NURS320 MIDTERM

Pre-19th Century

19th Century -

20th Century

Pre-19th Century

Religious orientation; no set guidelines, education, training

19th Century -

Florence Nightingale

Modernized nursing

Recognized nursing as separate from medicine

Set standards

Developed training and educational preparation

Conducted nursing research

20th century

Hospital nursing program emerged

1950's-present: Nursing broadened in all areas

Practice -

Specific body of knowledge -

Nursing research -

Role of nursing defined -

Nursing knowledge -

Definition of Nursing

ICN definition-

ANA definition-

ICN definition- Nursing encompasses autonomous and collaborative care of individuals of all ages, families, groups, and communities, sick or well and in all settings.

ANA definition- "the protection, promotion, and optimization of health and abilities, prevention of illness and injury, alleviation of suffering through the diagnosis and treatment of human response, and advocacy in the care of individuals, families, groups, communities, and populations"

aims in nursing

1. Promote health

2. Prevent illness

3. Restore health

4. Facilitate coping with disability or death

5. Knowledge, Skills, Attitudes --> (Knowledge = all cognitive information; Skills = hands-on skills; Attitude = caring communication)

6. Critical Thinking (Observation, analysis, inference, communication, problem solving)

Four Blended Competencies

Cognitive

Technical

Interpersonal

Ethical/Legal

QSEN Competencies

Patient-centered care

Teamwork and collaboration

Quality improvement

Safety

Evidence-based practice

Informatics

Healthy People 2030 Health Promotion Guidelines

Objectives:

Health conditions

Health behaviors

Populations

Settings & systems

Social Determinates of Health

education, health care, neighborhood, social and community context, economic stability

preventing illness, detection, restoring health, facilitating coping with disability and death

Preventing illness = Primary level of protection

What measures can nurses take?

Seat belts, helmets, vaccines

Detection = Secondary level of protection

Examples = Colonoscopy, mammograms

Restoring health = Tertiary level of protection (when someone is already sick)

Facilitating coping with disability and death

Palliative - comfort care → for people with or without a terminal illness

I.e chronic condition from a vehicle accident and is now paralyzed; end of life care/hospice (For people within about 6 months of their end of life)

Which phrase best describes the science of nursing?

The skilled application of knowledge

The knowledge base for care

Hands-on care

Respect for each individual person

The knowledge base for care

What is the purpose of the ANA’s scope and standards of practice?

To describe the ethical responsibilities of nurses

To define the activities that are special and unique to nursing

To establish nursing as an independent and free standing profession

To regulate the practice of nursing (this answer would be if we were talking about the state)

To define the activities that are special and unique to nursing

Nursing as a Professional Discipline

Well-defined body of specific and unique knowledge

Strong service orientation

Recognized authority by a professional group

Code of Ethics

Professional organization that sets standards

Ongoing research

Autonomy and self-regulation

nursing practice acts

Defines legal scope of nursing practice

Defines legal requirements

Establishes criteria for the education and licensure of nurses

nursing process

assessment --> analysis --> planning --> implementation --> evaluation

clinical judgment model: 6 functions of clinical judgment

recognize cues --> analyze cues --> prioritize hypothesis --> generate solutions --> take actions --> evaluate outcomes

profession =

Body of knowledge

Scope of practice

Agreed upon values, ethics

Oath or code

Accountability

how is professionalism judged

Against a set of expectations or standards

From our own personal values set and understanding of what "professionalism" means

May be situational in nature

Strongly influenced by culture

how is professionalism determined

Our image

Our communication

Our competence

Our Demeanor

professional organization

ANA =

NCSBN =

NLN =

Sigma Theta Tau International-

AACN =

ANA (American Nursing Association

NCSBN (National Council of State Boards of Nursing)

NLN (National League of Nurses)

Sigma Theta Tau International-

AACN (American Association of Critical-care nurses)

ANA scope of practice

standards of practice: (6)

Standard 1: Evidence-Based Assessment

Standard 2: Diagnosis identy actual/potential practice gaps l/t pt compliance issues

Standard 3: Outcomes identification - develop measurable outcomes

Standard 4: Planning w/DEI, interprofessionalism

Standard 5: Implementation 5-A: coordination w/stakeholders, teams, transitions 5-B: health teaching, health promotion

Standard 6: Evaluation achievement of progress towards desired outcomes

SMART goals

Specific

Measurable

Attainable

Realistic

Timely

Example:

standards of professional performance (7-18)

Standard 7: Ethics code of ethics

Standard 8: Advocacy supporting a cause/course of action

Standard 9: Cultural Humility social equity for marginalized people

Standard 10: Communication EB tools, non-judgmental/specific feedback

Standard 11: Collaboration

Standard 12: Leadership formal/informal, emotional intelligence, shared-decision making, just culture

Standard 13: Education ongoing learning

Standard 14: Scholarly Inquiry research

Standard 15: Quality of Practice QI

Standard 16: Professional Practice Evaluations reflection, self-eval, evaluating others

Standard 17: Resource Stewardship safe, efficient, financially responsible, judicious

Standard 18: Environmental Health SDOH, address incivility, emotional intelligence

code of ethics slideshow in week 1

sources of knowledge

Traditional-

Authoritative-

Scientific-

Traditional-

Authoritative-

Scientific-

types of nursing knowledge:

Science-

Philosophy-

Process-

Science-

Philosophy-

Process-

influences on nursing knowledge

Historical influences -

Societal influences-

framework of nursing theory: concepts vs theory

Concepts- abstract impressions organized into symbols of reality

Theory- group of concepts that describe a pattern of reality

deductive vs inductive reasoning

Deductive = general to specific

Dolphins are mammals

Mammals have kidneys

Dolphins have kidneys

Inductive = reasoning that takes specific information and makes a broader generalization

interdisciplinary base for nursing theory:

General system theory-

Adaptation theory-

Development theory-

General system theory- theory for universal application; break whole things into parts to see how they work together in systems

Adaptation theory- adjustment of living matter to other living things and environment

Development theory- orderly and predictable growth and development from conception to death

benefits of nurisng theory

Directs nurses toward common goal

Leads to improved patient care

Provides rational and knowledgeable reasons for nursing actions

Gives nurses knowledge base necessary for appropriate actions

Helps resolve current nursing issues

Prepares nurses to question assumptions and values

Serves research, education, and practice

goals of theoretical frameworks

Holistic patient care

Individualized care to meet needs of patients

Promotion of health

Prevention or treatment of illness

4 concepts r/t nursing theory

Person/Patient-

Health-

Environment-

Nursing -

Person/Patient-

Health-

Environment-

Nursing -

FLORENCE NIGHTINGALE'S ENVIRONMENTAL THEORY

Defined nursing as "the act of utilizing the environment of the patient to assist him in his recovery."

5 factors for a healthy envi according to Nightingale

Pure or fresh air

Pure water

Efficient drainage

Cleanliness

Light, especially direct sunlight

nightingale's general concepts of envi santitation

Proper ventilation

Adequate lighting

Cleanliness

Adequate warmth

Quiet

Diet

goals of research: general vs goals of nursing research

nursing research goals according to national institute of nursing:

Build the scientific foundation of clinical practice

Prevent disease and disability

Manage and eliminate symptoms caused by illness

Enhance end-of-life and palliative care

methods of nursing research: quant vs qual

Quantitative

Involves concepts of basic and applied research

Qualitative

Conducted to gain insight by discovering meanings

Belief that perceptions differ for each person and change over time

terms of quantitative research:

Variable

Dependent variable

Independent variable

Hypothesis

Data

Instruments

Descriptive

Correlational

Quasi-experimental

Experimental

Variable =

Dependent variable =

Independent variable =

Hypothesis =

Data =

Instruments =

Descriptive =

Correlational =

Quasi-experimental =

Experimental =

steps of quant research

State the research problem

Define purpose of the study

Review related literature

Formulate hypotheses and variables

Select population and sample

Collect data

Analyze data

Communicate findings and conclusions

qualitative research methods

Phenomenology

Grounded theory

Ethnography

Historical

Phenomenology =

Grounded theory =

Ethnography =

Historical =

evaluating the ethics of clinical research studies

Value

Scientific validity

Fair subject selection

Favorable risk-benefit ratio

Independent review

Informed consent

Respect for enrolled subjects

evidence based practice =

steps in implementing EBP

Cultivate a spirit of inquiry

Ask the burning clinical question in PICOT format

Search/collect most relevant best practice

Critically appraise the evidence

Integrate

Evaluate

Disseminate

PICOT =

impediments to nursing research

Limited time to participate in research

Restricted access to resources

Lack of educational preparation

Communication slides!!

IOM Recommendations: Communication

Improve communication verbally and in writing between professionals

key points =

using hand off communication: SBAR technique

bidirectional conflict possibilities

patient--> nurse --> other healthcare workers and vice versa

conflict resolution

Recognize it

Find the right time

Discuss both sides

Document the issue with the relevant topics

Mediation

Negotiation/compromise

Agree to disagree

teamwork for conflict resolution and prevention

Communication

Coaching

Patient satisfaction

Servant Leadership (greenleaf, 1973):

important factors with inter-professional communication

maslow's hierarchy of human needs

family structures:

Family:

Nuclear family:

Extended family:

Blended family:

Single-parent family:

Family: any group of people who live together and depends on one another for physical, emotional, and financial support

Nuclear family: traditional family; two parents and their children

Extended family: includes aunts, uncles, and grandparents

Blended family: two parents and their unrelated children from previous relationships

Single-parent family: may be separated, divorced, widowed, or never married

family functions

Physical

Economic

Reproductive

Affective and coping

Socialization

risk factors for aaltered family health

Lifestyle risk factors

Psychosocial risk factors

Environmental risk factors

Developmental risk factors

Biologic risks

community factors affecting health

Social support systems

Community health care structure

Economic resources

Environmental factors

nursing informatics =

examples of informatics used in today's nursing profession

EHR

Telehealth

Mobile devices

Patient portals

Data analytics

Technologies for educating nurses in academic settings

Technologies for conducting research

meaningful use of electronic health records

Improve quality, safety, efficiency

Reduce health disparities -

Engage patients and family

Improve care coordination - how broadly?

Public health reporting

Maintain privacy and security of patient health information - how so?

results of meaningful use compliance (EHR)

Better clinical outcomes

Improved population health outcomes

Increased transparency and efficiency

Empowered individuals

More robust research data on health systems

ANA definition of nursing informatics

The specialty that integrates nursing science with multiple information management and analytical sciences to identify, define, manage, and communicate data, information, knowledge, and wisdom in nursing practice"

nursing informatics specialist

pic on slides

daily tasks of informatics nurse

Use technology to sustain nursing work processes

Redesign clinical workflow

Help patients manage their own health through information systems

Analyze clinical and financial data

Perform research based on clinical data and trials

Develop storage and analytic technology to help optimize data for research

Keep technology up to date and accessible to medical personnel

Deliver nursing content to standardized languages

Assist with change management

Encourage provision of high-quality, evidence-based care

types of nursing informaticists

1. The informatics nurses

2. A registered nurse with an interest or experience in an informatics field

- Super-user

- The informatics nursing specialist

3. A registered nurse with formal graduate-level education in the field of informatics

- Often responsible for strategy development, implementation, and maintenance and evaluation of clinical systems requiring collaboration with multiple disciplines

system development life cycle (SDLC

analysis --> design --> development --> testing --> implementation --> maintenance --> planning

important informatics concepts

System usability

System optimization

Standard terminologies

Interoperability

Security and privacy

uses of patient portals

1. Access medical history and other health information

2. Complete various forms and questionnaires online

3. Communicates securely and conveniently with providers

4. Request prescription refills

5. Pay bills

6. Review lab results

7. Schedule appointments

8. Receive reminder for appropriate screenings

9. Enter clinical data, such as blood pressure, glucose levels, weight, Fitbit data, and other activity tracking data

10. Review progress notes

11. Access educational material based on diagnosis or procedure

benefits and downsides of patient portals

predictive analytics

data --> reporting/analysis (what and why happened) --> monitoring (what is hap now) --> predictive analysis (what is going to happen in the future)

bigdata

1. volume

2. velocity

3. variety

4. veracity

5. value

6. validity

7. variability

8. venue

9. vocaab

10. vagueness

telehealth and mobile tech:

Telehealth:

Telemedicine:

Telecare:

Telehealth: the use of electronic information and telecommunications technologies to support and promote long-distance clinical health care, patient administration

Telemedicine: the use of telecommunications technologies to support the delivery of all types of medical, diagnostic, and treatment-related services, usually by physicians and nurse practitioners

Telecare: technology that allows consumer to stay safe and independent in their own homes

telenursing =

The use of information and communication technology to transmit data relevant to any aspect of nursing activity, encompassing many activities:

Triage

Teleconsultations

Home care

Education

Research