Nursing Notes

Early Nursing Figures

  • Jeanne Mance:
    • Created the normal hospital structure.
    • Recruited people and funds.
    • Founded Ville Marie (Montreal) in 1641.
  • Florence Nightingale:
    • Considered the founder of modern nursing.
    • Known as "lady with the lamp".
    • Worked in Crimea, Ukraine.
  • Grey Nuns (Marguerite D'Youville, 1738):
    • Non-cloistered nuns who combined possessions to help the poor.
    • Known as the "tipsy nuns."
    • Sold alcohol and tobacco for funding.
    • Undertook a canoe trip from Quebec to Manitoba in 1844 to aid the sick.

Florence Nightingale's Influence on Nursing Education

  • Formalized nursing education using the apprenticeship model.
  • Advocated for university education for nurses.
  • Promoted hospital schools.
  • The 1932 Weir Report recommended university-level education for nursing.

Weir Report (1932)

  • Recommended university-level education for nursing.

Tommy Douglas

  • Known as the "father of medicare" in Canada.

British North America Act (1867)

  • United the three separate territories of Canada, Nova Scotia, and New Brunswick into a single dominion called Canada.

Criteria of the Canada Health Act (CUPPA)

  • Comprehensiveness:
    • Health care insurance plan must cover all insured health services provided by hospitals, physicians, and dentists.
  • Universality:
    • Must be entitled to health services provided by the provincial/territorial health care plan.
  • Public Administration:
    • Health care insurance plans must be administered and operated on a non-profit basis by a public authority.
  • Portability:
    • Coverage is transferable from province to province but does not allow travel outside the province specifically for care.
  • Accessibility:
    • Reasonable access to health services.

Five Sanitary Practices by Florence Nightingale

  • Pure air.
  • Pure water.
  • Efficient drainage.
  • Cleanliness.
  • Light.

UNB Faculty of Nursing - 5 Abilities

  • Knowledge and its Application.
  • Communication.
  • Critical Thinking.
  • Professional Identity/Ethics.
  • Social Justice/Effective Citizenship.

Primary Health Care

  • Meeting people’s health needs through promotive, protective, preventive, curative, rehabilitative, and palliative care throughout the life course.
  • Prioritizing healthcare services aimed at individuals and families through primary care and the population through public health functions.
  • Systematically addressing the broader determinants of health (social, economic, environmental, and individual characteristics/behaviours) using evidence-informed public policies and actions.
  • Empowering individuals, families, and communities to optimize their health.

Difference Between Primary Health Care and Primary Care

  • Primary Care:
    • Delivery of community-based clinical health care services.
  • Primary Health Care:
    • A principle-based comprehensive approach.
    • Seeks to improve the health of populations from birth to death, in all settings.
    • Stresses population, community, and person-oriented strategies for achieving health.

Five Essential Principles of Primary Health Care

  • Accessibility.
  • Public Participation.
  • Health Promotion and chronic disease prevention and management.
  • Use of appropriate technology and innovation.
  • Intersectoral cooperation and collaboration.

Four Pillars of Primary Health Care

  • Teams (right person for the right job).
  • Healthy Living (considering factors in people's lives).
  • Access (knowing what places need what help).
  • Information (teaching people how to find accurate medical info).

Levels of Care within Primary Health Care (5)

  • Health Promotion.
  • Disease and injury prevention.
  • Diagnoses and treatment.
  • Rehabilitation.
  • Supportive care.

Ottawa Charter for Health Promotion Actions (5)

  • Build healthy public policy.
  • Develop personal skills.
  • Strengthen community action.
  • Create supportive environments.
  • Reorient health services.

Definition of Caring

  • Reflecting on your practice, not simply focusing on signs and symptoms, but on the spiritual connections resulting from protecting, enhancing, and preserving a person’s health.

6 C's of Caring

  • Comportment (how you carry yourself).
  • Commitment.
  • Conscience (ethics).
  • Competence.
  • Compassion.
  • Confidence.

Determinants of Health (13)

  • Income and Social Status.
  • Employment and working conditions.
  • Education and Literacy.
  • Childhood experiences.
  • Physical environments.
  • Social support.
  • Individual health practices and coping skills.
  • Access to health services.
  • Biology and genetic endowment.
  • Gender.
  • Culture.
  • Race/Racism.
  • Food security.

Social Justice

  • The equitable or fair distribution of society’s benefits, responsibilities, and their consequences.
  • Focuses on the relative position of social advantage of one individual or social group in relation to others in society as well as on the root causes of inequities and what can be done to eliminate them.

Health Equality

  • Aims to ensure that everyone gets the same things in order to enjoy full, healthy lives.

Health Equity

  • A social justice goal focused on pursuing the highest possible standard of health and healthcare for all people, paying special attention to those in the context of greater risk of poor health, and taking into account broad social, political, and economic influences and access to care.

Trauma and Violence Informed Care

  • Focuses on understanding the impacts of trauma and creating environments that promote emotional and physical safety.

Structural Violence

  • Societies are organized in ways that grossly disadvantage some groups over others.

Cultural Safety

  • Takes into account the inherent power imbalance between the health care or social service provider and the person coming to you for care.

Cultural Humility

  • A lifelong process of self-reflection and self-critique to understand personal bias and to develop and maintain mutually respectful partnerships based on mutual trust.

Harm Reduction

  • Philosophy, set of programs and services, and a practice.
  • Focuses on preventing the harms of behaviours, not reducing or eliminating those behaviours.
  • Views substance use (and other potentially harmful behaviours) as a public and personal health issue.
  • Evidence-based approach.

Characteristics of a Profession (9)

  • Specialized training.
  • Well-defined body of knowledge.
  • Code of ethics/standards of practice.
  • Ongoing research.
  • Autonomy/Self-regulation.
  • Service.
  • Commitment to lifelong learning.
  • Advocacy.
  • Collegiality and collaboration.

Difference Between RNs and LPNs (3)

  • Education.
  • Level of responsibility.
  • Autonomy.

How Scope of Practice is Determined (5)

  • Legislation.
  • Standards of Practice.
  • Employer policies.
  • Individual competencies.
  • Client needs.

Delegation

  • The extension of authority by a nursing professional to another nursing professional who does not have the authority to perform the task for ONE client, ONE time.
  • Does not transfer accountability.

Assignment

  • Describes the distribution of work that each staff member is to accomplish.

NANB's Mandate

  • Regulation for safe, competent, and ethical nursing care, in the interest of the public.

NANB’s Regulatory Framework (3)

  • Promotion.
  • Prevention.
  • Intervention.

NANB's Standards of Practice (4)

  • Responsibility and Accountability.
  • Knowledge-based practice.
  • Client-centered practice.
  • Professional Relationships and Leadership.

Key Points of Professional Relationships and Leadership (2)

  • Understanding the similarities and differences of health care providers.
  • Advocating for change in practice/policies.

Key Points of Client-Centered Practice (3)

  • Interacting in a respectful manner.
  • Cultural humility.
  • Maintaining privacy.

Key Points of Knowledge-Based Practice (2)

  • Knowledge of diseases, medication, etc.
  • Recognizing change in condition and how to respond.

Key Points of Responsibility and Accountability (3)

  • Yearly registration.
  • Admitting mistakes.
  • Duty to report witnessed unsafe practice.

What NANB Standard of Practice Does "Yearly Registration" Fall Under?

  • Responsibility and Accountability

What NANB Standard of Practice Does "Admitting Mistakes" Fall Under?

  • Responsibility and Accountability

What NANB Standard of Practice Does "Duty to Report Witnessed Unsafe Practice" Fall Under?

  • Responsibility and Accountability

What NANB Standard of Practice Does "Knowledge of Diseases, Medication etc" Fall Under?

  • Knowledge-based practice

What NANB Standard of Practice Does "Recognizing Change in Condition and How to Respond" Fall Under?

  • Knowledge-based practice

What NANB Standard of Practice Does "Interacting in a Respectful Manner" Fall Under?

  • Client-centered practice

What NANB Standard of Practice Does "Cultural Humility" Fall Under?

  • Client-centered practice

What NANB Standard of Practice Does "Maintaining Privacy" Fall Under?

  • Client-centered practice

What NANB Standard of Practice Does "Advocating for Change in Practice/Policies" Fall Under?

  • Professional Relationships and Leadership

What NANB Standard of Practice Does "Understanding the Similarities and Differences of Health Care Providers" Fall Under?

  • Professional Relationships and Leadership

Nursing Theory

  • A conceptual framework that provides principles that underpin practice.

Nursing Metaparadigm

  • Client and person.
  • Environment.
  • Health.
  • Nursing.

Grand Theory

  • Global, abstract, don’t provide specific interventions.

Midrange Theory

  • More limited scope, less abstract than grand, address specific phenomena and reflect practice, not specific to one area.

Descriptive Theory (3)

  • Describe things.
  • Practice level theories.
  • Describes a phenomena and speculates why it occurs and the consequences of the phenomena.

Prescriptive Theory (3)

  • Describes what you do about things.
  • Practice-based theories.
  • Address nursing interventions and predicts the consequences of those interventions.

Carper’s Ways of Knowing Theory and What Type of Theory Is It? (5)

  • Midrange theory.
  • Describe how nurses develop the knowledge they have.
    • Ethic
    • Emperic (science of nursing, factual + descriptive)
    • Personal
    • Esthetics (“art of nursing”, intuition, caring)
    • Sociopolitical / emancipatory (newest addition, social justice, social determinants of health)

What Is the Newest Addition to the Carper’s Ways of Knowing Theory?

  • Sociopolitical / emancipatory

Stages in Benner’s Novice to Expert Theory and What Type of Theory Is It?

  • Midrange theory
    • Stage 1: novice (no previous experience, skill focused, follow rules, not flexible)
    • Stage 2: advanced beginner (some previous experience, more flexible, poor time management)
    • Stage 3: competent (around graduation, few years of experience, thinks more analytically)
    • Stage 4: proficient (more holistic, can do multiple assessments at once, uses experience to anticipate, proactive rather than reactive)
    • Stage 5: the expert (intuitive, flexible, seems very natural)

What Stage in Benner’s Novice to Expert Theory Has No Previous Experience, Is Skill Focused, Follows Rules, but Is Not Flexible?

  • Stage 1: novice

What Stage in Benner’s Novice to Expert Theory Has Some Previous Experience, Is a Little Flexible, and Has Poor Time Management?

  • Stage 2: advanced beginner

What Stage in Benner’s Novice to Expert Theory Is Around Graduation, Has a Few Years of Experience, and Thinks More Analytically?

  • Stage 3: competent

What Stage in Benner’s Novice to Expert Theory Is More Holistic, Can Do Multiple Assessments at Once, Uses Experience to Anticipate, and Is Proactive Rather Than Reactive?

  • Stage 4: proficient

What Stage in Benner’s Novice to Expert Theory Is Intuitive, Flexible, and Seems Very Natural?

  • Stage 5: the expert

Difference Between Clinical Reasoning and Clinical Judgement

  • Clinical reasoning is the thinking process, the application of critical thinking to a clinical situation.
  • Clinical judgement is a decision to take action (or not).

Tanner’s 5 Assumptions of Clinical Judgement

  • Clinical judgements are more influenced by what nurses bring to the situation than the objective data about the situation.
  • Sound clinical judgement rests on some degree to knowing the patient and their typical pattern of responses.
  • Clinical judgements are influenced by the context in which the situation occurs and the culture of the hospital.
  • Nurses use a variety of reasoning patterns alone or in combination.
  • Reflection on practice is often triggered by a breakdown in clinical judgement (mistake).

5 Steps of the Nursing Process

  • Assessment
  • Diagnoses
  • Planning
  • Implementation
  • Evaluation

Difference Between a Medical Diagnosis and a Nursing Diagnosis

  • Medical diagnosis = identification of disease condition based on physical signs & symptoms. Goal is to identify cause of illness/injury and make a treatment plan. Remains the same if disease is present.
  • Nursing diagnosis = clinical judgement about an individual, family, or community in response to actual or potential problems. Goal is to identify actual or potential responses. May change from day to day.

Difference Between Outcomes and Goals

  • Outcomes = specific and measurable, start with “client will”
  • Goals = broad, general statements

5 Leadership Styles

  • Authoritarian
  • Democratic
  • Transactional
  • Laissez-faire
  • Transformational

What Leadership Style Gives Full Power or Authority to the Leader?

  • Authoritarian

What Leadership Style Involves Team Members, Has Two-Way Communication, and Focuses on Quality Improvement?

  • Democratic

What Leadership Style Works Well in Emergency Situations Where One Person Needs to Take Control?

  • Authoritarian

What Leadership Style Blames When Mistakes Are Made Instead of Looking Why the Mistake Was Made?

  • Authoritarian

What Leadership Style Believes That Knowledge Equals Power?

  • Authoritarian

What Leadership Style Looks for Mistakes and Has Rewards/Punishments?

  • Transactional

What Leadership Style Delegates Responsibility to Team Members with Little to No Direction, Has a Hands-Off Approach, but Promotes Innovation and Flexibility?

  • Laissez-faire

What Leadership Style Leads by Example, Inspires to Perform Beyond Expectations, Where the Needs and Skills of Others Are Considered?

  • Transformational

Point of Care Nursing Leadership

  • Leadership activities relate to the care process.
  • Modeling, leading, and advocating for quality, safe patient care based on the best evidence.

Nursing Informatics

  • The use of information technology in combination with information management methods to support the delivery of health care.

Health Informatics

  • The umbrella term encompassing medical, nursing, dental, and pharmacy informatics among others. It focuses on the recipient of care rather than the discipline of the caregiver. Includes decision support, online clinical documentation, and provider order entry applications

Consumer Informatics

  • Focuses on the empowerment of consumers to manage their own health through the use of information and communication technologies

Digital Health

  • Technology solutions that support the delivery of clinical care

Benefits of Digital Health Solutions (4)

  • The ability to easily monitor and review patient health.
  • Decrease incidence of duplicative diagnostic testing.
  • Increased engagement of clients and their families in their care.
  • Improved access to care for individuals in remote communities.

Challenges Posed by Digital Health (2)

  • More focused on computer than patient.
  • Needs nursing input for better design

Acronyms

  • ICNP: International Classification for Nursing Practice
  • CT: Clinical Terminology
  • C-HOBIC: Canadian Health Outcomes for Better Information and Care
  • LOINC: Logical Observations Identifiers Names and Codes

4 P’s of Personalized Health Care

  • Predictive
  • Preventative
  • Personalized
  • Participatory

Difference Between Privacy and Security

  • Privacy = right of individuals to determine how, when, to whom, and for what purposes any personal information will be transmitted to others.
  • Security = focused on maintaining the confidentiality of information

4 Key Areas of Risk Related to the Use of Electronic Health Records

  • Access
  • Accuracy
  • Theft
  • Disposal

Benefits of ICTs in Health Care (4)

  • Improve safety related to clinical tasks like medication administration and clinical documentation/
  • Empowerment of clients in managing their health.
  • Improved accuracy and speed.
  • Large scale aggregation of data in health care decision making

Challenges of ICTs in Health Care (3)

  • Extra work burden on nurses.
  • Rapid evolution of technology that can make various platforms obsolete in a matter of years.
  • Finding a balance between technology-driven care and human-driven care.

7 Parts of the CNA Code of Ethics

  • Providing Safe, Compassionate, Competent, and Ethical Care.
  • Promoting health and Well-being.
  • Promoting and respecting Informed Decision Making.
  • Honouring Dignity
  • Maintaining Privacy and Confidentiality
  • Promoting Justice
  • Being Accountable

Difference Between Global Health, Public Health, and International Health

  • Global health = the optimal wellbeing of all humans, considered a fundamental human rights.
  • Public health = focuses on protecting and improving the health of individuals and communities, by promoting healthy lifestyles and injury prevention.
  • International health = focus on health issues of countries other than one's own.

Purpose of the UN SDGs

  • Promote prosperity while correcting the environment

Intersectionality

  • The influence of social characteristics on a particular phenomena such as health.

Benefits of Reflective Practice (4)

  • Improved critical thinking
  • Empowerment
  • Greater self-awareness
  • Reflect on personal biases and beliefs

Define Reflection in Action vs. Reflection on Action

  • Reflection in action = the nurses' ability to “read” the patient - how they know the patient is responding to the nursing intervention.
  • Reflection on action = reflecting after the fact, how nurses learn from experiences.

Steps of Gibb’s Reflective Cycle (5)

  • Description
  • Feelings
  • Evaluation
  • Conclusions
  • Action