Theory Exam 1

Nursing is the

protection, promotion and optimization of health and abilities

• prevention of illness/injury

• alleviation of suffering

• advocacy in care

Standards in nursing practice

1. Assessment

2. Diagnosis

3. Outcomes identification

4. Planning

5. Implementation

6. Evaluation

In the case of nursing, theories are designed to explain a \________________ such as self care or caring.

phenomenon

Since 1960 this organization has defined the scope of nursing and developed standards of practice and standards of professional performance. The organization is the:

ANA -American Nurses Association

In reviewing various roles of a professional nurse, the nurse who is an expert clinician in a specialized area of practice (such as adult diabetes education) is a:

Clinical Nurse Specialist

The preferred educational requirement for the nurse researcher is the

doctoral degree

The standards of care nurses work by were created to assure patients that they

are receiving high quality care

Watson's Theory of Caring

promote health, restore patient to health, and prevent illness

Leininger's culture care theory

provide care consistent with nursing's emerging science and knowledge with caring as a central focus

Standard's of professional performance

• Ethics

• Education

• Evidence-based practice & research

• Quality of practice

• Communication

• Leadership

• Collaboration

• Professional practice evaluations

• Resources

• Environmental health

Modern Nursing

art and science
blends the most current knowledge and practice standards with insightful and compassionate approach

Nursing as a profession

addresses the many responses of individuals and families to their health problems

Novice

beginning nursing student with no previous level of experience (clean slate)

Advanced Beginner

has some level of experience with the situation

Competent

nurse in same clinical position for 2-3 years

Proficient

nurse with more than 2-3 years of experience in same clinical position

Expert

nurse with diverse experience and has an intuitive grasp of an existing/potential clinical problem

nursing theory

conceptualization of some aspect of nursing communicated for the purpose of describing, explaining, predicting, and/or prescribing nursing care

Nightingale's theory

facilitate the reparative processes of body by manipulating patient's environment
- to include appropriate noise, nutrition, hygiene, light, comfort, socialization, and hope

Peplau's theory

develop interaction between nurse and patient
- participate in structuring healthcare systems to facilitate interpersonal relationships

Henderson's theory

work independently with other healthcare workers, assisting patient in gaining independence

Orem's theory

care for and help patient attain total self-care

Neuman's theory

help individuals, families, and groups attain and maintain max-level of total wellness by purposeful interventions

Roy's theory

identify types of demands placed on patient, assess adaptation to demands, and help patient adapt

therapeutic relationships

promote a psychological climate that facilitates positive change and growth, result in health related goal attainment for patient

phases of therapeutic relationships

1. pre-interaction phase

2. orientation phase

3. working phase

4. termination phase

pre-interaction phase

Before meeting patient:

• review data/histories

• talk with other caregivers whom have interacted with patient

• anticipate concerns/ issues that may arise

• identify a place for patient/nurse interaction

• plan time for interaction to not be rushed

orientation phase

Nurse and patient meet/get to know each other

• set tone for the relationship (warm, empathetic, caring manner)

• expect patient to test nurse's competence and commitment

• closely observe patient (patient will closely observe nurse)

• begin to make inferences and form judgments about patient's messages and behavior

• assess patient's health status

• prioritize patient problems and identify patient goals

• clarify patient/nurse roles

• form contracts with patient to specify roles

• let patient know when you will terminate the relationship

working phase

Nurse and patient work together to solve problems

• encourage patient to express feelings about his/her health

• provide info needed to understand and change behavior

• help patient with self-exploration and to set goals

• take actions to meet goals set

• use therapeutic communication skills to get successful interactions

• use appropriate self-disclosure and confrontation

termination phase

Ending the relationship (starts when meet patient)

• remind patient termination is near

• evaluate goal achievements with patient

• reminisce relationship with patient

• separate from patient relinquishing responsibility for his/her care

• achieve smooth transition for the patient to other caregivers as needed

\____________ is a variation of scientific reasoning

nursing

physical examination

investigation of body to determine its state of health

5 step nursing process

(ongoing cycle)

• Assess

• Diagnose

• Plan

• Implement

• Evaluation

practicing the 5 step nursing process allows

one to be organized and to conduct your practice in a systematic way

assess

gather info about patient's condition

diagnose

identify the patient's problems

plan

set goals of care and desired outcomes (patient agrees)

implement

perform nursing actions identified in planning

evaluation

determine if goals are achieved

How to assess patient?

interview, observations, and physical examination; family members, medical records

must \__________ assessment before diagnosis

validate

nursing process

critical thinking process that pro nurses use to apply the best available evidence to caregiving and promoting human functions and responses to health and illness

Subjective statements are

ones which are spoken by patient, not observed.

objective statements are

ones which are observed or measured

The client says he had chickenpbox as a child

subjective statement

During the process of the health assessment the nurse begins to notice a pattern. From this pattern the nurse

will begin to interpret and validate the information

The nurse says to the client "Please tell me about your periods of rest during the day." This is an example of:

open ended question

Gordon's functional health patterns is

a model offering a holistic framework for assessment

In order for the nurse to formulate a nursing diagnosis, he/she must first know the medical diagnosis of the client.

FALSE. The physician formulates the medical diagnosis. Nursing diagnoses are written for the nursing discipline.

Interpreting and validating the assessment components

critical thinking approach to assessment

involves collecting info from patient and from secondary sources, along with interpreting and validating the info to form a complete database

database

data revealed related goals, experiences, health practices, values, and expectations about healthcare

data collection (sources)

patient, family/significant other, healthcare team, medical records, scientific literature, nurse experience, subjective vs. objective data

cue

info collected through the use of your senses

inference

your judgement or interpretation of cues gathered

comprehensive assessment approaches

• use structured database format

• problem-oriented approach

• assessment moves from general to specific

• ex.) Gordon's model of functional health patterns

process of assessment

• collect data

• cluster data, make inferences and identify patterns and problem areas

• critically anticipate

• have supporting cues before making an inference

• knowing how to probe and frame questions (skills grow with experience)

patient-centered interview

organized conversation with patient

• set stage (preparation, environment, and greeting)

• set agenda/gather info about patient's concerns

• collect assessment or nursing health history (patient confidentiality)

• terminate interview (cue end)

interview techniques

use all types of questions/statements (open and closed ended, back channeling, and probing)

• patient's report includes subjective info; validate data from interview later with objective info

• obtain data about patient's physical, developmental, emotional, intellectual, social, and spiritual dimensions

open-ended questions

prompts patients to describe a situation in more than one or two words (describe, give examples)
ex.) Tell me how you are feeling

closed-ended questions

limits answers to one or two words, mostly yes or no ex.) Do you think the medication is helping you?

• Who helps at home?

• On a scale of 0 to 10, how would you rate your pain?

back channeling

includes active listening prompts; these indicate that you have heard what the patient said and are interested in hearing the full story (encourages patients to give more details)
ex.) "all right", "go on"

probing

encourage full description without trying to control direction of story; use open-ended statements
ex.) Is there anything else you can tell me?
- What else is bothering you?

cultural considerations

• when cultural differences exist between nurse and patient, respect the unfamiliar and be sensitive to a patient's uniqueness

• if unsure about what patient is saying (lang-barrier), ask for clarifications to prevent making the wrong diagnostic conclusion

Nursing health history

• biological info

• patient expectations

• reason for seeking care

• present illness or health concerns

• health, family, environmental, psychological history

• spiritual health

• review of systems -documentation of findings

next assessment steps

physical examination
observation of patient behavior (verbal/nonverbal)
diagnostic and lab data
interpreting and validating assessment

data documentation

not documented, IT DIDN'T HAPPEN!

• last component of a complete assessment

• legal and professional responsibility

• requires approved abbreviations

Nursing diagnosis

after assessing a patient, form diagnostic conclusion
- some conclusions can be used to select a nursing diagnosis

Advanced Beginner