NUR 1290 Final

What is nursing (according to ANA)

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

Characteristics of a profession

Possession of a Body of Specialized Knowledge, Use of Scientific Method to Enlarge the Body of Knowledge, Education within Institutions of Higher Education, Control of Professional Policy, Professional Activity and Autonomy, A Code of Ethics, The Profession as a Lifetime Commitment, Service to the Public

Two components of learning in Nursing

Didactic/Theory and Clinical Experiences

Didactic/Theory

content-focused experiences

Clinical Experiences

Laboratory/simulation experience or Hospital setting with patients

Learning Styles

Cognitive, Affective, and Psychomotor

Cognitive (style)

the "thinker", good at exams and answering questions in class

Affective (style)

thinking with one's heart "caring"

Psychomotor (style)

hands on "the doer"

Professional Resume

Objective, credentials, education, employment history, additional experience, and references

Florence Nightingale Theory

The act of utilizing the environment of the client to assist him in his recovery (basis of first nursing theory)

Nurses during Victorian Era

Clara Barton

started the red cross

Dorethea Dix

advocated for mentally ill, established mental asylums

New England Hospital for Women

the first hospital with a nurse training school

Linda Richards

First educated nurse

Early education development

rules were very strict, very strong military and religious influence, students viewed as "cheap labor", disciplining students responsibility of supervisor (good morals, were honest, conscientious, obedient, respectful, loyal, passive and devoted to duty)

Lillian Ward and Mary Brewster (1893)

established the Henry Street Settlements to help care for and educate residents, school nursing became a subspecialty of public health nursing

Clara Maas

lost her life helping to find the cure for typhoid fever

Great Depression

hospitals staffed by students

\#1 Rule of Nursing Education

it is built on the knowledge you gain from previous courses, it is a CONTINUUM

Diploma Programs

same courses in nursing and same hours, 24-36 month duration, take NCLEX-RN, accredited by NLN and ACEN

Associated Degree (ADN)

24-36 months, some liberal arts courses, focuses more on technical nursing, take the NCLEX-RN, accredited by NLN and NCEN, ADN stepping stone to BSN (tuition cheaper first 2 years)

Baccalaureate of Science in Nursing (BSN)

4-5 years duration and college/university, required liberal arts courses, take NCLEX-RN, accredited by NLN, CCNE, and ACEN, must have BSN for hospital RN staff

Masters Degrees in Nursing

Advanced practice nursing (APN), Clinical nurse specialists (CNS), Certified Registered Nurse Anesthetists (CRNA), Certified Nurse Midwife (CNM), Clinical Nurse Leader (CNL), Master's in Informatics, Master's Degree in Functional Areas (Administration or education), Master's programs earn accreditation from ACEN, CCNE & NLN

Core Competencies (IOM)

Provide Patient-Centered Care, Work in Interdisciplinary Teams, Employ Evidence-Based Practice (EBP), Apply Quality Improvement, Utilize informatics, Safety

Accreditation

a process by educational institutions or programs are surveyed and evaluated against previously determined standards. This is a voluntary process by private agencies, done by peers to assure that an educational program meets established standards for structure, function & performance (necessary for students to take NCLEX)

Credentials for individuals

Diplomas, degrees, certificates of completion, licensure, certification

Licensure

a legal credential conferred by an individual state that grants permission to the individual to practice a given profession (individual has demonstrated necessary degree of competency)

Certification

written documents that communicate to others the nature of one's competence and provide evidence of one's preparation to perform in a specific occupation (nongovernmental)

Current Nursing Licensure Laws

The purpose of a professional license is to protect the public from harm by setting minimal qualifications and competencies for safe entry-level practitioners

Nurse Practice Act (NPA)

SBON given responsibility for administering NPA, purpose of the act is to regulate protection of the public and to make individual practitioners accountable for their own actions, provides a legal bases for the regulation of nursing and the responsibility for interpreting the legal scope of nursing practice rests solely on individual SBON, all NPA have the same basic guiding principles

Role of SBON (state board of nursing)

establishes standards and examines applicants for licensure, approve operation of nursing education programs, provides for interstate endorsement, renews license, grants temporary license, investigate complaints against licensed practitioners, enforce disciplinary codes, provides rules for revocation of license, regulates advance/speciality practice, titling

Disciplinary action

penalties that may be imposed against an individual who has violated provisions of licensing law include: reprimands, restrictions on practice, suspension of license, revocation of license

Grandfathering

anyone currently holding a license may continue to hold that license if-and-when requirements for the license change.

Sunset Laws

Most laws remain in effect until the legislature votes to rescind or replace them

Characteristics of NCLEX

RN exam - computerized adaptive testing (CAT), no skipping questions/changing answers, 1 to 6 hours long, 75 to 265 questions, knowledge questions, comprehension questions, application questions, and analysis questions

Licensure by Endorsement

a nurse licensed in one state can seek licensure in another state without repeating the NCLEX, can be registered in more than one state but must meet the requirements of and following NPA of that state

Military and Government Nurses

practice throughout the US and in other countries with one license-must remain current with their home license

International Nursing

must contact the ICN for information about whom to contact in that country

Development of Nursing Associations

The british nurse association (1888 BEDFORD FENWICK), The american society of superintendents of training schools for nurses (1896 ISABEL HAMPTON), Nurses associated alumnae of the united states and canada (1896 ISABEL HAMTON ROBB)

Professional association activities

Publish journals, Continuing education, Developing professional standards, Professional education, Policy decisions in government; political Action, Advocacy in work environment

Scope of Nursing Practice

Initiating & maintaining comfort measures, Promoting & supporting human functions & responses, Establishing an environment conducive to well-being, Providing health counseling & teaching, Collaborating on certain aspects of the health regimen

Nursing Theories

Watson Theory of Caring, Swanson's caring theory, Orem Self-care theory, Leininger cultural diversity theory, peplau interpersonal relations theory

Learning Theories

Knowles Adult learning, The health Belief Model

Macro Consumers

government insures economic health policy

Micro Consumers

patient and family

Interdisciplinary Teams

NURSE IS CASE MANAGER, refers to people with distinct disciplinary training working together for a common purpose as they make different complementary contributions to patient-focused care

Microsystem

small group of people who work together on a regular basis to provide care to discrete subpopulations including patients

Hand offs

occurs when the patients care is transferred from one caretaker to the next

Time out Before Surgery

correct patient identity, correct site and site agreement on where the procedure is to be done

Delegation Principles

RN takes responsibility and accountability, may delegate components of care but not the nursing process itself, makes the decision to delegate or assign based on professional judgment

When not to delegate

roles that are limited to licensed individuals, work situation will not allow for adequate supervision

Five rights of Delegation

Right task, right circumstances, right person, right direction/communication, right supervision

Holistic Nursing Care

comprehensive total nursing care that considers the physical, emotional, social, economic, and spiritual needs of the person

What must you ask a patient before you can touch them

Name and Date of Birth

Classification of healthcare agencies

Length of stay, according to ownership (private/public), type of care (based on acuity so how serious the illness is)

HIstory of Hospitals

Almshouses (poorhouses) 1700's, Franklin creates Pennsylvania hospital 1751

Hospital Services

Inpateint, Outpatient, Educational Institutions

Inpateint

stay is over 24 hours

Outpatient (ambulatory)

stay is under 24 hours

Financing Healthcare

third party payers, personal payment, charitable care, health insurance plans

Third Party Payers

Insurance companies and the government programs

Health Insurance Plans

Blue Cross/Shield (oldest 1932), Oxford, Aetna, United Health Care

Managed Care Orgaizations

A system of healthcare that controls costs by placing limits on physicians' fees and by restricting the patient's choice of physicians

Independent Practice Association

present fee per individual in the program

Health Maintenance Organizations (HMO)

first to provide payments for preventative care include: state administered health plans (Workers Comp), Federal government (military health care=tricare, US department of veterans affairs, federal employees health benefit program)

Medicare

under the Title XVIII (18), an amendment to the Social Security Act: Federal program for individuals over 65, individuals with disabilities and end-stage renal disease, (does not pay for longterm care but will cover some skilled nursing and home health care for speciic conditons)

Part A (medicare)

All approved hospital bills

Part B (medicare)

Doctors Bills (up to 80%)

Part C (medicare)

Medicare Advantage: covers A & B, but through approved private insurance companies

Part D (medicare)

Prescription coverage of approved medications; Donuthole: prescription coverage: after patient reaches the maximum limit that medicare will permit, the difference is paid for by the patient

Medicaid

1965 by Title XIX (19) of the Social Security Act: federal/state program for Low income (indigent) people, the states administer the program and determine where the monies will be spent

State Children Health Insurance Plan (SCHIP)

children of low income families who are not eligilbe for medicaid, all children are covered for all services

Patterns of payment

Fee for service payment and Prospective Payment

Fee for Service Payment

each time a service is provided a fee is generated and then billed to the care recipient (insurance company/patient)

Prospective Payment

a fixed reimbursement amount for all the care required for a particular surgical procedure, an illness, or an acuity category, designed to provide an incentive to control costs (so there will be no unnecessary treatments to increase bill bc price is set)

Diagnostic Related Groups (DRG)

term used to predetermine a length of stay in the hospital for patients with similar diagnoses (ex fractured hip and hip replacement), predetermined by medicare, most costs are included

Comorbidity

when another illness is present, will increase the total length of stay therefore increase amount of reimbursement

Controversy

patients are leaving sooner so they are sicker when they leave

Resource Utilization Groups (RUGs)

determine prospective payment for nursing home patients

Capitation

fee is paid to a provider organization for each person who has signed up for healthcare services

Pay for Preformance (P4P)

to promote high quality care, hospitals and other providers are rewarded for metting standrds of care for certain conditons

Never Events

Medicare will no longer pay for the extra cost of keeping a patient in the hopital for medical errors: an occurance that happend that should not (preventable errors)

Certification

health care institutions meeting the standard of a state governmental agency

Accreditation

health care intitutions meeting the standards of a nongovernmental agency (necessay to recieve third party reimbursement)

Medicare/Medicaid certification

health care institutions must have to recieve funding

The Joint Commission

sets standards for hospital and other health care agencies

Community Health Accreditaion Program (CHAP)

voluntary accreditation system for community health and home health agencies

National Committee for Quality Assurances (NCQA)

data that provides a standard set of information that both employes and consumers can use to compare and evaluate HMOs

Influcing Political Process

Being informed, news media, specailized publications, online resources, organizational meetings, voting, shaping public opinion, communicating with legislators and officials, testifying for decision making bodies, individual support for legilsation and candidates, working in policy making agencies, seeking election to an office, group action (PACs, ANAPACs, NSTAT, Tri)

Hatch Act (1993)

limitations on political activity

Federal government role in healthcare

agencies, budget process, funding for nursing education and research, OSHA, nursing home regulations

Federal Agencies related to healthcare

The Department of Health and Human Services (DHH), The Public Health Services, Centers for Disease Control and Prevention (CDC), The National Institute of Health (NIH), The Food and Drug Administration (FDA), The Health Resources Administration (HRA), The Centers for Medicaid ad Medicare (CMS)

Omnibus Budget Reconciliation Act (OBRA)

federal budget process

The Authorization Act (fed budget process)

outlines the action to be taken

The Appropriations Act (fed budget process)

provides the funding

Funding for nursing education and research

Nurse Training Reinvestment Act (1964), Nurse Reinvestment Act (2002), Title VIII Nursing Workforce Reauthorization Act (2017), National Institute for Nursing Research (NINR 1980s)

Occupation Safety and Health Act (OSHA)

Mandates actions and prescribes safety equipment to improve the health and safety of all working environments

State governments role in healthcare

agencies (care for the mentally challenged and mentally ill, penal system, institutions of higher education), Legislative concerns (prohibition of mandatory overtime, nursing staffing system and rations, nursing workforce and data collection, ergonomics, needlestick injury prevention, violence in the work place, whistleblower protection)