NR 446 Exam 1 Review
Nursing process
o The weakness of the nursing process, like the traditional problem-solving model, is in not requiring
clearly stated objectives. Goals should be clearly stated in the planning phase of the process, but
this step is frequently omitted or obscured.
Role of the nurse as a client advocate
Advocacy
• Advocacy involves helping others to grow and self-actualize
• Nurses must advocate for themselves, clients, subordinates, and their profession
• Advocates must inform others of their rights and make sure they have enough information to
make informed decisions
• Advocacy is defined as protecting and defending what one believes in for both self and others
Nursing Values Central to Advocacy
1. Each individual has a right to autonomy in deciding what course of action is most appropriate
to meet his or her health-care goals
2. Each individual has a right to hold personal values and to use those values in making health-
care decisions
3. All individuals should have access to the information they need to make informed decisions
and choices
4. The nurse must act on behalf of patients who are unable to advocate for themselves
5. Empowerment of patients and subordinates to make decisions and take action on their own is
the essence of advocacy
How Nurses Can Act as Advocates
• Helping others make informed decisions
• Acting as intermediaries in the environment
• Directly intervening on behalf of others
• Advocating for social justice
Controlling Patient Choices versus Assisting Patient Choices
It is important for the patient advocate to be able to differentiate between controlling patient
choices (domination and dependence) and assisting patient choices (allowing freedom)
Allowing the patient to make his/her decision after he/she has been giving all necessary
information that could help in making the choice.
Advocating for Patients as Managers
• Creating a work environment that recognizes patients’ needs and goals as paramount
• Creating a work culture in which patients are respected, well informed, and empowered
• Advocating for patients with regard to distribution of resources and the use of technology
• Taking risks particularly when advocating for a client may be in direct conflict with a provider or
institutional goal
Common Areas Requiring Nurse–Patient Advocacy
• End-of-life decisions; aging populations
• Technological advances
• Health-care reimbursement
• Access to health care
, • Provider–patient conflicts
• Withholding of information
• Insurance authorization
• Medical errors
• Patient information disclosure
• Patient grievance and appeals process
• Culture and ethnic diversity and sensitivity
• Respect for patient dignity
• Inadequate consents; complex social problems
• Incompetent health-care providers
Nursing intervention - Antihypertension medications, anticonvulsant medications (e.g. clonazepam)
o Priority nursing diagnosis for a client taking an antihypertensive medication Alteration in cardiac
output related to effects on the sympathetic nervous system
o Instruct patients that htn drugs should not be stopped abruptly because this causes rebound htn
and could lead to stroke. Remind patients that meds are only part of therapy; encourage patients
to watch diet
o Clonazepam
Change LOC, sweating, diaphoresis, tachycardia
Contradiction with pregnancy
Life threatening or dangerous side effects: respiratory depression, hepatic dysfunction, renal
dysfunction, seizures
Monitor for S&S of overdose, including somnolence, confusion, irritability, sweating, muscle
and abdominal cramps, diminished reflexes, coma.
Should not discontinued suddenly because they may cause insomnia or seizures
Avoid sunlight and tanning beds
Decision-making process
o Decision-making models offer analytical tools to provide useful insights when making decisions.
The nursing process is a very useful and effective process that is used as a guide for decision
making and problem solving when addressing patient care needs and nursing accountability. This
process can be easily adapted to all management and leadership activities requiring decision
making and problem solving. The nurse in a leadership position is required to make many
decisions, ranging from assigning staff to calling a code on a nonbreathing client. Therefore,
whatever leadership model is being used, the nurse should be able to make and communicate
competent decisions.
o Rational, Normative: Nurses make clinical decisions using different approaches. The rationalist
approach involves an analysis of a situation so that subsequent actions are rational, logical, and
based on knowledge and judgments. It consists of a structured four-step sequence.
Problem identification
Formulate another solution
Implement the chosen solution
Evaluate the solution
o Group Decision-Making Model: The leader presents the problem to the group and all of the
members are asked to contribute and make suggestions. The leader makes the decision alone,
choosing to use or discard information obtained from the group.
Nursing process
o The weakness of the nursing process, like the traditional problem-solving model, is in not requiring
clearly stated objectives. Goals should be clearly stated in the planning phase of the process, but
this step is frequently omitted or obscured.
Role of the nurse as a client advocate
Advocacy
• Advocacy involves helping others to grow and self-actualize
• Nurses must advocate for themselves, clients, subordinates, and their profession
• Advocates must inform others of their rights and make sure they have enough information to
make informed decisions
• Advocacy is defined as protecting and defending what one believes in for both self and others
Nursing Values Central to Advocacy
1. Each individual has a right to autonomy in deciding what course of action is most appropriate
to meet his or her health-care goals
2. Each individual has a right to hold personal values and to use those values in making health-
care decisions
3. All individuals should have access to the information they need to make informed decisions
and choices
4. The nurse must act on behalf of patients who are unable to advocate for themselves
5. Empowerment of patients and subordinates to make decisions and take action on their own is
the essence of advocacy
How Nurses Can Act as Advocates
• Helping others make informed decisions
• Acting as intermediaries in the environment
• Directly intervening on behalf of others
• Advocating for social justice
Controlling Patient Choices versus Assisting Patient Choices
It is important for the patient advocate to be able to differentiate between controlling patient
choices (domination and dependence) and assisting patient choices (allowing freedom)
Allowing the patient to make his/her decision after he/she has been giving all necessary
information that could help in making the choice.
Advocating for Patients as Managers
• Creating a work environment that recognizes patients’ needs and goals as paramount
• Creating a work culture in which patients are respected, well informed, and empowered
• Advocating for patients with regard to distribution of resources and the use of technology
• Taking risks particularly when advocating for a client may be in direct conflict with a provider or
institutional goal
Common Areas Requiring Nurse–Patient Advocacy
• End-of-life decisions; aging populations
• Technological advances
• Health-care reimbursement
• Access to health care
, • Provider–patient conflicts
• Withholding of information
• Insurance authorization
• Medical errors
• Patient information disclosure
• Patient grievance and appeals process
• Culture and ethnic diversity and sensitivity
• Respect for patient dignity
• Inadequate consents; complex social problems
• Incompetent health-care providers
Nursing intervention - Antihypertension medications, anticonvulsant medications (e.g. clonazepam)
o Priority nursing diagnosis for a client taking an antihypertensive medication Alteration in cardiac
output related to effects on the sympathetic nervous system
o Instruct patients that htn drugs should not be stopped abruptly because this causes rebound htn
and could lead to stroke. Remind patients that meds are only part of therapy; encourage patients
to watch diet
o Clonazepam
Change LOC, sweating, diaphoresis, tachycardia
Contradiction with pregnancy
Life threatening or dangerous side effects: respiratory depression, hepatic dysfunction, renal
dysfunction, seizures
Monitor for S&S of overdose, including somnolence, confusion, irritability, sweating, muscle
and abdominal cramps, diminished reflexes, coma.
Should not discontinued suddenly because they may cause insomnia or seizures
Avoid sunlight and tanning beds
Decision-making process
o Decision-making models offer analytical tools to provide useful insights when making decisions.
The nursing process is a very useful and effective process that is used as a guide for decision
making and problem solving when addressing patient care needs and nursing accountability. This
process can be easily adapted to all management and leadership activities requiring decision
making and problem solving. The nurse in a leadership position is required to make many
decisions, ranging from assigning staff to calling a code on a nonbreathing client. Therefore,
whatever leadership model is being used, the nurse should be able to make and communicate
competent decisions.
o Rational, Normative: Nurses make clinical decisions using different approaches. The rationalist
approach involves an analysis of a situation so that subsequent actions are rational, logical, and
based on knowledge and judgments. It consists of a structured four-step sequence.
Problem identification
Formulate another solution
Implement the chosen solution
Evaluate the solution
o Group Decision-Making Model: The leader presents the problem to the group and all of the
members are asked to contribute and make suggestions. The leader makes the decision alone,
choosing to use or discard information obtained from the group.
