Concepts

CHAPTER 1- Evolution of Nursing Thoughts Pg -3 29 (26 pages)

Images of Nursing

What are 5 images of nursing that developed through history?

• Angel of Mercy- The curse as an angelic creature grew out of the influence of religion and the risks inherent to the practice of nursing.
• Battle -Ax- Woman who were charged with crimes, were sentence to care for the sick
• Handmaiden- Stereotype portrays the male physician in dominant role as woman nurse assists
• Military Image- wars had a positive impact on the development of nursing as a profession.
• Nurse as Professional- The battle-ax image of an unprofessional nurse remained until transformed by Florence’s Nightingale.

Florence Nightingale contribution in public health were among the first nursing efforts to fight disease.

Florence Nightingale made nursing a respectable profession: 

o established sanitary nursing care units
o founder of modern nursing
o began professional education of nursing.

Epidemiology- Distribution and origins of disease.

Nosocomial infection- an infection associated with a healthcare called healthcare associated infection.

What is Safe, Effective Nursing Care (SENC)?
o Provide goal-directed, client-centered care
o Collaborate with interpersonal healthcare team
o Validate evidence-based research to incorporate into practice
o Provide safe, quality client care
o Embrace incorporate technological advances.

Clinical judgement- involves observing, comparing, contrasting, and evaluating client’s condition to determine changes

Critical thinking- a reflective process that involves collecting data, analyzing accuracy of information, and considering options for action

Problem solving- where nurses consider an issue and attempt to find a solution for the best outcome

How is Nursing Define?

2 Important organization help define nursing:

o International council of nurse’s definition ICN
o American nurses’ association of definitions ANA

International council of nurses (ICN) key nursing roles:

• collaborative care
• health promotion
• illness prevention
• advocacy
• safe environment
• educating

American Nurse Association ANA's 5 characteristics of a RN

1. individualized,
2. Establishing relationships,
3. Caring,
4. The nursing process,
5. Environment at work and the ability of the RN equals quality healthcare

Why is a definition of nursing Important?

1. Help the public understand the value of nursing.
2. Describe what activities and roles belong to nursing versus other health professions.
3. Help students and practicing nurses understand what is expected

What do nurses use to care for patients?

Answer: Clinical judgement, critical thinking, and problem solving

Nursing is a: - Profession - Occupation - Discipline

Profession - Although the term profession is freely used, a group must meet certain criteria to be considered a profession.

Discipline - a profession must have a domain of knowledge that has both theoretical and practical boundaries.

Theoretical boundaries of nursing - questions from clinical practice and then they are investigated through research

How do Nurses Educational paths differ?
The transition into the nursing profession involves formal and informal processes.

Formal education -completing the initial and continuing education required for licensure.

Informal education involves a gradual progression in skill and clinical judgment that allows the nurse to advance in the profession.

Socialization- is the informal education that occurs as you move into your new profession. It is the knowledge gained from direct experience, real world observations and informal discussion with peers and colleagues.

Benner’s Model - describes the process by which a nurse acquires skills and judgement

Stage 1: Novice. This phase begins with the onset of your education. The novice has little clinical experience, is task oriented, and is focused on learning the rules and following the written sequential process.

Stage 2: Advanced beginner. A new graduate usually functions at this level. An advanced beginner begins to focus on more aspects of a clinical situation and applies more facts

Stage 3: Competence. Nurses achieve competence after 2 to 3 years of nursing practice in the same area. Competent performers have gained additional experience and are able to handle their client load, deal with complexity, and prioritize situations.

Stage 4: Proficient. The proficient nurse is able to quickly take in all aspects of a situation and immediately give meaning to the cluster of assessment data. Proficient nurses are able to see the “big picture” and can coordinate services and forecast needs.

Stage 5: Expert. Expert nurses are able to see what needs to be achieved and how to do it. They trust in and use their intuition while operating with a deep understanding of a situation, often recognizing a problem in the absence of the classic signs and symptoms.

How is nursing practices regulated? Answer: State board of nursing

Nursing Practice Acts- A compilation of laws that govern the practice of nursing and empower a state
board of nursing to oversee and regulate nursing practice.

Key points: To practice nursing, you must be licensed as a nurse by the state board of nursing.
All states require graduation from an approved nursing program and successful completion of NCLEX

Standards of Practice- “describes a competent level of nursing care demonstrated by nursing process.

What are some important nursing g organizations?

American nurses’ association (ANA)- focused on establishing standards of nursing to promote quality care and adhering to standards
National league for nursing (NLN)- first nursing organization with a goal to establish and maintain a universal standard of education
International council of nursing (ICN)- aims to ensure quality nursing care for all by:
 Supporting global health policies that advance nursing and improve worldwide health
 Striving to improve working conditions for nurses throughout the world

Who are the recipients of Nursing Care?

1. Direct care- involves personal interaction between nurse and clients
   ex: administering vaccines, giving medication
2. Indirect care- working on behalf of clients to improve health status
   ex: preparing the shot before hand, ordering unit supplies.

Care is provided to achieve the following:
o Health promotion
o illness prevention
o Health restoration
o End of life care

What Types of Care Are Provided?

• Clients can receive acute care or long-term support services.

Acute Care is defined as the services used to “treat active sudden, often unexpected,

The 6 domains of acute care are:
(1) Trauma care and acute care surgery,
(2) Emergency care
(3) urgent care,
(4) short-term stabilization,
(5) prehospital care, and
(6) critical care. The goal is to prevent deterioration and restore health

Long-Term Support Services (LTSS)—encompass “human assistance, assistive technologies and devices, environmental modifications, care and service coordination”

Skilled care- This is service that are needed for limited period of time after injury.

Custodial care- This is proving help with activities of daily living, bathing, dressing, eating, grooming, toileting.

Categories of Healthcare:

1. Primary Services- keeping the client well by preventing illness. Health promotion and illness prevention
2. Secondary services- are directed toward early diagnosis and treatment of illness, disease, and injury
3. Tertiary services- long-term rehabilitation services and care for the dying. Ex: hospice

Prospective reimbursement- uses pre-established criteria to determine in advance the amount of reimbursement used by Medicare

How Is Healthcare Regulated? Regulators are governing bodies that exert influence or control over the healthcare system. They include accrediting and licensing agencies (board of nursing), and legislators. The most prominent regulating body in the healthcare system is The Joint Commission

How Have Healthcare Reform Efforts Affected Care?

Affordable care act (ACA) - had a major impact in providing access to health insurance 

Healthcare reform has impacted not only access to care but also reimbursement rates for providers. The following are examples.

Managed Care - designed to control healthcare costs, is a competitive approach
to healthcare pricing.

Health Maintenance Organization (HMO)- Care based on capitated, meaning per head cost

Preferred Provide Organization (PPO)- Network of providers who will provide the care. Allows
patients’ greater choice and flexibility

Work redesign -looking at the level of care required and the mix of personnel necessary to achieve the best outcome. The following concepts emerged:

Critical pathway- inter-professional approach to care that services interventions 
over a length of stay for a given case type

Case management- coordination of care across a healthcare system

Collective bargaining - negotiating of better wages and working conditions for nurses as a group rather
than individually.

Not all states have collective bargaining groups for nurses.

Continuous quality improvement (CQI)- focus on quality care as an ongoing goal rather than something
audited randomly

Retrospective audit- launch program to improve quality. ex: peer review

Collaboration is the process of joint decision making among independent parties involving joint ownership of decisions and collective responsibility for outcomes

Chapter 15- Culture and Ethnicity- Pg 297-317 (20 pages)

What is meant by Culture?

Culture- “the totality of socially transmitted behavior patterns, arts, beliefs, values, customs.
changes over time

Culture is both universal and dynamic/active

Healthy people 2020 - overarching goal is to eliminate disparities, achieve health equity, and improve the health of all groups

Ethnicity, Race and Religion

Race- Unlike ethnicity, race is strictly related to biology. Race refers to the grouping of people based on biological similarities, such as skin color, blood type, or bone structure

Religion- Religion refers to an ordered system of beliefs regarding the cause, nature, and purpose of the universe, especially the beliefs related to the worship of a God or gods

Ethnicity- The fact or state of belonging to a social group that has a common national or cultural tradition. Ethnicity is similar to culture and subculture.

    The main difference between Culture and Ethnicity is that Culture is a social behavior or 

customary form followed by people, while Ethnicity is a fact of belonging to a group of people having a common ancestry, food habits, Culture, or physical attributes

Concepts Related to Culture

Bicultural - describes a person who identifies with two cultures and integrates some of the values and lifestyles of each into his life.
For example: A child whose father is Jewish and mother is an Italian Catholic
may choose to follow Jewish tradition while still holding some ofthe values and beliefs of her Italian heritage.

Multicultural - refers to many cultures and is used to describe groups rather than individuals

Socialization is the process of learning to become a member of a society or a group. A person becomes socialized by learning social rules and roles; by learning behaviors, norms, values; and by perceptions of others in the same group or role.

Acculturation is a learning process through which immigrants assume the characteristics of that culture.
Ex: when individuals or groups from one culture are placed into contact with another culture an d acquire some of those new elements

Assimilation - when the new members gradually learn and take on the essential values, beliefs, and behaviors of the dominant culture. Assimilation is complete when the newcomer is fully merged into the dominant cultural group.

Ethnocentrism is the tendency to think that your own group (cultural, professional, ethnic, or social) is superior to others and to view behaviors and beliefs that differ greatly from your own as somehow wrong, strange, or unenlightened

Dominant Culture - is the group that has the most authority or power to control values and reward or punish behaviors. It is usually, but not always, the largest group

Subcultures -are groups within a larger culture or social system that have some characteristics that are different from those of the dominant culture (e.g., values, behaviors, ancestry, ways of living).

Minority Groups differ from other groups in some characteristics and are subject to less power, fewer privileges, and discrimination

Personal Value- is a principle or standard that has meaning or worth to an individual.

Belief- something someone accepts as true

Practice- a set of behaviors that one follows.

Cultural Archetype- a symbol for the specifics of a group. not usually negative
Ex: a certain ethnicity having green eyes

Cultural Stereotype- a generalized belief about a group of people. Usually, negative

Environmental Control- refers to a person perception of his ability to plan activities to control natures or direct environmental factors.

Biological variations - include ways in which people are different genetically and physiologically

Scientific/biomedical health belief - based on the belief that life is controlled by physical and biochemical processes that can be manipulated by humans

Magico-religious health belief- health and illness are controlled by supernatural forces. The system is considered alternative or indigenous.
ex: voodoo

Holistic health belief- holds that the forces of nature must be maintained in balance or harmony

Complementary medicine- the use of rigorously tested therapies to complement those of conventional medicine. Used with western medicine.
ex: acupuncture

Nursing subculture- learned and transmitted lifeways, values, symbols, patterns, and normative practices of members of the nursing profession that are not the same as those of mainstream culture

True or false: Nursing is the largest subculture in healthcare Answer: True

Nursing values

1. Autonomy
2. Caring
3. use of nursing process
4. objective reporting
5. description of pain

Culture awareness- The understanding that an individual has regarding different cultures. Refers to an appreciation of the external signs of diversity.

Cultural sensitivity- being aware that cultural differences exist and have an effect on values, learning, and behavior

Cultural competence- The ability to interact effectively with people of different cultures

Purnell model for cultural competence- Stresses teamwork in providing culturally sensitive and competent care to improve outcomes for individuals, families, and communities

Leininger’s model of cultural competence- Guide research that will assist nurses to provide culturally congruent care

Be aware of your own cultural heritage.
Appreciate that the client is unique: influenced, but not defined, by his or her culture.
Learn about the client’s cultural group.
Incorporate the client’s cultural values/behaviors into the care plan.

L.I.V.E- Like, Inquire, Visit, Experience –
L.E.A.R.N- Listen, Evaluate, Acknowledge, Recommend, Negotiate
Chapter 21- Culture & Therapeutic Relationships- Pg 451-465 (14 pages)

Intrapersonal communication- Communication with oneself. Ex: self-talk, constructive affirmaitions

Interpersonal communication- the exchange of thoughts, feelings, and beliefs between two or more people

Group communication- communication in which one person is communicating with an audience of more than two people

Communication is a process of:
o Sending
o Receiving
o Interpreting
o Reacting to a message

Verbal Communication - is the use of written or spoken words to send a message. It is influenced by such factors as educational background, culture, language, age, and past experiences.

Denotative - This is the (literal) dictionary meaning of a word

Connotative- implied or emotional meaning of a word

Brevity- Using fewest words as possible

SBAR

• S: Situation
• B: Background
• A: Assessment
• R: Recommendation

Standardized communication- effective in overcoming differences in nurse-physician communication styles to convey information clearly

Structured communication- ensure accuracy and create an environment where people can express concerns to facilitate change in patient care

Therapeutic communication- CLIENT CENTERED communication directed as achieving client goals

5 characteristics of therapeutic communication

1. Empathy
2. Respect
3. Genuineness
4. Concreteness
5. Confrontation

therapeutic relationship when the relationship between the career and the cared for is used for promoting or restoring the health and well-being of people within the relationship 4 phases of therapeutic relationship Preorientation Orientation Working Phase Termination Phase