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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
Assessment
Diagnosis
Outcomes identification
Planning
Implementation
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
pre-interaction phase
orientation phase
working phase
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
Note 
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