Comprehensive Content (NUR 300)

4 Contributions to Healthcare: Ancient Egypt

1.) Sutures → wound repair

2.) Community Planning → public health promotion through laws (i.e. cleanliness, food preservation, drinking, exercise, sexual relations)

3.) Pharmacopoeia → classification of 700+ drugs

4.) Midwifery → baby delivery for kings and aristocrats

4 Contributions to Healthcare: Palestine

1.) Mosaic Code → disease control/prevention & public health laws

2.) Health Inspectors → Hebrew priests enforced code

3.) Food Expiration → prohibited eating animals dead > 3 days

4.) Quarantine → isolated individuals with communicable diseases

2 Contributions to Healthcare: Greece

1.) Aesculapius → god of medicine that carried staff of entwined snakes (model of today’s caduceus)

2.) Hippocrates → first to attribute disease to natural causes; emphasized patient-centered care & the scientific method

2 Contributions to Healthcare: India

1.) Vedas → book of Brahmanism used to guide health practices and promote hygiene/sickness prevention

2.) Surgery → amputations & cesarean sections

4 Contributions to Healthcare: China

1.) Hot/Cold Therapy

2.) Acupuncture

3.) Hydrotherapy

4.) Massage

4 Contributions to Healthcare: Rome

1.) Adapted Medical Practices → conquered countries and enslaved physicians

2.) Military Hospital → first one in Rome

3.) Red Cross → common emblem used today

4.) Bathing → emphasized advanced hygiene & sanitation

Significance of the Middle Ages

i.) Women used herbs for healing

ii.) Men used purging, leeching, & mercury

iii.) Roman Catholic church became central figure in health care

iv.) Cross became a forerunner for nursing pin design

Significance of the Renaissance Period

i.) Advancements in medicine (pharmacology, chemistry, medical knowledge)

ii.) Women were encouraged toward charitable services, childbearing at home

iii.) Nursing no longer respected; low class job for unfavorables (i.e. prisoners, prostitutes alcoholics)

Significance of the Colonial American Period

i.) First hospital/medical school founded in North America (located in Mexico City)

ii.) Individuals with infectious diseases were isolated in “pesthouses”

iii.) Benjamin Franklin advocated for the first colonial hospital (built in Philadelphia)

Florence Nightingale

Founder of modern nursing; correlated environmental outcomes and hygienic practices with positive patient outcomes (Crimean War); advanced professional nursing and established the first nursing school in London

Dorothea Dix

Organized military hospitals and provided medical supplies for troops; appointed by the Secretary of War during the Civil War

Harriet Tubman

Cared for soldiers during the Civil War; first woman to lead American troops into battle

Mary Seacole

Voted as the “Greatest Black Briton” in history in 2003

Clara Barton

Operated relief program to provide supplies to battlefields/hospitals; credited with founding the American Red Cross

Lillian Wald

Established the first viable public health practice (Henry-Street Settlement); developed the first nursing service for occupational health

Mary Mahoney

First professionally educated African American nurse; promoted awareness of cultural diversity and respect for individuals regardless of race/culture

Isabel Hampton Robb

Helped found the Nurses’ Associated Alumnae of the United States and Canada in 1896 (ANA precursor)

Sheppard-Towner Act

Legislation that provided funds to improve the health of women/children; public health nurses received resources to promote well-being; led to the creation of the Frontier Nursing Service (FNS)

Mary Breckenridge

Rode on horseback to patient homes to provide care in Kentucky; pioneered home health practices (Frontier Nursing Service)

The Hospital Survey and Construction Act (Hill-Burton Act)

Provided funding for the construction of hospitals/facilities based on community need; ↑ demand for professional nurses in hospitals

Social Security Act of 1935

Legislation that impacted health care benefits and provided avenues for nursing care; public health became the major source of health care for mothers/children and disabled; created hospital job opportunities for nurses

6 Outcomes of the Social Security Act of 1935

1.) National old-age insurance system

2.) Federal grants to states for maternal/child welfare services

3.) Vocational rehab services for the handicapped

4.) Medical care for crippled children and blind people

5.) Plan to strengthen public health services

6.) Federal-state unemployment system

Social Security Act of 1965 (Amended)

Replaced all previously instituted programs for medical assistance; marked the introduction Medicare and Medicaid; funding provided opportunities for mental nursing

Title XIX of the Social Security Act (Medicaid)

State regulated program that provides insurance to those eligible; recipients include families (primarily women/children) at or below the poverty line

Title XVIII of the Social Security Act (Medicare)

Federally regulated program that provides hospital (part A) and medical (part B) insurance to those eligible; recipients include individuals that are 65 years or older, totally/permanently disabled, suffering from end-stage renal disease

3 Outcomes of Medicare

1.) Nursing demand in hospitals (↑ bed occupancy)

2.) Nursing schools concentrated more on hospital-based nursing

3.) Home health movement emerged

Diagnosis-Related Groups (DRGs)

System developed by hospitals in response to widespread availability of health insurance; hospital received prospective payments (reimbursement) for services based on a predetermined/fixed price for diagnosis; improved hospital efficiency

Initiative on the Future of Nursing (RWJF & IOM)

Partnership between the Robert Woods Johson Foundation (RWJF) and IOM to assess/respond to need for nursing transformation; landmark report highlighted 4 key messages

4 Messages from the IOM Landmark Report

1.) Nurses should practice to the full extent of their education/training

2.) Nurses should achieve higher levels of education/training

3.) Nurses should be full partners with physicians and other healthcare professionals

4.) Workforce planning/policymaking require better data collection and info infrastructure

Affordable Care Act (ACA)

Legislation signed by President Obama in 2010 (ObamaCare); provides cheaper insurance for the unemployed Americans

6 Outcomes of the Patient Protection & Affordable Care Act (2010)

1.) Student loan amount ↑

2.) Funded nurse managed health centers

3.) Funded nursing gerontology fellowships

4.) Provided educational loan repayment for nurse faculty

5.) Advanced nursing education grants

6.) Provided hospitals with grants for clinical training of APRNs

What year did all states require a licensing exam for nurses?

1923

What year did states mandate a fully licensed workforce of nurses? What state was the first?

1947 in New York

National League for Nursing (NLN)

Organization that emphasizes realistic expectations for clinical practice; developed competency outcomes for nursing graduates of all levels

Licensed Practical or Vocational Nursing Programs

Provide the shortest and most restricted option for licensure; 9 to 12 months of education for licensure (LPN/LVN); basic technical bedside care in hospitals, nursing homes, home care, or offices

Hospital Diploma Program

Oldest, most traditional program for RN licensure that follow the Nightingale model; 2 to 3 years of education for basic RN positions in hospitals or agencies

Associate Degree Programs

Condensed program created based on demand for skilled, better-prepared nurses; 2 years of education prepares for RN licensure (ADN)

Baccalaureate Degree Nursing Programs

Generic programs that require 2 years of arts/sciences followed by 2 years of nursing courses at colleges/universities; 2 to 4 years of education (traditional or accelerated) for RN licensure (BSN); basic nursing roles in practically every setting

Clinical Nurse Leader (CNL)

Master’s-prepared generalist clinician (not APRN) who oversees the coordination of care, evaluates outcomes, and changes care plans for distinct patient groups; expert in quality improvement and centralized care coordination

Licensure

Distinguishes those sufficiently trained to provide care based on set criteria; serves to protect the public

Nurse Licensure Compact (NLC)

Allows nurses to practice in more than one state without applying for multiple licenses; revised in 2015 to account for telehealth (eNLC)

Nurse Practice Acts

Statues created by state legislators to determine the legal scope of nurses; regulates nursing practice and maintains the definition of professional nursing enforced by the state board

The State Board of Nursing

Appointed board within each state charged with the responsibility to administer/enforce the practice acts; maintains the definition of professional nursing and provides nurses with licensure

National Council of State Boards of Nursing (NCSBN)

Organization whose membership consists of each state board of nursing; oversees state board examination (i.e. NCLEX)

American Nurses Association (ANA)

Organization that develops, revises, and maintains the scope of practice statement and standards of the nursing profession

American Nurses Credentialing Center (ANCC)

Agency of the ANA that conducts certification examinations and certifies advanced practice nurses; developed/maintains the magnet program

5 Aspects of Scientific Method

1.) Hypothesis

2.) Method

3.) Data collection

4.) Results

5.) Evaluation

Theory

Related concepts that explain phenomena and predict future events; contains a set of (1) concepts, (2) definitions, & (3) assumptions to explain a phenomenon

6 Criteria for Theory Acceptance

1.) Inclusiveness

2.) Consistency

3.) Accuracy

4.) Relevance

5.) Fruitfulness

6.) Simplicity

Nursing Metaparadigm

Foundational framework that encompasses essential concepts and guides nursing practice; concepts include (1) person, (2) environment, (3) health, & (4) nursing

Grand Theory

Abstract, broad-scope, and complex theory that provides a framework for nursing ideas; require further clarification through research

Middle-Range Theory

Limited scope theory that addresses specific phenomenon and reflects nursing practice; expand on specific concepts within a specific field of nursing

Practice Theory

Situation-specific theory for bedside care that narrows scope to a specific population at a specific time

Descriptive Theory

Describe phenomena and the circumstances in which they occur (i.e. theories of growth and maturation)

Prescriptive Theory

Addresses nursing interventions for a phenomenon, guide practice change, and predicts the consequences

Shared Theory

Interdisciplinary theory that explains a phenomenon specific to the discipline of development (i.e. Piaget’s theory of cognitive development)

Henderson’s Theory (Focus & Application)

Focus: Practice of Nursing

Application: Nurses assist with 14 patient activities until patient can self-assist or dies peacefully

Johnson’s Theory (Focus & Application)

Focus: Behavioral System

Application: Patients are perceived to be more important than their disease; patient is behavioral system focused on meeting basic drives (i.e. achievement, aggression/protection, elimination/ingestion)

*Neuman’s Theory (Focus & Application)

Focus: Systems

Application: Patient is system that exchanges energy with environments; stabilize patient in response to stressors

*Roy’s Theory (Focus & Application)

Focus: Adaptation

Application: Help patient cope with physiological, self-concept, role function, and interdependence changes

*Roger’s Theory (Focus & Application)

Focus: Unitary Human Beings

Application: Patient is an energy field constantly interacting with the environment

*Parse’s Theory (Focus & Application)

Focus: Human Becoming

Application: Help patient realize their own potential to alter personal rhythms/patterns and promote/maintain health

*Newman’s Theory (Focus & Application)

Focus: Expanding Consciousness

Application: Accept patient POVs while providing guidance to enable health-related choices according to their belief system

Benner’s Theory (Focus & Application)

Focus: Skill Acquisition

Application: Nurses progress through 5 stages of skill acquisition (novice, advanced beginner, competent, proficient, & expert)

*Nightingale’s Theory (Focus & Application)

Focus: Environment

Application: Providing the best environmental conditions for nature to preserve health and improve patient outcomes

*Peplau’s Theory (Focus & Application)

Focus: Interpersonal relations

Application: Patient is organism in unstable equilibrium which is restored through constructive action and therapeutic relationship

*Orem’s Theory (Focus & Application)

Focus: Self-Care

Application: Assess ability to perform self-care and intervene as needed to ensure physical, psychological, sociological, and developmental needs are met

*Leininger’s Theory (Focus & Application)

Focus: Cultural care

Application: Provide culturally specific care by integrating traditions, values, and beliefs into a care plan

*Watson’s Theory (Focus & Application)

Focus: Human Caring

Application: Occurs when a transpersonal relationship facilitates the ability for self-healing: transpersonal care is the fulcrum and science/philosophy are the core

Mishel’s Theory (Focus & Application)

Focus: Uncertainty

Application: Appraisal and management of uncertainty surrounding an illness to mitigate stress and improve quality of life

Grounded Theory

Qualitative research design used to collect and analyze data aiming to develop theories grounded in real-world observations

Evidence-Based Practice (EBP)

Systematic approach that integrates the best available evidence, clinical expertise, and patient values to improve outcomes (especially in healthcare)

6 Steps of Evidence-Based Practice

1.) Ask a clinical question in PICOT format

2.) Search and collect relevant evidence

3.) Critically appraise the evidence

4.) Integrate the evidence

5.) Evaluate the outcomes of practice decision or changes

6.) Communicate the outcomes of the evidence-based practice decision

PICOT

Framework used to formulate a structured clinical question used in healthcare/nursing to guide evidence-based practice…

Patient population

Intervention

Comparison

Outcome

Time

7 Levels of Evidence

1.) Level I → systematic review or meta-analysis of randomized controlled trials (RTCs); highest quality of evidence

2.) Level II → well-designed randomized controlled trial (RCT)

3.) Level III → controlled trial w/o randomization

4.) Level IV → single nonexperimental study (i.e. case-control, correlational, cohort)

5.) Level V → systematic review of descriptive/qualitative study

6.) Level VI → single descriptive/qualitative study

7.) Level VII → opinion of authorities and/or reports of expert committees; lowest quality of evidence

Pilot Study

Small-scale investigation conducted to test the feasibility of design

Quasiexperimental Study

Quantitative research study design that lacks one of the components of an experimental design (i.e. randomization, control group, variable manipulation)

Agency for Healthcare Research and Quality (AHRQ)

Agency that aims to (1) translate research evidence into clinical practice, (2) reduce risk of harm through optimal care, (3) facilitate access to effective care, & (3) reduce unnecessary costs

Institutional Review Board (IRB)

Human subjects committee required by federally funded institutions; reviews/oversees research involving human subjects to ensure ethical standards and participant safety

Code of Ethics for Nursing

Set of guiding principles that influences the expectations/standards of behavior associated with the profession; first developed by the American Nurses Association (ANA) in 1950

4 Guiding Principles of the Nursing Code of Ethics

1.) Advocacy

2.) Responsibility

3.) Accountability

4.) Confidentiality

Sentinel Event

Unexpected occurrence involving death or serious physical/psychological injury of a patient

Ethnography

Qualitative research method for the purpose of investigating cultures; data collection, description, and analysis used to develop behavioral theory

Phenomenology

Qualitative research design that employs inductive/descriptive methodology to describe the lived experiences of study participants

Autonomy (Definition & Example)

Definition: Patient’s freedom from external control; nurse’s commitment to include patients in decisions about all aspects of care

Example: Obtaining consent from the patient before implementing a procedure

Beneficence (Definition & Example)

Definition: Taking positive action to help others

Example: Providing care that makes patients feel better

Maleficence (Definition & Example)

Definition: Taking negative action to cause harm or hurt to others

Example: Neglecting hand hygiene and aiding in the transmission of infection to a patient

Nonmaleficence (Definition & Example)

Definition: Avoidance of harm or hurt

Example: Using proper technique to execute a procedure

Justice (Definition & Example)

Definition: Ensures that all patients receive equal treatment

Example: Providing the same relative level of care to patients of differing cultural backgrounds

Fidelity (Definition & Example)

Definition: Faithfulness or the nurse’s agreement to keep promises

Example: Keeping a patient’s health information confidential when asked to do so by the patient

Advocacy (Definition & Example)

Definition: Application of the nurse’s skills and knowledge for the benefit of another person

Example: Notifying the provider that the patient is allergic to a newly prescribed medication

Responsibility (Definition & Example)

Definition: Willingness to respect the nurse’s professional obligations and be answerable for the patient’s condition

Example: Passing medications to the patient as ordered

Accountability (Definition & Example)

Definition: The nurse’s obligation to respect and maintain patient privacy

Example: Refusing to share information about the condition of patient when asked to do so by a friend

Health Insurance Portability and Accountability Act of 1996 (HIPAA)

Legislation that mandates confidentiality and protection of patient’s personal health information; defines the rights and privileges of patients for privacy protection

6 Steps to Resolve and Ethical Dilemma

1.) Gather information about the case

2.) Distinguish among facts, values, and opinion (clarify values)

3.) Clearly verbalize the ethical problem

4.) Identify possible courses of action and

5.) Draw a plan of action

6.) Evaluate the action plan

Deontology

Ethical approach that defines actions as right or wrong based on their adherence to rules and principles

Utilitarianism

Ethical approach that proposes that value is determined by its usefulness

Casuistry

Ethical approach that utilizes case-based reasoning to focus on the details of a situation (rather than conventional principles) to determine best actions

Feminist Ethics

Ethical approach that places an emphasis on caring relationships and a strong sense of responsibility; natural caring for others is the basis for moral behavior

3 Resources for an Ethical Problem

1.) Consultation services (i.e. ethics committee)

2.) Nurse leaders (i.e. charge nurse)

3.) Members of interprofessional team (i.e. pharmacist)