Unit 1-foundations

What is 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

What is health?

state of optimal functioning/well-being

Florence Nightengale (1820-1910) is famous for

Founder of modern nursing

How did Florence Nightingale change the course of history?

She limited the amount of soldiers dying from infection by implementing cleaning practices

Dorothea Dix

A reformer and pioneer in the movement to treat the insane as mentally ill, beginning in the 1820's, she was responsible for improving conditions in jails, poorhouses and insane asylums throughout the U.S. and Canada. She succeeded in persuading many states to assume responsibility for the care of the mentally ill. She served as the Superintendant of Nurses for the Union Army during the Civil War.

Clara Barton

Nurse during the Civil War; founder of the American Red Cross

Lillian Wald

Founder of Henry Street Settlement House in NY and Founder of Public Health Nursing

Mary Brewster

worked with Lillian Wald on the Henry St settelment as a visiting nurse.

Edward Lyon

was the first male nurse to be commissioned in the Army Nurse Corps in the United States

Lavinia Dock

A nursing leader and women's rights activist; instrumental in the Constitutional amendment giving women the right to vote. Created first drug manual for nurses

Mary Mahoney

First professionally trained African American nurse

Which individual provided care in tents and was founder of American Red Cross?

Clara Barton

What is the difference between LPN and BSN?

LPNs provide more traditional bedside care and perform the tasks that RNs tell them to do

Licensed practical nurse (LPN)

prepares nurses to provide basic care to clients under the direction of a registered nurse (RN) or primary care provider; educational programs usually last 1 year; after completing education program, must pass NCLEX-PN exam and send to the state that you want to practice in

Diploma nursing

3 years in a hospital based nursing education program affiliated with a college or university, few remain, is educated in a hospital-based nursing education program, takes the NCLEX-RN

Associate degree nursing

A 2-year community college or technical school program. The title RN is used after passing the NCLEX-RN

Baccalaureate degree (BSN)

course of study in prelicensure Bachelor of Science in nursing programs; lasts at least eight semesters (4 years); prepared to assume administrative responsibilities, address complex clinical situations, oversee and provide direct client care, work in community care, apply research findings, and enter graduate education; minimum education for professional-level nursing practice; can hold any RN leadership position

RN to BSN

A degree program that enables registered nurses who do not have a bachelors degree to obtain a BSN more quickly than would be the case for those without a RN

Master’s degree

prepare RN’s to function in a more independent and autonomous role; takes 2 years to complete

List some master's degree to obtain in nursing

1. Nurse practitioner

2. Nurse education

3. Leadership

Doctorate in Nursing

2 or more years in a doctoral program at a university; offer professional degrees; master’s is required to enter

What are the 5 stages of nursing

1. Novice

2. Advanced Beginner

3. Competent

4. Proficient

5. Expert

Novice nurse

has no experience with specific patient populations and uses rules to guide performance.

Advanced beginner nurse

has enough experience to recognize patterns in work but continues to need help in setting priorities; relies on rules and protocols

Competent nurse

usually been in practice 2-3 years

demonstrate increasing levels of skill and proficiency and clinical judgment

proficient nurse

understands a patient situation as a whole rather than as a list of tasks, attends to an assessment data pattern, and acts without consciously labeling it

Expert nurse

has an intuitive grasp of a clinical situation and zeroes in on the accurate solution. Takes around 5 years

Nurse practice act

law established to regulate nursing practice in each state. Defines the criteria to be an RN, defines practice of professional nursing, and defines scope of practice

What can a LPN not do?

-Can not be a charge nurse or hold leadership positions

-cannot do head to toe evaluations

Who gives you your nursing license?

The state board of nursing after you pass the NCLEX

Standards of practice for nursing

what the average person expects an RN to be able to do

Which organization is directly responsible for regulating the practice of nursing in each state?

State board of nursing

Who creates the board of nursing in each state?

The state legislature who enacts the nurse practice act (NPA).

How is the nursing scope of practice defined at the national level?

By the licensure exam (NCLEX)

How does the state define nursing scope of practice?

-GA Nurse Practice Act

-Board of Nursing

-institutions

How do institutions define a nurse's scope of practice?

Each facility has own written instructions of how to perform each duty

American Nurses Association

largest organization advocating for legislation

National League for Nursing (NLN)

sets the schooling standards at the national level

International Council of Nurses (ICN)

advocates for nursing globally

National Student Nurses Association (NSNA)

nation-wide group of nursing students

Sigma Theta Tau International (STTI)

international honor society; invite only; top 30% in each class

Specialty Groups

groups that determine further certifications such as in ICU, peds, labor and delivery, etc.

4 broad aims of nursing

1. Promote health

2. Prevent illness

3. Restore health

4. Facilitate coping

8 roles of the nurse

1. caregiver

2. communicator

3. teacher

4. counselor

5. leader

6. researcher

7. collaborator

8. advocate

What is in an RN's scope of practice?

assessment, education, planning care, triage, interpret data, discharge planning, care of invasive lines, parenteral medications

the nursing process

five-step problem-solving process that nurses use to guide their professional actions

5 steps of nursing process

1. assessment

2. diagnosis

3. planning

4. implementation

5. evaluation

assessment

involves gathering data about the patient and their health status

diagnosis

using critical-thinking skills, the nurse analyzes the assessment data to identify patterns in the data and draw conclusions about the client’s health status, including strengths, problems, and factors contributing to the problems

planning

encompasses identifying goals and outcomes, choosing interventions, and creating nursing care plans

implementation

involves performing or delegating planned interventions; this is the step in which you carry out the care plan

evaluation

occurs as the last step of the process and involves making judgements about the client’s progress toward desired health outcomes, the effectiveness of the nursing care plan, and the quality of nursing care in the healthcare setting

Three types of healthcare prevention

primary, secondary, tertiary

primary prevention

Efforts to prevent an injury or illness from ever occurring.

Examples of primary prevention

Vaccines, healthy diet, exercise, showering daily

secondary services

Efforts to limit the effects of an injury or illness that you cannot completely prevent by early identification and treatment of illness.

example of secondary services

screening for cancer

Tertiary services

actions taken to contain damage once a disease or disability has progressed beyond its early stages

-what can we do so it does not get any worse?

example of tertiary services

Tertiary services refer to long-term rehabilitation services and care for the dying. Historically, these services were provided in extended care facilities. Now, however, many tertiary care services are provided in the home or in outpatient settings.

what is delegation?

transfer of responsibility, sometimes to an unlicensed assistive personnel

T/f: an RN can delegate tasks including the nursing process

False! Nurse cannot delegate the nursing process

t/f: an RN is responsible for monitoring safety of actions to minimize risks

true

Health Insurance Portability and Accountability Act (HIPPA)

legislation enacted by congress to minimize the exclusion of preexisting conditions as a barrier to healthcare insurance, designate special rights for those who lose either health coverage, and eliminate medical underwriting in group plans. the act includes the privacy rule, which creates national standard for of the disclosure of private health information

Emergency Medical Treatment and Active Labor Act

When a patient presents to an emergency department, they must be treated

Health Information Technology for Economic and Clinical Health (HITECH)

when information breaches do occur, patients must be notified within a reasonable amount of time

Patient Self-Determination Act (PSDA)

A federal law that mandates that every individual has the right to make decisions regarding medical care, including the right to refuse treatment and the right-to-die

Americans with Disabilities Act (ADA)

Legislation passed in 1990 that prohibits discrimination against people with disabilities. Under this Act, discrimination against a disabled person is illegal in employment, transportation, public accommodations, communications and government activities.Includes accommodations by employers and for students

Who is prosecutor in criminal law?

federal or state government

What can criminal cases lead to for the defendent?

fine, imprisonment or death

Misdemeanor v. Felony

Misdemeanor is usually defined as a crime which is punishable by up to a year in jail time (minor crime, DUI).

Felony is usually defined by the fact that they are punishable by prison sentences of greater than one year (homocide).

A DUI is an example of a

misdemeanor

Civil Law

Allows for resolutions of dispute between private parties.

Result of civil law

monetary compensation

Who brings lawsuit to trial in civil cases?

plaintiff

Who is the person being sued in civil law?

defendant

List the 6 intentional torts

1. assault

2. battery

3. defamation

4. invasion of privacy

5. false imprisonment

6. fraud

intentional torts

deliberate acts intended to cause harm

Assault vs. Battery

assault = intentional threat to bring harm. Battery = intentional touching/contact w/o consent (harmful or only offensive)

A nurse tells the patient that they will restrain them if they do not behave. What intentional tort does this describe?

Assault. They are threatening to make bodily contact with person without their consent

Two types of defamation

libel and slander

Slander vs. Libel

slander (spoken) and libel (written)

invasion of privacy

violating a person's right not to have his or her name, photo, or private affairs exposed or made public without giving consent

False Imprisonment

restraining an individual or restricting an individual's freedom. Nurse needs formal order before restraining patient

Fraud in nursing

Making fraudulent patient record by purposefully entering in wrong information

Two types of unintentional torts

negligence and malpractice

Negligence

careless neglect, often resulting in injury

Malpractice

Failure by a health professional to meet accepted standards

"I see you are working with Beth today. Beth is one of the worst nurses and hides her medication errors." This information about Beth is incorrect, so it is an example of

slander because the person is reflecting only her opinion that may cause harm to her colleague's reputation

To win and recover damages (money) in a malpractice lawsuit, the plaintiff must prove what four elements?

duty, breach of duty, causation, damages

When does a duty form?

when the patient is assigned to the nurse or seeks treatment from the nurse, or when the nurse observes another person doing something that could harm the patient.

When does a nurse commit a breach of duty?

nurse fails to meet standard of nursing care. If it was not charted, it did not happen.

What is causation?

The breach of duty or deviation from acceptable standards of care by the nurse must be the direct and proximate cause of the injury sustained by the patient.

How is causation established?

Causation is usually established based on the testimony of experts who can link the nurse's actions with the injury

What are damages?

a sum of money roughly equivalent to the loss suffered as a result of the wrong committed

5 values of nursing

1. altruism

2. autonomy

3. human dignity

4. integrity

5. social justice

altruism

concerned for the welfare and well-being of others

autonomy value

-right to self-determination

-Realizing that the only one who knows what is best for patient is patient

Human dignity value

respect for all people and populations

Integrity value

Acting in accordance with an appropriate code of ethics and accepted standards of practice; includes honesty.

How is the value of social justice upheld by nurses?

when the nurse works to ensure equal treatment under the law and equal access to quality healthcare.