NSG 310 FINAL EXAM 1 QUESTIONS AND ANSWERS

NSG 310 FINAL EXAM 1 QUESTIONS AND ANSWERS Topic 1 1. Examine the historical foundations of the nursing profession. • nursing history provides students with a: sense of professional identity, useful methodological research skill, context for evaluating information • American Civil War- Volunteer women demonstrated effectiveness of skilled nursing on improving outcomes, Emergence of nurse training schools • First Three Training Schools for Nurses- nurses under superintendent, graduate private duty nurses, long days of patient service, training at end of day spent in the ward • 1901: Army Nurse Corps, 1908: Navy Nurse Corps • World War I: American red cross and Jane Delano • Society of Superintendents of Training Schools for Nurses of the United States &Canada: Focus: Advance and standardize training of nurses (Renamed the ANA) • Progressive Era and Community Health Nursing- started prevention and health promotion • 1930s: improve economy = graduate nurses are better, new hospital income, affordable nurse wages = surplus of graduate nurses willing to work for minimum wage • 1941: World war IIo 1943: Frances Payne Bolton, U.S. Congress, authorized bill → U.S. Public Health Service established Cadet Nurse Corp, whose focus was to increase the number of professional nurses by financially subsidizing nursing education • Cadet Nurse Corps- allowed nurses to be in school with free tuition but practice nursing in the military • Redesign of nursing edu. • 1950s- hospitals hired nurses more but still clashed w/physicians and admins • Rockefeller Foundation endowed the establishment of two university-based nursing schools, Yale (1924) and Vanderbilt (1930) • 1920 and 1930s- Premise of Baccalaureate Programs • African American Nurseso Late 1800s: Separate hospitals and schools o 1952: All state nurses associations had dissolved racial restrictions o 1971: National Black Nurses Association • Male nurseso Selective Services Act: Male nurses were denied professional status and served as enlisted personnel in health-related positions o 1955: Korean Conflict: Legislation allowed appointment of male nurses as reserve officers in the Army, Navy, and Air Force • Post WWII: o Hill-Burton Act of 1946: Federal funds for hospital construction and new health centers, Advances in medicine • Nursing shortage- Growing elderly population, crowding and restricted admissions o 1964: Nurse Training Act: Scholarships, loans, recruitment, school construction and maintenance, and special educational projects o 1950 to 1967 • Registered nurses: Increased by 67% • Practical nurses: Increased by 134% • Nursing aides: Increased by 244% 2. Identify key figures in the development of the art and science of nursing practice. • Florence Nightingale o Established first nursing philosophy based on health maintenance and restoration. o Developed the first organized program for training nurses o First practicing nurse epidemiologist. o Volunteered (lady with lamp) during Crimean War o Nursing as in charge of someone’s health o Improved sanitation- cholera and dysentery • Lillian Wald: Established role for nursing in the community because the needs of NY residents were limitless. Founded the National Organization for Public Health Nursing in 1912, Worked with Metropolitan Life Insurance Company, • Mary Brewster: Henry Street Settlement House and Henry Street Visiting Nurse Services • Mildred Montag: Associate Degree Nursing Programs 3. Compare and contrast various nursing theories and theoretical frameworks that underpin nursing practice. • Nightingale- environment is critical to health, nurse’s role in caring is to provide a clean, quiet, peaceful environment to promote healing (Sunlight, ventilation, fresh air, light, warmth, cleanliness, quiet and proper selection and admin of diet, patient never awakened, variety of color/objects). N’s intent was to describe nursing and provide guidelines for nursing edu. o Nursing: nursing is a service to humanity intended to relieve pain and suffering. Role is to promote or provide proper environment for patients. • Rogers- individual is viewed as an irreducible energy field, made whole with the environment. nurses promote interactions between humans and environments. o Nursing: should be concerned w/studying the nature and direction of unitary human development integral with the environment and with evolving descriptive, explanatory, and predictive principles for use in nursing practice. • Orem- individual practices self-care, a set of learned behaviors, to sustain life, maintain or restore functioning, and bring about a condition of well-being. Nurses assists client with self-care when they experience a deficit in ability to perform. o Nursing: assists client with self-care to sustain life and health, recover from disease or injury, and cope with their effects. Nurse chooses actions from nursing systems designed to bring desirable conditions in persons and environment. • Roy- individual is a biopsychosocial adaptive system, and the nurse promotes adaptation by modifying external stimuli. o Nursing: nurses act to modify stimuli affecting adaptation by increasing, decreasing, or maintaining stimuli. Nurse promotes adaptation in physiological, self-concept, role function, and interdependence. • Neuman- wholistic view of the client system, including the concepts of open system, environment, stressors, prevention, & reconstitution. Nursing concerned w/whole person. o Nursing: concerned w/all variables affecting the individual’s response to stress, keeping the client system stable through accuracy in assessment and possible effects. Goals are determined by negotiation w/client (approved by the client) • Watson- caring (moral rather than task-oriented behavior) is central to nursing and includes aspects of the actual caring occasion and transpersonal caring relationship. Caring results in the satisfaction of human needs. o Nursing: nursing values, knowledge, and practices of human caring that are geared toward subjective inner healing processes and life world experiences (creative factors). Goal of nursing: help persons attain higher degree of harmony by offering a relationship the client can use for personal growth and development. • Peplau- goal-directed interpersonal process, psychodynamic nursing is being able to understand one’s own behavior to help other identify felt difficulties and to apply principles of human relations to the problems that arise at levels of experience. Once the problem (that prompts client for nursing help) is resolved, relationship ends. o Nursing: therapeutic interpersonal process because it involves the interaction between two or more individuals who have a common goal. Nurse relationship w/client: stranger, resource person, teacher, leader, surrogate, and counselor. • King- individual is open system and as one component of a nurse-client interpersonal system whose interactions lead to attainment of mutually agreed-upon goals. o Nursing: nurse and client communicate, set goals, and explore means to achieve the goals. Goal of nursing is health for individuals, groups, and communities. • Leininger- focusses on comparative study and analysis of different cultures and subcultures in the world regarding their caring behaviors, nursing care, health-illness values, and patterns of behavior with the goal of developing body of knowledge. o Nursing: learned humanisitic and scientific profession that focuses on personalized care behaviors, functions, and processes that have significance for meaning. Goal of nursing to assist, support, facilitate, or enable individuals/groups to regain or maintain their health in a way that is culturally confluent or to help people. 4. Articulate how caring forms the foundation of the art and science of nursing practice. • As an art: nurses deliver care with compassion, caring, and respect for each patient’s dignity and personhood • As a science: nursing practice is based on a body of knowledge that is continually changing with new discoveries and innovations • includes several components: o Blend of current knowledge o Understanding and incorporation of practice standards o Insightful and compassionate approach to care o Socialization within the profession o Gaining experience and expertise • Patients value the affective dimension of nursing care: Connecting with patients and families, Being present, Respecting values, beliefs, and health care choices CHAPTER 1 The Nurse’s Associated Alumnae was created to focus on achieving legal recognition for nurses. This action would help protect the public from incompetent nurses and strengthen the union of nursing organizations. The Nurse’s Associated Alumnae viewed a united group as a strong force. The statement that the Nurse’s Associated Alumnae created fair wages and the statement that it ensured employment for registered nurses are incorrect because these are not contributions of the Nurse’s Associated Alumnae. Lillian Wald significantly contributed to the nursing profession. These contributions include helping found the Henry Street Settlement House, improving health conditions for immigrants, helping with the creation of a visiting nurse service, and founding nursing’s first specialty organization. Wald did not establish the first American training school for nurses, so this statement is incorrect. Florence Nightingale was a British nurse who revolutionized care to the British soldiers during the Crimean War. Training schools were set up following her nursing model of care. These training schools led the way to modern nursing education. The statement that Nightingale was American is incorrect because Nightingale was a British nurse. The idea that Nightingale believed that certain women were born to be nurses is incorrect because Nightingale believed that all women cared for others at one point or another and therefore were nurses. Over the course of 150 years, the nursing profession has faced many challenges. These challenges include issues surrounding gender, strict requirements for entry into nursing programs, pandemic diseases, wars, and lack of licensed nurses to provide safe patient care. The idea that nursing has been minimally impacted by wars is incorrect because over the course of history, war has had a significant impact on the profession of nursing. Public health nurses of the early 1900s contributed significantly to the health and well-being of the nation. Nurses went out into the public and directly influenced the health of others by teaching sanitation methods, including the patient and family in nursing practice and decreasing the rate of disease. The actions of these nurses shaped the American health system by teaching individuals to manage and be active in their own health. The elimination of certain diseases is incorrect because the rate of disease was decreased, but not eliminated because of the actions of nurses during this era. CHAPTER 5 Neuman’s systems model is concerned with defining appropriate actions in stress-related situations. Actions the nurse can take include evaluating the client’s financial concerns, developing a plan to help the client reduce stressors, and helping the client strengthen resistance to stressors. Providing the client with fresh air and maintaining an organized and clean environment for the client are incorrect because these actions are consistent with Florence Nightingale’s environmental theory. Watson’s theory focuses on the philosophy and science of caring at the core of nursing. The nurse incorporating this theory into practice can take steps to instill faith and hope, embrace altruistic values, and be authentically present with each client. Reducing stressors is consistent with Betty Neuman’s systems model, and promoting a quiet environment is consistent with Nightingale’s theory. Dorothea Orem focuses on nursing as a deliberate human action. Orem states that the goal of nursing is to move clients toward responsible self-care. Orem also states that all individuals benefit from nursing when they have health-derived or health-related limitations for engaging in self-care. Martha Rogers’ theory views the individual as an irreducible energy field with the environment. Florence Nightingale described disease as a reparative process. She believed it was the nurse’s role to manipulate the environment to encourage healing. Sister Calista Roy’s theory placed emphasis on the person’s own coping skills. Florence Nightingale believed that disease was a reparative process and that the nurse’s role was to manipulate the environment to facilitate and encourage this process. Actions the nurse can take include providing the client with nutritious food choices, keeping the client and surroundings clean, and providing the client with a quiet space. Keeping windows and doors closed is incorrect because Nightingale believed in providing clients with fresh air and sunlight as a method of healing. According to Watson, caring is the core of nursing. The nurse with an understanding of this theory knows that caring is a moral idea, results in the satisfaction of human needs, and is central to the nursing process and that transpersonal caring involves the nurse–patient relationship. Watson defines caring as a moral idea, not a task-oriented idea. Topic 2 1. Discuss the Arizona Nurse Practice Act and how it regulates professional nursing practice. • Regulates how nurses practice in AZ • Statues: the law • Rules: governing principles that associate with status • establish specific legal regulations for practice 2. Discuss the scope and standards of professional nursing practice and the local, state, national, and global organizations that regulate and influence the profession. • Scopes and standards: o ANA (American nurses association) Standards of nursing practice • ADOPIE: assessment, diagnosis, outcomes identification, planning, implementation, evaluation • Standards of professional performance: •Ethics •Education •EvidenceBased Practice and Research •Quality of Practice •Communication •Leadership •Collaboration •Professional Practice Evaluation •Resources •Environmental Health o Nurse practice acts • Establish specific regulations for practice • Regulate scope of nursing (what level each nursing practice does) • Protect public health • Organizations- endorse the demonstrated knowledge base and clinical practice behaviors associated with high quality performance in an area of specialization o American Nurse Association (ANA) VOICE for nurses • American Nurses Credentialing Center (ANCC) • American Academy of Nursing (AAN) o National Student Nurse Association (NSNA) o National League for Nursing (NLN) o American Organization of Nurse Executives (AONE) o International Council for Nurses (ICN) 3. Relate the ANA Scope and Standards of Practice to clinical practice, professionalism, and conduct. • Standards of practice: 1. Assessment 2. Diagnosis 3. Outcomes identification 4. Planning 5. Implementation 6. Evaluation • Professional development: benner o Novice- beginner no experience, new nurse o Advanced beginner- acceptable performance, graduate nurse o Competent- more aware of long-term goals, 2-3 yrs o Proficient- care of patient not just skills acquired w/care, 3-5 yrs o Expert- relies on experience not guidelines, 5 or more yrs • ANA (Standards of practice: nursing process, standards of professional performance: code of ethics for nurses)…nurse practice acts (establish specific legal regulations for practice, regulate scope of nursing practice, protect public health) • The Nursing Scope and Standards of Practice describes the “who,” “what,” “where,” “when,” “why,” and “how” of nursing practice: • Who: Registered Nurses (RN) and Advanced Practice Registered Nurses (APRN) comprise the “who” constituency and have been educated, titled, and maintain active licensure to practice nursing. • What: Nursing is the protection, promotion, and optimization of health and abilities; prevention of illness and injury; facilitation of healing; alleviation of suffering through the diagnosis and treatment of human response; and advocacy in the care of individuals, families, groups, communities, and populations. • Where: Wherever there is a patient in need of care. • When: Whenever there is a need for nursing knowledge, compassion, and expertise. • Why: The profession exists to achieve the most positive patient outcomes in keeping with nursing’s social contract and obligation to society. 4. Compare and contrast the primary roles and scope of practice of the registered nurse (RN), licensed practical nurse (LPN), and unlicensed assistive personnel (UAP). • RN: care plan, patient edu., supervising o Caregiver: Caring, Compassion, and Empathy o Colleague: Collaborating and Connecting • Interprofessional collab. o Manager: Leading, Inspiring, Thinking Critically • Impediments to compassionate patient-centered care o Educator: Learning and Guiding • Nursing and process and teaching process • Lifelong learning o Mentor: Sharing and Role Modeling → in charge of LPN and UAP • Be true to self and guide another to be greater o Researcher: Inquiring and Discovering • Research at bedside, curiosity o Advocate: Passion and Vision • Purpose is change, evolution, health for all • LPN: give meds not IV or narcotics (took the NCLEX), work care plan, patient edu. • UAP: work care plan, NO patient edu., “they know nothing” o ⦁ unlicensed assistive personnel (UAP) have the education, legal authority, and demonstrated competency to perform the delegated task ⦁ task is consistent with UAP’s job description ⦁ task can be safely performed according to clear, exact, and unchanging directions ⦁ results of the task are reasonably predictable ⦁ task does not require assessment, interpretation, or independent decision making ⦁ patient and circumstance are such that delegation of the task poses minimal risk to the patient ⦁ consequences of performing the task improperly are not life threatening 5. Identify how the RN prioritizes and delegates tasks to licensed and unlicensed personnel in the care environment based on scope of practice. • 6. Articulate how the ANA Code of Ethics impacts nursing practice and the primary ethical responsibilities of the registered nurse when providing client-centered care. • the philosophical ideals of right and wrong that define principles used to provide care 7. Discuss the ANA social policy statement for nursing in relation to public expectations and trust in the profession of nursing. • Statement is about the many ways that nursing helps others. It is about the relationshipthe social contract-between the nursing profession and society and their reciprocal expectations. • Nursing is the pivotal health care profession, highly valued for its specialized knowledge, skill, and caring in improving the health status of the public and ensuring safe, effective, quality care. (ANA, 2003) o Provision of a caring relationship that facilitates health and healing o Attention to the full range of human experiences and responses to health and illness within the physical and social environments o Integration of objective data with knowledge gained from an appreciation of the patient's or group's subjective experience o Application of scientific knowledge to the processes of diagnosis and treatment through the use of judgment and critical thinking o Advancement of professional nursing knowledge through scholarly inquiry o Influence on social and public policy to promote social justice CHAPTER 3 Nurses work as interprofessional collaborators, often without even realizing it. Nurses who understand this role would state that improved systems are often the result of health care collaboration, insights into nursing practice typically begin within each nurse’s practice and being advocates gives nurses a voice to speak out on behalf of patients. Nurses often use their experiences to make changes in the health care system to better benefit future patients. The idea that structured interprofessional education systems only occasionally aid in accomplishing goals is incorrect because these systems help and are needed to aid in accomplishing nursing goals. Nurses are called to a higher standard of care. To prepare for full partnership with other health care disciplines, the nurse must ensure competency as a nurse, act as a patient advocate, maintain professionalism, and become familiar with health care policy. The statement that nurses should function only in the staff nurse role is incorrect because the nurse is called to enhance leadership skills, such as in a charge nurse role. Nurses are called to be lifelong learners in order to enhance patient care and influence a bright future for nursing. Nurses have many opportunities to accomplish this, such as signing up for a telemetry course, initiating a hand washing protocol based on research, participating in hospital committees, and leading discussions about educational opportunities. The statement that nurses should obtain continuing education credits every 3 years is incorrect because nurses should be prepared to learn new information on a continuing basis. Also, continuing education credits are required to be submitted every 2 years for license renewal. Professional identity is important for nurses to understand for the profession to continue to grow. A nurse with an understanding of professional identity would state that nurses are empowered to assume an identity that reflects a responsible and equitable role. The nurse would also state the importance to direct the future of nursing. It is also important for the nurse to recognize the power over how he or she perceives others because this could potentially impact patient care. The statement that nurses need to maintain traditional nursing roles is incorrect because a nurse with an understanding of professional identity recognizes the need to develop a more relevant notion of professional identity. The idea that nurses do not have the means to change how they are perceived is incorrect because nurses solely have the means to change how they are perceived by others, through their actions and words. It is crucial for nurses to take steps to move the profession forward in order to set the profession up for success. To influence a positive future for nursing, nurses can take many actions. These include achieving higher levels of education, practicing fully as nurses, and developing an infrastructure for workplace data collection. The idea that nurses should maintain their traditional roles is incorrect because nurses must continue to advance the profession as the world, and patient needs, advance. The statement that nurses should focus on the area of practice is incorrect because nurses should strive to “see the big picture” that is outside of their area of practice. CHAPTER 4 The media often portrays nurses, both male and female, in a negative light. It is imperative that nurses take immediate action for the future of nursing. Nurses can take steps by giving presentations and educating the public on what nursing is, improving their leadership skills, and being an example of a professional nurse. Remaining silent about the media representation of nurses is incorrect because nurses should speak about their profession and educate the public. Creating barriers only allows for the negative portrayal of nurses to continue, so this statement is incorrect. Caring is an important feature of nursing; it is central to the nurses’ identity. Caring is grounded in the development of empathy. Nurses need to be aware of themselves in order to meet the needs of clients. Because caring is an essential feature of the profession, the statement that caring is not the most important feature is incorrect. The idea that people of different cultural backgrounds all experience caring the same way is incorrect because individuals from differing backgrounds often do not perceive caring in the same way. Male nurses are not immune to stereotypes. Men are often criticized for doing women’s work or being less than a man. These stereotypes do seem to be slowing down as more men enter the nursing profession. Male nurses do not experience fewer stereotypes than women, so this statement is incorrect. The idea that male nurses are not affected by stereotypes is incorrect because stereotypes affect everyone in the nursing profession. The nurse has an important role in the health care team and should be able to actively collaborate for the needs of the client. The nurse should take actions such as learning to value and manage diversity, using personal power to create win-win situations, and mastering interpersonal skills. Working closely with one or two individuals is incorrect because the nurse should collaborate with the group as a whole. The idea that collaboration is necessary for every decision is incorrect because collaboration is not necessarily required for all decisions. The role of the educator is essential to the overall function of the nurse. The nurse as educator should commit to be a learner, foster personal knowing, assist other nurses in developing critical thinking skills, and express empathy to others. The statement that the nurse should provide only literature is incorrect because the nurse as educator should actively teach clients and answer all questions. Topic 3 1. Explain the educational requirements for entry to practice and advanced practice nursing. • Diploma Programs o 2 to 3 years in length o No college degree, nongraduates o Eligible to take licensure examination o Designed to meet staffing needs o Apprenticeship model o Recommendations: Align with degree-granting institutions, Become degree granting as newly established academic institutions. • Baccalaureate o Prepare generalists to practice in beginning leadership positions in a variety of settings o Accelerated BSN programs • “Bridge” and “transition” courses • Recruit men and other minorities o Recommendations: Consider a different license for baccalaureate nurses, Give additional emphasis to health care costs and so on, Strive to reach the goal that at least two thirds of the nursing workforce hold a baccalaureate or higher degree. • Vocational Education o Certificate program: 9 to 15 months o These do not articulate well with college programs o Original purpose: Prepare nurses to care for sick and perform homemaking skills. o Later and current purpose: Prepare nurses to perform technical skills under the supervision of RNs. o Recommendations: Elevate to community college level and award the AND, Adjust enrollments to reflect market demands. • Associate Degree o Mildred Montag created ADN o 2-year program taught in community college setting o Focus: Prepare technical bedside nurses for secondary care settings: community hospitals or long-term health care facilities o Original belief: ADN nurse would work under the supervision of BSN-prepared professional nurses o Recommendations: Collaborate with LPN/LVN leadership to prepare a technical nurse, Assess the marketplace and consumer needs, Explore transitioning to baccalaureate level. • Master’s Degree o Strong on role preparation than advanced nursing practice o Phenomenal growth of master’s programs • RN-MSN and non-nurse master’s entry options • Dual degree programs • Clinical nurse leader program o Recommendations: Consider different exams for professional nurses, Bring greater uniformity and meaning to certification programs, Monitor transitioning of advanced practice nursing education to the DNP. • Doctoral o Research-Focused Doctoral Programs (PhD, DNS, or DNSc) o Practice-Focused Doctorate Programs (DNP) • Emphasis on the translation and application of new knowledge to practice o Recommendations: Stabilize growth of research-focused programs, Market the practice-focused doctorate as the preferred route to preparation for advanced practice nursing in the clinical setting. 2. Examine the various nursing practice specialties and certifications. • (above) 3. Discuss the role of state boards of nursing in licensure, certification, and discipline, including the National Council Licensure Examination for Registered Nurses (NCLEX). • Each state governs nursing licensure and certification 4. Examine the role of the nurse in relation to the levels of care in the current U.S. health care system. • With fewer nurses available, what does that mean for you? o Using patient contact time efficiently and professionally o Time management o Therapeutic communication o Patient education • Nurses’ Self Care • The Affordable Care Act and Rising Health Care Costs • Demographic Changes • Medically Underserved CHAPTER 2 Accelerated BSN programs emerged because of the nursing shortage during the 1980s and 1990s. These programs allowed students to progress toward a baccalaureate degree in a timelier fashion. Scholarships emerged to help men and underrepresented minorities obtain careers in nursing. The idea that transition programs are good for students without college degrees is incorrect because these programs are created for individuals who already have some kind of college degree. The statistic that 30% of students in BSN programs are male is incorrect because it is actually 40% of students in BSN programs that are male. Although diploma programs initially met the needs of nursing students and hospitals alike, changes occurred that became problematic. Diploma programs lengthened, and students began to be used as hospital staff instead of being able to function in a student role. Eventually, the high costs of the programs became too much for the students or hospitals to take on. Another cause of program closure was the drop in enrollment because of other collegiate options becoming available. Because of these issues, students encouraged the abandonment of the apprenticeship model in the diploma program. The statement that the diploma program was too short and did not adequately prepare nurses is incorrect because the program was often considered to be too long, and it also adequately prepared nurses for their jobs. RN-BSN tracks emerged to meet the growing demand for nurses. This track is designed to recognize and reward prior learning and capitalize on the characteristics of adult learners. The RN-BSN track is not a research-based program, so this statement is incorrect. The statement that fewer than 200 RN-BSN programs currently exist in the United States is incorrect because more than 600 RN-BSN programs are offered nationwide. Early nursing programs were modeled after the influence of Florence Nightingale. Because of the efforts of anti-collegiate forces, diploma programs became the most popular, and they still exist today. The first nursing program in the United States was a 4-month hospital-based program. The statement that the hospital-based associate degree was the predominant program is incorrect because diploma programs were predominant during this time. The statement that early nursing programs were university based is incorrect because they were actually hospital based. The first baccalaureate program was established in the United States in 1909. Until the mid-1950s, these programs were 5 years in length and included a focus in public health nursing. Often the nursing faculty members who were hired to teach these programs were not qualified for university faculty appointments. Graduates of both diploma and baccalaureate programs are eligible to take the NCLEX exam