Nursing Foundations and Professional Practice Exam Study Guide
Ethical Principles and Professional Standards
Ethical Principles in Nursing: Nurses must adhere to core ethical principles that guide decision-making and patient interactions. These include:
Autonomy: Respecting the patient's right to make their own decisions regarding their healthcare.
Beneficence: Taking positive actions to help others and acting in the best interest of the patient.
Non-maleficence: The commitment to do no harm.
Justice: Fairness in care delivery and use of resources.
Fidelity: Keeping promises and being faithful to commitments made to patients.
Veracity: The obligation to tell the truth.
American Nurses Association (ANA) Code of Ethics (COE): A formal statement of the nursing profession's ideals and values. It serves as a guide for carrying out nursing responsibilities in a manner consistent with quality in nursing care and the ethical obligations of the profession.
Breaches in Nursing Practice: These occur when a nurse fails to meet professional standards. Examples include:
Failing to provide the standard of care, which results in harm to a patient.
Violating patient confidentiality.
Accessing medical records without proper authorization.
Failing to protect a patient from harm.
Failure to follow the established Code of Ethics (COE).
Professionalism: Nurses must avoid behaviors unbecoming of the profession. Maintaining a professional demeanor is essential to establishing trust with patients and the healthcare team.
Health Nurse Healthy Nation: This initiative was developed by the ANA to promote the health and wellness of nurses. It includes five key initiatives:
Physical activity
Rest
Nutrition
Quality of Life
Safety
Legal Frameworks and Regulatory Bodies
Nursing Licensure Compact (NLC): This agreement allows nurses to have one multi-state license, providing the flexibility to practice in their home state and other compact states without needing additional licenses.
Board of Nursing (BON): The state-specific regulatory body responsible for overseeing nursing practice, issuing licenses, and ensuring that nurses follow the laws and regulations within their jurisdiction.
Health Insurance Portability and Accountability Act (HIPAA): A federal law that protects sensitive patient health information from being disclosed without the patient's consent or knowledge. Confidentiality and authorized access are primary components.
Emergency Medical Treatment and Active Labor Act (EMTALA): A federal law that requires anyone coming to an emergency department to be stabilized and treated, regardless of their insurance status or ability to pay.
Standard of Practice: These are authoritative statements of the duties that all registered nurses, regardless of role, population, or specialty, are expected to perform competently. They list specific skills and outline the responsibilities of every nurse.
Mandated Reporter: Nurses have a legal and ethical role as mandated reporters. They are required by law to report any suspicion of abuse, neglect, or maltreatment of vulnerable populations, such as children or the elderly.
Good Samaritan Law: Legal protection for healthcare professionals and others who provide reasonable assistance to those who are, or who they believe to be, injured, ill, in peril, or otherwise incapacitated.
Informed Consent: The nurse’s role regarding informed consent typically involves witnessing the patient's signature on the consent form and ensuring the patient was provided the necessary information by the provider to make an informed decision.
Patient Care and Safety Initiatives
Advance Directives: Legal documents that allow patients to spell out their decisions about end-of-life care ahead of time. They give patients a way to tell their wishes to family, friends, and healthcare professionals and to avoid confusion later.
Quality and Safety Education for Nurses (QSEN) Competencies: Frameworks designed to prepare future nurses with the knowledge, skills, and attitudes (KSAs) necessary to continuously improve the quality and safety of healthcare systems. Key competencies include:
Patient-centered Care
Teamwork and Collaboration
Evidence-based Practice (EBP)
Quality Improvement (QI)
Safety
Informatics
The Joint Commission (TJC): An independent, not-for-profit organization that accredits and certifies healthcare organizations and programs in the United States, focusing on quality and safety.
Sentinel Events: Any unanticipated event in a healthcare setting resulting in death or serious physical or psychological injury to a patient or patients, not related to the natural course of the patient's illness.
Press Ganey survey: A tool used to measure patient satisfaction and the patient experience. This data helps healthcare organizations improve patient-centered care.
Food and Drug Administration (FDA): This agency ensures that medications are strictly tested for safety and efficacy before they are available to the public.
Hand Hygiene: A critical safety practice. Following specific protocols (often detailed in instructional videos) is the most effective way to prevent the spread of healthcare-associated infections.
Clinical Concepts and Frameworks
Nursing Process: A systematic, patient-centered goal-oriented method of caring that provides a framework for nursing practice. It consists of the following steps:
Assessment: Systematic collection of data relating to the patient.
Diagnosis: Analysis of the assessment data to identify problems or needs.
Planning: Developing a plan of action with goals and outcomes.
Implementation: Carrying out the interventions outlined in the plan.
Evaluation: Assessing the effectiveness of the interventions and the patient's progress toward goals.
ABCDE Algorithm: A prioritized clinical assessment framework:
A: Airway
B: Breathing
C: Circulation
D: Disability
E: Environment/Exposure
Levels of Disease Prevention:
Primary Prevention: Steps taken to decrease the risk of acquiring a condition (e.g., immunizations, health education).
Secondary Prevention: Focusing on early detection of a disease before it progresses (e.g., screenings, mammograms).
Tertiary Prevention: Controlling a disease or illness the patient already has to prevent further deterioration (e.g., rehabilitation, chronic disease management).
Risk Factors for Disease:
Modifiable: Factors a person can change (e.g., diet, smoking, exercise).
Non-modifiable: Factors that cannot be changed (e.g., age, genetics, family history).
Health Literacy: The degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions.
Healthy People 2030 Framework: A national initiative that provides 10-year, measurable public health objectives and targets to improve the health of all Americans.
Nursing Roles and Leadership
Diverse Roles of the Nurse: A nurse may take on many roles depending on the needs of the patient and the facility:
Researcher: Investigating best practices (e.g., researching how to prevent falls on a specific unit).
Educator: Providing information to patients and families to improve health outcomes.
Care Coordinator: Managing the patient's overall care and collaborating with other disciplines.
Counselor: Offering emotional support and guidance to patients.
Case Managers: Professional nurses who often set up the specific services and resources a patient will need upon discharge from the hospital to ensure continuity of care.
Types of Leaders: Includes various styles such as Autocratic, Democratic, Laissez-faire, and Transformational leaders, each affecting the health care team dynamic differently.
Principles of Shared Governance: A professional practice model, founded on the cornerstone principles of partnership, equity, accountability, and ownership that form a culturally relevant structure; it allows staff nurses to have a voice in decision-making.
Novice to Expert Model: Developed by Patricia Benner, this model describes the stages of clinical competence that a nurse passes through as they gain experience, moving from "Novice" to "Advanced Beginner," "Competent," "Proficient," and finally "Expert."
NLN Competencies: National League for Nursing competencies that define the core goals for nursing education and practice.
Whistleblowing: The act of reporting unethical or illegal actions within an organization. It is essential for maintaining safety and integrity in healthcare.
Social and Economic Influences on Health
Social Determinants of Health (SDOH): The conditions in the environments where people are born, live, learn, work, play, worship, and age that affect a wide range of health, functioning, and quality-of-life outcomes and risks.
Affordable Care Act (ACA): Comprehensive health care reform law enacted in 2010 that increased health insurance coverage for the uninsured and implemented reforms to the health insurance market.