Review For Professional Practice 1 (gc)
Week 2 PowerPoint and Note
Health -objective process (functional stability, balance, and integrity);relates to disease, illness and wellness
Disease - objective, pertains to ‘ill health’, seen and managed by medical science
Illness - subjective experiences of either loss of health
Wellness - the subjective experience of health
Teleology - study of ends or final causes
Exacerbation of Disease - reappearance of symptoms and reactivation of disease
Healthcare Models
Medical model - healthcare model that views health is absence of disease
Holistic model - healthcare model that considers all parts of the person and focuses on positive aspects of health
Indigenous Wholistic Theory of Health - similar to holistic model of health; considers mental, physical, cultural and spiritual well being, of the person AND community.
Wellness model - builds on medical and holistic models. Emphasizes the ability of individuals/groups to cope with health-related challenges.
Ethical Theories
Deontology - ethical concept of defining actions as right or wrong
Utilitarianism (consequentialism) - ethical concept that the value of something is determined by its usefulness
Bioethics - ethical concept that actions are obligation based, outcome oriented, and based on reason. 4 principles of autonomy, beneficence, nonmaleficence, justice
Feminist Ethics - ethical concept that focuses on continuing injustices between people, being attentive to issues of difference, power dynamics.
Relational Ethics - ethical concept that ethical understandings are formed in, and emerge from, a person’s relationships with others. 4 themes: Environment, Embodiment, Mutuality, Engagement
Virtue Ethics - ethical concept looks at ethical character of making decision rather than their reasoning
Divine Command - ethical concept follows philosophies and rules set out by higher power
Code of Ethics for Nurses
statement of ethical values of nurses and of nurses commitments to person with health care needs
A. Providing safe, compassionate, competent, ethical care
B. Promoting Health and well-being
C. Promoting and respecting informed decision making
D. Honoring dignity
E. Maintaining privacy and confidentiality
F. Promoting justice
G. Being accountable
Ethical Issues
Advance Care Planning - multidimensional process that involves health care providers in discussion with patients to ensure they clearly understand their illness, its trajectory, and treatment options
Medical Futility - medical treatment that is considered impossible or unlikely to receive its therapeutic goal
Moral Distress - inability to act according to moral judgment
Moral Integrity - doing right thing when nobody is watching
Moral Residue - distress that remains when the situation generating the moral. distress ends
Legal Implications in Nursing Practice
Professional Regulation
- nurses must be regulated by professional nursing association
- use of NCLEX
- registration may be suspended or revoked by regulatory body
Standards of Care
- legal guidelines for nursing practice
Nursing Practice Acts - define scope of nursing practice, sets educational requirements, distinguishes between nursing and medical practice
Regulation of Health Care Providers
Title Protection
- legally entitled to use specific designation
- defined scopes of practice
Educational Standards
- exams
- competency-based assessment programs to ensure continued maintenance of practice standard
License to Practice
- annual renewal of licenses
- regulators/educational facilities oversee regulation of their members
Controlled Acts
- must be preformed by registered professional
- may only be preformed in response to order given by physician or nurse practitioner or in accordance with conditions identified in regulation
Exceptions:
- first aid in emergency
- students learning to perform act
- person, such as caregiver, trained to perform act
- appropriate person designated in accordance with religion ( rabbi circumcision)
Delegated Acts
- means by which regulated health professional transfers legal authority or permits another person to carry out a controlled act they are otherwise unqualified to do
- acts that can be delegated defined by provincial regulations
- acts in most jurisdictions cannot be sub-delegated
- delegating health care professional, delegate, facility share responsibility for the act
5 Controlled Acts Authorized to RPNs and RNs
- Performing a prescribed procedure below the dermis or a mucous membrane.
- Administering a substance by injection or inhalation.
- Putting an instrument, hand or finger i. beyond the external ear canal, ii. beyond the point in the nasal passages where they normally narrow, iii. beyond the larynx, iv. beyond the opening of the urethra, v. beyond the labia majora, vi. beyond the anal verge, or vii. into an artificial opening into the body.
- Dispensing a drug.
- Treating, by means of psychotherapy technique delivered through a therapeutic relationship
Dimensions of Wellness
Physical, mental, emotional, intellectual, social, spiritual, environmental, intellectual, social, spiritual, environmental, occupational
Week 3 Review
Evolution of Canadian Health Care System
Social Safety Net - network of national, provincial, social programs in place to protect vulnerable members of society
Medicare - Canadian insurance scheme that provides prepaid access to medically necessary hospital/physician services to citizens and permanent residents
Indian Act - identified the federal government’s role in providing healthcare to Indians
Early Healthcare in Canada
- Tommy Douglas of Saskatchewan introduced medical insurance for all in Canada (HIDSA paid 1/2 cost); lead to Medical Care Act of 1966
- Federal government enacted the Canada Health Act in 1984, amalgamated HIDSA and Medical Care Act; banned extra billing and user fees associated with previous 2 acts
* Principles of Canada Health Act *
Public Administration - provincial/territorial plans operate on nonprofit basis
Comprehensiveness - covers medically necessary services (may differ in provinces)
Universality - Free of discrimination based on race, gender, ethnicity, religion
Portability - ability to access healthcare services in another province/territory without cost/penalty
Accessibility - based on medical need regardless of ability to pay
- excludes Canadian Forces, RCMP, Veterans, Federal inmates, Refugees as they are federally covered
* Organization and Governance of Health Care
Federal Jurisdiction
- set/administer Canada Health Act Principles
- Assist in financing services through transfer payments
- Deliver/co-deliver health services to targeted groups
- Provide national policy/programming to promote health/prevent disease
Provincial/Territorial Jurisdiction
- manage, finance, plan insurable health care services
- determine location of healthcare facilities
- Reimburse physician and hospital expenses and provide co-payment with users for rehabilitation
Primary Health Care
- initially envisioned at addressing non-medical determinants of health by connecting health status and social determinants of health
- philosophy/model for improving health with emphasis on principles of health promotion/disease prevention
- building spectrum of programs and services beyond traditional health care system
- distinct from primary care as primary care focuses on personal health and primary health care extends
*Levels of Primary Health Care
Level 1: Health Promotion
- enabling people to increase control over and impact their health
- i.e antismoking efforts, advocacy of healthy public policy
Level 2: Disease/Injury Prevention
- illness prevention services to help clients reduce risk factors
- i.e immunization, support groups, climate control action
Level 3: Diagnosis/Treatment
- recognizing and managing existing health problems
*** Three Levels:**
Primary Care - first contact of patient and leads to decision regarding action to resolve health problem. Physicians + NPs, early detection, routine care, education
Secondary Care - specialized medical service by physician specialist or hospital on referral from PC practitioner
Tertiary Care - Specialized technical care in diagnosing and treating complicated health problems. Specialized hospitals that have sophisticated equipment
Level 4: Rehabilitation
- interdisciplinary effort
- improve health and quality of life facing life-altering conditions
Level 5: Supportive Care
- illness/disabilities that are chronic and progressive
- health, personal, social services provided over prolonged period
Respite care - short-term relief or time off for family care givers by health care providers
Development of Nursing in Canada
First Nurses/Hospitals in New France
- Marie Rollet Herbert confronted notion that Indians needed saving
- Male attendants at “sick bay”
- Jesuit priests, allied mission to convert Indians
Grey Nuns
- 1738 “agreed to combine possessions in a house of refuge for the poor”
- operated several businesses to make funds
- took work in remote areas to treat people
- term “grey nun” is derogatory, referred to their unusual work
Health Care and Educational Reform
Jordan’s Principle - if disagreement between 2 governments for status Indian, government first contacted should pay
* 1932 The Wier Report
- concerns of quality of nursing education and exploitation of nursing students led to nationwide study in nursing education
- Resultant scrutiny of nursing education in Canada: insufficient classroom instruction and lack of variety in clinical experience
- recommended nurse preparation be transferred from hospital to general education system
1965 Royal Commission on Health Services
- Instrumental in transition away from hospital training schools
- First to Colleges as 3 year diploma programs, then they became housed in universities
1974 Lalonde Report
- stated that health is determined by more than just biology
1978 Alma-Alta Conference
- health for all 2000
- expanded on by Ottawa charter for health promotion
Week 4 Review
Fiduciary Relationship - a relationship in which a professional provides services that, by the nature, cause the recipient to trust in the specialized knowledge and integrity of the professional
Legislation – laws developed with a specific intent (such as directing the actions of nursing). Usually provincially Regulation – the act of being registered in a professional capacity
Sources of Law
- constitution divides areas of responsibility between provincial and federal government
- civil law in Quebec and common law in rest of country
Constitutional Law - relationship between people and government (fundamental freedoms)
Statute Law - created by elective legislative bodies such as parliament/provincial legislators. Federal statues apply throughout the country, provincial only in provinces created.
Regulatory Law - legally binding feature of an act
Tort Law - person/property wrongly harmed by another
Contract Law - private agreements that are generally enforceable by court
Criminal Law - wrongful act or wrongful intent
Legal liability issues in Nursing Practice
Tort - civil wrong committed against person or property
Intentional Tort - willful act to violate patient’s rights. (Assault, battery, invasion of privacy, false imprisonment)
Unintentional Tort - negligence, conduct that does not meet the standard of care established by law
Advance Directive - mechanism enabling mentally competent patient to plan for a time where they may lack mental capacity to make medical treatment decisions
Living Will - document in which person makes anticipatory refusal of life-prolonging measures during a state of mental incompetence
Abandonment, Assignment, Contract Issues
Short staffing - nurses should not walk out (charges of abandonment)
Floating - should not float unless adequately trained in areas
Prescriber’s Orders - obliged to follow physician’s orders unless they are in error, violate hospital policy, or harm patients
Standard Statements
1. Appropriate Health Care Provider
nurses must consider each situation to determine if performance of procedure promotes safe client care, and if it is appropriate for a nurse to perform procedure
2. Authority
nurses ensure they have appropriate authority before performing procedures
3. Competence
nurses ensure they are competent in both cognitive and technical aspects of procedure prior to performing it
4. Managing Outcomes
prior to performing procedures, nurses ensure they are able to identify potential outcomes of procedures, have authority and competence to manage outcomes of procedures, or have resources available to manage outcomes
Nursing Act 1991
* 6 Criteria Nurses Must Meet to Become Registered
(The regulatory body is responsible for enacting the legislation passed for the profession to operate, and ensuring the members are registered and competent. Any regulatory body's mission is to : PROTECT THE PUBLIC)
- Nursing Education from an approved educational institute
- Evidence of recent practice (which you get at the educational institution)
- Passing the jurisprudence exam Jurisprudence examination
- Proficiency in English / French (only French in Quebec)
- Past Offenses and Legal Findings
6. Attestation of Health and Good Conduct
Week 5 Review
Levels of Critical Thinking
Basic Critical Thinking
- concrete, based on rules/procedures
Complex Critical Thinking
- separate thinking process from those of expert others, analyze/examine choices more independently
Commitment
- anticipate need to make choices, assume responsibility + accountability for those choices
Components of Critical Thinking
Specific Knowledge Base
Experience
Critical Thinking Competencies
Diagnostic reasoning - process of determining patient’s health status after you make physical and behavioral observations
Clinical Inference - process of drawing conclusions from related pieces of evidence
Clinical Reasoning - term used to describe cognitive process of thinking about patient issues, making inferences, deciding on action to be implemented in certain scenarios
Nursing Process
Attitudes for Critical Thinking
- knowing when you need more information, recognizing personal biases
Standards for Critical Thinking
Intellectual Standards - thoroughness, precision, accuracy, consistency
Professional Standards - ethical criteria for nursing judgments, evidence-informed criteria, professional responsibility
Developing Critical Thinking Skills
Analytic Interpreting - expand on noticing aspects by focusing on one family member at a time
Intuitive Interpreting - immediate apprehension of clinical situation and is a function of exposure to similar situations
Narrative Interpreting - understanding particular case and is viewed through interpretation of human concerns, intents, morals
Reflection-in-action - consider how planned interventions are having an impact moving toward
Three Factor Framework
- framework used to determine which nurse category need to meet patient needs (RN/RPN)
1 Client Factors
- complexity: variability of client’s condition and care requirements
- predictability
- risk of negative outcomes
2 Nurse Factors
- factors that affect a nurses ability to provide safe/ethical care to client
- limits of individual competence
3 Environment Factors
- practice supports, consultation resources and the stability/predictability of the environment
- less stable the factors, the greater the need for RN staffing
Week 6 Review
Nursing Diagnosis - nurse’s perspective on the appropriate focus for the patient
Metaparadigm - set of concepts that define the important characteristics of a phenomena
Types of Theories
Grand - broad theory, structural focus
Middle-Range - theory that encompasses more middle-scope and less abstract
Descriptive - theory that describes phenomena, speculates on why they occur, describes consequences
Prescriptive - addresses nursing interventions, helps predict consequences of intervention
Metaparadigm Concept
- key bodies of knowledge needed to understand nursing process
Client and Person
- nurses do more than care for hospitalized patients
- use term client rather than patient
Environment
- person is part of and interacts with a complex environmental system
Health
- recognizes as more than just absence of disease; ideal state of optimal health/wellbeing
Nursing
- View of client with understanding of person’s environment, life, health goals
Ways of Knowing
Personal: Understanding of self and others through own our experiences (includes experiential knowing) Empirical: Use of data and scientific methods (Rationalism and scientific inquiry) Ethical: What is morally correct & ought to be versus what is or what is desired. We use this a lot in ethical dilemmas Esthetical: The ‘art’ of nursing. Not the scientific aspect but expressed through art, music, non-linear type activities. Finding a meaning in life.
Emancipatory: socio-political awareness – critical examination of things outside the issue that contribute to the issue. Used in advocacy and ‘standing up’ for your clients. (current push for decriminalization of small amount of drugs, safe injection sites, etc)
Major Theoretical Models
Practice-based theories - theories that reflect issues that shape rate and context of nursing
Needs theories - theories that conceptualize patient as representing a collection of needs
Interactionist Theories - theories that detail the relationships between nurses and their clients
Systems Theories - theories that account for whole of entity (system) and its component parts (subsystems) and their interactions
Simultaneity Theories - Human beings and environmental factors are viewed as energy fields which change continuously
Guiding Ethical Principles for Research in Canada
- respect for human dignity
- respect for persons
- concern for welfare
- respect for privacy and confidentiality
- justice
PICOT Questions and Nursing Research
P: patient population of interest I: intervention of interest C: comparison of interest O: outcome T: time
- 3 levels of questions (What? What is relationship? Why?)
- “What” is qualitative
- “What is relationship?” and “Why?” are quantitative
Ethical Values (CNO)
- client well-being;
- client choice;
- privacy and confidentiality;
- respect for life;
- maintaining commitments;
- truthfulness; and
- fairness.
Six Principles of Code of Conduct
- Nurses respect the dignity of patients and treat them as individuals
- Nurses work together to promote patient well-being
- Nurses maintain patients’ trust by providing safe and competent care
- Nurses work respectfully with colleagues to best meet patients’ needs
- Nurses act with integrity to maintain patients’ trust
- Nurses maintain public confidence in the nursing profession.
Code of Ethics For Nurses
statement of ethical values of nurses and of nurses’ commitments to person with health care needs A. Providing safe, compassionate, competent, ethical care B. Promoting Health and well-being C. Promoting and respecting informed decision making D. Honoring dignity E. Maintaining privacy and confidentiality F. Promoting justice G. Being accountable
Social Determinants of Health
- Income and social status
- social support networks
- education and literacy
- employment and working conditions
- physical environments
- biological and genetic endowment
- individual health practices and coping skills
- healthy child development
- gender
- culture
- social environments
Determinants of Health (Lalonde 1974)
- human biology
- health care systems
- environment
- lifestyle