Fundamentals of Nursing - Exam 1

Professional nursing (nursing)

The protection, promotion, and optimization of health and abilities and advocacy in the care of individuals, families, communities, and populations

Involves critical thinking, clinical judgment, communication, and leadership

Autonomy

Accountability

Altruism

Ongoing education

Evidence-based practice

Ethical & legal foundations

What are the 6 characteristics of the nursing profession?

Autonomy

A characteristic of the nursing profession where nurses make independent clinical decisions based on assessment & patient needs

Accountability

A characteristic of the nursing profession where nurses are responsible for their actions and must maintain licensure and competence

Altruism

"A selfless regard for the wellbeing of others"

A characteristic of the nursing profession where there is a focus on service and helping others, often in emotionally and physically demanding conditions

Ongoing education

A characteristic of the nursing profession that emphasizes that nursing is a lifelong learning profession where clinical guidelines and technology are constantly evolving

Evidence-based practice (EBP)

A characteristic of the nursing profession where nurses are to incorporate research and best practices in care.

Ethical & legal foundations

A characteristic of the nursing profession that is guided by the code of ethics (ANA) and laws (Nurse Practice Act)

Theory of Animism

An older viewpoint that good spirits brought health; evil spirits brought sickness and death.

Florence Nightingale

Founder of modern nursing.

Reduced mortality rates of soldiers by improving hygiene & sanitation

Used statistics to demonstrate patient care outcomes, laying the foundation for evidence-based practice and professional ethics.

Emerged during the Crimean War (1853-1856)

Hospital-based diploma programs

Early 1900s nursing training centered on hands-on skill acquisition that lacked a formal academic foundation

1965 ANA position paper

A policy recommendation establishing the Baccalaureate (BSN) degree as the minimum educational requirement for professional nursing entry

Baccalaureate (BSN) degree

Mid-20th-century degree programs designed to develop critical thinking, community health expertise, and leadership skills

Nurse practitioner (NP)

An expanded clinical role established in the 1960s in response to physician shortages and healthcare access issues

Clinical nurse specialist (CNS)

Advanced practice experts focused on specific patient populations or care settings

Nurse educators

Responsible for preparing the next generation of nurses

Nurse researchers

Scholars who lead evidence-based projects and contribute to scientific literature

Nurse informaticists

Specialists who integrate technology into care processes to enhance patient outcomes

Feminist movement

A 20th-century social movement challenging traditional gender hierarchies to assert nurses as professional equals to physicians

Civil rights movement

A reform movement driving diversity, equity, and inclusion in nursing education and workplaces, pioneered by figures such as Mary Elizabeth Mahoney and Estelle Osborne

American Nurses Association (ANA)

Organization that plays a central role in

- Advocating for nursing policy & legislation on state + federal level (policy)

- Published the Code of Ethics for Nurses (ethics)

- Defines the Scope & Standards of Nursing Practice (scope of practice)

National League for Nursing (NLN)

Organization that promotes excellence in teaching & learning in nursing schools

- Accredits LPN, ADN, and some BSN programs

- Provides faculty development tools, assessment services, and sim guidelines

- Publishes position statements on diversity, sim, and student success

American Association of Colleges of Nursing (AACN)

Organization that represents academic nursing programs at the baccalaureate & grad levels

- Develops the AACN Essentials that structure nursing curriculum based on competency domains

- Oversees the CCNE accreditation process for BSN, MSN, & DNP programs

- Advocates for nursing education reform & advanced nursing roles

National Council of State Boards of Nursing (NCSBN)

Organization that unites all USA boards of nursing to promote public health, safety, welfare by ensuring that licensed nurses are competent & practice safely

- Develop & maintain the NCLEX

- Create the Clinical Judgment Measurement Model (CJMM) used in the NCLEX

- Support state boards with licensure policy, research, and transition-to-practice tools

Nursing licensure

Legally grants a nurse permission to practice after verifying the individual has met educational, ethical, and exam standards

- Protects the public: ensures that only those who demonstrate minimum safety competency can give care

Nurse Practice Act (NPA)

Functions in each state as the legal scope-of-practice document for nurses in jurisdiction.

- Defines what tasks RNs, LPNs, & APRNs are legally allowed to perform

- Clarify what delegation, supervision, and documentation are required

- Guidelines for disciplinary action, license suspension, and revocation

Board of Registered Nursing (BORN)

Each one regulates nursing standards and approve + evaluate nursing education programs

- Issues licenses to new nurses & renews existing ones

- Investigates complaints from patients, families, employers, or colleagues

- Conducts disciplinary hearings & imposes sanctions

Massachusetts Nurse Practice Act

The legal framework governing nursing practice in Massachusetts

- Details qualifications for RN & LPN licensure such as education, exam requirements, and continuance of education

- Defines the scope of practice for nurses such as responsibilities related to assessment, delegation, documentation, and ethical decision-making

Continuing education units (CEUs)

Formal learning activities that keep nurses up-to-date on best practices, technology, pharmacology, and clinical guidelines --> ensures nurses are competent & respond to evolving patient needs & public health challenges

Can be earned through online learning modules, conferences/workshops, or webinars offered by professional organizations

Most states require a specific # every 2-3 years to maintain licensure**

Renewal of licensure

Required by state boards of nursing, typically every 2 years

Requirements:

- Documentation of completed CEUs

- Fee payment

- Attestation of good moral character and/or no criminal violations

Speciality certification

A credential that demonstrates advanced clinical knowledge & skill in a focused area of practice

Telehealth

The use of digital technology to deliver care remotely

ex: remote monitoring for chronic conditions, virtual primary care visits, psychiatric teleconsults

Nursing informatics

Combine nursing science with information management & communication systems

- EHR optimization

- Data analytics

- Workflow improvement

- Patient safety alerts

Health disparities

Differences in health outcomes that are unfair & avoidable.

Linked to social, economic, or environmental factors that may hinder access to health.

Populations affected (racial/ethnic minorities, rural areas, low-income, & uninsured people) face higher chronic disease risk, lower life expectancy, & limited access to preventative care

Health equity

Fair access to health resources for all

- recognizing & addressing social determinants of health

- using interpreters, understanding religious beliefs, respecting gender identity

- advocating for policy changes & equitable access

Culturally competent care

Care that involves

- self-reflection & bias awareness

- respecting patient autonomy & traditions

- incorporation of cultural practices into care

Health

A dynamic, ever-changing state encompassing the balance of physical, mental, emotional, social, and spiritual well-being

- influenced by lifestyle choices, environment, genetics, and access to care

Holistic health

Supporting the whole person, not just treating physical symptoms

Wellness

An active, ongoing process involving becoming aware of and making choices to maintain or achieve a healthier & more fulfilling life

- involves self responsibility, goal setting, and behavior modification

"The pathway to health"

Physical

Emotional

Intellectual

Social

Spiritual

What are the 5 dimensions of wellness?

Illness

A subjective experience reported by the individual that can exist without formal medical diagnosis; a response to disease that impairs emotional/physical function

- influenced by perception, culture, emotional state, and social support

Disease

A pathological condition diagnosed by medical professionals that is often identifiable by clinical signs/symptoms or diagnostic testing

** could be acute, chronic, or may/may not produce noticeable illness**

Maslow's Hierarchy of Needs

A psychological theory proposed by Abraham Maslow that outlines 5 levels of human needs, starting from most basic (should be met first) to most advanced

** essential for nurses in prioritizing interventions, addressing psychosocial aspects of health, understanding how illness may disrupt needs at different levels, and guiding holistic care

Physiological needs (basic survival)

Highest priority life-sustaining measures that must be addressed first

Includes oxygen, food, water, sleep, shelter, temperature regulation, and elimination

Safety needs (security)

2nd most high priority needs

Physical safety --> protection from harm, infection, injury (fall prevention)

Psychological safety --> stability, security, order, and freedom from fear (patient education)

Love and belonging needs (social relationships)

3rd most high priority needs

Social relationships --> friendships, family, intimacy, connection

- can be heavily impacted by hospitalization (ex: isolation & loss of support)

** Nurses should support this by building rapport, establishing therapeutic relationships, involving family, and showing empathy **

Empathy

Being able to put yourself in the patient's shoes

Sympathy

Feeling bad for the patient

Esteem needs (self-respect) (self-esteem)

4th most high priority needs

Respect from others, self-respect, feeling capable, loved, and confident

** Nurses establish this by involving patients in decision-making, providing information, and allowing the choice to give back control

Self-actualization needs

Least high priority needs

Achieving one's full potential: growth, creativity, purpose, personal fulfillment

** Nurses should work with patients to set goals, encourage hobbies, and help find meaning after illness

Primary

Secondary

Tertiary

What are the 3 levels of preventive care?

Primary prevention

Preventing the onset of illness before the disease process begins

- Action: reduce risk factors, increase resistance to disease

- Target: healthier individuals/populations

examples --> immunizations, health education campaigns, promote physical activity & diet balance, wearing seatbelts, safe sex education

Primary prevention

The following are examples of what preventive care?:

Immunizations, health education campaigns, promote physical activity & diet balance, wearing seatbelts, safe sex education

Secondary prevention

Early detection & intervention to halt disease progression

- Action: routine screenings & assessments

- Focus: identify disease in earliest stages

examples --> blood pressure checks (hypertension), mammograms (breast cancer), colonoscopies (colorectal cancer), pap smears, blood glucose testing (diabetes)

Secondary prevention

The following are examples of what preventive care?:

Blood pressure checks (hypertension), mammograms (breast cancer), colonoscopies (colorectal cancer), pap smears, blood glucose testing (diabetes)

Tertiary prevention

Managing & reducing complications for existing conditions that are already diagnosed to prevent further deterioration + maximize quality of life

Action: rehabilitation, chronic disease management

examples --> cardiac rehab (after myocardial infection), physical therapy (stroke recovery), support groups for chronic illness (COPD, diabetes), medication adherence programs, wound care (pressure injuries)

Tertiary prevention

The following are examples of what preventive care?:

Cardiac rehab (after myocardial infection), physical therapy (stroke recovery), support groups for chronic illness (COPD, diabetes), medication adherence programs, wound care (pressure injuries)

Family

Influence health beliefs, values, and behaviors from an early age

- often serve as primary caregivers & sources of emotional + financial support

- genetic factors & hereditary conditions may increase risk of certain diseases

- dynamics may impact mental health & wellness

Community

Influences access to resources such as safe housing, clean water, nutritious food, & healthcare facilities

- environmental hazards or lack of healthcare access in underserved areas can influence health outcomes

Culture

Shapes perception of health, illness, and healing

- beliefs may influence whether a person seeks traditional medicine, spiritual healing, or clinical treatment

- language & communication barriers

- diet, religious practices, concepts of modesty, gender roles can play a role in health

Acute illness

Typically appears suddenly with a rapid onset and lasts a short duration (less than 6 months)

- Often resolves with or without medical treatment

examples --> influenza, appendicitis, broken bone

Acute illness (acute)

The following are examples of acute OR chronic illness?:

Influenza, appendicitis, broken bone

Chronic illness

Develop gradually and is long-lasting (6+ months)

- Often require ongoing medical care & can impact quality of life

examples --> diabetes, heart disease, arthritis

Chronic illness (chronic)

The following are examples of acute OR chronic illness?:

Diabetes, heart disease, arthritis

Social Determinants of Health (SDOH)

Conditions in which people are born, grow, live, work, learn, and age that affect a person's ability to stay healthy, seek care, and manage illness

examples --> availability of nutritious food, access to safe housing & clean water, transportation to medical appointments, quality of schools & early childhood education, job opportunities & working conditions, access to health insurance & care services

Risk factors

Characteristics or conditions that increase a person's chance of developing a disease or health problem

- nurses can use this for prevention, early diagnosis, and to tailor care plans

Modifiable risk factors

Lifestyle related factors that can be changed or controlled through behavior or treatment

examples --> smoking, poor diet, physical inactivity, excessive alcohol use, high stress levels, sleep habits

** Nurses should implement patient education, behavior change, and support

Modifiable risk factors (modifiable)

The following are examples of modifiable OR non-modifiable risk factors?:

Smoking, poor diet, physical inactivity, excessive alcohol use, high stress levels, sleep habits

Non-modifiable risk factors

Factors that cannot be changed, but can help inform screening schedules & risk assessments

examples --> age, sex, family history/genetics, ethnicity

** Nurses should take proactive measures such as increased screenings or preventative surgeries/care

Non-modifiable risk factors (non-modifiable)

The following are examples of modifiable OR non-modifiable risk factors?:

Age, sex, family history/genetics, ethnicity

Health promotion

A proactive process that empowers individuals & communities to take control over their health by focusing on preventing illness, improving quality of life, and supporting overall well-being.

Occurs in all settings, integrates with all levels of prevention, and nurses play a big role in healthcare settings

Nurse's role (nurse)

Educator: teach about prevention, lifestyle changes, self-care, balanced meals, safe sex

Advocate: for patient health

Coach: encourage small, sustainable behavioral changes

Intrapersonal

Interpersonal

Group

What are the 3 levels of communication?

Intrapersonal communication

Inner dialogue (self talk) including self-reflection, critical thinking, & mental rehearsal of care tasks that is key for making ethical decisions, managing emotion, and preparing for patient care (challenging situations)

Interpersonal communication

Communication between two or more people where the nurse builds rapport & trust (nurse-patient interaction) & uses therapeutic communication (ask open-ended questions, validate patient feelings)

Group communication

Communication among members of a team or a collective that emphasizes clear communication (hand-offs) and team discussion to prevent errors & ensure continuity of care

Verbal

Nonverbal

Technology

What are the 3 forms of communication?

Verbal communication

A form of communication that depends on understanding of language.

Involves words, tone, clarity, vocabulary

Nonverbal communication

An extremely important form of communication where no words are exchanged.

Involves facial expressions, gestures, eye contact, posture, body language. Therapeutic touch. Space, time, boundaries. Sounds. Silence

Technological communication

A form of communication done via electronic means that can encompass aspects of both verbal & non-verbal communication.

examples --> email, text, social media, teleheath, telemedicine

A. Intrapersonal (intrapersonal) (A)

A nurse reassuring oneself of being prepared to speak in front of a peer group is using which of the following types of communication?

A. Intrapersonal

B. Interpersonal

C. Group

D. Organizational

Cultural

Spiritual

Physical

What are 3 major influencing factors that must be addressed for effective communication?

False

Tell whether the following statement is true or false.

Touch is a personal behavior that means the same thing to all persons.

True OR false?

Therapeutic relationship

A caring, person & patient-centered relationship that is dynamic, purposeful, and time-limited.

- is built gradually by building rapport & trust

- the person providing assistance is professionally accountable for the outcomes

- goals are determined cooperatively in terms of patient's needs

Conversation, listening

Developing both ___ skills & ___ skills are essential to building the therapeutic relationship.

Conversation skills (conversation)

The following are examples of developing ___ skills in order to build the therapeutic relationship:

- control tone of voice

- knowledgeable about the topic of conversation

- flexibility

- clear & concise

- avoid slang or overly technical medical terminology

- truthfulness

- open-mindedness

- take advantage of available opportunities

Listening skills (listening)

The following are examples of developing ___ skills in order to build the therapeutic relationship:

- sit when communicating with patient

- alertness, relaxed, take your time

- natural conversation

- maintain eye contact

- appropriate facial expression & body gesture

- think before responding

- do not pretend to listen or interrupt patient

- listen for themes in patient comments

- use silence, therapeutic touch, and humor as appropriate

Block

The following are examples of things that will (facilitate/block) effective communication?:

- failure to perceive the patient as a human being

- failure to listen

- non-therapeutic comments & questions

- cliches

- closed questions (unless necessary)

- "why" or "how" questions

- questions that probe

- leading questions

- giving advice

- judgmental comments

- changing subject

- false assurance

- gossip & rumors

- disruptive interpersonal behavior

SBAR technique (SBAR)

A standardized, concise, accurate, and organized tool that ensures important details and critical patient information are communicated clearly to other healthcare professionals in clinical settings

- helpful in emergencies or shift hand-offs

ISBAR

Introduction

Situation

Background

Assessment

Recommendation

SBAR

Situation

Background

Assessment

Recommendation

Identification

Step in ISBARR

Identify yourself --> name, role, credentials

& the patient using 2 identifiers --> name, DOB

Situation

Step in ISBARR (SBAR)

What is the immediate problem? State patient name, age, & primary reason for visit/concern

Background

Step in ISBARR (SBAR)

Provide relevant context/information

Include primary diagnosis, reason for admission, relevant medical history, treatments already given

Background

The following is an example of what step of SBAR?:

"Patient was admitted with pneumonia two days ago, on antibiotics, productive cough"

Assessment

Step in ISBARR (SBAR)

Provide objective (vital signs, etc) & subjective (what client reports) assessment data related to the situation

Include current vital signs, specific system assessment, relevant lab work & mention trends in patient status

Recommendation

Step in ISBARR (SBAR)

State what you believe needs to be done

Give your suggested actions for the provider or next nurse

Recommendation

The following is an example of what step of SBAR?:

"I'd like you to assess the patient, consider changing the antibiotics, and order oxygen."

Read back

Step in ISBARR

After receiving verbal orders or a plan, check/say it back to confirm understanding & ensure accuracy

**doesn't substitute for written orders, but does confirm a verbalized plan**

Learning (learning process)

An active process that requires engagement, participation, motivation, & readiness

** nurse must assess a patient's motivation & readiness

--> fosters therapeutic relationship & builds trust