient repeat directions observe that message is understood restate directions speak louder speak slower use a translator Cultural encounter - An intervention that involves a nurse directly interacting with patients from culturally diverse backgrounds Cultural desire - The motivation of a health care professional to "want to" not "have to" engage in the process of becoming culturally competent Core measures - Key quality indicators that help health care institutions improve performance, increase accountability, and reduce costs CHAPTER 10 - Caring for Families Nuclear family - Mother, father and children living as a unit Extended family - Includes the nuclear family plus grandparents, aunts, uncles, and cousins Single-parent family - Formed when one parent leaves the nuclear family because of death, divorce, or desertion or when a single person decides to have or adopt a child Blended family - Formed when a single parent marries another person, who may or may not have children Alternative family - Relationships include multi-adult households, "skip-generation" families (grandparents caring for grandchildren), communal groups with children, "nonfamilies" (adults living alone), and cohabitating partners Five trends as threats or concerns facing families - 1) Changing economic status 2) Homelessness 3) Domestic violence 4) Presence of acute or chronic illnesses or trauma 5) End of life care Absolute Homelessness vs. Relative Homelessness - Absolute - people without physical shelter who sleep outdoors, in vehicles, in abandoned buildings, or in other places not intended for human habitation Relative - describes those who have a physical shelter but one that does not meet the standards of health and safety Stages of Family Life Cycle - Family Health System (FHS) - Interactive Developmental Coping Integrity Health Family hardiness - Internal strengths and durability of the family unit; characterized by a sense of control over the outcome of life events and hardships, a view of change as beneficial and growth-producing, and an active rather than passive orientation in responding to stressful life events Family resiliency - Helps to evaluate healthy responses when individuals and families experience stressful events Family nursing practice has three levels of approaches - 1) Family as context 2) Family as patient 3) Family as system Family as context - Primary focus is on the health and development of an individual member existing within a specific environment Family as patient - Family processes and relationships are the primary focuses of nursing care Family as system -