Final Exam Intro to Nursing

Health People 2030

A national health promotion and disease prevention objectives developed every 10 years to improve the health of all Americans

Health risk factors, modifiable and nonmodifiable

Modifiable: tobacco use, poor diet, physical inactivity, high blood pressure, and obesity

Nonmodifiable: genetics, ethnicity/race, age, and family health history

Factors that impact health

genetics, behavior, environmental and physical influences, medical care, and social factors

Levels of prevention

Primary: act of intervening before negative health effects occur

Secondary: detection and treatment of preclinical changes to reduce the impact of disease or injury

Tertiary: aims to reverse, minimize, or delay the effects of a disease or disability

Quaternary: focuses on protecting clients from excess medical intervention that can cause more harm than good

Health Promotion vs. Disease Prevention

Health: the process of enhancing people’s influence over and improvement of their health

Disease: primary and secondary (early detection) preventative measures aimed at reducing the burden of disease

Cultural Care

Culture is the shared group of ideas and behaviors by people or society

Affects what values and beliefs the client embraces

reflected in language, foods, emotional expression, and social groups

Health Literacy

the capacity to find, understand, and use information, and to make informed health decisions

Ethical Principles

Beneficence, Autonomy, Nonmaleficence, Veracity, Fidelity, Justice

Beneficence

actions guided by compassion/kindness

Autonomy

freedom or independence to make own decisions

Nonmaleficence

to do no harm

Veracity

telling the truth

Fidelity

keeping promises or commitments

Justice

actions are fair and equitable

Code of Ethics

a documented set of rules, values, and principles guiding an organization or profession to ensure, honest, and responsible behavior

How to process an ethical dilemma

identify the ethical dilemma

identify all possible solutions

apply all ethical principles to the solution

include all relevant individuals and factors

decide on a solution

review the decision

put the decision into action

5 Professional Values

Altruism, Integrity, Social Justice, Dignity, Autonomy

Altruism

to do something or act for the sake of benefiting someone

Integrity

the quality of being honest and having strong moral principles and uprightedness

Social justice

regardless of societal status, every person has the right to quality health care

dignity

everyone has value and should be respected simply because human beings are all equal

autonomy

the right to self-determination; the nurse’s responsibility to respect the client’s right to make their own decisions regarding health care

Falsification of records

intentionally altering, destroying, or creating false documents. This white-collar crime includes modifying, forging, or omitting information on official records

EMTALA

a federal law requiring emergency departments to provide a screening exam and treatment for anyone, regardless of ability to pay.

Whistleblowing

an act when a person formally reports on illegal, wrongdoing, or unethical practice

many laws exist to protect whistleblowers

Good Samaritan Law

Deciding whether to provide care outside of work is up to the nurses ethical discretion and the nurse cannot be held liable for deciding not to provide care.

If the nurse does provide care, they are protected

Informed Consent

consent that is expressed in writing

requires providers to educate clients about the risks, benefits, and alternatives to procedures

must be provided for clients to make well-informed decisions about their healthcare

HIPAA

The Health Insurance Portability and Accountability Act is a federal law designed to protect patient information from disclosure without consent, ensure health insurance portability, and reduce healthcare fraud

Patient Self Determination Act

The Patient Self-Determination Act is a federal law requiring Medicare/Medicaid-funded healthcare institutions to inform patients of their right to accept or refuse medical treatment

Legal implications related to delegation

Delegation in nursing legally entails the transfer of task responsibility to a competent individual while the RN retains ultimate accountability for the outcome, patient safety, and assessment

Factors that would cause a breach of care

failure to maintain standards of care (standards of practice and professional performance) lack of confidentiality, falsification of health records

Responsibility vs Accountability

Responsibility is the duty to act or complete a task, focusing on the process

Accountability is the obligation to own the final results and consequences, which cannot be delegated

Leadership styles

transactional, transformational, Laissez-Faire, Bureaucratic, and situational leaders

Transactional Leaders

establish standards, highlight obligations, concentrate on monitoring behaviors, and use rewards or punishments based on how tasks are completed

encourages compliance with rules by getting others to focus on their responsibilities and doing what is expected of them

Transformational leaders

Establish a common mission and vision and, encourage employees to heighten their level of performance.

Relay trustworthiness and a hopeful future, provide meaning, and challenge the best within people.

Display compassion and a sense of understanding toward team

Laissez-Faire Leaders

Hands-off leaders that oversee and encourage their team to work independently, providing little direct control over decision making.

Relinquishes power and responsibility to others, facilitating independent decision-making, goal setting, and solutions.

Makes minimal decisions yet provides the necessary resources and tools needed for employees to self-sufficiently demonstrate their knowledge and accomplish tasks

Bureaucratic Leaders

A “by-the-book’ leader who relies heavily on consistency and

adherence to rules within a top-down decision-making organization.

Assures that employees know their role and responsibilities, follow

procedures precisely, and meet expectations.

Situational Leaders

Transition or move from one leadership style to another depending on the circumstances.

Nursing Roles

caregivers, patient advocates, and educators, managing treatment plans, monitoring vitals, administering medications, and performing diagnostic tests

What constitutes professional and unprofessional behaviors

Professional: accountability, ethical practice, and effective communication, ensure patient safety and foster trust

Unprofessional: including bullying, boundary violations, drug diversion, and neglecting safety protocols—jeopardize patient care, damage professional reputation, and can lead to license loss

Professional Boundaries

the essential, therapeutic limits that define the safe space between a nurse’s professional power and a patient’s vulnerability

Social Media

Social media carries significant risks to patient privacy if not used responsibly. Follow HIPAA, maintain professional boundaries with patients, and follow employer policies

HIPAA

Health Insurance Portability and Accountability Act; protects patient privacy and confidentiality.

Only share information with those directly involved in care

Patient-centered care = respecting patient autonomy and privacy

Examples:

Speaking quietly about patient info

Not accessing charts without reason

Advocacy

Speaking up for the patient’s needs, rights, and preferences.

Ensuring informed consent

Respecting patient decisions (even if you disagree)

Protecting vulnerable patients

Patient-Centered Care

Care that respects patient autonomy and privacy.

Swanson’s Theory of Caring

Includes knowing, enabling, doing for, maintaining belief, and being with.

1. Knowing – understanding the patient’s experience  

2. Being with – emotional presence  

3. Doing for – doing what the patient cannot do  

4. Enabling – helping patients through transitions  

5. Maintaining belief – supporting hope and meaning  

Focus: relationship-based, emotional support 

Watson’s Transpersonal Caring Theory

Emphasizes deep human connection

Mind-body-spirit approach

Focus on:

Caring moments

Healing relationships

Encourages nurses to connect beyond physical care

Palliative Care

Focuses on comfort and quality of life for patients with serious illnesses.

Includes:

Pain management

Emotional & spiritual support

Medically Futile Care

Care that does not improve outcomes and may prolong suffering without benefit.

Ethical issue → involves:

Family discussions

Provider judgment

Patient wishes

Incorporating client preferences into care

• Respect:  

• Cultural beliefs  

• Treatment choices  

• Lifestyle  

• Shared decision-making is key

Root-Cause Analysis

Investigates why an error occurred, focusing on system issues.

Example:

Medication error → check communication, labeling, workflow

Incorporating a change in practice using evidence based practice

Steps: 

1. Ask a clinical question  

2. Gather evidence  

3. Evaluate evidence  

4. Apply to practice  

5. Assess outcomes  

Improves safety and quality 

Sentinel Events

Unexpected events causing serious harm or death; require immediate investigation.

Wrong-site surgery

Patient suicide in hospital

Fatal medication error

Patient fall resulting in death

Standardization of nursing practices 

• Use of:  

• Protocols  

• Guidelines  

• Checklists  

• Reduces variation → improves safety

Nurse-sensitive quality indicator categories and examples 

Categories: 

1. Structure  

1. Staffing levels  

2. Nurse education  

2. Process  

1. Nursing interventions (e.g., turning patients)  

3. Outcomes  

1. Falls  

2. Pressure ulcers  

3. Infection rates 

Measure nursing impact on patient outcomes: 

Nursing impact on patient outcomes is measured using nursing-sensitive indicators (NSIs)—metrics reflecting the structure, process, and outcomes of nursing care—such as fall rates, pressure injury prevalence, infection rates (CAUTI/CLABSI), and patient satisfaction 

National Patient Safety Goals

Focus on correct patient identification, medication safety, preventing infections, and improving communication.

Incident Reports 

• Used to document unexpected events  

• NOT part of the medical record  

• Used for:  

• Legal protection  

• Quality improvement 

Quality Improvement Tools

• Chart Audit → review patient records  

• Histogram → shows data distribution  

• Process Flow Chart → maps steps in a process  

• Run Chart → tracks data over time  

• Checklists → ensure steps are followed  

• Cause-and-Effect Diagram (Fishbone) → identifies causes of problems

Caring behaviors

Providing touch, presence, comfort, listening, compassionate care 

• Touch  

• Presence  

• Active listening  

• Compassion  

• Providing comfort

Spiritual care 

• Respect beliefs and practices  

• Support meaning, hope, and purpose  

• Examples:  

• Prayer support  

• Chaplain referral  

• Quiet time 

Cultural Awareness

Recognizing your own biases.

Cultural Knowledge

Learning about different cultures.

Cultural Skill

Performing culturally appropriate care.

Cultural Encounters

Interacting with diverse patients.

Cultural Desire

The motivation to improve care.

Generational Considerations for providing patient centered care 

Different age groups have different preferences: 

• Older adults  

• Prefer respect, formality  

• May need slower communication  

• Middle-aged adults  

• Value independence and involvement  

• Younger patients  

• Prefer technology and quick communication  

Patient-centered care = adapting to generational needs 

 Clinical practice guidelines: 

• systematically developed recommendations to guide healthcare decisions 

• Based on best evidence, clinical expertise, and patient preferences 

• EX: guidelines for treating hypertension using first-line medications 

 Critical Pathway: 

• Multidisciplinary plan outlining expected patient care over time for a specific diagnosis 

• Focuses on outcomes and timelines 

• EX: post-op hip replacement recovery pathway (day-by-day care plan) 

 Standard of Care: 

• Level of care a competent nurse/health professional should provide 

• Legal benchmark for practice 

• EX: turning immobile patients every 2 hours to prevent pressure ulcers 

 Qualitative and quantitative research: 

• Qualitative: explores experiences, feelings, perceptions 

EX: patient interviews about living with chronic pain 

• Quantitative: uses numbers, statistics, measurable data 

EX: study measuring BP reduction with a new medication 

Theory-practice gap: 

• Difference between what is known (research) and what is actually done in practice 

• EX: Nurses know what hand hygiene is critical but don’t always perform it consistently 

Essential elements of EBP (steps of EBP) 

1. Ask a clinical question (PICOT) 

2. Collect best evidence 

3. Critically appraise evidence 

4. Apply evidence with clinical expertise and patient values 

5. Evaluate outcome

Levels of Evidence (Evidence triangle) 

• Top (strongest): Systematic reviews and meta-analyses 

• Randomized controlled trials (RCTs) 

• Cohort and case-control studies 

• Case reports 

• Bottom (weakest): expert opinion 

PICOT 

P: Patient/problem 

I: Intervention 

C: Comparison 

O: Outcome 

T: Time 

EX: in hospitalized adults (P), does hourly rounding (I) vs no rounding (C) reduce falls (O) during hospitalization 

 Handoff report: 

• Transfer of patient information between providers 

• Must be accurate, complete, and standardized 

• EX: using ISBAR during shift change 

Cognitive rehearsal: 

• Practicing responses to difficult situations (like incivility) 

• EX: preparing what to say if a coworker is disrespectful 

 Lateral and vertical violence: 

• Lateral: peer-to-peer (nurse to nurse) 

• Vertical: between levels (manager to nurse or vice versa) 

• Includes bullying, intimidation 

Read Back and Verifying with transcribing orders: 

• Receiver repeats order to confirm accuracy  

• Required for verbal/phone orders 

• EX: “You said morphine 2 mg IV now, correct?” 

Conflict management and resolution: 

• Strategies: 

• Avoiding 

• Accommodating 

• Competing 

• Compromising 

• Collaborating (BEST) 

Teamwork benefits and barriers: 

• Benefits: improved safety, better outcomes, fewer errors 

• Barriers: poor communication, hierarchy, unclear roles 

 Discharge planning:

• Begins at admission 

• Ensures safe transition home or to another facility  

• Includes education, meds, follow-ups 

 Continuity of Care: 

• Consistent care across settings and providers 

• EX: communication from hospital – home health nurse 

 Incivility:

• Rude/disrespectful behavior 

• Can affect patient safety 

Zero-Tolerance Policy: 

No acceptance of bullying, harassment, or violence in workplace 

Changes for Effective Prevention of incivility: 

• Promote respectful culture 

• Education/training 

• Leadership support 

• Reporting systems 

 Emotional Intelligence: 

• Ability to understand/manage emotions (self and others) 

• Improves teamwork and communication 

 ISBAR:

Identify, situation, background, assessment, recommendation 

Teach-back:

patient repeats information to confirm understanding 

Closed-Loop Communication:

sender gives message – receiver repeats – sender confirms

Check-Back:  

verifying information (similar to read-back)

Checklists:

standardized steps to reduce errors. EX: surgical safety checklist  

CUS:

C- Concerned, U- Uncomfortable, S- Safety issue 

DESC:

D- Describe, E- Express, S- Specify, C- Consequences 

Effective Team Tools—Brief, Huddle, Debrief  

• Brief: before task 

• Huddle: during task 

• Debrief: after task  

Referral:

directing patient to another provider/service 

Confidentiality: 

• protecting patient information (HIPAA) 

• Only share with authorized individuals 

 In-text citation:

• Format: (author, year) 

• EX: (Smith, 2023) 

Reference: 

• Full source at end of paper 

• EX: Smith, J. (2023). Nursing practice. Publisher 

Level headings: (APA 7) 

• Level 1: Centered, bold 

• Level 2: Left, bold 

• Level 3: Left, Bold Italic