Foundations Quiz 1

what is a provider?

anyone who can order tests and write prescriptions (NP, DR, PA)

what is a nurse? (what do we need to have to become a nurse)

a profession!

\-requires extended education

\-requires its own body of knowledge (nursing research, nursing journals etc.)

\-provides a specific service (putting in catheter, changing dressings)

\-has autonomy (freedom to do things on own)

\-incorporates a code of ethics (right vs wrong; every nurse must follow the same one)

The code of ethics is decided by

the ANA or american nurses association

do we need a doctors order to give medicine or start an IV?

YES

western medicine is often ----- oriented

disease

holistic medicine

not just the physical, what is going on around you plays a role like spiritual, mental, psychological, physiological, developmental

the ANA helps to make big decisions for the

profession

can anyone be a nurse?

no

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has rigors that must be met to stay in that profession

\-NCLEX, certification exam, requirements of hiring facility, stamina for environment

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mental/physical/emotional stress

what are the 4 pillars of nursing PADE

1. educates patients and families (consider this/that)
2. diagnose problems within the scope of nursing (medical vs nursing diagnoses)
3. provides care within nurses scope
4. advocates for the health and wellness of the client (speak up for them on all levels, look for the best possible way to care for the patient)

medical diagnoses

disease focused (cancer/asthma)

nursing diagnosis

how the disease is impacting the patient (instability, SOB, pain, impaired perfusion)

should we ever cast judgement?

NO

Levels of Nursing

LPN-lisenced practical nurse (1 yr)

ADN-associates degree RN (3 yr)

Diploma RN

BSN-baccalaureate RN (4 yr degree at least)

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what is the NYS Law BSN in 10?

pressure for nurses to complete a BSN degree, makes it so that after you get first degree you must go back and get your BSN within 10 years

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ADN/LPN not promoted and encouraged to get more educated

what is the purpose of the BSN in 10 law?

lower mortality, more educated nurses decrease chances of death; less chance of hospital related errors/sores

Advanced Practice Nursing

CRNA-certified nurse anesthetist, DNP required after 2025, anesthesia/thermodynamic monitoring/pre and post care

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CNMW-certified nurse midwife, masters degree required, womens health, care pre and post delivery, no c sections

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CNS-clinical nurse specialist, DNP after 2030, educators of staff and patients

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NP-nurse practitioner, DNP currently not required in NYS, can diagnose and prescribe

advanced practice nursing is

above an RN but not as much medical responsibility as a DR, step below an MD, all need specialized training after a BSN though

Doctoral Options

DNP-doctorate of nursing practice (clinically based)

PhD (doctorate of philosophy) research based

DNS-doctorate of nursing science (research based)

lots of options like public health, health admin etc.

how would you go by name in the hospital now?

Peyton Shales, SN, SUNY Brockport

how will our name be written after we graduate?

Peyton Shales, BSN, RN

How did nursing start? with who?

Florence nightingale, born 1820 in England, born affluent, turned away from this privilege and was ridiculed by friends and family

Florence Nightingale was the first person to say that we should

wash our hands between patients

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keep sick and healthy patients separate

Florence Nightingale is most famous for her help in which war

Crimean (1853), many died but only 1/6 was from battle wounds; the rest died of disease like malaria, cholera, typhus, dysentery (sanitation measures were not good)

What did florence do?

took group of 38 nurses to help

told people they need to wash their hands

created “sick rooms” and separated them from “clean” and “dirty”

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provide physical and emotional care

florence is called the ------ of ------ and the ---- she carried became the symbol of nursing (walk up and down aisles with it)

mother of all nursing, lamp

what did florence write?

the notes on nursing--the first formal teaching of infection control and patient care-→holistic approach

Clara Barton

work during civil war, founded the red cross

dorothea dix

helped the mentally ill, created mental asylums during civil war, superintendent of army

mary eliza mahoney

first african american RN, helped create the ANA (created code of ethics), and fought for civil rights

when did nursing education and creation of establish practices emerge?

in early 1900s

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1920s started specializing and specialized nsg organizations emerged

what is our first priority in patient care?

keeping the pt safe

what does nursing look like in the 21st centrury?

1. changes in profession (shortage of nurses, changes in nursing code of ethics, changes in curriculum, at various levels of education/authority)
2. healthcare struggles (EBP--best way to take care of ppl backed by evidence), multiple care settings, safety, regulations, who is paying, superbugs, lifesaving techniques)
3. societal influences (political agendas within and without health care, bioterrorism, demographic shifts in population--baby boomer biggest population so many elderly now)

Healthcare error is the --- leading reason why patients die

3rd

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many deaths caused by medical errors

hospitals must follow pt safety goals to ensure that they remain accredited and follow to remain in good standing (all in institute of medicine, to err is human)

what is QSEN

quality and safety education for nurses (movement to make sure nurses are working safer for their patients)

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helping nurses improves the entire system

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nurses make up 1/3 of all HCW

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no task oriented people--bigger picture nurses

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all HCW work as a team, work to keep the team effective

why was there a push to keep patients safe?

many errors being made

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focused on seeing more people instead of proper quality of care

Statistics on patients errors/trouble in hospital

est. 440, 000 ppl die each year from errors injuries accident or infection

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that is 1200 people a day

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1/25 people will acquire an infection while in the hospital

1/4 pts who receive medicare will experience an error or injury while hospitalized

Medicare punishes hospitals for what?

if you end up with UTI or bed sores from the hospital, medicare will not pay because it was preventable (occur at hospital), same thing for falls or infections

JCAHOs definition and safety goals

Joint Commission of American Hospital Organizations

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what is it? agency that makes sure all care providing facilities are doing the right thing, wont get paid by insurance unless accredited by JCAHOS

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role in pt safety? make sure facilities are running safely

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current goals


1. identify pt with 2 identifiers *name and bday*
2. improve staff communication
3. safe medicine handling and administration
4. use alarms safely (on beds etc)
5. prevent infection
6. patient safety (reduce risk of suicide)
7. prevent surgical errors (wrong pt or wrong cut or wrong side)

Scientific Knowledge Base

1. safety in health care setting (reduce incidence of injury/illness, prevents extended length of treatments/stay, improve and maintain functional status, increase clients sense of well being)
2. a safe environment (includes meeting clients needs (pain/confusion), reduce transmission of pathogens, maintain sanitation, reduce pollution, protect pt from violence against self/from others)

if a pt is confused or in pain you cannot trust their ability to make a well-informed decision

what are examples of a risk for an `infant`/toddler/prek?

putting things in mouth, touching others/things, germs, try to crawl or walk in dangerous areas, play with cupboard, allergies

what are examples of a risk for a school aged child?

running around, not socializing just watching tv all day, increased burns from chicken nuggets etc, nutritious foods needed, over developed thumbs from screen time and not other fingers, climbing and rough housing, discovering allergies

what are examples of a risk for an adolescent?

eating disorder, bullying, self esteem issues, drugs/alcohol, developing hormones and impaired decision making, STD/STI, peer pressure, driving or learning to drive, anxiety/depression, too much screen time

what are examples of a risk for an adult?

consequences of adolescent decisions, coping issues, independence vs isolation, alcoholism/drugs, thinking they know everything, job stressors, having children, job chemicals

what are examples of a risk for an older adult (elderly)

falling, dental health, drowsiness, thin skin, regrets, falling, fragile bones, confusion/memory loss dementia (not normal but it happens), reduced hearing and eyesight, lack of social support, poor driving, less active, loss of independence (and deny this loss; try to push through it)

what are individual risk factors that you can control?

using drugs, dietary choice, STD/STI, who you surround yourself with, relationships yo uare in

what are individual risk factors you cannot control?

genetics, financial status, access to healthcare (transport/money/available geographically), mental health issues

what are risks that occur in a healthcare agency?

HIPPA compliance (put pt privacy at risk if no comply), medical errors (giving wrong drug), chemical use, falls, client inherent accidents (doing things that may be risky that they should not be doing), procedure related accidents (UTI with catheter placement), equipment related accidents (lean on walker and it breaks or IV bolus breaks)

Nursing theory and the women who helped with systems theory

a theory is a framework or foundation for which we can base our knowledge off of/something we can test

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betty newman created systems theory as a way to see pt as center of a circle that is attacked by different holistic factors (psych, developmental, spiritual, sociocultural)

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nursing theory-→ to keep pt safe

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try to stop drops in wellness through actions called nursing interventions or preventions

what is a primary prevention?

things nurses do to keep the pt from becoming ill (preventative care)

what are secondary preventions?

things nurses do once the pt is already ill to help the pt return to baseline or “normal” health

what is a tertiary prevention?

things nurses do after the pt has recovered to help the pt stay well and not become ill again (physical therapy or rehab)

prevention/intervention/action are all

interchangable

if a patient ate 4 big macs and 7 milkshakes and had a heart attack in front of you what are the pp, sp, and tp?

pp: eat slower, lower intake of high fat/high salt, monitor blood pressure, exercise, smoking?, stressful life, better diet, learn about health history/predisposition---teach dangers

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sp: treat heart attack in hospital, call 911, check for pulse; if none begin cpr

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tp: educate, give nutritionist information, meet pt where they are instead of 4 big mac maybe 2 and 5 shakes then each week try a little less (no cold turkey doesnt usually work), encourage exercise/financial help with resources

what are the settings of healthcare? why does it matter?

anywhere the pt is receiving care; clinic, home, ED, rehab, nursing home, school nurse

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it matters because the pt will have access to different types of care in different settings

\--management of resources (keep icu beds for very ill pt)

\--patient comfort and care (tied to monitors, wont be good/take away independence of those who do not need this type of care)

prevention is

nursing action

setting is

places ppl can go to get help

Preventative Care and Primary Health Care

\-preventative care

\-primary care (PCP)

\-first place person may go with a health concern

\-stresses health promotion as a key to quality health

where would you go for a sore throat?

primary healthcare; not emergency dept because its cheaper and not an emergency

Secondary and Tertiary Care

focus on diagnosis and treatment of disease

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in hospitals, icu, subacute facilities, urgent care centers, rural hospitals

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secondary: a few specialists, minor surgeries, can deliver babies, but no trauma center or big surgeries

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tertiary: big hospital, help with anything/everything, trauma expertise centers

Home Care, why would a pt need this?

focus on client and family independence

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involves coordination of services and equipment for health maintenance, education, illness prevention, diagnosis and treatment of disease, palliative care, and rehabilitation

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no reliable transportation, immunocompromised, hip surgery, those who are more independent but need some help, end of life care (comfort), developmental issues

Skilled Nursing Centers, Nursing Homes and Long Term Care facilities

skilled nursing center: like a nursing home but with would care and antibiotics

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nursing home: pt is stable; no need for wound care or antibiotics

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provides 24 hr intermediate and custodial care (rehabilitate, dietary help, nursing, recreational, social, and religious services)

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regulated by standards--omnibus budget reconciliation act of 1987

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for care of elderly and geriatric (need round the clock care)

Assisted Living Centers

need some help, but also more independent pt’s

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dont need as much care as nursing home; need to be able to walk to be here

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long term care center with home like environment, more autonomy, allow to live in own units while not being alone like an apartment

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need some help but can be independent with things (for adults who benefit with help bc they fall, ned help with meals, laundry, housekeeping, 24 hour oversight etc.)

Respite Care

provides short term relief to family providing care for the pt to go and do other things like errands and social time

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trained volunteers/person take care of pt while family or caregiver does other things or gets away for a little while

Adult Day Care Centers and Outpatient Therapy

may be associated with hospital or nursing home or operate independently

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offer services to patients in need of physical rehab, counseling for emotional, drug, ED, or alcohol treatment

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day treatment centers

counseling/food involved

Hospice

family centered care that allows clients to live and remain at home

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focus on comfort, independence and dignity

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provides client and family support during terminal phase/time of death

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when diagnosed with a 6 month prognosis; all about keeping pt comfortable for end of life (make it easier, pain relief)

The Health Care Delivery System

before hospital: preventative care, primary care

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hospital treatment: small-midsize hospitals (secondary care), specialists (secondary care), trauma centers (tertiary care)

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after the hospital: nursing homes (for rehab), skilled nursing facilities (SNFs), homecare; nursing, PT, respiratory care, wound care, outpatient rehab

a person who gets an education course during the day and then goes home is in

outpatient therapy/ day treatment center

a woman has bump in her breast and is concerned, where would she go first to check it out

pcp (primary care)

the woman finds out she has cancer and needs a small surgery where would she go?

secondary hospital

during the surgery they find that the women has cancer all throughout her body and is going to need more intense care/surgeries/ where does she go now?

tertiary care

what setting would a pt be in if they wanted to go home after a surgery but needed a little extra help?

home care

Ethics

gives us an idea of what is right/wrong when it comes to care of our pt

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can look diff for diff people

as DR/heath-care providers we all need to make sure we are on the same page (dont have to agree but need to follow it)

what are some things providers may disagree on?

vaccinations, universal healthcare, our role in helping immigrants, abortion, physician assisted suicide and our role, death penalty, euthanasia

who decides what the nursing ethics are?

american nursing association

ethics definition

conduct and character that reflects the greater good rather than what is just good for the individual

autonomy definition and example

respect for acting independently (pt right to have a choice, nurses right to practice within scope)

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ex. jehovahs witness cant recieve blood, dont try to make them

support pt right to choose

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parent say no and pt says yes, then it is yes

is our patient just who we are treating/who is in the bed

no, the family is the patient too

beneficence definition and example

first goal is to have a positive impact on others (what is good for that patient), all actions have to be good (intention has to be good for all actions)

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giving the pt the best cancer treatment backed with EBP instead of one that is easier

nonmaleficience definition and example

“first…. do no harm” make sure your actions do not cause harm even if they are good-intentioned (slow down and prioritize what the pt wants--tell them what is going on)

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opposite: give pt vaccine even if parent says no bc nurse thinks it is the best and “i know what is best”----broke pt autonomy

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you might want to do something but to protect the pt autonomy I am not going to do it (educate in professional/informative/respectful way)--dont try to scare ppl it wont work

justice definition and example

fairness; may refer to allocation of resources or “just culture”

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equal access to different healthcare

give everyone excellent treatment

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pro bball player should get same treatment as a normal jo shmo not better bc he pays more

fidelity and example

keeping your promises; helps build trust

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if u say youll be back in 5 minutes actually come back in 5 minutes

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pain meds ordered say Ill call Dr, call Dr and get it to the patient asap (pain should always be a priority)

if we made a mistake and gave someone 8mg of morphine instead of 3g morphine should we tell the provider?

YES

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or else you will be the cause of the pt dying/severe complications

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they could try to treat something else and end up opening up the pt for no reason

living will

says what you want done with your body after death

healthcare proxy

person to speak for you, knows what you want

DNR

do not resuscitate

full code

do whatever we can to save your life

if there is an emotional convo, are the words coming out of the peoples mouths always their true intention?

NO, find motivation for their actions or why they are feeling this way

every healthcare facility needs a board of ethics; what does it do?

each part of heath-care team represented (PT/speech path, DR, nurse etc.) look at the situation in an ethical way/look at laws and then try to make a decision

defining health, wellness, and holistic care

how we see our pt and our role; determines our effectiveness

American Nursing Association definition of nursing (2010)

nursing is the “diagnosis and treatment of human responses to actual or potential health problems”

pneuomonia, lack of oxygen to body which one is the nursing diagnosis and which is the medical diagnosis

pneumonia-medical

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lack of oxygen--nursing

potential health problem means that is has not

happened yet

cataracts, lives by cliff outside house which is the actual vs potential health issue?

actual: cararact

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potential: cliff outside

world health organization definition of health (1947)

a state of complete physical, mental, and social well being not merely the absence of disease or infirmity

are you healthy if you do not have cancer but you are depressed?

NO

are you healthy if you dont have ulcers but theres shootings everywhere you live?

NO

domain of nursing

the perspective of a profession; everything that a profession addresses

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in nursing: education, research, theories, scientific knowledge, practical experience

if a nuclear plant is by the school and was leaking into the playground is it within the nurses domain to test chemicals and help make laws to protect the kids?

yes

paradigm/what is nurses paradigm

“your world view'“ the perspective you use to interpret events;

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nurse: always look at how can I help this person in the situation/be benificent

does good health mean the same thing for everyone?

NO; varies with the patients baseline health and what the pt desires