NR 222 Exam #1 Chamberlain

CHAPTER 1

Nursing Today

Benner's Model of Novice to Expert

Novice
Advanced beginner
Competent
Proficient
Expert

ANA definition of nursing

the protection, promotion, and optimization of health and abilities, prevention of illness and injury, alleviation of suffering through the diagnosis and treatment of human response, and advocacy in the care of individuals, families, communities, and populations

ANA Standards of Nursing Practice

Assessment
Diagnosis
Outcomes Identification
Planning
Implementation
Coordination of Care
Health Teaching + Health Promotion
Consultation
Prescriptive Authority + Treatment
Evaluation

ANA Standards of Professional Performance

Ethics
Education
Evidence-Based Practice
Quality of Practice
Communication
Leadership
Collaboration
Professional Practice
Resources
Environmental Health

Autonomy

Essential element of professional nursing that involves the initiation of independent nursing interventions without medical orders.

Advanced Practice Registered Nurse (APRN)

Most independently functioning nurse; has masters degree in nursing

Clinical Nurse Specialist (CNS)

An APRN who is an expert clinician in a specialized area of practice

Nurse Practioner (NP)

Are prepared to provide direct client care in primary care settings, focusing on health promotion, illness prevention, early diagnosis, and treatment of common health problems

Certified Nurse-Midwife (CNM)

An APRN who is also educated in midwifery and is certified by the American College of Nurse-Midwifes

Certified Registered Nurse Anesthetist (CRNA)

An APRN with advanced education in a nurse anesthetia accredited program

Nurse Educator

works primarily in schools of nursing, staff development departments of health care agencies, and patient education departments

Nurse Administrator

manages patient care and the delivery of specific nursing services within a health care agency

Nurse Researcher

conducts evidence-based practice and research to improve nursing care and further define and expand the scope of nursing practice

Florence Nightingale

Founder of modern nursing; started first organized program to train nurses; first practicing nurse epidemiologist; connected sanitation with cholera and dysentery

Clara Barton

Nurse during the Civil War; founder of the American Red Cross

Mary Mahoney

First professionally trained African American nurse

Mary Adelaide Nutting

First professor of nursing at Columbia University Teachers College in 1906.

Compassion fatigue

described as physical, emotional, and spiritual exhaustion resulting from seeing patients suffer, leads to a decreased capacity to show compassion or empathize with suffering people

Burnout

Occurs when perceived demands outweigh perceived resources

Lateral violence

Aggressive and destructive behavior or psychological harassment of nurses against each other

Genomics

Study of whole genomes, including genes and their functions

CHAPTER 2

Health Care Delivery System

Health Services Pyramid

Managing health instead of illness
Emphasis on wellness
Injury prevention programs

Primary Health Care

Focuses on improved health outcomes for an entire population; includes primary care and health education, proper nutrition, maternal/child health care, family planning, vaccines, and control of diseases

Intensive Care

Patients receive close monitoring and intensive medical care

Psychiatric Facilities

Patients who suffer emotional and behavioral problems such as depression, violent behavior, and eating disorders often require special counseling and treatment in psychiatric facilities

Rural Hospitals

Located in a county that has a low population density

Restorative Care

Care that helps persons regain their health, strength, and independence

Home Care

Provision of medically related professional and paraprofessional services and equipment to patients and families in their homes for health maintenance, education, illness prevention, diagnosis and treatment of disease, palliation, and rehabilitation

Rehabilitation

Restores a person to the fullest physical, mental, social, vocational, and economic potential possible

Extended Care Facility

A facility that provides health care and help with the activities of daily living to people who may be physically or mentally unable to care for themselves; this type of care may last from days to years

Skilled Nursing Facility (SNF)

Includes administration of IV fluids, wound care, long term ventilator management, and rehab

Continuing Care

For people who are disabled, functionally dependent, or suffering a terminal disease

Assisted Living

A living arrangement for elderly people that combines privacy and independence with medical supervision

Respite Care

A type of care provided for caregivers of homebound ill, disabled, or elderly patients; gives the normal care-takers time off

Adult Day Care

A program for impaired adults that attempts to meet their health, social, and functional needs in a setting away from their homes

Hospice

Allows patient to live with comfort, independence, and dignity while easing the pains of terminal illness

IOM Competencies

Patient Centered Care
Work in Interdisciplinary Teams
Use Evidence-Based Practice
Apply Quality Improvement
Use Informatics

Ten Rules of Performance in a Redesigned Health Care System

1. Care is based on continuous healing relationships
2. Care is individualized based on patient needs and values
3. Patient is the source of control, participates in decision-making
4. Knowledge is shared, info flows freely
5. Decision making is evidence-based
6. Safety is a system property and focused on reducing errors
7. Transparency is necessary through sharing info with patients and families
8. Patients needs are anticipated
9. Waste is continuously decreased
10. Cooperation and communication among clinicians are priorities

Quality Health Care

The degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge

Pay for performance programs

Designed to promote quality, effective, and safe patient care by physicians and health care organizations
Quality improvement strategies that reward excellence through financial incentives to motivate change to achieve measurable improvements

Six Sigma

A data-driven approach for improving quality by removing defects and variations in processes

Patient-Centered Care

Recognize the patient or designee as the source of control and full partner in providing compassionate and coordinated care based on respect for patient's preferences, values, and needs

Magnet Recognition Program

Recognition by the American Nurses Credentialing Center that an organization provides quality nursing care

Nursing-sensitive outcomes

Patient outcomes and nursing workforce characteristics that are directly related to nursing care such as changes in patients' symptom experiences, functional status, safety, psychological distress, registered nurse job satisfaction, total nursing hours per patient day, and costs

Nursing Quality Indicators

Outcomes of nursing care, identified by the American Nurses Association, that address patient safety and quality of care

Nursing informatics

Uses information and technology to communicate, manage knowledge, mitigate error, and support decision making

Telemedicine

Involves the use of video, audio, and computer systems to provide medical and/or health care services

Vulnerable populations

Collection of individuals who are more likely to develop health problems as a result of excess risks, limits in access to health care services, or being dependent on others for care

CHAPTER 6

Health and Wellness

Healthy People 2020

A set of disease prevention and health promotion objectives for Americans to meet during the second decade of the new millennium

Health

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

Health beliefs

A person's ideas, convictions, and attitudes about health and illness

Positive health behaviors

Activities related to maintaining, attaining, or regaining good health and preventing illness

Negative health behaviors

Inculde practices actually or potentially harmful to health such as smoking, drug or alcohol abuse, poor diet and refusal to take necessary medications

Health Belief Model

Addresses the relationship between a person's beliefs and behaviors

Health Promotion Model

Directed at increasing a patient's level of well-being

Maslow's Hierarchy of Needs

Physiological
Safety
Love + Belonging
Self Esteem
Self-actualization

Holistic Health Model

Attempts to create conditions that promote optimal health

Internal Variables that Influence Health

Developmental stage, intellectual background, perception of functioning, emotional factors, spiritual factors

External Variables that Influence Health

Family practices, socioeconomic factors, cultural background

Health promotion

The process of enabling people to increase control over, and to improve, their health

Illness Prevention

Health education programs or activities directed toward protecting patients from threats or potential threats to health and minimizing risk factors

Passive Health Promotion Strategies

Ex. Fluoride in water, fortified foods

Active Health Promotion Strategies

Ex. weight reduction, smoking-cessation

Levels of Preventive Care

Primary, secondary, tertiary

Primary Prevention

True prevention, precedes disease or disfunction and applied to patients considered physically and emotionally healthy
Includes: health education, vaccines, nutritional programs, fitness activities

Secondary Prevention

Focuses on individuals who are experiencing health problems or illnesses and are at risk for developing complications or worsening conditions

Tertiary Prevention

Occurs when a defect or disability is permanent or irreversible; involves minimizing the effects of long-term disease or disability by interventions directed at preventing complications and deterioration

Risk Factor

Any situation, habit, or other variable such as social, environmental, physiological, psychological, developmental, intellectual, or spiritual that increases the vulnerability of an individual or group to an illness or accident

Transtheoretical Model of Change

1. Precontemplation
2. Contemplation
3. Preparation
4. Action
5. Maintenance

Illness

A state in which a person's physical, emotional, intellectual, social, developmental, or spiritual functioning is diminished or impaired

Acute Illness

A sudden illness from which a person is expected to recover

Chronic Illness

Persists longer than 6 months, is irreversible, and affects functioning in one or more systems

Illness Behavior

Ways in which people monitor their bodies, define and interpret their symptoms, take remedial actions, and use the health care system.

CHAPTER 16

Nursing Assessment

Nursing Process

Assessment
Diagnosis
Planning
Implementation
Evaluation

Nursing Assessment

Systematic and continuous collection and analysis of information about the client

Two Steps:
1. Collect info from primary source (pt) and secondary sources (family, friends, health prof, records)
2. Interpret and validate data to ensure complete database

Critical thinking and the assessment process

Cue

Information that you obtain through use of the senses

Inference

Your judgement or interpretation of these cues

Health perception-health management pattern

Describes patient's self-report of health and well-being; how patient manages health (e.g., frequency of health care provider visits, adherence to therapies at home); knowledge of preventive health practices

Nutritional-Metabolic Pattern

Describes patient's daily/weekly pattern of food and fluid intake (e.g., food preferences or restrictions, special diet, appetite); actual weight; weight loss or gain.

Elimination Pattern

Describes patterns of excretory function (bowel, bladder, and skin)

Activity-Exercise Pattern

Describes patterns of exercise, activity, leisure, and recreation; ability to perform activities of daily living

Sleep-Rest Pattern

Describes patterns of sleep, rest, and relaxation.

Cognitive-Perceptual Pattern

Describes sensory-perceptual patterns; language adequacy, memory, decision-making ability

Self-Perception-Self-Concept Pattern

Describes patient's self-concept pattern and perceptions of self (e.g., self-concept/worth, emotional patterns, body image)

Role-Relationship Pattern

Describes patient's patterns of role engagements and relationships

Sexuality-Reproductive Pattern

Describes patient's patterns of satisfaction and dissatisfaction with sexuality pattern; patient's reproductive patterns; premenopausal and postmenopausal problems

Coping-Stress Tolerance Pattern

Describes patient's ability to manage stress; sources of support; effectiveness of the patterns in terms of stress tolerance

Value-Belief Pattern

Describes patterns of values, beliefs including spiritual practices, and goals that guide patient's choices or decisions

Problem-Focused Patient Assessment

Subjective Data

Things a person tells you about that you cannot observe through your senses; symptoms
Includes patient's feelings, perceptions, and self-reported symptoms

Patient-Centered Interview

Requires: courtesy, comfort, connection, confirmation

PQRST

Provokes
Quality
Radiate
Severity
Time

Interview Techniques

Observation
Open-ended questions
Leading question
Back channeling
Probing
Direct close-ended questions

Concomitant Symptoms

Does the patient experience other symptoms along with the primary symptom? For example, does nausea accompany pain?

Review of Systems (ROS)

A systematic approach for collecting the patient's self-reported data on all body systems.