Nursing 104 Exam 2 Study Guide

evidence based practice

the process of systematically finding, appraising, and using research findings as the basis for clinical practice

practice guidelines

research-based recommendations stated as standards of practice, procedures, or decision algorithms

research

a process of systematic inquiry or study to build knowledge in a discipline

to develop a body of knowledge for a profession

what is the purpose of research?

nursing research

a systematic approach used to examine phenomena important to nursing and nurses

florence nightingale

who did nursing research begin with?

nursing education

what was the focus of research during the 1900s-1940s?

teaching, administration, curriculum

what was the focus of research until the 1970s?

improvement of patient care

what was the focus of research during the 1970s?

to provide high quality care to individuals

why does nursing exist?

to put the knowledge gained to work in health care

what is the main outcome of research activity for nurses?

federal funding, private foundations, nursing organizations

what are the 3 types of funding for nursing research?

national institute of nursing research (NINR) and agency for healthcare research and quality (AHRQ)

what are the 2 sources of federal funding?

national institute of nursing research (NINR)

symptom science, wellness, self-management, end of life and palliative care

NINR innovative question initiative

launched to encourage new thinking and creativity in nursing to promote results-oriented innovations

agency for healthcare research and quality (AHRQ)

improve health care outcomes, reduce the risk of harm, transform research into practice, promote use of EBP, advanced use of information technology for coordinating patient care and conducting quality and outcomes research, include priority populations health care needs in their research

robert wood johnson foundation and w.k. kellogg foundation

what are the 2 private foundations that provide research funding?

sigma theta tau international (STTI), american nurses association (ANA), oncology nurses society (ONS), american nurses foundation (ANF)

what are the 3 nursing organizations that provide research funding?

sigma theta tau international (STTI)

makes research grant awards to increase scientific knowledge related to nursing practice; supports creative interdisciplinary research and places important on identifying best practices and benchmark innovations

american nurses association (ANA)

awards small grants through the American Nurses Foundation

oncology nurses society (ONS)

awards grants that focus on issues related to oncology

clinicians, students, educators, administrators, and policymakers

EBP has become a major driving force in the disciplinary life of who?

translation science

extensive work is being done on the best ways to translate research into practice, spawning a new area of health care science; to provide guidance on the best ways to incorporate best evidence into health care

clinical nurse specialist (CNS), clinical nurse researcher (CNR), clinical nurse leader (CNL), doctor of nursing practice (DNP)

what are the 4 nursing research roles?

clinical nurse specialist (CNS)

registered nurse with graduate preparation in a specialized area of nursing practice and an expert clinician with additional responsibility for education and research

clinical nurse researcher (CNR)

doctorally prepared nurse with clinical and research experience

clinical nurse leader (CNL)

use quality improvement methods in evaluating individual and aggregate client care and for self-improvement

doctor of nursing practice (DNP)

provide leaderships for EBP in nursing and translate evidence-based nursing research in their own practice

clinical practice guideline

an evidence-based guide to clinical practice developed by experts in a particular field for direct application in clinical environments

evidence

what are practice guidelines driven by?

institutional review board (IRB)

examines research proposals to make sure that the ethical rights of those individuals participating in the research study are protected

humans

the institutional review board only deals with research involving who?

false; its optional

T/F: IRB approval is required

nazi experiments, tuskegee syphilis study, jewish chronic disease hospital

what are 3 examples of unethical research?

nazi experiments

experiments with untested drugs, sterilization, and euthanasia on prisoners of war; caused grievous harm to the subjects and denied the opportunity to refuse participation

tuskegee syphilis study

conducted to determine the natural course of syphilis in African-American men; participants were not informed about the purpose and procedures of the study; did not receive treatment for syphilis

jewish chronic disease hospital

the setting for a study that determine patients' rejection of liver cancer cells; 22 patients were injected with liver cancer cells without being informed that they were taking part in the research

finding, appraising, using

what are the 3 methods for processing EBP?

provide foundation for behaviors; create a strong scientific base; provide support for the quality and cost-effectiveness of interventions; demonstrates professional accountability; generate knowledge in areas that indirectly affect nursing care

what are the benefits of nursing research? (5)

symptom science

promoting personalized health strategies

wellness

promoting health and preventing illness

self-management

improving quality of life for individuals with chronic illness

end of life and palliative care

the science of compassion

research findings, research reviews, EBP theory

what types of evidence does EBP encompass?

research utilization

a subset of EBP; the use of research knowledge, often based on a single study in clinical practice

population, intervention, comparison, outcome, time

what does PICOT stand for?

UL library

where is the nearest research university?

internet (www.), CINAHL, MEDLINE, EBP.com, clinical practice guidelines

what are some official computerized databases? (5)

saline for flushing IVs and prevention and management of pressure ulcers

what are 2 examples of evidence-based nursing practice?

informed consent signature

explains the study; statements about potential risks and benefits; protection of anonymity and confidentiality, voluntary participation; right to refuse to participate or to withdraw from the study

IRB approval

demonstrates scientific rigor to the audience when the research is disseminated either through presentation or publication

1.Conditions

2.Society

3.Education

*Educational Issues and Trends*

Shifts in 1. __________ and concerns that emerge from and influence various aspects of 2.______; broad changes in the US and the world that influence the 3.________ and practice of nurses & providers

1.Problems

2.Present

*Contemporary Issues*

the 1.__________, changes, and concerns that are current for the 2.________ time.

1.Technology

2.Competency

3.Cultural Diversity

4.Engagement

5.Nurses

*Examples of Educational Issues and Trends*

Knowledge Expansion and use of 1._______ and the Internet.

Practice-based 2._______ outcomes.

Sociodemographics, 3._________ ________, and economic and political changes.

Patient-centered care: 4._________ , safety, and privacy.

Shortage of 5._______ and faculty.

1.Practice

2.Volume

3.Information

*Knowledge Expansion and Use of Technology and the Internet*

A major part in education & 1._________.

Information 2._______ growing exponentially.

Ability to create, access, disseminate 3.________ rapidly is beneficial.

1.Measurable

2.Purpose

3.Nurse

4.Implement

5.Conduct

6.Stressful

7.Incentive

*Practice-Based Competency Outcomes*

Specify expected results -1.________

Competence - 2._______ of study / target to be reached

Actually learning to think like a 3._____.

Outcomes include actions such as:

-4._______

- Plan

-5._______

Validation of Competencies

- Can be 6.________

Major 7._________ to promote patient safety and effective care

1.Aging

2.Practitioners

3.Immigrants

4.Homeless

5.Disrespect

6.Abuse

7.Violence

8.Epidemic

9.Families

*Sociodemographics, Cultural Diversity, and Economic and Political Changes*

1._________ population—people living longer

Diverse population

- Use of traditional 2.________ and treatments other than traditional Western medicine

- Illegal 3.________

Increasing number of people living in poverty, 4._________, and/or uninsured

5.__________ for others

Domestic 6._______ of women and children

Various forms of 7._________ in homes, schools, and public places

Obesity 8.____________

Nontraditional 9.___________

1.Health Care

2.Errors

3.Examinations

*Patient-Centered Care: Engagement, Safety, and Privacy*

Shift from "giving care" to "working with" the patient as a member of the 1.______ _______ team

Increased number of medical 2.________ leading to lawsuits have supported the need to insist on competency-based performance 3.____________ in schools of nursing and as part of employer evaluations and accreditation

1.Agency

2.Stress

3.Preceptors

4.Admission

5.Aging

*Shortage of Nurses and Faculty*

Has caused serious issues

Inadequate clinical staff

- use of part-time and 1._______ nurses

-Reduces quality of care

- Contributes to 2._______ & burnout

Fewer 3._______

Qualified student applicants denied

4._________

Faculty are 5.______ & retiring - limited replacements

1.Shortest

2.Supervision

3.Licensing

*Licensed Practical Nurse*

1.________ programs (9 to 12 months)

Must work under the 2.__________ of an RN or physician

NCLEX-PN 3._________ exam

1.Traditional

2.Nighingale

3.2-3 Years

4.NCLEX_RN

*Hospital or Diploma Programs*

Oldest, most 1._________ RN programs

Modeled after 2._________ programs in Europe

Approximately 3.________ in length

1950-1960 - increase in the number of hospitals led to the increase in the number of diploma programs. More than 1300 programs operational

4.________ licensing exam

1.Shortage

2.Community

3.NCLE-RN

*Associate Degree Programs (ADN)*

Emerged in 1950s; response to societal changes & RN 1.__________

Began as 2-year program in 2.________colleges

3._________ licensing exam

1.4

2.Professional

3.Yale

4.NCLEX-RN

*Bachelor's Degree*

1.__ year degree program

Intended to be the "2._______ nurse"

First BSN program at 3.______ University in 1924

BSN degree usually required for admission to graduate programs

4._______ Exam

1.Education

2.Administration

3.Practioner's

4.Clinical

*Master of Science in Nursing (MSN)*

Different areas of specialty

-Nursing 1.________

-Health Care 2.______

-Advanced Nurse 3.__________

-4.________ Nurse Leader (CNL)

1.LACE

2.Anesthetist

3.Midwife

4.Specialist

*Advance Practice Nurse (APRN)*

1.____ Report—Model of Regulation

- Licensure, Accreditation of programs,

Certification, and Education programs

4 APRN roles

- Nurse 2._____

- Nurse-3._______

- Clinical Nurse 4._______

- Nurse Practitioner

1.Coordination

2.Improvement

*Clinical Nurse Leader*

Master's prepared generalist clinician

-Not Advanced Practice Registered Nurse

Oversees the care 1.________ of a distinct group of patients, evaluates outcomes, and has the decision - making authority to change care plans when necessary

Expertise in quality 2._______ and cost-effective resource utilization

1.Research

2.Science

3.Practitioners

*Doctorate*

PhD - doctor of philosophy - 1._______

DNS - doctor of nursing 2._______ - advance clinical nursing practice

DNP - doctor of nursing practice - advanced nurse 3._______

1.Innovative

2.Regents

3.Traditional

*Excelsior College*

1.________ distance mobility program

Developed under New York Board of 2._______

- 'the external degree program'

Provides degree programs for adult learners underserved by 3.________ programs

The nursing programs enroll thousands

The History of Nursing Licensure

Identification/recognition of nursing skills

- Recognition: pins and registries

-Nursing pins

-Registries

The History of Nursing Licensure

Purpose of licensure

-Graduate nurses, physicians, and hospitals set criteria for licensure of nurses in the US

-Primary purpose was, and still is, the protection of the public

1896

Attempts made to license Nurses in the United States

Failed due to lack of broad-based support

1901

International Council of Nurses passed a resolution that each nation and state examine and license its nurses.

1903

Four states instituted permissive licensure, and nurses were not required to comply

1915

Due to variability among states' licensure requirements, ANA designed "model nurse practice acts"

1923

All states had instituted examinations for permissive licensure

1947

Mandatory licensure

American Nurses Association [ANA] formed the National Council of State Boards of Nursing [NCSBN]

1950

Standardized examination for licensure

National League for Nursing (NLN) administered the first State Board Test Pool Examination

1982

National Council Licensure Examination - Registered Nurse [NCLEX-RN]

1994

Paper & Pencil test replaced by Computerized Adaptive Testing [CAT]

Nurse Practice Acts [NPAs]

Each state develops rules and regulations [laws] to govern the practice of nursing within that state

-Written and passed by legislator

American Nurses Association (ANA) and later the National Council of State Boards of Nursing (NCSBN) provide a template for nurse practice acts

Components of Nurse Practice Acts

Purpose of Act

Definition of Nursing and Scope of Practice

Licensure Requirements

Renewal of Licensure

Mandatory Continuing Education

Regulatory Boards of Nursing

Role of regulatory boards to ensure safe practice

- Membership of the board of nursing usually appointed by the governor's office

Duties of the board of nursing

- Administer the state's nurse practice act

- Grant and renew licenses and take disciplinary action when provisions of the act are violated

Louisiana

Louisiana State Board of Nursing (LSBN)

- Regulatory board for the state of LA

- Located in Baton Rouge, LA

- Annual license renewal for RN

Special Cases of Licensure

Military and Government nurses

Internationally Educated Nurses [IENs]

- 8.1% of U.S. registered nurse workforce

International Practice

Mutual Recognition Model

Nurse License Compact (NLC)

-One multistate licensure for nurses

-Practice in home state & other compact states

- The eNLC has been implemented as of January 19, 2018

Certification

Recognizes excellence in practice

Awarded by nongovernmental agencies

ANCC - central organization for certification of nurses

Other specialty organizations offer certification examinations

Licensure [NCLEX]

establishes minimal levels of practice

granted & governed by legislation & administered through state boards of nursing

Cerification

recognizes excellence in practice

awarded by nongovernmental agencies

Nursing Science

Science

- A method of bringing together facts and giving them coherence and integrity

- Dynamic and static

Five Steps of the Scientific Process

Hypothesis: Ask the question that is to be the main focus. It usually includes independent and dependent variables.

Method: Decide what data will be collected to answer the question. Decide on and identify the step-by-step procedure that will be used to collect these data. Make sure this process can be easily replicated.

Data collection: Implement the step-by-step procedure that has been determined to answer the question.

Data collection: Implement the step-by-step procedure that has been determined to answer the question.

Results: On the conclusion of the data collection, statistically identify the outcomes. Establish parameters (e.g., level of significance) that will determine whether the data are relevant.

Evaluation: Examine the results to determine the relevance of outcome data in answering the hypothesis. Determine the significance and identify the potential for future research.

Nursing Theory

Theory

- A group of related concepts that explain existing phenomena and predict future events

- An abstract generalization that presents a systematic explanation about how phenomena are interrelated.

The Language of Nursing Theory

Concept

- An idea or a general impression.

- Basic ingredients of theory/labels given to ideas, objects, events, a way to categorize thoughts/ideas

Conceptual Model

- A group of concepts that are associated because of their relevance to a common theme

- Structure to organize concepts (ideas)/framework

Philosophy

- Values and beliefs of the discipline

Theory

-Organization of concepts that show relationship of ideas

Theory Acceptance

Inclusiveness: Does the theory include all concepts related to the area of interest?

Consistency: Can the theory address new entities without having its founding assumptions changed?

Accuracy: Does the theory explain retrospective occurrences? Does the theory maintain its capacity to predict future outcomes?

Relevance: Does the theory relate to the scientific foundation from which it is derived? Is it reflective of the scientific base?

Fruitfulness: Does the theory generate new directions for future research?

Simplicity: Does the theory provide a road map for replication? Is it simple to follow? Does it make sense?

Nursing Theory

(importance to nursing practice)

Guides nursing practice and

generates knowledge

Describes or explains nursing

Enables nurses to know WHY they are doing WHAT they are doing

Florence Nightingale

1st nursing theorist

Foundation for health promotion and guidance for the practice of professional nursing

Theory of Practice, Environmental adaptation theory

Future of Nursing Theories and Theorists

Health care concerns in the twenty-first century

- Primary focus of federal and state legislative agendas

- Major concerns: uninsured population, patient safety, nursing shortage, rising health care costs, technology, confidentiality issues, and advanced practice nursing

Nursing theories in the twenty-first century

- Established nursing theories will be re-evaluated and modified to answer important health care questions

- Will embrace complex issues such as genetics, computers, noninvasive surgery, robotics, decreasing energy sources, increasing pollutants under a thinning ozone layer, environmental hazards, new diseases, and antibiotic-resistant illness

Nightingale

Bedding

Nightingale

Air

Nightingale

Nutrition

Nightingale

Health of house