PN1 QUIZ 2

weeks 4-8

general research steps

• formulate your question

• determine which databases to search

• identify search terms (keywords, controlled vocab)

• combine terms with Boolean operators (AND, OR, NOT)

• filter results: age group, publication date, publication type/article type

• document your search strategy: word document; create an account in each database

• save results

boolean operators

OR: links similar terms, BROADENS the search

AND: combines different concepts, NARROWS the search

NOT: excludes a term; use cautiously. NARROWS, but risks losing relevant articles

keywords

natural language that describes your topic

controlled vocabulary

standardized terminology used to describe articles. do not need to think of every synonym

• MeSH, CINAHL subject headings, thesaurus of psychological index terms

4 concepts of nursing metaparadigm

• person

• health

• environment

• nursing

nursing paradigm: PERSON

the recipient of nursing care

• individuals, patients, groups, families, communities

nursing paradigm: HEALTH

degree of wellness or well-being that the client experiences

nursing paradigm: ENVIRONMENT

the internal and external surroundings that affect the client

nursing paradigm: NURSING

the attributes and actions of the nurse providing care on behalf of, or in conjunction with, the client

nightingale

relationship of patient to the environment

• cleanliness, clean air and water, balanced diet, rest

henderson

14 basic needs

• assist individual, sick or well, with activities contributing to health, recovery, or a peaceful death that they would do unaided if they had the strength, will, or knowledge

• nurses help only when the patient cannot meet the need

orem

self-care model

• assess patient’s ability to meet self-care needs and design nursing actions for unmet needs

  • self care deficit → teach pt to do it at home

roy

adaptation model

• nursing considers how patients adapt to changes/stimuli

• stimuli trigger coping processes → produce behavior

• goal = adaptation

leininger

Culture Care Diversity and Universality

• plan nursing care based on knowledge that is culturally defined, classified, and tested, to provide culturally congruent care (transcultural nursing)

watson

caring

• create and maintain an environment that supports human caring while meeting patients’ primary human needs

  • emphasize loving kindness, faith/hope, trusting relationships, a healing environment

evidence-based practice

an approach to healthcare that integrates the best evidence from research studies and patient care data with clinician expertise and patient preferences/values

randomized controlled trial (RCT)

experimental method in which participants are randomly assigned to intervention groups- gold standard

hierarchy of scientific evidence (strongest to weakest)

EBP; systematic reviews/meta analyses; RCTs; cohort studies; case-control studies; case reports/series; expert opinions, editorials

systematic review

critical appraisal and synthesis of primary research on a topic

meta-analysis

statistical integration of findings from multiple studies to draw conclusions

qualitative research

in-depth exploration using narrative data and flexible design

• no variables manipulated

• uses techniques like narrative interviews and participant observation

• goal = detailed description and interpretation of phenomena

• i.e. experience of a breastfeeding parent, fatigue related to cancer treatment

quantitative research

precise measurement and statistical analysis using structured methods

• hypothesis, measurable variables and outcomes

• requires that subjectivity and bias are minimized

• i.e. effect of a new medication on diabetes using control and experimental groups, survey measuring compassion fatigue in ICU nurses

mixed methods

combination of qualitative and quantitative approaches

nursing research

systematic investigation to improve patient care

researchable nursing problems

come from clinical situations, existing literature, and theories

purpose of nursing research

identification, description, exploration, explanation, prediction, and control

basic/pure science

explains the universe without regard for immediate usefulness; new knowledge

applied/clinical science

practical application of scientific theory and laws; applying knowledge in patient caret

translational research

conduit between bench (lab) and beside research; takes lab findings to the bedside and bedside findings back to ask new questions

inductive reasoning

particular experience that proceeds to generalizations

• useful for hypothesis generation and overall exploration

deductive reasoning

conclusions drawn by logical inference from given premises; general case to specific

• useful for hypothesis testing and structured logic

research process: 8 steps

• identify researchable problem

• review literature

• formulate research question/hypothesis

• design of the study

• implementation of the study

• drawing conclusions based on findings

• discussion and/or clinical implications

• dissemination of findings

PICOT

population, intervention, comparison, outcome, time

acute illness

sudden onset, rapid progression, but relatively short-lived. changes not permanent, does not require long-term treatment

• common cold, acute appendicitis, acute MI, spinal cord injury

chronic illness

gradual onset, can have remission and exacerbations, permanent and progressive changes. requires long-term treatment

• HTN, DM, arthritis, cancer, COPD, CHD

adjusting to illness

disbelief and denial, irritability and anger, attempting to gain control, depression and despair, acceptance and participation

tort

wrongful act committed against a person or property that results in harm

intentional tort

a willful act that violates a patient’s rights or causes harm

assault

• threat or attempt to make bodily contact without consent

  • threatening to give an injection if the patient refuses medication

battery

• assault carried out; any unauthorized, unprivileged touching

  • giving an injection or treatment without patient’s consent

false imprisonment

• patient is unlawfully confined

  • restraining a patient who wants to leave without an order or proper justification

slander

• defamation by spoken word

  • telling others a patient has a contagious disease when untrue

libel

• defamation in written form

  • writing in a chart that pt is “drug-seeking” w/o evidence

invasion of privacy/breach of confidentiality

• violates HIPAA and ethical principles

  • sharing diagnosis or posting about a patient’s care on social media

fraud

• willful deception

unintentional tort

unintended acts that cause harm, usually from negligence or failure to meet the standard of care

negligience

failure to act as a reasonably prudent nurse would

• forgetting to raise side rails on confused patient → fall

malpractice

professional negligence → failure to use the degree of care expected of a nurse

• giving the wrong medication dose that harms the patient

failure to communicate

delayed intervention that can lead to harm

• not reporting a critical lab result to provider

failure to assess/monitor

missed deterioration

• ignoring changes in vital signs after surgery

four elements of negligence

• nurse assumed duty of care (responsibility for patient’s care)

• nurse breached duty by failing to meet standard of care

• failure to meet standard → proximate cause of injury

• actual injury/damage is proven

delegation: 5 rights

right task

• is task appropriate?

right circumstances

• is delegation appropriate? consider pt status

right person

• is person competent to complete task?

right direction/communication

• is RN giving clear, specific instructions?

right supervision/evaluation

• can RN or other nurses supervise/evaluate patient and performance of task?

delegation

• RN delegating tasks to other nursing personnel

• RN responsible for:

  • accountability for delegated acts

  • determining that delegatee is competent to perform act

  • AND remains legally liable for delegated acts

• delegatee responsible for:

  • carrying out the delegated act safely

• state nurse practice acts do NOT give LPNs/LVNs the authority to delegate!!!!

values

attitudes, ideals, or beliefs an individual or group holds and uses to guide behavior

morals

standards of behavior that guide an individual or social group

established rules of conduct for deciding right and wrong

specific beliefs and behaviors based on personal judgement

ethics

ideal human behavior and ideal ways of being

distinguishing right from wrong

may refer to a profession’s code

bioethics

application of ethical theories and principles to moral issues in healthcare

• life-sustaining technology, organ transplants

nursing ethics

ethics related to nurse-patient relationship where the nurse is the main care provider

moral reasoning

making decisions based on morals

moral reflection

critical analysis of one’s morals, beliefs, and actions

how a person develops and maintains moral integrity

moral distress

response when nurses face ethical dilemmas but encounter institutional constraints that limit their actions

ethical dilemma

a moral conflict where the decision maker is unsure because the available choices result in conflicting values or ethical principles

autonomy

right of individuals to determine their own actions and make their own decisions

• self-determination

beneficence

do good; actions that benefit others

nonmaleficence

do not harm, intentionally or unintentionally

avoid actions that harm others

justice

fairness; equitable treatment and access

fidelity

faithfulness; keeping commitments and professional promises

foundation of nurse-patient relationship

veracity

truth-telling. avoiding deliberate deception

telling truth even when it may cause patient distress

ethical decision making

clarify the ethical dilemma

gather additional data

identify options

make a decision

act

evaluate

CODE model

Courage

• analyze situation to decide whether action is required

Obligations to honor

• consider personal values, ethical principles at stake, ANA code provisions to decide which obligations to honor

Danger management

• identify strategies to manage fear of repercussions

Expression and action

• decide what action maintains integrity

deontology

duty-based; action is right if motives or intentions were good, regardless of outcome

utilitarianism

rightness determined solely by the consequences

greatest good for the greatest number

virtue ethics

emphasizes the decision maker’s character

principalism

• use beneficence, nonmaleficence, autonomy, and justice to resolve ethical conflicts