Fundamentals of Nursing Exam 1

Benner’s stages of nursing proficiency levels

1. Novice

2. Advanced beginner

3. Competent

4. Proficient

5. Expert

Novice

A beginning nursing student or any nurse entering a situation in which there is no previous level of experience. The learner learns via a specific set of rules or procedures, which are usually stepwise and linear. 

Advanced beginner

A nurse who has some level of experience with the situation. This experience may be only observational in nature, but the nurse is able to identify meaningful aspects or principles of nursing care. 

Competent

A nurse who has been in the same clinical position for 2-3 years. This nurse understands the organization and specific care required by this type of patient. This nurse can anticipate care needs and establish long-range goals.

Proficient

A nurse with more than 2-3 years of experience in the same clinical position. This nurse perceives the patient's clinical situation as a whole, can assess the entire situation, and can transfer knowledge gained from multiple previous experiences.

Expert

A nurse with diverse experience who has an intuitive grasp of an existing or potential clinical problem. This nurse can zero in on the problem and focus on multiple dimensions of the situation. This nurse can individualize petite problems and problems related to the health care system. 

Standards of Professional Nursing Practice

Contain authoritative statements of the duties that all RNs are expected to competently perform. 

Standards of Professional Performance

Describe a competent level of behavior in the professional nursing role. These standards are set to assure patients that they are receiving high-quality care. Involves ethics, collaboration, and quality of practice.

Compassion fatigue

Describes a state of burnout and secondary traumatic stress. It occurs without warning and often results from giving high levels of energy and compassion over a prolonged period. Typically results in feelings of hopelessness, hypervigilance, and anxiety. 

Secondary traumatic stress

Trauma that health care professionals experience when witnessing and caring for others suffering trauma.

Burnout

The condition that occurs when perceived demands outweigh the perceived resources. It is a state of physical, mental, and emotional exhaustion. 

Genomics

A branch of molecular biology that examines the structure, function, and mapping of an individual's genome. This plays a role in many diseases, so it is important to understand it and use it in an appropriate manner.

Challenges facing nursing

1. Aging populations

2. Physician shortages

3. Nurses' retirement rates

4. Uncertainty about health care reform

5. Competency

6. Health care quality

7. Technology

8. Patient-centered care

9. Magnet recognition programs

Levels of Health Care

1. Preventive

2. Primary

3. Secondary 

4. Tertiary

5. Restorative

6. Continuing

Preventive

Focuses on reducing and controlling risk factors for disease through activities such as immunization and occupational health programs. 

Primary

Focuses on improved health outcomes for an entire population by promoting regular health visits, health education, proper nutrition, immunizations, family planning, and disease prevention.

Secondary

Care provided by a specialist or agency on referral by a primary care provider. It requires more specialized knowledge, skill, or equipment. This occurs in the hospital, ICU, mental health facilities (voluntary or involuntary), rural hospitals (critical access hospitals need to be 35 miles from another hospital, and discharge planning.

Tertiary

Specialized consultative care is provided on referral by a secondary care provider. This is typically expensive. This occurs in the hospital, ICU, mental health facilities, rural hospitals, and during discharge planning (starting at admission).

Restorative

Help individuals regain maximal functional status to enhance quality of life through promotion of independence and self-care. EX. Home care, rehabilitation, skilled nursing facility, and extended care facility.

Home care

The provision of medical professionals and equipment to patients and families in their homes for health maintenance, education, illness prevention, rehabilitation, and palliative care. The frequency of these services is based on patient need. 

Rehabilitation

The process aimed at enabling people with disabilities to reach and maintain their optimal physical, sensory, intellectual, psychological, and social functional levels. This begins the moment the patient enters a health care setting for treatment. This type of treatment can be given in acute care centers, outpatient settings, or the home.

Extended care facility

Provides intermediate medical, nursing, or custodial care to patients with acute or chronic illness or disabilities. 

Skilled nursing facility

Offers skilled care from a licensed nursing staff around the clock. Patients receive extensive supportive care until they can move back into the community or residential care. 

Continuing

Prolonged services for people with disabilities who were never functionally independent or who have a terminal disease. EX. Nursing facility, assisted living, respite care, adult day care center, palliative care, and hospice.

Nursing facility/center

Long-term intermediate and custodial care for residents with chronic or debilitating illnesses. Consists of older adults. 

Assisted living

Long-term care setting with an environment more like home and greater resident autonomy. Costs about 4500 monthly, so this is not an option for everyone.

Respite care:

Provides short-term relief for primary caregivers. Can be provided by family, friends, or a paid service for hours to weeks.

Adult day care centers

Provide health and social services to those who require some supervision but not continuous care. These centers usually operate weekdays during typical business hours. 

Palliative care

Focuses on improving quality of life for those facing life-threatening illnesses. Provides pain relief, continuity of care, and facilitates patient autonomy. Can be delivered in any health care setting.

Hospice

Allows patients to live with comfort while easing the pain of terminal illness. This is supportive care, not curative treatment.

Social determinants of health

These are nonmedical factors that influence health and quality of life. Include economic stability, education, health care, neighborhood, and social/community context.

Integrated Health Care Delivery (IHCD)

A health reform movement in response to fragmented, costly, and varying quality of health care in the US. It is a network of health care organizations that work together to provide a continuum of health services to a defined population. Aims to better align resources, improve quality, and control costs.

Outcome and Assessment Information Set (OASIS)

A comprehensive assessment designed to gather data needed to measure outcomes and patient risk factors in the home setting.

Resident Assessment Instrument (RAI)

Helps nursing facility staff gather definitive information on a resident's strengths and needs. Involves a minimum data set and a care area assessment.

Inpatient Prospective Payment System (IPPS)

Establishes payment rates prospectively for inpatient stays based on the patient’s diagnosis, services provided, and severity of illness.

Magnet Recognition Program

Established by the American Nurses Credentialing Center to recognize health care organizations that achieve excellence in nursing practices. To gain magnet status, the hospitals must demonstrate leadership, structural empowerment, exemplary professional practice, innovation, and empirical quality results. Research shows that magnet organizations are significantly better than non-magnet organizations.

Healthy People initiative

Provides evidence-based national objectives for promoting health, well-being, and disease prevention since 1979. This is widely cited because it emphasizes how the health of communities affects the overall health status of the nation. The newest publication promotes a society where all people live long, healthy lives and indicates leading health indicators (LHIs). 

Health

Defined by WHO as a “state of complete physical, mental, and social well-being, not merely the absence of disease or infirmity”. Each person has their own concept of health. This is influenced by culture, environment, circumstances, and health beliefs. 

Health Belief Model (HBM)

Addresses the relationship between a person’s beliefs and behaviors. This model is based on the individual's desire to avoid illness, the individual's belief that certain health choices will prevent illness, and the likelihood that the individual will take action to promote health. This helps develop a plan of care. 

Health Promotion Model

Defines health as a positive, dynamic state, not merely the absence of disease. Health promotion increases a patient's level of well-being. This model focuses on individual characteristics and experiences, behavior-specific cognitions and affect, and behavioral outcomes, which result from a patient changing a behavior. This helps develop a plan of care.

Health belief

A person’s ideas, convictions, and attitudes about health and illness. Can be based on reality, false expectations, misinformation, and experiences. Negative or positive. 

Variables influencing health and health beliefs and practices

1. Internal Variables: Personal factors that influence your health. EX. Developmental stage, intellectual background, perception of functioning, and emotional/spiritual factors

2. External Variables: Family role, social determinants, and culture can influence a patient’s perception of health.

Holistic nursing

Preventive care that focuses on the health of the whole person. It considers social, psychological, and environmental influences that affect a person's health and recovery. Used alone or in conjunction with conventional medicine. EX. Meditation, guided imagery, and relaxation therapy. 

Maslow’s Hierarchy of Needs

Provides a basis for nurses to care for patients of all ages. When applying the model, focus care on the patient's needs rather than strict adherence to the hierarchy. 

1. Self-actualization: Top tier. 

2. Love and belonging:

3. Safety and security: Physical safety and physiological safety. 

4. Physiological: Basic human needs necessary for human survival and health. All people need this. EX. Food, water, shelter, and oxygen. 

Health promotion

Helps individuals maintain or enhance their present health. It motivates people to engage in healthy activities such as good nutrition. Operated by health care agencies, FQHCs, or independently. 

Federally Qualified Health Centers (FQHC)

Provide services that address causes of poor health in medically underserved communities. Supported by the US government. They increase access to primary care. 

Health education

Provides information on topics such as stress management and self-responsibility that allows people to develop a greater understanding of their health and how to better manage health risks.

Illness prevention

Activities that protect people from actual or potential health risks. Also prevents decline in health or functional ability. 

1. Primary prevention

2. Secondary prevention

3. Tertiary prevention

Primary prevention

Reduces the incidence of disease by promoting health and wellness activities. Many of these programs are supported by the government. EX. Immunizations, health education, nutrition programs, etc.

Secondary prevention

Prevents the spread of disease, illness, or infection once it occurs. Activities are directed at diagnosis and prompt interventions. EX. Screening surveys, focused examinations, and adequate treatment

Tertiary prevention

Occurs when a defect or disability is permanent and irreversible. It involves minimizing the effects of long-term disease by using interventions directed at preventing complications and deterioration. EX. Rehabilitation and accommodation.

Risk factor

Any attribute, quality, environmental situation, or trait that increases the vulnerability of an individual or group to an illness or accident. They do not cause disease or accidents. Instead, they increase the chance a person will experience one. Can be modifiable, nonmodifiable, or environmental.

Nonmodifiable risk factor

Risk factors that cannot be changed. EX. Age, sex, genetics, and family history.

Modifiable risk factor

Risk factors that can be changed. EX. Smoking, drinking alcohol, diet, exercise, stress, and sleep.

Transtheoretical Model of Change

1. Precontemplation: No intent to make changes within the next 6 months. 

2. Contemplation: Considering a change within the next 6 months.

3. Preparation: Making small changes in preparation for a change in the next month.

4. Action: Actively engaging in strategies to change behavior. Lasts up to 6 months.

5. Maintenance: Sustained change over time. Begins 6 months after action has started and continues indefinitely. 

Disease

A medical condition that causes distress for a person in the form of its symptoms. This includes all disorders, infections, disabilities, and deformities. Can be acute or chronic.

Chronic

Usually lasts more than 6 months, is irreversible, and affects functioning in one or more body systems. Patients often fluctuate between maximal functioning and serious health relapses. About 60% of adults in the US have one chronic disease and 40% have two or more. Usually related to physical inactivity, poor nutrition, tobacco use, and excessive alcohol. 

Acute

Usually reversible and has a short duration. The symptoms appear abruptly, are intense, and subside after a short time. 

Illness

A state in which a person’s physical, emotional, intellectual, social, developmental, or spiritual functioning is diminished or impaired. It is a feeling of poor health, which can be felt with or without a disease. 

Illness behavior

Involves how people monitor their bodies and define and interpret their symptoms. Internal and external variables influence illness. 

Caring

A universal phenomenon influencing the ways in which people think, feel, and behave in relation to one another. Caring is a deep human connection that improves healing and promotes overall health and well-being. 

Watson’s Theory on Caring

A holistic model that supports a nurse's conscious intention to care to promote healing and wholeness. Places care before cure. 

1. Forming a human-altruistic value system: Use loving kindness to extend yourself. Use self-disclosure appropriately to promote a therapeutic alliance with your patient. 

2. Instilling faith-hope: Provide a connection with the patient that offers purpose and direction when trying to find the meaning of an illness.

3. Cultivating a sensitivity to oneself and to others: Accept yourself and others for their full potential. 

4. Develop a caring relationship: Learn to develop relationships with patients through effective communication

5. Promoting and expressing positive and negative feelings: Support and accept your patients' feelings. 

6. Using creative problem-solving: Apply critical thinking in the nursing process to make clinical judgements

7. Promoting transpersonal teaching-learning: Learn together while educating the patient to acquire self-care skills. 

8. Provide for a supportive, protective, and/or corrective environment: Create a healing environment at all levels, physical and nonphysical. This promotes wellness, dignity, beauty, and peace.

9. Meeting human needs: Intentionally help patients meet basic needs.

10. Allowing for spiritual forces: Allow spiritual forces to provide a better understanding of yourself and your patient.

Swanson’s Theory of Caring

Defines caring as a nurturing way of relating to an individual. Used in developing caring interventions that improve patient satisfaction.

1. Knowing

2. Beinng with

3. Doing for

4. Enabling

5. Maintaining belief

Ethics of caring

Refers to the ideals of right and wrong behavior. An ethic of care is concerned with relationships between people and with a nurse’s character and attitude towards others. 

Caring assessment tool

Measures patients' perception of caring. Involves mutual problem solving, attentive reassurance, respect, encourgaging manner, healing environment, appreciation, and meeting basic human need.

Presence

A person-to-person encounter conveying a closeness and sense of caring. Presence involves “being there” and “being with”. This results in improved mental well-being for nurses and patients and improved physical well-being in patients. This is very important during stressful situations because it calms anxiety and fear. 

Touch

Provides comfort and creates a connection. Use with discretion.

1. Noncontact touch

2. Contact touch

Noncontact touch

Communicates care, respect, or presence without physical contact. EX. Eye contact, facial expressions, and posture.

Contact touch

Skin-to-skin contact

1. Task-oriented touch: Used when performing a task or procedure. EX. RN placing an IV

2. Caring touch: A form of nonverbal communication, which successfully influences a patient’s comfort and security, enhances self-esteem, increases confidence of caregivers, and improves mental well-being. EX. Holding a patient's hand during a procedure

3. Protective touch: A form of touch that protects a nurse and/or patient. EX. Preventing a patient from falling

4. Therapeutic touch: Use of touch to promote healing. Effective in managing anxiety, pain, dementia, and other physical and mental health conditions

Challenges in the care system

1. Time constraints

2. Reliance on technology

3. Lack of staff

4. Efforts to standardize work processes

5. Cost-effective strategies

6. Personal stressors

7. Compassion fatigue

Culture

Refers to the learned and shared beliefs, values, norms, and traditions of a particular group, which guide our thinking, decisions, and actions. This is a learned behavior that applies to both nurses and patients. 

Culturally congruent care

Emphasizes the need to provide care based on an individual's cultural beliefs, practices, and values. Requires effective communication. 

Implicit bias

Refers to the bias we are unaware of and that happens outside our control, which is influenced by our personal background, cultural environment, and personal experiences. 

Stereotype

An assumed belief regarding a particular group. Research shows that healthcare providers activate these routinely when communicating with and providing care to minority individuals. As a result, their care may be biased.

Emic worldview

Insider perspective.

Etic worldview

Outsider perspective.

Health disparity

A particular type of health difference that is closely linked with social, economic, and/or environmental disadvantage. Health disparities limit individuals from achieving their optimal health. EX. Living in a rural area

Social Determinants of Health (SDOH)

The aspects of nonmedical conditions in which people are born, grow, live, work, and age that affect health functioning and quality of life outcomes. 80% of SDOH are modifiable. 

Intersectionality

A research and policy model for studying the complexities of people's lives and experiences.  Describes the forces, factors, and power structures that shape and influence life.

Privilege

The factors or advantages that benefit certain individuals, groups, or populations.

Oppression

A formal and informal system of advantages and disadvantages tied to membership in social groups, reinforced by societal norms, biases, interactions, and beliefs. Disadvantages occur due to prejudice and the interaction of power that leads to discrimination against some groups. 

Acculturation

Occurs when an individual or group transitions from one culture and develops traits of another culture. This can lead to stress when the values of the transitioning culture differ from the accepted traits of another (blend; but not replacing).

Assimilation

The process by which the individual adapts to another’s cultural behaviors, beliefs, values, and rituals and no longer prefers the components of the original culture.

Core measures

Evidence-based, researched standards of care. Help health care agencies improve performance, increase accountability, and reduce costs. Intended to reduce health disparities by keeping hospitals accountable. 

Cultural competence

The act whereby a health care professional develops an awareness of one’s existence, sensations, thoughts, and environment without letting these factors have an undue effect on those for whom care is provided. 

Cultural humility

A process of self-exploration and self-critique that leads to an understanding of how culture affects another person's health behaviors. This is an ongoing process, which differs from content mastery that is found in cultural competence. Uses interpersonal and intrapersonal approaches to provide person-centered care to patients with diverse backgrounds.

Campinha-Bacote’s model of cultural competence constructs

A framework that help providers be aware of their bias and assumptions when completing a skill.

1. Cultural awareness: The process of conducting a self-examination of one's own biases toward other cultures and the in-depth exploration of one's cultural and professional background. It also involves being aware of the existence of documented racism and other "isms" in health care delivery.

2. Cultural knowledge: The process in which a health care provider seeks and obtains a sound educational base about culturally diverse groups.

3. Cultural skill: The ability to conduct a cultural assessment of a patient to collect relevant cultural data about a patient's presenting problem, as well as accurately conducting a culturally based physical assessment.

4. Cultural encounter: A process that encourages health care providers to directly engage in face-to-face cultural interactions and other types of encounters with patients from culturally diverse backgrounds. A cultural encounter aims to modify a health care provider's existing belief about a cultural group and to prevent possible stereotyping.

5. Cultural desire: The motivation of a health care provider to "want to" (and not "have to") engage in the process of becoming culturally aware, culturally knowledgeable, and culturally skillful in seeking cultural encounters.

LEARN Model

1. Listen to the patient's perception of the problem 

2. Explain your perception of the problem

3. Acknowledge the similarities and differences between the two perceptions

4. Recommendations must involve the patient

5. Negotiate a treatment plan

The National Culturally and Linguistically Appropriate Services (CLAS)

Intended to advance health equity, improve quality, and help eliminate health care disparities by establishing a blueprint to help individuals and health care organizations implement culturally and linguistically appropriate services. The CLAS standards include standards for communication and language assistance. The standards apply when you care for patients who have limited English proficiency and/or other communication needs. 

Health literacy

The degree to which individuals have the capacity to obtain, process, and understand basic health information and the services needed to make appropriate health decisions. 

Nurse Practice Acts

Civil state laws overseen by the State Board of Nursing. Each state is different. It regulates the scope of nursing practice and standards. Protects public health, safety, and welfare.

Code of Ethics

Philosophies that define what is right and wrong. Used to guide patient-care. 

Professional responsibilities

1. Autonomy and accountability

2. Caregiver

3. Advocate

4. Educator

5. Communicator

6. Manager

Quality and Safety Education for Nurses (QSEN)

An initiative to help deliver safe care. Broken down into 6 competencies. Aimed to reduce errors. 

1. Patient-centered care

2. Teamwork and collaboration

3. Evidence-based practice

4. Quality improvement

5. Safety

6. Informatics

Hospital Acquired Condition (HAC)

A condition that a patient develops while being treated in the hospital for a different reason. These can occur frequently, cause significant harm, and are often preventable. The amount of funding hospitals receive depends on their frequency of HACs. 

Evidence-based practice (EBP)

A problem-solving approach to clinical practice that combines the systematic use of best evidence from research in combination with a clinician's expertise, patient preferences, and available health care resources in making decisions about patient care. Research shows this enhances the patient experience, improves quality and safety, decreases costs, empowers clinicians, and improves patient outcomes.

Evidence-based practice steps

1. Cultivate a spirit of inquiry within an EBP culture and environment

2. Ask a clinical question in PICOT format

3. Systematically search for and collect the most relevant and best evidence

4. Critically appraise the evidence you gather for usefulness, feasibility, and value

5. Integrate the best evidence with your clinical expertise and patient and family preferences and values to make the best practice decision or change. 

6. Evaluate the outcomes of practice decisions and changes based on evidence

7. Communicate the outcomes of EBP decisions or changes with clinical staff

PICOT format

1. Patient population of interest EX. Age, gender, disease, etc

2. Intervention of interest EX. Treatment, medication, prognostic factor, etc

3. Comparison of interest: Compare to current practice

4. Outcome: Results of observation of intervention

5. Time: Amount of time needed to note changes or reaching outcomes

Randomized Controlled Trial (RCT)

A researcher tests an intervention against the usual standard of care. Researchers randomly assign subjects in an experiment to either a control group or a treatment group. The researcher measures both groups for the same outcomes and then performs statistical tests to see whether the experimental intervention made a significant difference.

Pilot study

A small-scale research study or one that includes a quality or performance improvement. The results of this study tell you whether the practice change can be implemented easily and whether it results in the desired outcomes.