Unit 1 Exam NP1

Roles and functions

Care provider → nursing process (ADPIE)

Educator → ensures patients receives sufficient info on which to base consent for care

Advocate → nurse accepts and respects patients decisions even if they are different

Leader → provides direction and purpose to others, motivates others toward common goals

Change agent → works with patients and staff to improve care and identify/fix problems

Manager → promoting, restoring, maintaining patients health requires coordinating all providers

Researcher → nurses critique research studies and apply research to practice (EBP)

Collaborator → interprofessional collaboration to work toward common goal

Delegator → the RN retains ultimate responsibility for patient care, requires supervision

Benners Stages

Novice → student nurse

Advanced beginner → 6 months experience

Competent → 2 years experience

Proficient → 3 years experience

Master → 5 years experience

Maslows hierarchy of needs

Needs at the lower levels of the hierarchy must be met before needs at higher levels

• physiological needs (air, water, food, shelter, sleep, clothing, reproduction)

• safety needs (personal security, employment, resources, health, property)

• love and belonging (friends, intimacy, family, sense of connection)

• esteem (respect, self esteem, status, recognition, strength, freedom)

• self actualization (desire to become the most that one can be)

Nursing as a profession

altruism → selfless commitment to caring for patients above personal interests

body of knowledge → scientific evidence, theories, clinical research that guide nursing practice

accountability → accepting responsibility for actions and omissions

higher education → extended education and basic liberal knowledge

autonomy → making ethical clinical decisions while respecting patients rights about their own care

code of ethics → ICN and ANA

professional organizations → to support and advance nursing, ANA

licensure → must obtain licensure to practice

Nursing as a profession has a code of ethics, licensing, a body of knowledge, and altruism.

Nurse practice act

regulate and protect the public from nurses, who are a risk to the health, safety, and welfare of the citizens within its state board jurisdiction.

state defined scope of practice.

board of nursing.

they also function as an accrediting agency for the state schools of nursing.

QSEN competencies

patient centered care, teamwork and collaborations, safety, professionalism, EBP, informatics

Future of nursing

aging population

nursing shortage

quality and safety education (QSEN)

Healthcare system - insurance

medicare → federally funded for 65 and older

medicaid → federally funded for low income

private → purchased individually or by employer

levels of health care

primary → first contact, preventative, routine care

secondary → specialists services (ex. cardiologists)

tertiary → specialized care (ex. cancer treatment)

Healthcare barriers

financial → lack of insurance, high out of pocket costs

geographic → rural areas with limited access

cultural and language → miscommunication or lack of culturally competent care

First order beliefs

developing beliefs about what is correct, real and true in early childhood directly through experiences and indirectly through authority figures, and continue to develop through adulthood.

challenging these can cause emotional and cognitive effect

Higher order beliefs

ideas derived from first order beliefs through reasoning, can lead to generalizations and stereotypes

Values system

ethical principles learned in childhood that guide decision making and conflict resolution

Values conflict

arises from differences in beliefs systems

Beneficence

actively doing good

nurses demonstrate beneficence by acting on behalf of others and placing a priority on the needs of others rather than on personal thoughts and feelings.

Nonmaleficience

avoiding causing harm

requires nurses to provide compassionate care for all patients, especially those who are undergoing painful medication interventions developed to cure debilitating diseases.

Autonomy

freedom to make decisions supported by knowledge and self confidence, self determination.

nurses promote autonomy when they include patients in the process of developing care plans and when supporting them in their decisions about treatment options, including the decision to refuse recommended treatment.

Justice

obligation to act fairly and equitably to everyone regardless of income or power.

Veracity

Obligation to always be truthful. honesty promotes unrestricted communication among individuals, demonstrates respect for others, and builds trust.

Accountability

Willingness to accept responsibility for ones actions.

Advocacy

supporting or promoting the interests of others or of a cause greater than oneself

speaking up for the patient when they are not able to.

Confidentiality

limit sharing private information

HIPAA

Fidelity

Keeping promises or agreements made with others.

Responsibility

concept of being dependable and reliable. adheres to professional standards of care, complies with institutional policies, meets requirements of continuing education, and follows the orders of physicians and NP’s.

ethical theories - deontology

focuses on only the rights and wrongs of individual behaviors, duties , and obligations without concern for the actual consequences of those actions.

challenges include rigidity in complex situations

Kant

ethical theories - utilitarianism

evaluates actions based on the outcomes, aiming for the greatest happiness of most people

challenges arise when individual rights conflict with societal need

Bentham

Rights based ethics

focuses on the rights of the individual and does not always take into consideration the effects on society as a whole

problems arise when a persons rights are in conflict with recommend medical treatment.

Justice based ethics

no individual person should have any advantage over another

problems arise when access to healthcare is dependent on income and other socioeconomic characteristics

Virtue based ethics

focuses on personal traits of individuals rather than societal norms

problems arise when not everyone has the same virtues

(ex. people entering nursing field because of a calling vs because of money)

Code of ethics

defines the values, morals, and standards guiding practice in a specific discipline or profession.

10 provisions

respect, advocacy, accountability, advancement, justice, commitment, integrity, ethics, collaboration, globalism

Constitutional law

based on a constitution, foundational legal framework, affects law indirectly

ex. bill of rights

Statutory law

created by legislators, enacted as statues, affects law directly

ex. nurse practice acts (defines scope of nursing practice in each state, matters pertaining to licensure, accreditation of schools, and professional roles, establishes a board of nursing in each state)

criminal → drug diversion, patient abuse, HIPAA violations

civil → intentional torts are wrongs committed by people who deliberately seek to injure or hurt people (libel slander, assault, battery, defamation, false imprisionment invasion of privacy) unintentional torts are omissions or acts by people that cause unintended harm (negligence, malpractice)

Regulatory law

created by government agencies, based on statues, details how laws are applied

ex.) HIPAA privacy regulations

Case law

created by judicial decisions, based on court rulings, established by precedents

ex.) court rulings on nurses liability

Legal issues in nursing

informed consent, mandatory reporting, consent for minors and incompetent patients, advance directives, patients bill of rights, organ donation, DNR

Legal acts in nursing

licensure → requires NCLEX exam

standards of care → minimum requirements for providing safe nursing care

HIPAA → protects health info privacy

Good Samaritan → protects providers offering emergency care from negligence claims

uniform determination of death → cessation of respiratory and brain death

americans with disabilities act → protects against discrimination, mandates reasonable accommodation

Safer practice

Certification → specialty certification for high level of clinical competence

education → higher education programs

EBP

integration of the best available research evidence and the nurses clinical judgement expertise to make patient care decisions,

allows a nurse to address questions and problems by reviewing the research, clinical guidelines, and other resources to determine practice.

results in better patient outcomes, keeps nursing practice current, and increases the nurses confidence in professional decision making.

Individual factors affecting safety

musculoskeletal → restrict ROM, diminish strength, loss of balance and unsteady gait. no rugs

neurological → cognitive ability and sensory perception. impaired judgement, forget, cant see

cardiopulmonary → impair perfusion, less blood/O2 to brain, SOB, chest pain, orthostatic HPTN

Renal/hepatic → metabolism and excretion, toxicity from buildup

Life span safety factors

children → infants should be placed in supine position, appropriate rear facing car seats and carriers, rear facing until 2yo or meet height/weight requirements, children under 13 in backseats with belt positioning booster seats until 4’9

adults → people should plan relaxation periods and schedule annual visits to a doctor for screenings.

Environmental factors affecting safety

pollution → land, water, noise

lighting → home, work, community, healthcare

communicable diseases → transmission, prevention

workplace hazards → injuries, exposure

Altered safety in home and community

poisoning, toxins, lead, carbon monoxide, plants, medications, household chemicals, fires and electrical hazards, abuse, bioterrorism, suffocation and drowning, falls, restraints, med admin errors, radiation, procedural errors, drug resistant microorganisms

Prevent falls

fall risk assessment at administration and intervals, individualize according to pt

encourage call light use, respond quickly to call

orient pts to the setting

make sure frequently used items are in reach

sedated or unconscious keep side rails up

use gaitbelt and safety equipment

lock bed and wheelchairs

Restraints

always use the least restrictive method for the shortest time, must try other methods before using restraints

requires a physician order except in emergencies → includes reason, type, location, type of behavior. if removed new order is required, renew every 24hrs

documentation → every 2 hours for nonviolent, every 15 minutes for violent. include justification, application details, ongoing assessments (circulation and ROM, skin integrity, monitor vitals and offer food, offer means of elimination and hygiene), behavior and mental status, basic needs, pt response, communication, discontinuation

physical and chemical restraints

physical → wrist and ankle, vest, lap belt, side rails

chemical → sedative, neuroleptic

Using restraints

Pad bony prominences to prevent skin breakdown

Secure/tie restraints to a part of the bed frame that can raise/lower when the bed controls are used

Do not secure/tie restraints to the side rails of the bed. If restraints with a buckle strap are not available, use a quick-release knot to tie the strap. do not tie in a knot

enough room to fit two fingers between the restraints and the client

Remove or replace restraints frequently to ensure good circulation to the area and allow for full range of motion to the limbs

Fire safety

PASS (pull, aim, squeeze, sweep)

RACE (rescue all patients in the vicinity, activate fire alarm, contain fire by closing doors, extinguish the fire)

cultures of safety

recognizing human fallibility

provide a blame free culture

encourage team work

maintain a culture of continuous improvement

encourage reporting

Referent

• event or thought initiating the communication

• The incentive or motivation for communication between two people

Sender

The person who initiates and transmits the message

Message

• content transmitted during communication

• The verbal and nonverbal information the sender expresses and intends for the receiver

Channel

The method of transmitting and receiving a message (sight, hearing, touch, facial expression, body language)

Receiver

person who recieves and decodes or interprets the communication

feedback

• response of the receiver

• Can be verbal, nonverbal, positive, negative

Intrapersonal communication

• communication within an individual

• it is each person’s “self-talk,” the internal discussion when thinking but not outwardly verbalizing thoughts

• It helps nurses assess clients and situations and think critically about them before communicating verbally.

Interpersonal communication

• takes place between two or more people

• This form of communication is the most common in nursing and requires an exchange of information with another individual

• However, the receiver can perceive a message differently than the sender intended.

Small group communication

focuses on meeting established goals or the needs of group participants

(in committees, research teams, and support groups

Public communication

through patient and community education on health care issues, including wellness

Orientation phase

nurse gathers assessment data, recognizes and analyzes cues, and identifies nursing diagnoses that are appropriate for the patient

objective data are collected during pre interaction and the orientation phase

subjective data are obtained exclusively while interacting with the pt orientation

• making introductions, establishing professional roles

• observing, interviewing, assessing the pt, validation of perceptions

• identify needs and resources of the pt

Working phase

goals or outcome statements and nursing interventions are developed in collaboration with pts and their families

nurse discusses assessment findings and concerns w the pt to establish goals

• implementation of the care plan

• collaboration among other HCP as needed

• enhancement of trust between nurse and pt

• use of therapeutic communication to keep interactions focused on the pt

Termination phase

evaluation of the nursing process is completed here

the nurse and pt determine the level of pt goal fulfillment and the need for further intervention

• alerting the pt to impending closure of the relationship

• evaluating the outcomes achieved during the interaction

• concluding the relationship and transitioning pt care to another caregiver

Therapeutic communication

active listening, open posture, reflection

• verbal techniques → seeking clarification, summarizing, validating

• nonverbal techniques → active listening, science, therapeutic touch

Nontherapeutic communication

• asking why questions

• using closed ended questions or comments

• changing the subject

• giving false reassurance

• giving stereotypical or generalized responses

• showing agreement/disagreement

• comparing patient experiences

• using personal terms (honey, sweetie, sport)

• being defensive

defense mechanisms - compensation

using personal strengths ot abilities to overcome feelings of inadequacy

defense mechanisms - denial

refusing to admit the reality of a situation or feeling

defense mechanisms - displacement

transferring emotional energy away from an actual source of stress due to an unrelated person or object

defense mechanisms - introjection

taking on certain circumstances of another individuals personality

defense mechanisms - projection

attributing undesirable feelings to another person

defense mechanisms - rationalization

denying true motives for an action by indentifying a more socially acceptable explanation

defense mechanisms - regression

reverting to behaviors consistent with earlier stages of development

defense mechanisms - repression

storing painful or hostile feelings in the unconscious, causing them to be temporarily forgotten

defense mechanisms - sublimation

rechanneling unacceptable impulses into socially acceptable activities

defense mechanisms - suppression

choosing not to think consciously about unpleasant feelings

hearing impaired patients

• make sure the area is well lit, little background noise as possible

• stay within 3-6ft of pt, avoid turning or walking away

• avoid overenunication, speak slowly

use of interpreters

• collaboration with the department responsible for obtaining interpreters should be initiated by the nurse ASAP

• family members should not be used as interpreters of specific medical info to maintain patients privacy rights and to avoid misinterpretation

Visually impaired patients

• alert pts of potential hazards or object locations

• position of numbers on analog clock is used as reference to location

• gentle physical contact to alert patient if they have been sleeping, noisy environment, or if hearing impaired

African americans

refer to diabetes as sugar

asian culture

considered disrespectful to make direct eye contact with individuals of authority because doing so implies equality

orthodox and conservative jewish patients

• require a kosher diet

• pork, shellfish, rare meats, and blood is prohibited and combining milk or dairy products with meat

• cooking restrictions on the sabbath

• jewish holidays require eating only unleavened bread or fasting

Jehovas witnesses

refuse blood transfusions based on their interpretation of scriptual restrictions on receiving blood

muslim patients

prefer diets that do not include pork products

seventh day adventists

• regard the body as a temple and typically do not eat meat or consume caffeine, alcohol, or tobacco products

• encourage a vegetarian diet

Catholics

observe holy days with fasting especially on fridays

Islamic traditions

prohibits the consumption of alcohol, pork, caffeine

halal food preparation rules share similarities with kosher laws

Bhuddists

avoid the consumption of meat and meat by products

vegan diet

Complementary and alternative pain therapies

• herbal remedies → herbal mixes relieve pain

• yoga/ meditation

• biofeedback → uses electronic monitoring to gain voluntary control over physiological responses (muscle tension, HR, BP)

• aromatherapy

• hypnosis

• Reiki and therapeutic touch → hand placement to correct/balance energy fields restores health

• (traditional Chinese medicine) acupuncture - series of channels, or meridians, to re-establish the flow of vital energy or qi. acupressure, cupping

Nonverbal communication

• Appearance, posture, gait

• Facial expressions, eye contact, gestures

• Sounds

• Territoriality, personal space

Top safety practices

· Always follow the five rights of medication administration + 2 identifiers

· Scan the patient and med whenever possible.

· Double-check high-alert medications with a second RN.

· Use standardized handoff tools like SBAR.

· Report near misses to improve systems.

· Never use workarounds.

never use room number alone to verify pt. ask pt name and DOB

Medication safety

• 5 Rights of medication administration (right pt, med, dose, route, time)

• Barcode scanning

• Double-check high-alert meds

• Avoid unsafe abbreviations

• Medication reconciliation during transitions of care

Infection control prevention

• Hand hygiene (MOST effective intervention, before during and after pt)

• PPE use

• Aseptic & sterile technique (outer 1in is not sterile)

• Isolation precautions

• Proper disposal of sharps

• Cleaning equipment between patients

Client centered care

An approach to healthcare that respects the patient's values, preferences, and expressed needs, empowering them as an active participant and partner in their own care decisions.

Conflict Management and Resolution

The process of identifying and handling disputes in a sensible, fair, and efficient manner. In nursing, it involves strategies to resolve disagreements within the interprofessional team to maintain a safe and collaborative environment.

Ethical Dilemmas in Healthcare

Situations in which there is a conflict between two or more ethical principles (e.g., autonomy vs. beneficence), requiring a difficult choice between two or more undesirable actions.

Establishing andMaintaining Professional Boundaries

The practice of defining the limits of the therapeutic nurse-patient relationship to ensure it remains safe, professional, and focused on the patient's needs, avoiding dual relationships or personal entanglement.

Evidence-Based Practice

(EBP)

The conscientious and explicit use of current best evidence from research, combined with clinical expertise and patient values, to make decisions about the care of individual patients.

Health Care Delivery

Systems

The organization of people, institutions, and resources that deliver health care services to meet the health needs of target populations.

Healthcare Informatics

The field of science and engineering that aims at developing methods and technologies for the acquisition, processing, and study of patient data, information, and knowledge for clinical practice, research, and education.

Legal Aspects of Healthcare Informatics

The body of laws, including HIPAA, that governs the privacy, security, and confidentiality of electronic health information and dictates the legal responsibilities for its proper use and protection.

Legal Responsibilities in Nursing Practice

The duties and obligations of a nurse as defined by law, including adherence to the Nurse Practice Act, maintaining standards of care, and protecting patient rights to avoid malpractice or negligence.

Legal Safeguards and Litigation Prevention

The proactive measures taken by nurses and healthcare institutions to reduce legal risk, such as maintaining competence, proper documentation, establishing rapport with patients, and carrying professional liability insurance.