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138 Cards in this Set

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Florence Nightingale
Recognized the importance of the environment on the health of the patient
Florence Nightingale
Demonstrated that trained nurses, clean water and air, nutritious food, and organized care could reduce the mortality of soldiers wounded in the Crimean War
Florence Nightingale
Engaged in the first known nursing research by keeping mortality and other records for the hospital in Scutari
Florence Nightingale
Published several volumes advocating reforms in hospitals workhouses, and infirmaries
Florence Nightingale
Advocated improved patient care including hygiene, sanitation, nutrition, equipment, and supplies
Florence Nightingale
Advocated improved conditons for nurses including housing conditions, salaries, holidays, and retirement benefits
Florence Nightingale
Recognized that a body of knowlege was the necessary foundation for nursing.
Florence Nightingale
Established a nurses' training school at St Thomas, London, which became a model for nursing training worldwide.
Florence Nightingale
Advocated careful selection of students, paid instructors, and a curriculum that included theory, supervised practice and the writing of case studies
Florence Nightingale
Advocated "holism," suggesting that the whole patient must be treated.
Believed there were two types of nursing:

the care of the sick

the promotion of health
Florence Nightingale
Published

"Notes on Nursing: What it is and What it is not"
Florence Nightingale
The founder of professional nursing, she developed a model for training schools that was eventually used in the United States
Florence Nightingale
Clara Barton
Founded the orgainzation that would later become the American Red Cross
Established a public health nursing in the United States through her work at the Henry Street Settlement house
Lillian Wald
Code of ethics
with the development of licensure and a Code of Ethics for nurses, the profession moved toward greater self-regulation. Collegiate education for women became more popular, paving the way for women to select degree conferring nursing programs
Nursing practice is guided by a code of ethics. This is a written public document that outlines the professional responsibilities of the practicing nurse. The code of ethics defines the fundamental values and commitment of the nuse and also the boundaries of duty and loyalty toward the patient and the profession.
Code of Ethics
Code of Ethics
Strengthen and guide nurses decision making as they navigate the troubled waters that now exist in many practice settings

Empowers nurses to maintain their focus on the patient as the center of health care
Written, public document that reminds practitioners and the public they serve of the specific responsiblilties and obligations accepted by the profression's practitioners
Code of Ethics
A tool that guides a group toward professional self-determination and provides evidence of professional legitimacy
Code of Ethics
Recognize characteristic behaviors of professional nurses
Characteristics Behaviors of Professional Nurses
Develops own philosophy of Nursing
Characteristics Behaviors of Professional Nurses
Characteristics Behaviors of Professional Nurses
Uses self-determination
Uses critical thinking
Characteristics Behaviors of Professional Nurses
Collaborates and communicates with other professionals
Characteristics Behaviors of Professional Nurses
Characteristics Behaviors of Professional Nurses
Demonstrates accountability for self and others
Commited to lifelong learning
Characteristics Behaviors of Professional Nurses
Active in proffessional organizaitons
Characteristics Behaviors of Professional Nurses
Mentors aspring professionals
Characteristics Behaviors of Professional Nurses
Recognizes own limitations: seeks necessary help
Characteristics Behaviors of Professional Nurses
Contributes to expansion of nursing's body of knowlege
Characteristics Behaviors of Professional Nurses
Provides leadership
Characteristics Behaviors of Professional Nurses
Uses principles of time management
Characteristics Behaviors of Professional Nurses
Represents the profession to the public
Characteristics Behaviors of Professional Nurses
Characteristics Behaviors of Professional Nurses
Delegates responsibility wisely
Models altruism
Characteristics Behaviors of Professional Nurses
Possesses self-awareness
Characteristics Behaviors of Professional Nurses
Demonstrates commitment to the profession
Characteristics Behaviors of Professional Nurses
Models healthy coping behaviors
Characteristics Behaviors of Professional Nurses
Demonstrates collegiality
Characteristics Behaviors of Professional Nurses
Characteristics of Professions
Education takes place in a college or university
Education is prolonged
Characteristics of Professions
Work involves mental creativity
Characteristics of Professions
Decision making is based largely on science or theoritcal constructs
Characteristics of Professions
Values, beliefs, and ethics are an integral part of preparation
Characteristics of Professions
Commitment and personal identification is strong
Characteristics of Professions
Workers are autonomous
Characteristics of Professions
People are unlikely to change professions
Characteristics of Professions
Commitment transcends material reward
Characteristics of Professions
Accountability rests with individual
Characteristics of Professions
Obtained from patients as they describe their needs, feelings, strengths, and preceptions of the problem
Subjective Data
Objective Data
other types of data the nurse collects through observation, examination, or consultation with other care providers.

Data is measureable.
Pulse rate, Blood Pressure, Often called signs
Objective Data
Often called symptoms
Subjective Data
A universal intellectural standard by which problems are addressed and solved
Nursing Process
A method of critical thinking focused on solving patient problems in professional practice. A designated series of actions intended to fulfill the purposes of nursing, to maintain the patient's wellness
Nursing Process
Assessment

Analysis and Diagnosis

Planning

Implementation of planned interventions

Evaluation
Steps of the Nursing Process
Early Definition of Nursing by Nightingale
The importance of the observational skills of the nurse and the impact of the environment on health. Her definition recognized health promotion and health maintenance as important functions for nursing
Nursing may be defined as that service to an individual that helps him to attain or maintain a healthy state of mind or body
Virginia Henderson
Her definition of nursing is perhaps the best known in the world due to its adoption by the International Council of Nurse
Virginia Henderson
"The unique function of the nuse is to assist the individual, sick or well, in the performance of those activities contributing to health or its recovery (or to a peaceful death) that he would perfom unaided if he had the necessary stength, will or knowlege. And to do this in such a way as to help him gain independence as rapidly as possible
Virgina Henderson
The ANA position paper (1965)
Educational preparation for nurse practitioners and assistants to nursing concluded that the BSN should be the minimum credential for entry into practice
The actual contact with another person or the person's body or his or her property in an offensive, insulting, or physically injurious manner
Battery
Law that affects individuals (rather than state entites)
Civil law
Law that affects the state in its political capacity and so affects society as a whole
Criminal Law
Professional Negligence
Malpractice
Negligence in which the standards of a resonable and prudent person are elevated to the status of those of a professional person
Malpractice
Negligence
(a) the commission of an act that a reasonable and prudent person would not do in a given stituation

(b) the failure to act when a reasonable and prudent person would do so
The licensure process is a police of the state
Licensure
A mandatory licensure law requires any person who practices the profession or occupation to be licensed
Licensure
What do all states have that is mandatory for the practice of nursing
Licensure
Negligence applied to the acts of a professional
Malpractice
A professional fails to act as a reasonable and prudent professional would have acted in similar circumstances
Malpractice
A nurse's actions will be judged against the nursing standard of care. This is a higher standard of care than a reasonably prudent layperson would be expected to uphold. This standard represents the minimum that would be expected of a nurse in a similar circumstance
In determining Malpractice
The responsibility of a nurse or other health professional for the care of a patient
Malpractice

Duty of Care
Failure to perform the duty of care according to accepted standards of care
Malpractice

Breach of Duty of Care
the failure to meet the standard of care resulted in an injury
Malpractice

Proximate Cause
The injury is Proved
Malpractice
Major Categories of Neglience that result in Malpractice Lawsuits
-failure to follow standards of care

-failure to use equipment in a responsbile manner

-Failure to communicate

- failure to document, including failure to note in the patient's medical record

-failure to assess and monitor

-failure to act as a patient advocate
Touching without consent or consent is present unless informed consent is given or implied by the patient. The patient may withdraw consent at any time
Battery
An implied contract through which a group (profession) informs society of the rules and principles of how they will function
Code of Ethics
Informs new professionals of the ethical positions accepted by other members of the profession and guides professional behavior
Code of Ethics
Modified intermittently to meet the changing demands of health care and society
Code of Ethics
Ethical Theories
Deontology

Utilitarianism

Virtue Ethics

Principalism
An act is moral if it originates from good will

Doing one’s duty or honoring one’s obligations to human beings

The intention of the action is important, not the consequences even if the consequence is negative
Deontology
Act Deontology – gather all facts and make a decision

Rule Deontology – principles guide our actions
Deontology
The moral value of an action is wholly independent from the consequences of an action
Rather than focusing on consequences, deontological methods emphasize duty as the basis of moral value
Emphasize a principle of right action, or the right, over the good.
Deontology
Moral rightness of an action is determined solely by its consequence
Useful actions bring about the greatest good for the greatest number of people
Example – triage in healthcare
Utilitarianism
Individual moral actions are based on innate moral value
Based on the virtues of faith, hope, charity and wisdom
Virtue Ethics
the emphasis is more on one’s character, the states of character from which actions flow, and actions that are in accordance with these states of character, rather than on any foundational principles from which practical judgments can be deduced.


Rather than deducing what it is good to do, an agent must be practiced in the performance of virtuous action in order to be able to judge right and wrong, good and bad. In this way, the order of moral knowledge is reversed in virtue ethics in so far as we must first do what is good in order to be able to recognize what is good.
Virtue Ethics
Based more on ethical principles versus ethical theory

Draws on the key principles of beneficence, nonmaleficence, autonomy, and justice
Principalism
begins with students entering nursing school. They have little background. They depend on rules and expectations because their practical skills are limited.
Benner Stage of Nursing Proficiency

Novice or Stage 1
learners have become marginally competent, can use theory and principles, and may have difficulty setting priorities.
Benner Stage of Nursing Proficiency

Advanced beginners Stage II
learners have 2 to 3 year’s experience and begin to feel organized and efficient most of the time. They have mastered planning and goal-setting skills and can think abstractly and analytically. They can coordinate several complex demands simultaneously.
Benner Stage of Nursing Proficiency

Competent practioners or Stage III
learners have begun to view patients holistically. They can recognize subtle changes in patient condition, set priorities with ease, and can focus on long-term goals, not merely the task at hand.
Benner Stage of Nursing Proficiency

Proficient practitioners or Stage IV
learners perform fluidly. They grasp patient needs automatically. Their responses are integrated with actions and their expertise comes naturally. They have a “sense” of what needs to be done based on knowledge and prior experience
Benner Stage of Nursing Proficiency

Expert practitioners or Stage V
(funded by the Carnegie Foundation in 1948), which recommended that basic schools of nursing be in universities and colleges and that efforts be made to recruit men and minorities into nursing education programs
The Brown Report
a process by which an agency of government grants permission to qualified persons to engage in a given profession or occupation. It is required of all who practice professional nursing.
Licensure
the validation of specific qualifications demonstrated by a registered nurse in a defined area of practice. It is voluntary and is sought by an individual nurse who wishes to demonstrate that his/her qualifications exceed minimal competence
Certification
Based more on ethical principles versus ethical theory

Draws on the key principles of beneficence, nonmaleficence, autonomy, and justice
Principalism
begins with students entering nursing school. They have little background. They depend on rules and expectations because their practical skills are limited.
Benner Stage of Nursing Proficiency

Novice or Stage 1
learners have become marginally competent, can use theory and principles, and may have difficulty setting priorities.
Benner Stage of Nursing Proficiency

Advanced beginners Stage II
learners have 2 to 3 year’s experience and begin to feel organized and efficient most of the time. They have mastered planning and goal-setting skills and can think abstractly and analytically. They can coordinate several complex demands simultaneously.
Benner Stage of Nursing Proficiency

Competent practioners or Stage III
learners have begun to view patients holistically. They can recognize subtle changes in patient condition, set priorities with ease, and can focus on long-term goals, not merely the task at hand.
Benner Stage of Nursing Proficiency

Proficient practitioners or Stage IV
learners perform fluidly. They grasp patient needs automatically. Their responses are integrated with actions and their expertise comes naturally. They have a “sense” of what needs to be done based on knowledge and prior experience
Benner Stage of Nursing Proficiency

Expert practitioners or Stage V
(funded by the Carnegie Foundation in 1948), which recommended that basic schools of nursing be in universities and colleges and that efforts be made to recruit men and minorities into nursing education programs
The Brown Report
a process by which an agency of government grants permission to qualified persons to engage in a given profession or occupation. It is required of all who practice professional nursing.
Licensure
the validation of specific qualifications demonstrated by a registered nurse in a defined area of practice. It is voluntary and is sought by an individual nurse who wishes to demonstrate that his/her qualifications exceed minimal competence
Certification
The Study of Nursing and Nursing Education in the United States, published in 1923, focused on the clinical learning experiences of student nurses, the hospital control of schools, and the lack of prepared nursing teachers.
The Goldmark Report
Significant signs and symptoms that are relatively short lived
Acute Illness
Symptoms tend to appear suddenly and progress steadily
Acute Illness
Recovery is typically rapid depending on the patient’s general condition
Acute Illness
Illness tends to develop gradually
Chronic Illness
Consists of ongoing health problems of a generally incurable nature, such as diabetes
Chronic Illness
May go through periods of remission and exacerbation
Chronic Illness
Stages of Illness
Stage I: Disbelief and Denial
Stage II: Irritability and Anger
Stage III: Attempting to Gain Control
Stage IV: Depression and Despair
Stage V: Acceptance and Participation
difficulty believing that the signs and symptoms are actually related to illness. Denial as a defense mechanism can cause a delay in seeking treatment
Stage 1: Disbelief and Deniel
Stage II: Irritability & Anger
changes in ability to function results in anger either toward self or others.
patient seeks medical attention or tries to control symptoms with home remedies or over-the-counter medications
Stage III: Attempting to Gain Control
illness leads to feelings of loss, resulting in depression. May experience loss of ability to work or play
Stage IV: Depression and Despair
Stage V: Acceptance and Participation
patient acknowledges the reality of the illness and is ready to participate in treatment decisions. Ideally, this leads to feelings of mastery over the illness
Influence of Culture on Illness Behaviors
Meanings attached to health, illness, and perceptions of treatment

Timing of treatment-seeking behavior and choice of practitioner consulted

The illness behaviors the individual is likely to use

Customs of responding to people who are sick
What is Culture?
The totality of socially transmitted behavioral patterns, arts, beliefs, values, customs, lifeways, and all other products of human work and thought characteristics of a population that guides its worldview and decision-making. These patterns may be explicit or implicit, are primarily learned and transmitted within the family, and are shared by the majority of the population
Influence of Culture on Illness Behaviors
Patterns of communication used by the sick individual

The role expectations of both the nurse and the patient

Level of family involvement in the care

Response to health care providers by patient and family members
Culturally Competent Nurse
Takes cultural differences into consideration

Usually interprets patient behavior accurately

Recognizes problems that need to be managed
Culturally Competent Nurse Cont'd
Realizes that cultural norms must be included in the plan of care to prevent conflict between nurse’s goals and patient and family goals

Believes the time spent in cultural assessment is well spent and enhances positive patient outcomes

Respectful of the attitudes and behaviors of patients of other cultures
Having the knowledge and skills about another culture to communicate effectively and know what questions to ask (Purnell)
Culturally Competence
Fatigue

Muscle tightness

Tension

Increased blood pressure

Increased pulse rate

Sleep disturbances

Appetite disturbances
Symptoms of Physical Stress
Patient Center Nursing
Do I refrain from taking about myself and my problems to patients and their families?

Do I always introduce myself to patients and families when I first meet them?

When a patient or family member approaches me, do I immediately acknowledge them and turn my attention to them asap?

Do I really listen when patients and family members attempt to express a problem or concern?

Do I clarify patients’ reasons for refusing medications or treatments without becoming defensive or taking the refusal personally?

Do I give prompt attention to all my patients, even those who are “difficult”?

Do I make every effort to be pleasant and polite to patients, family members, co-workers, and students, even when I am having a bad day?

Do I explain procedures to patients and take every opportunity to educate them about their medications and conditions?

Am I alert to patient anxiety and attempt to “talk them through” anxiety-laden procedures?

Do I project high self-regard through my professional image, which includes tidy hairstyle, clean and polished shoes, neat uniform, short nails, and conservative makeup/grooming.

Do I recognize that I am accountable for both my actions and my omissions?

Do I take every opportunity to lean, grow, and enhance my competence as a nurse?
Dorothea Orem
Her 1959 definition captures the flavor of her later, more completely elaborated self-care theory of nursing: “Nursing is perhaps best described as the giving of direct assistance to a person, as required, because of the person’s specific inabilities in self-care resulting from a situation of personal health”
Dorothea Orem
She continued to develop her conceptual model over several decades, with the 6th edition of her work Nursing: Concepts of Practice published in 2001
belief that nurses should do for a person only those things the person cannot do without assistance emphasized the patient’s active role
Dorothea Orem
Theory of Self-Care

Theory of Self-Care Deficit

Theory of Nursing System
Dorothea Orem
Her model focuses on the patient’s self care capacities and the process of designing nursing actions to meet the patient’s self-care needs. In this model, the nurse prescribes and regulates the nursing system based on the patient’s self-care deficit, which is the extent to which a patient is incapable of providing effective self-care
Dorothea Orem
Orem's Model
Diagnostic – the nurse initiates a diagnostic operation that begins with the establishment of the nurse-patient relationship.

Prescriptive – prescriptive operations occur when therapeutic self-care requisites are determined and the nurse reviews various methods, actions, and priorities with the patient.

Regulatory – in regulatory operations, the nurse designs, plans, and produces a system for care. Systems range from wholly compensatory, which is the most comprehensive form of care for patients with few abilities to provide care for self, to supportive-educative, in which the patient has the ability to provide effective self-care, but needs to work with the nurse to further develop these abilities or acquire additional information to promote self-care
Orem's Model
 Prescriptive – prescriptive operations occur when therapeutic self-care requisites are determined and the nurse reviews various methods, actions, and priorities with the patient
Orem's Model
Regulatory – in regulatory operations, the nurse designs, plans, and produces a system for care. Systems range from wholly compensatory, which is the most comprehensive form of care for patients with few abilities to provide care for self, to supportive-educative, in which the patient has the ability to provide effective self-care, but needs to work with the nurse to further develop these abilities or acquire additional information to promote self-care
Sojourn Truth
African-american

A famous abolitionist

Served the Union Army forces