Intro to Nursing - Exam 1

Past status of nursing

Dependency on doctors, little to no education, poor public opinion on nurses, custodial/cooking tasks, lack of evidence-based practice, no technology (electricity, poor sewage system), no social advocacy

Today’s status of nursing

Independent, opportunities for education, change in tasks, high public opinion, use of evidence-based practice, developing role of social advocacy, advanced technology

Entry level preparation of nurses

Diploma (hospital based), associate degree (2-3 community college), bachelor’s degree (4 years college/uni)

Why is nursing licensure important?

To protect the public

Where can we find the statutes for nurse license?

Under the Bureau of Professional and Occupational Affairs (BPOA)

Nursing licensure is under

Nurse Practice Act

What does the PA State Board of Nursing do?

Establishes practice guidelines, can give or take away license, protect the public from the unsafe practice of nurses

Is healthcare and education is determined by the federal government or state?

Determined differently by each state

Compact licensure

Can work in any state that is part of the Enhanced Nurse Licensure Compact

Licensure steps

Graduate from an approved school of nursing, request a 1 year temporary practice permit, pass the NCLEX

NCLEX

National Council Licensure Examination

License renewal

Renew every 2 years, pay certain fees set by statute, 30 hours of CE, state that you have not been convicted of a felony

PA Nurse Practice Act

Defines nursing, determines nurses’ scope of practice, sets requirements for nursing schools, makes disciplinary determinations

Dorthea Orem’s Theory of Nursing

The more a patient needs, the more the nurses do

Aesthetic knowledge

“Art” of nursing: empathy, caring, skill, and compassion. Use of past experience to consider alternative interpretation of a clinical situation

Ethical knowledge

Conception of what’s good and right. Based on the ethic of caring

Empirical knowledge

Objective, textbook, evidence knowledge

Personal knowledge

Connecting with the patient

Sociopolitical knowledge

Understanding of the political backdrop that supports healthcare

Self care deficit theory of nursing (Dorethea Orem)

Nursing analyze the patient’s current situation, determining what their self-care deficit is, and then supplementing what they do not know or cannot do

Clinical judgement is the sum of

Caring, knowledge, competence, and scholarship

Advocacy is made of

Knowledge, competence, clinical judgement, communication skills, ability to work with interdisciplinary teams, and willingness to stand up

What is research?

Systematic investigation

EBP

Finding out what the best practice is

PICO question

Helps formulate a clinical question and helps find sources

PICO(T) acronym

Population, intervention, comparison, outcome, (time)

Population

Who we are targeting

Intervention

Find a research article about an observation or intervention

Comparison

Compare with a control group

Outcome

Finding out what worked

Research vs EBP

Research is a systematic investigation to find new knowledge, while EBP is finding existing research and putting it to best use

Time

Time frame

Barriers to EBP

Not knowing about EBP and its value, not knowing where to find/lack of resources, limited time, nursing shortage, forgetting the practical part of EBP

Facilitators of EBP

Support and encouragement from administration, time, clearly written research reports, shared vision and mission of healthcare team

First step if blood pressure is too low

Re-check it

How to take BP

Keep forearm support at the level of the heart, support patient’s back/should be relaxed, uncross legs, cuff and stethoscope should be on bare skin, apply cuff snugly with the arrow pointing to the brachial artery, choose correct cuff size

Nursing process (AADPIE-C)

Assess, analyze/diagnose, plan, implement, evaluate, communicate

Assess

Collect data

Analyze

Analyze data, identify health problems, check for what is concerning/not concerning

Plan

Select interventions, formulate goals and design health outcomes

Implement

Implement interventions, supervise care

Evaluate

Check if intervention was successful

Subjective

What the patient says

Objective

What we (the nurses) observe

Diagnose

Outcome of the analysis

SBAR-R

Situation, background, assessment, recommendation, repeat back

Situation

Who I am, which patient I am talking about

Background

Patient background, be short and concise

Assessment

I think “this” is happening and the patient needs “this”

Recommendation

Suggest solution

Repeat back

Repeat doctor’s orders for confirmation

Normal BP

<120/<80

Elevated

120-129/<80

HTN stage 1

130-199/80-89

HTN stage 2

>140/>90

HTN emergency

>180/>90

When analyzing BP

Keep patient’s lifestyle in mind such as meds they are taking, look for trends

True or false: low BP is dangerous when not acted on quickly

True

Low BP

Systolic <100

What to do for a patient with chest pain

Stick with patient, have them sit and relax, check vitals, call fo rhlep, ask to rate pain from 1-10, ask where the pain is

If the patient has hypotension

Have them lay down

What to do with patients who are short of breath/respiratory diseases

Pull patient up to the top of the bed, have them sit up/forward before putting the head of the bed up, call for help, get vitals (rr, bp, hr)

Deadly respiratory rate

<8

Normal rr

12-20

Normal heart rate for adults

60-100

What to do if a patient falls

Stay with patient, don’t move patient, get help, evaluate the causes of the fall and for any injuries

What to do if a patient has a seizure

Don’t restrain them, wait (if seizure doesn’t stop after 1 min it could be status epilepticus), don’t open their mouth, protect head. After the seizure, turn them on their side to protect airway

Signs of a stroke

Check balance, check vision, ask pt to smile for droopiness, ask pt to raise arms, ask pt to repeat sentence, turn them to the side, get help

SNS

Fight or flight response

Signs of activated SNS

HR increased, BP elevated, cold sweat

What does a high pulse but low blood pressure mean

The SNS failed and something is wrong with the patient

Discipline for nurses

Can be fined or have license revoked for various actions, most common being substance abuse

Clinical judgement process from the National Council on State Boards

Recognize cues (assess), analyze cues, generate hypothesis (diagnoses), prioritize hypothesis, consider possible actions/take action (plan and implement), evaluate