Nursing success midterm

What Is a Nursing Theory?

An organized set of concepts and relationships that describes, explains, or predicts something about nursing care — and gives nurses a shared way to think and talk about their work

Nursing Theory is not?

A history lesson, Optional background, or common sense

Nursing theory answers what question?

why did you do that?

Florence Nightingale and her theory

Environmental Theory

• Shape the environment so the patient's own healing can work. → Hand hygiene, noise at night, light, air, nutrition

Virginia Henderson and her theory

14 basic needs

• Assist with what the person would do unaided; aim at independence. → ADL assessment, discharge teaching

Hildegard Peplau and her theory

interpersonal Relations

• The nurse–patient relationship is itself the therapeutic instrument. → Therapeutic communication, building trust fast

Dorothea Orem and her theory

Self-Care Deficit

• Nursing is needed when self-care demand exceeds self-care ability. → How much you do for vs. with a patient

Sister Callista Roy and her theory

Adaptation Model

• The person adapts across physiologic, self-concept, role function, and interdependence modes. → Coping after diagnosis or loss.

Jean Watson and her theory

Human Caring

• Caring is the moral core of nursing, not a soft add-on. → Why the two minutes you sit down matter clinically

Madeleine Leininger and her theory

Culture Care

• Care must be culturally congruent: preserve, accommodate, or repattern. → Diet, faith practice, family decision-making

Patricia Benner and her theory

Novice to Expert

• Competence develops in stages, and rule-following is the correct first stage. → You. Right now.

STAGE 1: Novice

Rule-governed. No experience to draw on

STAGE 2: Advanced beginner

Recognizes recurring patterns.

STAGE 3: Competent

Plans deliberately, 2–3 years in

STAGE 4: Proficient

Sees situations whole

STAGE 5: Expert

Intuitive grasp; no longer relies on rules

FIVE STAGES OF CLINICAL COMPETENCE

• Novice

• Advanced beginner

• Competent

• Proficient

• Expert

PERSONAL Morals

Your own beliefs about right and wrong, formed by upbringing, culture, and faith

PROFESSIONAL Ethics

Systematic reflection on morality. In nursing it is a standard you agreed to — and it can override personal preference at work

ENFORCEABLE Law

The minimum. The floor, not the ceiling.

Legal and ethical are not …?

synonyms. Something can be perfectly legal and still be unethical

Seven Ethical Principles

autonomy, beneficence, nonmaleficence, justice, veracity, fiedelity, accountability

PRINCIPLE 1: Autonomy

The person's right to self-determination.

• Example: informed consent; the right to refuse

PRINCIPLE 2: Beneficence

Act for the person's good.

• Example: repositioning a patient at risk for a pressure injury

PRINCIPLE 3: Nonmaleficence

Do no harm.

• Example: verifying an allergy before you administer

PRINCIPLE 4: Justice

Fairness in care and resources.

• Example: equal responsiveness to call lights, regardless of insurance or behavior.

PRINCIPLE 5: Veracity

Truthfulness.

• Example: not misrepresenting what an injection will feel like

PRINCIPLE 6: Fidelity

Keeping promises; loyalty to the patient.

• Example: "I'll be back in ten minutes" — and coming back.

PRINCIPLE 7: Accountability

Owning your actions and their outcomes.

• Example: self-reporting your own medication error.

TERM 1: Ethical dilemma

Two or more defensible options conflict. Choosing one means giving up something genuinely valuable

TERM 2: Moral distress

You know the right action but are constrained — by hierarchy, staffing, policy, or fear.

TERM 3: Moral courage

Acting on your ethical judgment anyway, despite risk to yourself

Repeated moral distress leaves…?

moral residue that accumulates. It is a leading driver of nurses leaving the profession — and it is not a personal failing.

Four Layers That Define What You May Do:

1. State Nurse Practice Act

2. Board of Nursing rules and advisory opinions

3. Employer policy and job description

4. Your individual competence

State Nurse Practice Act

Statute passed by your legislature. Defines nursing, creates the board, sets licensure and grounds for discipline. The outer legal boundary

Board of Nursing rules and advisory opinions

The regulatory detail. The board licenses you — and can discipline or revoke

Employer policy and job description

May be narrower than the Nurse Practice Act. Never wider

Your individual competence

Education, training, demonstrated skill, and currency. Practicing beyond competence is itself a violation

"My license allows it" does not…?

authorize it if facility policy forbids it — or if you have never done it

STANDARDS 1–6: Standards of Practice

The nursing process:

• Assessment · Diagnosis · Outcomes identification · Planning · Implementation · Evaluation

STANDARDS 7–18: Standards of Professional Performance

Ethics · Advocacy · Communication · Collaboration · Leadership · Education · Evidence-based practice · Quality · Professional practice evaluation · Resource stewardship · Environmental health

RN, Registered Nurse does what?

Owns the full nursing process: assessment, nursing diagnosis, planning, evaluation, and patient teaching.

LPN / LVN Licensed Practical Nurse does what?

Scope varies significantly by state. Typically contributes data rather than performing the initial assessment

UAP / CNA, Unlicensed Assistive Personnel/certified nursing assistant does what?

No nursing judgment. Performs delegated, standardized tasks.

Assessment cannot be what?

delegated. The RN who delegates retains accountability for the outcome.

what the code is, SCOPE: Every nurse

Every role. Every setting. No exceptions for specialty or seniority

what the code is, STATUS: Non-negotiable

Not aspirational, not a suggestion. It is the professional standard.

what the code is, STRUCTURE: Ten provisions

Each followed by interpretive statements explaining how to apply it

Nine provisions became ten in 2025… then what?

Many textbooks, prep books, and slide decks still in circulation say nine. Check the edition on every source you use.

Ten Provisions by Relationship

• 1 Nurse to patient — dignity and respect

• 2 Nurse to patient — primary commitment

• 3 Nurse to patient — trust and advocacy

• 4 Nurse to nurse — authority and accountability

• 5 Nurse to self — moral duties to yourself

• 6 Nurse to nurse — the ethical environment

• 7 Nurse to profession — advancing the field

• 8 Nurse to others — collaboration

• 9 Nursing to society — justice and equity

• 10 Nursing to the global community — NEW in 2025

Nurse to patient — dignity and respect

Practice with compassion and respect for the inherent dignity, worth, and unique attributes of every person

Nurse to patient — primary commitment

Your primary commitment is to the recipient of care: individual, family, group, community, or population

Nurse to patient — trust and advocacy

Build a trusting relationship and advocate for the recipient's rights, health, and safety

Nurse to nurse — authority and accountability

Nurses hold authority over nursing practice and are responsible and accountable for it

Nurse to self — moral duties to yourself

Inherent dignity and worth, a safe workplace, authenticity at work, integrity, and competence.

Nurse to nurse — the ethical environment

Individually and collectively, nurses create, sustain, and improve the ethical environment of the workplace.

Nurse to profession — advancing the field

Through knowledge development, professional standards, and policy generation

Nurse to others — collaboration

Building relationships across health care and non-health care disciplines, and with the public

Nursing to society — justice and equity

Enacting practices, policies, and legislation that promote social justice and eliminate health inequities

Nursing to the global community — NEW in 2025

Participating through nursing organizations in global human and environmental health and well-being

PROVISION 2: The tiebreaker

When the employer, the physician, the family, and the patient all want different things — the patient is your primary commitment.

PROVISION 5: Not permission to be selfish

Nurse well-being and patient welfare are inseparable. Your fatigue is a patient safety issue.

PROVISION 4: Why "I was told to" fails

You are accountable for your own practice. Following an order does not transfer that.

interpersonal process phase 1: orientation

You are strangers. Establish who you are, what you do, what the patient can expect, and how long you will be involved. Trust is built or lost here.

interpersonal process phase 2: working

The bulk of the relationship. Identify problems, explore feelings, teach, plan, and act together. Most therapeutic techniques live in this phase.

interpersonal process phase 3: Termination

Summarize what was accomplished, evaluate goals, and prepare the patient for the ending. Do not skip it — an abrupt exit can undo the work.

Active listening

Attend fully, without composing your reply while they talk. Note what is said and what is avoided.

• Put the workstation down and turn toward the patient

Open-ended questions

Invite an account rather than a yes or no. Start with what, how, or tell me.

• “Tell me what the pain has been like today.”

Silence

Leave space. Patients often say the important thing three seconds after you would have interrupted.

• Wait. Count to five before filling the gap

Reflection

Return the feeling you heard so the patient can confirm or correct it.

• “You sound frightened about going home alone.”

Techniques that open a conversation

• Active listening

• Open-ended questions

• Silence

• Reflection

Restating

Repeat the substance in your own words to check accuracy.

• “So the nausea starts about an hour after you eat.”

Clarifying

Ask for detail when meaning is uncertain. Never guess.

• “When you say dizzy, do you mean the room spins?”

Focusing

Narrow a scattered account to the point that matters most.

• “Let's stay with the chest tightness for a moment.”

Summarizing

Close a segment by consolidating what was covered and agreed.

• “We covered the new inhaler and when to call. What did I miss?”

Offering self

Make your presence available without conditions or promises.

• “I'll sit with you for a few minutes.

Techniques that focus and confirm

• restating

• clarifying

• focusing

• summarizing

• offering self

Your body is speaking before you are s

Egan's SOLER is a starting posture for attending behavior — a default to adapt, never a rule to im

Egan’s SOLER: S

Sit squarely

• Face the patient. Signals that you are here for this

Egan’s SOLER: O

Open posture

• Uncrossed arms and legs. No clipboard as a shield

Egan’s SOLER: L

Lean in

• A slight forward lean conveys interest without crowding

Egan’s SOLER: E

Eye contact

• Comfortable and intermittent, not a stare

Egan’s SOLER: R

Relax

• Your calm regulates the room. Rushing is contagious

Adapt, don't apply blindly

• Sustained eye contact reads as respectful in some cultures and as confrontational in others

• Personal space norms vary widely — watch for the patient stepping back

• Touch requires permission, and for some patients requires a same-gender caregiver

• A patient who is deaf or hard of hearing needs your face visible and lit

• A patient who is blind needs you to say who you are and narrate what you are doing

False reassurance

“Don't worry, you'll be fine.”

• Dismisses the fear and tells the patient not to raise it again

Asking why

“Why did you stop the medication?”

• Demands justification. Patients hear an accusation

Changing the subject

“Anyway — did you eat lunch?”

• Protects the nurse from discomfort, abandons the patient

Giving advice

“If I were you, I'd have the surgery.”

• Substitutes your judgment for theirs and undermines autonomy

Minimizing

“At least it's not cancer.”

• Ranks their suffering and ends disclosure

Defensiveness

“The staff here work very hard.”

• Turns a complaint into a conflict and buries useful data

Use qualified medical interpreters

Family members and children are not interpreters. Using them risks omission, editing, and breach of privacy — and in most settings violates policy and federal requirement

Plain language, always

Say kidney, not renal. Say we will watch it, not we will monitor for

deterioration. Plain language is not condescension

Ask, don't assume

Ask the patient's name and pronouns, and what they want to be called. Ask before touching. Ask what matters to them about this admission

Speak to the patient, not the interpreter

Maintain eye contact with the patient. Use first person: “How long have you had the pain?” not “Ask him how long.”

Confirm with teach-back

“I want to be sure I explained it well — how will you take this at home?” Ask the patient to explain it back. Never ask “Do you understand?”

Accommodate, proactively

Written materials in large print, materials in the patient's language, ASL interpretation, and adequate time are access requirements, not courtesies

Five fundamentals of the encounter

AIDET

A in AIDET

Acknowledge

• Knock. Greet the patient by name and acknowledge everyone else in the room. Make eye contact before you touch the equipment.

I in AIDET

Introduce

• Say your name, your role, and your relevant experience. “I'm a student nurse working with Tanya, your nurse today.”

D in AIDET

Duration

• Give a time frame: how long this will take, when results are expected, when you will be back. Uncertainty is what patients find hardest.