nurs 320 midterm

Florence Nightingale

Florence Nightingale

founder of nursing theory and pushed nursing into professional atmosphere:

• allowed nursing to be respected, under positive light

• advocated for public health and new sanitation measures

Nightingale’s changes

• prejudices against women and elevated status of all nurses

• developed the first training school

• established standards

• defined role of nurse

• believed it was important to know the why

• occupational/recreational therapy for patients

role of the nurse

to meet personal and basic human needs

Nightingale’s established standards

• cleanliness

• fresh air

• clean bandages

Nightingale’s nursing research

developed the first nursing theory (Environmental Nursing Theory)

• focused on the environment for patients and how they can heal

ICN nursing defintion

nursing encompasses autonomous and collaborative care of individuals of all ages, families, groups and communities, sick or well and in all settings

International Council of Nurses

ICN

autonomous

making decisions for oneself

ANA nursing definition

• the protection, promotion, and optimization of health and abilities

• prevention of illness and injury

• alleviation of suffering through diagnosis and treatment of human response

• advocacy in the care of individuals, families, groups, communities, populations

patient

central focus of all nursing defintions

goal of nursing

provide safe/effective care + prevention/promotion of health

holistic

the field of nursing is ____; encompasses mind, body and spirit

• medicine is focused on body (diagnosis, treatment, cure)

• look at the psychosocial aspect → mind and spirit

interrelated roles of nurses

• caregiver

• communicator

• teacher/educator

• counselor

• leader

• researcher

• collaborator

nurses as caregivers

• provide care needed for patients

• range from basic care (hygiene, bed bath) to administering medications/treatments

nurses as communicators

• therapeutic communication

• how to address patients/families?

nurses as teachers

• teach patients about condition, treatment, medication

• age appropriate teaching

nurses as counselors

• therapeutically interacting with patient → help patient through difficult time

• bad diagnosis → devastating news that requires counseling

nurses as leaders

• fight/advocate for best care and patient

nurses as researchers

• evidence based practice

nurses as collaborators

• engage in interprofessional collaboration

nursing’s aims

• promote health

• prevent illness

• restore health

KSA

• knowledge

• skills

• attitudes

critical thinking

looking at all potential outcomes → quickly, prioritize, decision making, reflection

• recognizing that there’s a problem

four blended competencies

• cognitive

• technical

• interpersonal

• ethical/legal

cognitive competency

consists of knowledge

technical competency

involves hands on skills and hand-eye coordination

interpersonal competency

includes attitude and caring/affirming patient centeredness

ethical/legal competency

consists of deep knowledge of the legal aspects of nursing

QSEN competencies

• patient-centered care

• teamwork and collaboration

• quality improvement

• safety

• evidence based practice

• informatics

quality improvement

• systematic and continuous actions that lead to measurable improvements

ex:

• getting better at skills/techniques

• looking at new research

• patient satisfaction score

• implementing policy changes

• reflection

factors affecting health

• genetic inheritance

• cognitive abilities

• educational level

• race/ethnicity: culture

• age and gender

• developmental level

• lifestyle and environment

• socioeconomic status

genetic inheritance

predisposition to certain illness/condition

• ex: diabetes, breast cancer, sickle cell, certain autoimmune disorders

cognitive abilities

ability to think/take care of yourself/make decisions

educational levels

nurses will not make assumptions; affects literacy and ability to follow medical advice

race and ethnicity

• are all people getting the same level of care?

• cultural beliefs can change treatment plan

• different races have hereditary disease

modifiable aspects

can be changed; if they can make changes, do they have the desire to make the change

ex: lifestyle and environment, preventions to limit genetic inheritance’s effects

non-modifiable aspects

cannot be changed

ex:

• not everyone has the means to getting higher education

promoting health

identifying, analyzing, maximizing each patient’s individual strength as components of preventing illness, restoring health and facilitating coping

health

state of optimal functioning (holistic)

wellness

active state of being healthy

healthy people 2030 guidelines

• health conditions

• health behaviors

• populations

• settings and systems

• social determinants of health

goals that are set to reach by the end of decade

social determinants of health

• education

• healthcare and quality

• neighborhood and built environment

• social and community context

• economic stability

primary prevention

prevent illness from HAPPENING

• immunizations, helmet, strength training, seatbelts, educational programs

secondary prevention

early detection for best favorable outcome

• screenings, blood work, BP checks

tertiary prevention

restoring health (AFTER person has illness/injury/disease)

• trying to get back to pre-illness status or recovers as many abilities as possible

• referrals and collaboration focused

• ex: mental health and chemical restoring programs

palliative care

• improving the quality of life that patient can possibly have

• diagnosis of something incurable

• comfort care

hospice care

• patient has <6 months of remaining life; terminally ill

• comfort care w/o curative intent

nursing as a profession

• well defined body of specific and unique knowledge

• strong service orientation

• recognized authority by a professional group

• code of ethics

• professional organization that sets standards

• ongoing research

• autonomy and self-regulation

LPN

licensed practice nurse

RN

registered nurse

graduate education in nursing

• masters

• APRN (advanced practice)

  • NP, midwife

national standard of nursing practice

set by the ANA

nursing practice and licensure

handled by each state

• ex: NYS nursing laws are handled by DOE

nurse practice acts

• define legal scope of nursing practice (LPN vs. RN)

• defines legal requirements

• establishes criteria for education and licensure of nurses

nursing process

trends in nursing education

• changes

• technology

• globalization

• educated consumer

• complexity of care

• collaborative practice

• shortage

• significant advances

early signs of fatigue in nurses

• compassion fatigue

• burnout

• secondary traumatic stress

social contract

between society and profession of nursing

• nurse have autonomy → expected to act responsibly and remain mindful of public trust

• assuring quality, safety, performance

SMART goals

• specific

• measurable

• attainable

• realistic

• timely

emotional intelligence components

1. self awareness

2. self regulation

3. internal/intrinsic motivation

4. empathy

5. social skill

profession

• body of knowledge

• scope of practice

• agreed upon values, ethics

• oath or code

• accountability to society (patients, peers, self)

how is professionalism judged?

• against a set of expectations or standards

• from our own personal values set and understanding of what “professionalism” means

• may be situational in nature

• strongly influenced by culture

professionalism is determined by

• our image

• our communication

• our competence

• our demeanor

unprofessional behavior perceived by patient

• non-therapeutic relationships

• inappropriate communication

• inappropriate self-disclosure

• exploitation (money, gifts)

• breaches of HIPAA

unprofessional behavior perceived by coworkers

• inappropriate relationships

• disengagement

• provision of misleading information

• disrespect

professional organizations

• American Nursing Association (ANA)

• National Council of State Boards of Nursing (NCSBN)

• National League of Nurses (NLN)

• Sigma Theta Tau International

• American Association of Critical-Care Nurses (AACN)

traditional source of knowledge

information passed down generation to generation (unreliable compared to other sources)

authoritative source of knowledge

information from expert (less confident than scientific)

scientific source of knowledge

information derived from research (most reliable)

types of nursing knowledge

• science

  • knowledge in/of nursing

• philosophy

  • study of wisdom

• process

  • conceptual framework

influences of nursing knowledge

• historical (Florence Nightingale)

• societal (changes influence knowledge nurses have to know)

concept

abstract impressions organized into symbols of reality

theory

group of concepts that describe a pattern of reality:

• explain, predict, understand a certain phenomenon

deductive reasoning

builds from general ideas

inductive reasoning

builds from specific ideas/actions

general system theory

theory for universal application → break whole things into parts to see how they work together in systems

adaptation theory

adjustment of living matter to other living things and environment

development theory

orderly and predictable growth/development from conception to death

• ex: Erikson’s developmental theory

benefits of nursing theory

• directs nurses toward common goal 

• leads to improved patient care 

• provides rational + knowledgeable base necessary for appropriate actions 

• give nurses knowledge base necessary for appropriate actions 

• help resolve current nursing issues 

• prepare nurses to question assumptions + values 

• serves research, education, and practice

goals of theoretical frameworks

• holistic patient care

• individualized care to meet patient needs

• promotion of health

• prevention/treatment of illness

nursing theory concepts

• person/patient

• health

• environment

• nursing

environmental nursing theory

define nursing as “the act of utilizing the environment of the patient to assist him in his recovery”

Nightingale’s concepts of environmental sanitation

• proper ventilation

• adequate lighting

• cleanliness

• adequate warmth

• quiet environment

• diet

general research’s goal

to find solutions to problems

nursing research’s goal

• find solution to problems that affect people in nursing care

• develop greater autonomy, provide EBP, affect policy development

• keeps the discipline a profession

national institute of nursing research goals

• build scientific foundation of clinical practice

• prevent disease and disability

• manage and eliminate symptoms caused by illness

• enhance end of life and palliative care

MOLST form

patient state their desires at the end of their life

quantitative research

involves concepts of basic/applied research; uses surveys and valid data

types of quantitative research

• descriptive

• correlational

• quasi-experimental

• experimental

steps of quantitative research

1. state the research problem

2. define purpose of study

3. review related research

4. formulate hypotheses and variables

5. select population and sample

6. collect data

7. analyze data

8. communicate findings and conclusions

qualitative research

conducted to gain insight by discovering meanings; belief that perceptions differ for each person and change over time

• more subjective, no hypothesis

qualitative research methods

• phenomenology (lived experience)

• grounded theory

• ethnography (culture)

• historical

ethics of clinical research studies

• value

• scientific validity

• fair subject selection

• favorable risk-benefit ratio

• independent review

• informed consent

• respect for enrolled subjects

evidence based practice

comes from conducted research

• problem solving

• specific nursing interventions

• mandates analysis/review of research findings

implementing EBP

• cultivate spirit of inquiry

• ask question in PICOT format

• search/collect relevant best practice

• critically appraise evidence

• integrate

• evaluate

• disseminate

PICOT

• patient

• intervention

• comparison

• outcome

• time

nursing research impediments

• limited time to participate in research

• restricted access to resources

• lack of education preparation

parts of communication

• stimulus/reference

• sender/encoder

• message

• medium/channel of communication

• receiver/decoder

factors influencing communication

• perception

• cultural context

• time

intrapersonal communication

within self, communication that happens in your own head