clinical concepts exam 1 review

Where does the legal definition of nursing come from?

Nurse Practice Act

What does the Nurse Practice Act do?

Defines the scope of practice → what nurses are legally allowed to do, lists qualifications required for licensure, defines nursing titles that can legally be used, and explains actions that can occur if a nurse does not follow nursing law

Missouri Nurse Practice Act definition of professional nursing

Professional nursing involves acts requiring specialized education, judgment, and skill.

responsible for:

• teaching of health care and prevention of illness

• assessment, nursing diagnosis, nursing care, and counsel

• administration of medications and treatments

• coordination and assistance in the delivery of health care

• teaching and supervision of others

Definition of nursing according to the American Nurses’ Association

Incorporating the art and science of caring, focusing on promoting health, preventing illness, facilitating healing, and alleviating suffering. Nursing also involves diagnosing and treating human responses and advocating for patients. 

Virginina Henderson’s nursing definition

Help patients perform activities contributing to health, recovery, or peaceful death that they would perform independently if they had the strength, will, or knowledge. 

Dorothea Orem nursing theory

Self care deficit theory: Nursing is needed when a person cannot meet their own self-care needs.

Callista Roy nursing theory

Adaptation Model: The person is an adaptive system who responds to changes in their environment.

Virginia Henderson nursing theory

Principles and Practice of Nursing: nursing helps patients become independent

Imogene King nursing theory

Theory of Goal Attainment: Nursing involves helping the patient and nurse work toward goals

Madeline Leininger nursing theory

Cultural Care Theory: Nursing care should recognize and incorporate the patient's culture

School of nursing 4 metaparadigm concepts

Person, environment, health, nursing

Person

Adaptive system that interacts with the environment + can be an individual, family, group, or community. The person has physiological, psychological, spiritual, and sociocultural dimensions. 

Environment

External factors that surround or interact with the client and influence their development and behavior 

Health

Dynamis state of fluctuating from high wellness to death 

Nursing

Science and art that assists person toward maximal integrity 

Nursing definition according to SLUSON conceptual framework

Nursing is both a science and an art that helps clients with actual or potential health-related difficulties adapt. 

Core concepts of the nursing model

Communication, collaboration, curiosity, competence, and care/cure. 

How does caring affect the nurse-patient relationship

Caring builds a foundation of dignity, respect, and optimism that helps patients navigate health transitions and process their care without assumptions. However, organizational stress, time limits, and compassion fatigue can strain this relationship by causing nurse burnout and reducing empathy 

Dr. Benner’s “Caring is Primary” theory

People, events, projects, and things matter to people. Patients are unique with unique backgrounds, experiences, values, and cultural perspectives 

Leininger “Transcultural Caring” theory

Caring is personal. Expression of care varies among cultures

Watson’s “Transpersonal Caring” theory

Holistic intention promoting healing and wholeness 

Swanson’s “Theory of Caring”

Knowing, Being with, Doing for, Enabling, Maintaining Belief

Knowing

• Understanding the lens of the client, how it affects their life.  

• Practice this by avoiding assumptions, focusing on client, asking/knowing their preferences

Being With

• Emotionally present 

• Practice this by being present, sharing feelings

Doing For

• Do as you would want done for yourself 

• Practice this through comfort, protection, preserving dignity

Enabling

• Assisting others to do things independently, with support 

• Practice this by supporting (but not taking over), informing, explaining

Maintaining Belief

• Faith that others have the capacity to get through an event of transition 

• Practice this by believing in, hope filled attitude, offering realistic optimism

Cura Personalis Conceptual Model of Communication

Psychological, Physiological, Spiritual, Sociocultural

Physiological

nutrition/metabolism, activity/exercize, elimination, sleep/rest, sensory/perception, sexuality/reproduction

Psychological

Self-perception, self-concept, coping and stress tolerance, learning and decision-making

Spiritual

Values and beliefs regarding purpose of life

Sociocultural

Broader community, cultural, and other groups. Learned patterns of behavior, cultural values, and practices as well.

What is Holistic Relief of Suffering

Caring goes beyond physical tasks to offer dignity, comfort, peace, and emotional relief 

Active Engagement

How nurses interact through core behaviors: providing presence, using touch, listening, knowing the patient, offering spiritual care, and involving family

Personal Development

Self-care ("can’t care for others on an empty tank"), observing patient needs, reflecting on practice, and assessing expectations 

Presence

emotionally available, saying “I’m here”, and offering a quiet, supportive presence during situations

Contact Touch

Physical, skin-to-skin touch such as holding a hand, giving a massage, or gently positioning a client.  

Protective Touch

Touch used to protect the nurse or client, such as holding a client to prevent a fall or physically distancing from a client during high tension.

Therapeutic Touch

Intentional, holistic, and compassionate touch aimed at helping clients find inner balance. (Note: Always use touch with discretion and inform patients when touch will occur)

Therapeutic benefit of listening to patients

Listening provides a quiet, comforting presence that helps alleviate patient suffering, reduce symptoms, and preserve human dignity. It enables the nurse to truly know the patient and deliver personalized care that honors individual preferences

Therapeutic relationships

Purpose is to achieve health-related treatment goals, focus is patient needs, time is limited, and boundaries are professional 

Social relationships

Purpose is mutual pleasure, social connection, focus is mutually beneficial, time is ongoing, boundaries are flexible

Paralanguage

Verbal style that influences communication: pacing, intonation, clarity, brevity, timing relevance, non-verbals, touch

Categories of distance

Intimate distance: 0-18in

Personal distance: 18-40in

Social distance; 4-12ft

Public distance: 12+ ft 

Therapeutic use of self

Focuses on who the nurse is in relation to the patient, rather than simply what the nurse does: authencity, self-awareness, presence, empathy, appropriate level of involvement

Phases of Nurse-Client relationship

Pre-interaction phase, Orientation phase, Working phase, Termination phase

Pre-interaction phase

Patient not present, identify professional goals, plan time and space for initial interaction

Orientation phase 

When nurse and patient get to know one another, clarify roles, assess patients' health questions, begin to identify patient problems/goals

Working phase

Work together to solve patient problems and achieve patient goals, utilize therapeutic communication skills

Termination phase

End of relationship, reminding the patient of closure, transition of care 

Active listening responses used in therapeutic communication

Minimal cues: brief verbal and non-verbal prompt to encourage the client to speak, use SURETY

Therapeutic responses in Nurse-Client relationship

Reflection, summarization and validation, providing information

silence, touch, restatement, clarification, paraphrasing

SURETY

• S: sit at an angle 

• U: uncross arms and legs 

• R: relax 

• E: eye contact 

• T: touch 

• Y: your intuition

Communication styles that block therapeutic communication

False reassurance, giving advice, false inferences, over generalizing, changing subject, moralizing

Nurse Practice Act

State laws to protect citizens and make nurses accountable 

Affordable Care Act (ACA)

Federal health care reform law in US makes health care more affordable 

Good Samaritan Laws

Limits liability and offers legal immunity if nurse helps at scene of accident 

Public Health Laws

Requirements for reporting disease, immunizations to reduce health risks and promote health in community (CDC, OSHA)

Physician Assisted Suicide

• Competent individuals with terminal disease can request to end their life- state laws 

• American Nursing Association believes it is a violation of the code of ethics 

• American association of colleges of nursing supports

Uniform Determination of Death Act

Act that gave the basic definition of death 

Tort

• civil wrongful acts or omissions of care

• 3 types- Intentional, Quasi-intentional, and Unintentional

Intentional Tort

deliberate acts against a person or property 

ex:

• Assault: verbal threat 

• Battery: offensive touching 

• False imprisonment 

• Fraud 

Quasi-intentional

Person invades another’s privacy in some way or defames one’s character; intent to harm is not there 

Slander

Spoken defamation

Libel

Written defamation

Unintentional Tort

a nurse does not intend to cause harm, but their care falls below the acceptable standard through carelessness or recklessness

Malpractice

negligence by a professional 

Negligence

Can be act of omission or act of commission 

4 necessary elements for malpractice

1. Nurse had duty to patient 

2. Nurse failed to carry out duty 

3. Patient was injured as result; foreseability 

4. Damages to patient 

HIPPA (Health Insurance Portability and Accountability Act)

provides right to patients to consent to the disclosure and use of health info 

Examples of legal issues that arise in nursing practice. 

• Medication errors 

• Falls 

• Inadequate assessment/judgment 

• Patient identification errors 

• Inappropriate delegation 

Ethical principles important to nursing practice

• Autonomy: freedom from external control 

• Beneficence: act in patient’s best interest 

• Nonmaleficence: avoid harm 

• Fidelity: faithfulness or the agreement to keep promises 

• Justice: treating all patients equally 

• Veracity: truth telling 

Legal responsibilities of nursing students

• Primary commitment is to the patient 

• Promotes safety and rights of patient 

• Owes same duties to self as others 

• Participates in establishing/advancing healthcare 

• Collaborates with other health professionals/public 

Ethical issues

Ethical issues involve moral principles and values about what is right or wrong

Legal Issues

Legal issues involve laws and regulations established by the government

Why is effective Interprofessional communication is imperative in health care 

It is essential for patient safety and quality care because health care teams must share information and work toward goals. Collaboration is based on trust, respect, and understanding of each team member’s role. 

Passive behavior/communication

Avoid or sidestep issues; feelings of powerlessness or anxiety

Aggressive

Goal of dominating, contains “you” statements 

Passive-aggressive

Indirect expression of hostility, indirect expression of hostility 

Assertive

Acting on goals in a clear, consistent manner, taking responsibility for consequences (express empathy, describe the behavior, state expectations, list consequences)

techniques that promote assertive communication and behavior

• Use “I” statements 

• Verbal and non-verbal messages are the same 

• Adress only current issues 

• Express empathy 

• Descrive feelings 

• State expectations 

• List consequences

Incivility

Lack of respect or civility and can include obvious or underhanded behavior 

Lateral violence/bullying

workplace bulling among colleagues

Strategies to enhance conflict resolution in health care settings

• Use CUS: concerned, uncomfortable, safety 

• Emphasize specifics of the putdown behavior 

• Prepare a few standard responses

how is inormation from the nursing process documented

• Record objective observations and subjective client statements using direct quotes 

• Use structured approaches such as SOAP notes

Charting by Exception

detailed charting for abnormal/significant findings only using predefined standards/flowsheets

Narrative charting

statement nurse makes regarding incident that occurs with patient 

Use of client health records

Purpose is to provide legal accountability, support continuity of care, interprofessional communication, and assist with quality assurance 

EHR pros

lifetime patient data, cost savings, efficiency/ease of use, enhanced quality of care 

EHR cons

High cost, lack of standardization, confidentiality login issues, time consuming 

Strategies to safely record/report information 

• Use clear, factual data; sign entries with first & last name and credentials 

• Handoff: use ISBAR 

• Telephone orders: used closed-loop communication by completing a “read-back” 

• SOAP

ISBAR

• Identify yourself 

• Situation 

• Background 

• Assessment 

• Recommendation 

S in SOAP

Subjective data- what patient says 

O in SOAP

Objective data- Measurable and objective data: vital signs, lab results, etc

A in SOAP

Assessment- Nurse’s clinical judgment or conclusion

P in SOAP

Plan- Proposed interventions, treatments, etc

Do not use abbreviations of…

• U for unit 

• IU for international unit 

• Q.D. or Q.O.D. for daily or every other day 

• Trailing zero or lack of leading zero 

• MS (can mean morphine sulfate or magnesium sulfate) 

• MSO4 or MgSO4 (can be confused for one another) 

How do provisions of the Health Insurance Portability and Accountability Act (HIPAA) impact nursing practice

Mandates protection of 18 protected health information (PHI) identifiers 

18 protected health information (PHI) identifiers 

• Name 

• Address 

• SSN 

• Dates 

• Medical Record # 

• Telephone # 

• Email address 

• License plate # 

• Full facial photographs 

• Fax # 

• Health plan # 

• Account # 

• Certificate/license # 

• Device identifiers 

• URLs 

• IP address numbers 

• Biometric identifiers 

• Any other identifying code