Chapter 1-7 NURS MISC Fundamentals of Nursing Study Guide Test Latest updated 2022,100% CORRECT

LR Chapter 1-7 NURS MISC Fundamentals of Nursing Study Guide Test Latest updated 2022 Chapter #1: Nursing Today. Art: deliver care artfully with compassion, caring and respect for patient’s dignity and personhood. Science: based on a body of knowledge, that is continually changing with new discoveries and innovations. Integrate art and science into nursing practice. Quality of care at a level of excellence that benefits patient and their families. Science and Art of Nursing Practice: Nursing practice requires a blend of the most current knowledge and practice standards with an insightful and compassionate approach to patient care. Nursing practice incorporates ethical and social values, professional autonomy, and a sense of commitment and community. The patient is the center of your practice, it includes individual, families, and/or communities. As a professional you administer quality patient centered care in a safe, prudent and knowledgeable manner. Nurses are responsible and accountable to themselves, patients and peers. LR Health care advocacy groups recognize the important role nurses have on the nation’s health care. Nursing: The American Nurses Association (ANA) defines nursing as the protection, promotion, and optimization of health and abilities; prevention of illness and injury; alleviation of suffering through the diagnosis and treatment of human response; and advocacy in the care of individuals, families, communities, and population (ANA, 2010b). Standards of Practice: describe a component level of nursing care. The levels of care are demonstrated by a critical thinking model as the nursing process: assessment, diagnosis, outcomes identification and planning, implementation, and evaluation. Standards of Professional Performance: describe a competent level of behavior in the professional role. Code of Ethics: is the philosophical ideals of right and wrong that define the principles you will use to provide care to your patients. Professional Responsibilities and Roles: Autonomy is an essential element of professional nursing that involves the initiation of independent nursing interventions without medical orders. LR Caregiver: help patients maintain and regain health, manage disease and symptoms, and attain maximal level of function and independence through the healing process. Advocate: protect your patient’s human rights and legal rights and provide assistance in asserting these rights if the need arises. Educator: explain concepts and facts about health, describe reason for routine care activities, demonstrate procedures such as self-care activities, reinforce learning or patient behavior, and evaluate the patient’s progress in learning. Communicator: is central to the nurse-patient relationship. It allows you to know the patient, including their strength, weakness, and needs. It’s essential for all nursing roles and activities. Manager: coordinates the activities of members of the nursing staff in delivering nursing care and has personnel, policy, and budgetary responsibility for a specific nursing unit or agency. Career Development: Advanced Practice Register Nurse (APRN): is the most independently functioning nurse, with advance education in pathophysiology, pharmacology, and physical assessment and certification and expertise in in a specialized area of practice (clinical nurse specialist CNS, certified nurse practitioner CNP, certified nurse midwife CNM, and certified RN anesthetist CRNA. Nurse Educator: works primary in schools of nursing, staff development departments of health care agencies, and patient education departments. Nurse Administrator: manages patient care and delivery of specific nursing services within the health care agency. Nurse Researcher: conducts evidence-based practice and research to improve nursing care and further define and expand the scope of nursing practice. Nursing Shortage: This shortage affects all aspects of nursing, including patient care, administration, and nursing education: but it also represents challenges and opportunities for the profession. Historical Influences: Florence Nightingale LR Volunteered during the Crimean War. First practicing nurse epidemiologist. Contributed to the Standards of Nursing Care. Established the first nursing philosophy based on health maintenance and restoration. Establish the role of the nurse as being in charge of people’s health. Established first organized program to train nurses. Nutrition, Occupational & Recreational Therapy. Importance of documentation- reduced mortality rate from 42.7% to 2.2% in 6 months. Organized and improved sanitation facilities. First Nurse Epidemiologist. The Civil War: Clara Barton Founder of the American Red Cross. Mother Bickerdyke Organized ambulance services and walked abandoned battlefields looking for wounded soldiers. Lillian Wald & Mary Brewster Open Henry Street Settlement to care for the poor people in tenements in New York City. Mary Mahoney 1st professionally trained African American nurse. Hattiet Tubman Active in the Underground Railroad movement and helped lead 300 slaves to freedom. 20TH & 21ST Century Mary Adelaide Nutting: First nursing professor at Columbia Teacher’s College in 1906 she was instrumental in moving nursing education into universities. Army and Navy Nurse Corps: Was established as education development and practice expanded. Nursing organizations and the Robert Ward Johnson Foundation (RWJF): Currently involved in programs to decrease nursing shortage and improve health of the population. Contemporary Influences: Importance of Nurses’ self-care: Nurses require resiliency skills to better manage the stressors that contribute to compassion fatigue and lateral violence. Skills such as managing stress and conflict, building connections with colleagues. And self-care are helpful in dealing with difficult situations and contribute to safe and effective self-care. Demographic Changes: Impacts how and where nursing care is provided. Predict a continuing rise in the population over 65. Population is still shifting from rural areas to urban center. More people are living with chronic and long-term illness. Changes will be to occur as to how care is provided (outpatient, community and home-based services. The Affordable Care Act and Rising Health Care Costs: Impacts how and where nursing care is provided. Nursing services will be in community-based settings. Nurses will required a better assess for resources, identify services gaps, and helps patients adapt to safely return to their communities. Medically Underserved: Unemployed, underemployed, mental illness, homelessness and rising health care cost. Trends in Nursing: Evidence-Based Practice: Use to show commitment to reduce health care errors and improve patient safety. Quality and Safety Education for Nurses (QSEN): Addresses the challenges to prepare nurses with competencies needed to continuously improve the quality of care in the work environment. Impact of Emerging Technologies: Rapidly change nursing practice, EHR (electronic heath record), CPOE (computerized physician/provider order entry). Genomics: A newer term that describes the study of all genes in a person and interactions of these genes with one another and with that person’s environment. Allows health care providers to determine how genomic changes contribute to patient conditions and influence treatment decisions. Public Perception of Nursing: When you care for patients realize how your approach to care influences public opinion. Nurses are essential to providing skilled, specialized, and knowledgeable care. Improve status of the public, ensuring safe, effective and quality care. Nursing’s Impact on Politics and Health Policy: Nurses are actively involved in social policy and political arenas. The ANA works for the improvement of health standards and availability of heath care services for all people. Emphasis in nursing curricula, professional organizations, and health care settings. Nursing board employ lobbyist to urge state legislatures to improve the quality of health care. Continuing Education and In-Service Education. Continuing Education: Formal organized educational programs offered by universities, hospitals, state nurses associations, professional nursing organizations and educational and health care institutions. In-Service Education: Instruction or training provided by a heath care agency or institution. Nursing Practice/ Nursing Practice Act: Nurses practice in a variety of settings, in many roles within those settings and with caregivers in other related health professions. Nurse practice act regulate the scope of nursing practice and protect public health, safety, and welfare. It shields the public from unqualified and unsafe nurses. The advanced practice role expands the scope of practice of these nurses. State Board of Nursing: Sets standards for entry into practice. Ensures education requirements met. Enforces the Nurse Practice Act- suspension or revocation of license. Defines standards of nursing practice. Licensure and Certification: Licensure: In the US all boards of nursing require RN candidates to pass the NCLEX-RN. Regardless of educational preparation the RN licensure is exactly the same in every state in the US. Criminal background check varies from state to state. Certification: The nurse may choose to work toward certification in a specific area of nursing practice. National nursing organizations have many types of certifications, you maintain by continuing education. Professional Organizations: Deals with issues of concern to those practicing in the profession. National League for Nursing (NLN). American Nurses Association (ANA). International Council of Nursing (ICN). National Student Nurses Association (NSNA). Professional organizations that focus on specific area of practice e.g. critical care, nursing research, nurse midwifery etc. improve standard of practice and expand nursing roles. Increasing Autonomy: Nursing Actions. Dependent –physician initiated Independent – nurse initiated Interdependent / collaborative Chapter #2: The Health Care Delivery System. The U.S Health Care System: Is complex and constantly changing. Uninsured people present a challenge to health care and nursing. Challenge is to reduce health care cost, maintain high-quality care, improve access, and coverage for more people and encourage healthy behaviors. Nursing is a caring discipline, focus is to help people regain, maintain, or improve health, prevent illness and find comfort and dignity. IOM (2011) has a vision to transform health care. Health care of the future envision quality care accessible to all populations, focus on wellness and disease prevention, improves health outcomes and provide compassionate care across the life span. Health Care Regulation and Reform: As health care cost rise out of control regulatory and competitive approaches are used to control health care spending. The federal government, congress, and most health care insurance influence how much a hospital or health care is paid. Manage Care: Describes health care systems in which a provider or health care system receives a predetermined capitated payment for each patient enrolled in the program. Capitation means the provider receives a fixed amount per patient or enrollee of a health care plan. The federal government (F.G.) is the biggest consumer of health care which paid Medicare and Medicaid. F.G. Created professional standards review organizations (PSROs) to review the quality, quantity and cost of hospital care. LR Medicare have physician supervised utilization review (UR) committees to review admissions and eliminate overuse of diagnostic and treatment services by physicians. Prospective payment system (PPS) established by congress eliminates cost-based reimbursement and based on the diagnostic related groups (DRGs) receive a fixed reimbursement regardless of the LOS or use of services. Managed care provider receives a predetermine capitated payment for each patient. The focus is on reducing cost, increasing patient satisfaction, improve the health or functional status of individuals. Patient Protection and Affordable Care Act (PPAC) 2010: Focus on the major goals on increase access to health care services for all, reducing health care cost, and improving health care quality. Emphasis on Population Wellness. Health Services Pyramid: Managing health instead of illness. Emphasis on wellness. Injury prevention programs. A model for improving the health care system. LR Shows that population-based health care services provide the basis for preventive services. Emphasis on wellness and health of populations and the environment enhances quality of life. Health Care Settings and Services: Currently the U.S health care system has five levels of care: Health Promotion (preventive). Primary Care. Secondary Care. Tertiary Care (restorative and continuing care). Preventive and Primary Health Care. Primary Health Care: It includes primary care and health education, proper nutrition, maternal/child health care, family planning, immunization, and control of diseases. Requires collaboration among health care professionals, leaders, and community members. Focus on improving health care equity, making health care systems person centered. Promote and protect the health of communities. Secondary and Tertiary Care: (also called acute care). Diagnosis and treatment of illnesses are traditionally the most common service. Managed care now allows these services to be delivered in primary care. Hospital emergency departments, urgent care centers, critical care units, and inpatient medical-surgical units provide secondary and tertiary levels of care. Intensive care. Psychiatric facilities. Rural hospitals. Restorative Care: Serves patients recovering from an acute or chronic illness/disability. Helps individuals regain maximal function and enhance quality of life. Home Health Care: Provision of medically related services and equipment to patients and families in their homes for health maintenance, education, illness prevention, diagnosis and treatment of disease, palliation, and rehabilitation. Involves coordination of services. Focuses on patient and family independence. Usually reimbursed by government (such as Medicare and Medicaid in the United States), private insurance, and private pay. Rehabilitation: Includes physical, occupational, and speech therapy, and social services Begins on admission Focuses on preventing complications Maximizes patient function and independence. Extended Care: Extended care facility: Provides intermediate medical, nursing, or custodial care for patients recovering from acute illness or disabilities. Intermediate care/skilled nursing facility : Provides care for patients until they can return to their community or residential care location. Continuing Care: For people who are disabled, functionally dependent, or suffering a terminal disease. LR Available within institutional settings or in the home: Nursing centers or facilities Assisted living Respite care Adult day care centers Hospice Nursing Centers or Facilities: Provide 24-hour intermediate and custodial care. Nursing, rehabilitation, diet, social, recreational, and religious services. Residents of any age with chronic or debilitating illness. Regulated by standards: Omnibus Budget Reconciliation Act of 1987. Interdisciplinary functional assessment is the focus of clinical practice: MDS, RAIs. Assisting Living: Long-term care setting Home environment Greater resident autonomy No fee caps. Respite Care: Respite care provides short-term relief or “time off” for people providing home care to an individual who is ill, disabled, or frail. Settings include home, day care, or health care institution with overnight care. Trained volunteers enable family caregivers to leave the home for errands or social time. Adult Day Care Centers: Provide a variety of health and social services to specific patient populations who live alone or with family in the community May be associated with a hospital or nursing home or may operate independently Hospice: LR Family centered care that allows patients to live with comfort, independence, and dignity while easing the pains of terminal illness. Focuses on palliative (not curative) care Many hospice programs provide respite care, which is important in maintaining the health of the primary caregiver and family. Care Coordination: Accountable care organizations (ACOs). Developed to coordinate medical care. Nurses act as leaders and care coordinators. Patient-centered medical home (PCMH). Coordinates care, gathers clinical data, and monitors patient outcomes. Primary care providers function as the hub of the PCMH. Issues and Changes in Health Care Delivery: Nursing Shortage: Increase age of workforce, slow growth in school enrollment due to faculty shortage, space and clinical sites. Competency: Emphasize public service, health of the community and developing responsible ethical behaviors. LR Quality and Safety in Health Care: Safety is a critical part of quality health care. Eliminate unnecessary, and reduce waste. Provide patient centered care. Magnet Recognition Program: Provide excellence in nursing practice see (box 2-7). Recognize health care organizations that achieve excellence in nursing practice. Nursing Informatics and Technological Advancements: Use information and technology to communicate, manage knowledge, mitigate error and support decision making. Globalization of Health Care: Increased connectedness of the world economy, culture and technology. Health tourism, hiring nurses from other countries. Quality & Performance Improvement: Quality Improvement: is an approach to the continuous study and improvement of the process of proving health care services to meet the needs of the patients and others and inform health care policy. Quality Improvement Programs: Six Sigma or Lean: in this model organizations evaluate processes to reduce cost. Rapid cycle improvement or rapid improvement event (RIE); are very intense, usually week-long events, in which a group gets together to evaluate a problem with the intent of making radical changes to current processes. The Future of Health Care: Health and wellness of the population. Access to health care for the uninsured. LR Changes in how service is provided, reduce unnecessary costs, improving access to care and trying to provide high-quality patient care. Active participation of professional nurses to improve health care. Globalization: Increasing connectedness on the world’s economy, and technology. Advances in communication through the internet, allow nurses, patients, and other health providers to talk with others worldwide about healthcare issues. Chapter #3: Community-Based Nursing Practice. Focus on health promotion, disease prevention, and restorative care. Components of a health care delivery system that improves the health of the general public. Occurs outside traditional health care institutions such as hospitals. Community health nursing and community-based nursing are components of a health care delivery system that improve the health of the general public. LR Community-Based Nursing: Takes place in community settings such as home or a clinic, where the focus is on the needs of the individual or family. The first level of contact between members of the community and the health care delivery system. Helps to reduce the cost of health care for the patient and the stress associated with the financial burdens of care. Vulnerable Populations: Groups of patients who are more likely to develop health problems as a result of excess risks, who have limited access to health care services or who depend on others for care. Immigrant population. Effects of poverty and homelessness. Patients who are abused. Patients who are substance abusers. Patients with mental illness. Older adults (dependent on other people to care for them). Competency in Community-Based Nursing: Nurses need a variety of skills and talent to successfully assist patients to meet their health care needs. Care giver. Educator. Case Manager . Change Agent. Patient Advocate. Collaborator. Epidemiologist. Counselor. Community Assessment: Components of community assessment. Systematic data collection on the population. Monitoring the health status of the population. Making information available about the community’s health. LR Components of the community. Structure or locale. People. Social systems. Assess individuals in the context of a community. Chapter #4: Theoretical Foundations of Nursing Practice. What is a Theory? A set of concepts, definitions, and assumptions that explain a phenomenon. LR A Nursing Theory: Conceptualizes an aspect of nursing to describe, explain, predict, or prescribe nursing care. Helps to identify focus, means, and goals of practice. Enhance communication and accountability for patient care. Components of a Theory: A theory contains a set of concepts, definitions, and assumptions or propositions that explain a phenomenon. Phenomenon: term or description given to describe an idea or response. Concepts: help describe or label phenomena. Definition: used to communicate the general meaning of the concepts of the theory. Assumptions: are the taken-for-granted statement that explain the nature of the concepts, definitions, purpose, relationships, and structure of a theory. Assumptions are accepted as truths and are based on values and beliefs. The Domain of Nursing: It’s the perspective or territory of a profession or discipline. It provides the subject, central concepts, values and beliefs, phenomena of interest and central problem of the discipline. Gives nurses a comprehensive that allows you to identify and treat patient’s health care need in all health care settings. It is the knowledge of nursing practice, nursing history, nursing theory, education and research. A paradigm is used to describe the domain of a discipline. Provides both a practical and theoretical aspect of the discipline. Conceptual Framework: LR Provides a way to organize major concepts and visualize relationships among phenomena. Paradigm: A pattern of thought that is useful in describing a domain of a discipline. Links the concepts, theories, beliefs, values and assumptions acceptable and applied to the discipline. Nursing Metaparadigm: Allows nurses to understand and explain what nursing is, what nursing does, and why nurses do what they do. The nursing paradigm includes four links Person: The recipient of nursing care including individual patients, groups, families, and communities. Health: Has different meaning for each patient. The nurse provides the best possible care based on the patient’s level of health and health care needs at the time of care delivery. Environment/Situation: Includes all possible conditions affecting patients and the settings in which health care needs occur. Nursing: The diagnosis and treatment of human responses to actual or potential health problems. Types of Theories: Grand theories: are abstract, broad in scope, and complex. Therefore they require further clarification through research so they can be applied to nursing practice. A grand theory does not provide guidance for specific nursing interventions. Middle-range theories: limited in scope and less abstract. Practice theories: Known as situation-specific theories, bring theory to the bedside. Descriptive theories: are the first level of theory development. They describe phenomena and identify circumstances in which the phenomena occur. Do not direct specific nursing activities or attempt to produce change but rather help explain patient assessments. Prescriptive theories: address nursing interventions for a phenomena, guide practice change, and predict the consequences. Anticipate outcome and nursing interventions. Notable Theorists: Nightingale’s Theory: (environment) The environment is focus of nursing care and helping patients deal with symptoms and changes in function related to an illness. Known as founder of modern nursing and helped developed the first nursing theory. The focus of Nightingale’s grand theory is a patient’s environment, which Nightingale believed nurse could manipulate (ventilation, light, decrease noise, hygiene, nutrition). She linked the patient’s health status with environmental factors, and initiated improve hygiene and sanitary conditions. Peplau’s Theory: (interpersonal relations nurse/patient) Middle-range theory focus is on the interpersonal relationship between the nurse, the patient and the patient family developing the nurse-patient relationship. According to Peplau, nurse help patient reduce anxiety by converting it into constructive actions. Develop therapeutic relationships with patients that are respectful, empathetic, and non-judgmental. Henderson’s Theory: (recovery) Defines nursing as assisting the individual, sick or well, in the performance of those activities that will contribute to health, recovery or a peaceful death unaided. Orem’s Theory: (self-care) Self-care deficit theory focuses on helping the patient perform self-care and manage his or her health problems. Leininger’s Theory: (cultural diversity) Focus on cultural diversity and the goal of the nursing care is to provide the patient with culturally specific nursing care. LR Recognizes the importance of culture and its influence on everything that involves the patient, including health beliefs, the role of family, community and dietary practices. Betty Newman’s Theory: (stress) Based on stress and the client’s reaction to the stressor. Roy’s Theory: (adaptation) Views the patient as an adaptive system, the goal of nursing is to help the person adapt to changes in physiological needs, self-concept, role function and interdependent relations during health and illness. Watson’s Theory: (caring) The purpose of nursing action is to understand the interrelationship among health, illness and human behavior. Nursing is concern with promoting and restoring health and preventing illness. Benner Theory: (skill acquisition) Caring is central to nursing and creates possibilities for coping, enables possibilities for connecting with and concern for others, and allows for the giving and receiving help. Relationship between Nursing Theory and Nursing Research: Builds the scientific knowledge base of nursing which is then applied to practice. As an art, nursing relies on knowledge gained from practice and reactions of past experiences. As a science nursing draws on scientifically tested knowledge applied in practice setting. The expert nurse transports the art and science of nursing into the scientific realm of creative caring. Research validates, refutes, supports, and/or modifies theory; and theory stimulates nurse scientists to explore significant issues in nursing practice, leading to the improvement of nursing care. Chapter #6: Health and Wellness. Definition of Health. Health is more than the absence of disease. A state of complete physical, mental, and social well-being, not merely the absence of disease or infirmity (WHO, 1947). A state of being that people define in relation to their own values, personality, and lifestyle. Healthy People Documents: LR Healthy People: The Surgeon General’s Report on Health Promotion and Disease Prevention, 1979. Introduced national goals for improving the health of Americans by 1990. Healthy People 2000: National Health Promotion and Disease Prevention Objectives. Identifies health improvement goals & objectives to be reached by 2000. Healthy People 2010: Serves as a road map for improving the health of all people in the USA. Healthy People 2020 (current version): promotes a society that in which all people live long, healthy lives. Goals Healthy People 2020: Attain high quality, longer lives free of preventable disease, disability, injuries, and premature death. Achieve Health quality, eliminates disparities, and improve all health groups. Create physical and social environments that promote good health for all. Promote quality of life, healthy development, and healthy behaviors across life stages. Models of Health and Illness. Health Belief Model: Addresses the relationship between a person’s beliefs and behaviors. Health Promotion Model: Directed at increasing a patient’s level of well-being. Holistic Health Model: Attempts to create conditions that promote optimal health. Maslow’s Hierarchy of Needs: Attempts to meet the patient’s basic needs (food, water, safety, and love). Influences on Health, health beliefs and Practices: Health beliefs are a person’s ideas, convictions, and attitudes about health and illness. Health beliefs can negatively or positively influence health behavior or health practices. Health beliefs and practices are influenced by internal and external variables and should be considered when planning care. Variables influencing health & health beliefs and practices. Internal Variables. Developmental Stage. Knowledge of stages helps to predict a patient’s response to the present illness or the threat of future illness. Intellectual Background: A nurse considers intellectual background so these variables can be incorporated into communication and instructional approaches. LR Perception of Functioning: This information allows you to more successfully plan and implement individualized approaches such as self-care and mobility. Emotional Factors: The way people perceive their physical functioning affects health beliefs and practice. Spiritual Factors: You need to understand patient’s spiritual dimensions to involve patients effectively in nursing care. External variables: Family Practices: The way patients and families use health care services generally affects their health practices. Psychosocial and Socioeconomic Factors: These factors increase the risk for illness and influence the way a person defines and reacts to illness. Cultural Background: It influences the approach to the health care systems, personal health practices and the nurse patient relationship. Levels of Preventive Care: Nursing care related to health promotion, wellness, and illness prevention is described in terms of health activities on: Primary, secondary, and tertiary levels. Primary Prevention (True Prevention): We use primary prevention methods before the person gets the disease. LR Goals of Primary Prevention: aims to prevent the disease from occurring. reduces both the incidence and prevalence of a disease. Examples: Health education programs. Immunizations. physical and nutritional fitness. Sunscreen Education. Secondary Prevention: Focuses on individuals experiencing health problems or illnesses and who are at risk for developing complications or worsening conditions (person may not even know anything is wrong). Goal: The goal of secondary prevention is to find and treat disease early thereby reducing severity and enable the patient to return to a normal level of health as early as possible. Example: Screening for cancer. Tertiary Prevention: When a defect or disability is permanent or irreversible targets the person who already has symptoms of the disease. Goals of tertiary prevention are: prevent damage and pain from the disease. slow down the disease. prevent the disease from causing other problems (These are called "complications.) give better care to people with the disease. Minimizes the effects of disability by preventing complications and deterioration. Example: Rehabilitation rather than diagnosis and treatment. Risk Factors: LR A risk factor is any situation, habit, social or environmental condition, physiological or psychological condition. Developmental or intellectual condition, spiritual condition, or other variable that increases the vulnerability of an individual or group to an illness or accident. Risk factors include: Genetic and physiological factors. Age. Environment. Lifestyle. Illness: A state in which a person’s physical, emotional, intellectual, social, developmental, or spiritual functioning is diminished or impaired compared with previous experience. Acute & Chronic Illness: Acute Illness: is usually reversible, has a short duration, and is often severe. May affect functioning of any dimension. Chronic Illness: persists usually longer than 6 months, is irreversible, and affects functioning of one or more systems. Illness Behavior: Describes the way people who are ill generally act, involves how people monitor their bodies, interpret symptoms, take remedial actions, and use the resources of health care. Internal Factors: Perception of cause of symptoms (serious or not). Symptoms and nature of the illness (acute or chronic). Coping skills. Locus of control (the degree to which people believe they control what happens to them). External Factors: Visibility of symptoms (body image and illness behavior). Social Group: recognizing the threat of the illness or support the denial. (families and friends). Trust or mistrust the system, support new lifestyle changes or no Economics Variables: because economic constrains patients delay treatment. The health system is complex and confusing. LR Impart of Illness on the patient and Families. Behavioral and emotional changes. Impact on body image. Impact on self-concepts. Impact on family roles. Impact on family dynamics. Chapter #7: Caring in Nursing Practice. Caring: Is a universal phenomenon influencing the ways in which people think, feel, and behave in relation with one another. Caring is the central focus of nursing and it’s integral to maintain the ethical and philosophical roots of the profession. Leininger’s Transcultural Caring Theory: Describes the concept of care as the essence and central, unifying and dominant domain that distinguishes nursing from other health disciplines. Stresses culturally specific caring (reflect caring the way the person understands it).must learn culturally specific behaviors and words. Stresses how important it is for nurses to understand cultural caring behaviors. Caring is very personal, thus is expression differs for each patient. Watson’s Transpersonal Caring Theory: LR Is a holistic model for nursing that suggests that a conscious intention to care promotes healing and wholeness. Emphasizes the nurse-patient relationship. Caring is expressed through a caring connection that the nurse expresses towards the patient. Both the nurse and the patient are transformed and healing is promoted (caring has a spiritual aspect). Focuses on transpersonal caring, he or she looks for deeper source or inner healing to protect, enhance, and preserve person’s dignity, humanity and wholeness, and inner harmony. Swanson’s Theory of caring: Five Caring Categories/Processes: Knowing (understand event as it has meaning in life of another). Being with (emotionally present). Doing For (as the person would if they could). Enabling (facilitating the other person’s passage through a life’s event). Maintaining Belief (hope-filled attitude/ realistic optimism, sustaining faith) Caring in the Nursing Practice: Providing Presence: is a person to person encounter conveying with closeness and sense of caring. Touch: is a comforting approach that reaches out to communicatee concern and support, leads to connect between the nurse and the patient. Listening: critical component of nursing care and is necessary for a meaningful interaction with the patients. Listener is present engages the patient in a nonjudgmental and accepting manner. LR Knowing the Patient: essential element of nursing practice and is linked to patient satisfaction and successful outcomes of care. Nurses engages a continuous assessment striving to understand and interpret the patient’s needs across all dimensions. Spiritual Care: nurses develops spiritual caring. Relieving Pain and Suffering: nursing actions to give patients comfort, dignity, respect, peace, and support to the family or significant others. Family Care: it’s important to know the family almost thoroughly as you know the patient, family it’s an important resource. Ethic of care: is concerned with the relationship between people and with a nurse’s character and attitude towards others. The Challenge of Caring: Demands of the profession. Task orientation. Institutional demands. Technology and cost-effective health care. LR Chapter #27: Patient Safety and Quality. Safety: freedom of from psychological and physical injury. Health organization foster a patient centered culture by continually focusing on: Performance improvements endeavors. Risk management findings and safety reports. Providing current reliable technology. Integrating evidence-based practice into procedures. Designing safe work environment. Providing continuing education. Access for appropriated resources for staff. Patient-centered care as health that establish a partnership among practitioners, patients and their families (when appropriate) to ensure that decisions respect patients wants, needs, and preferences that patients have the education and support the need to. Make decisions and participate in their own care. The quality and safety education for nurses (QSEN) project was develop too meet the challenge of preparing future nurses who will the knowledge, skills and attitudes necessary to continually improve the quality and safety of thee health systems within which they work. Environmental Safety: Patient environments includes physical and psychological factors that influences or affect the life and survival of patients. A safe environment includes meeting basic needs, reducing physical hazards and transmission of pathogens, and controlling pollution. Basic Needs: Oxygen. Nutrition. Temperature (65-75 F). Physical Hazards: Motor vehicle accidents. Poisons. Falls. Fire. Disasters. LR Transmission of pathogens: HIV, AIDS, Immunization, and hand hygiene. Pollution: pulmonary diseases, land, air, water pollution. Factors Influencing Patient Safety: Patient developmental level: creates threats as a result of lifestyle, cognitive and mobility status, sensory impairments, safety awareness. Child abuse, domestic violence and elder abuse serious threats in safety. Infant, toddler, and preschooler: lead poising is highest in in infancy and toddlerhood. Increase level of oral activity (put objects in their mouth), falls from bicycles and riding unrestrained in a motor vehicle, drowning, and head trauma. School age child: bicycle accidents major cause of injuries, tricycles, scooter and motorized toys. Adolescent: peer pressure, smoking, drinking alcohol, using drugs, drowning and motor vehicle accidents. Motor vehicle crashes (drinking while driving). Adult: lifestyle habits, excessive use of alcohol, motor vehicle accidents, smoking great risk of cardiovascular and pulmonary disease, stress (accidents, illness, headaches, gastrointestinal GI disorders, and infections. Older adult: aging, multiple medications, psychological and cognitive factors, risk of falls. Individual Risk Factors: Lifestyle. Impaired mobility. Sensory and communication impairment. Lack of safety awareness. Risks in Health Care Agency: emphasize medical error prevention and patient safety. “speak up” campaign. (patient becomes active and involve in their care) The Joint Commission Patient Safety Goals 2015: Identify patients correctly. Improve staff communication. Use medicine safely. Use alarm safely. Prevent infections. LR Prevent mistake inn surgery. The mission of the National Quality Forum (NQF) is proving the quality of health care in America by: Building consensus on national priorities for performance improvement and working in partnership to achieve them. Endorsing national consensus standards for measuring and widely reporting on the performance. Promoting the accomplishment of national goals through education and outreach programs. Many if the NQF measures of patient safety (falls, incidence of pressure ulcers, central bloodstream line infections). The NQF endorsed a selects list of serious reportable events (SREs) which was updated in 2006. The 28 events are major focus in health care providers for patient safety initiatives. Never events: adverse events that should never occur in a health care setting. The (CMS 2015) denies hospitals higher payment for any hospital-acquired condition resulting from or complicated by the occurrence of certain never events. Patient-inherent accidents: accidents (other than falls) in which a patient is the primary reason of the accident. Self-inflicted cuts. Injuries. Burns. Ingestion or injection of foreign substances. Self-mutilation. Fire setting. Seizure. Procedure- related accidents: accidents are cause by health care providers. Medication and fluid administration errors. Improper application of external devices. Dressing changes. Catheter insertion. Equipment-related accidents: accidents that are the result from malfunction, disrepair, or mishandling of equipment or from an electrical hazard. Critical thinking: Successful critical thinking requires a synthesis of knowledge, experience, critical thinking attitudes, and intellectual and professional standards. The American Nurses Association (ANA) standards for nursing practice address the nurse’s responsibility in maintaining patient safety. TJC also provides standard of patient safety. LR Apply the nursing process and use a critical thinking approach in you care for patients. Nursing Process: Assessment. Nursing Diagnosis. Planning. Implementation. Evaluation. Used the information gather in your assessment to your nursing diagnosis. Set goals and expected outcomes with patient and their families during the planning process. Set priorities and interventions to provide safe and efficient care. A standard approach to communication such as SBAR (Situation, Background, Assessment, Recommendation). Health Promotion: (Edelman and Mandle 2013). Passive and active strategies aimed at health promotion. Passive Strategies: public health and government legislative interventions (sanitation and water laws). Active Strategies: are those in which the individual is actively involved through the changes in lifestyle (engaging better nutritional health or exercise program, wearing seat belts) and participation in wellness programs. Acute & Restorative Care Environment: Fires Types of Extinguishers: ABC: all kinds of fires. B: grease fires C: electrical fires. P.A.S.S: Pull the pin. Aim the nozzle. Squeeze the handle. Sweep the nozzle. Restrains: A physical restrain is any manual method, physical or mechanical device, material, or equipment that immobilizes or reduces the ability of a patient to move his or her arms, legs, body, or head freely. Patients who are confused or disoriented or who wander and repeatedly fall or try to remove medical devices (oxygen, IV lines, or dressings) often requires the use of restrains to keep them safe. Laws prohibit the unnecessary use of retrains, except in emergencies, nursing homes cannot use restrains without residents’ consent. Complications associated with the use of restrains: Pressure ulcers. Pneumonia. Constipation. Restricted breathing and circulation. (death). Loss of self-esteem. Humiliation. Electrical Hazards: remove equipment not properly working. Seizures: patient with neurological injuries or metabolic disturbance are at risk of seizures. Assess a patient’s home for environmental hazards in light of a seizure condition. Fall prevention: most organization apply a yellow color-coded wristband to patients to communicate to all health care providers that a patient is a fall risk. LR Disaster: Nurses need to be prepared to respond and care for sudden inflow of patient during a disaster. TJC requires hospital to have an emergency-management plan that addresses identifying possible emergency situations and their probable impact. Maintaining adequate amount of supplies. Formal response that include action taken by the staff. Infection control practices are critical in the event of biological attack (bioterrorism). For certain disease such as smallpox or pneumonic plague, additional precautions are necessary. Transport and move patients only when essential for treatment and care. Radiation: Reduce your exposure to radiation. Limit the time near to the source. Make distance from the source as much as possible. Use shielding devices such as lead aprons. Staff who work regularly near radiation wear device that track the accumulative exposure to radiation. LR Chapter #28: Immobility & Mobility. Mobility Purposes: Expression of emotions with nonverbal gestures. Basic needs. Self-defense. Activities of daily living (ADLs). Many functions of the body depend on mobility. Nature of Movement: Movement: complex process that requires coordination between the musculoskeletal and nervous system. Body mechanics: coordinate efforts of the musculoskeletal and nervous system. Body alignment and posture are similar and refer to the positioning of the joints, tendons, ligaments, and muscles. Gravity: Weight is the force exerted on the body by gravity. (use the right procedure to lift a patient by overcoming the patient weight and known its own center of gravity.) Friction: Is the force that occurs in the direction to oppose movement. (grater the surface of the object, greater the friction.) Shear: The force exerted against the skin while the skin remains stationary and the bony structures move. (head of the bed elevated more than 60 degrees and the patient slides down against gravity) Pathological Influences on Mobility: Postural Abnormalities: congenital or acquired affect the efficiency of the musculoskeletal system and body posture, alignment and appearance. Muscle Abnormalities: alterations of musculoskeletal functions. (muscular dystrophies). LR Damage of the central Nervous System: trauma from a head injury, ischemia from a stroke, bacterial infections (meningitis). Direct Trauma to the Musculoskeletal System: results in bruises, contusions, sprains and fractures (immobilization can also cause muscle atrophy, loss of muscle tone, and joint stiffness). Factors Influencing Mobility and Immobility: Mobility refers to a person’s ability to move about freely, and immobility refers to the inability to do so. Bed Rest: cause major physical, psychological and social effects. Systemic Effects: an alteration in mobility, each body system is at risk for impairment. Metabolic changes: changes mobility alter endocrine metabolism, calcium absorption, and functioning of the gastrointestinal system. Slow metabolic rate (carbohydrates, fats and protein). Increase the basal metabolic rate BMR. Negative nitrogen balance, weight loss, decrease muscle mass, weakness result of tissue catabolism (tissue breakdown). Respiratory Changes: atelectasis (collapse of the alveoli), hypostatic pneumonia (inflammation of the lung from stasis or pooling of secretions). Cardiovascular Changes: increase cardiac workload, orthostatic hypotension (is a drop of blood pressure greater than 20 mm Hg in systolic pressure or 10 mm Hg in diastolic pressure). Thrombus formation (is an accumulation of platelets, fibrin, clotting factors and the cellular elements of the blood attached to the interior of the wall of the vein or artery). Musculoskeletal Changes: cause permanent or temporary impairment or permanent disability, loss endurance, strength, and muscle mass and decrease stability and balance; and impaired calcium metabolism and joint mobility. Muscle Changes: impair calcium metabolism and joint abnormalities, osteoporosis, joint contracture (possible permanent condition characterized by fixation of the joint). Foot drop and muscle atrophy. Urinary Elimination Changes: urinary stasis and increase the risk of urinary tract infection and renal calculi (calcium stones that lodge in the renal pelvis or pass through the ureters: causing risk for calculi because of the frequently have hypercalcemia.). Risks for dehydration increases, urinary output declines, urine becomes concentrated which is a risk for calculi formation and infection. LR Integumentary Changes: major risk factor for pressure ulcers (is an impairment of the skin as a result of prolonged ischemia (decrease blood supply) in tissues. Psychosocial Effects: leads to emotional and behavioral responses, sensory alterations, and changes in coping, social isolation and loneliness, and depression. Developmental Changes: Infants, Toddlers and Preschoolers: the newborn spine is flexed and acks of anteroposterior curve of the adult. Adolescents: often behind peers in gaining independence and accomplishing certain skills such as obtaining driver’s license; and social isolation. Adults: physiological factors are at risk, family, social structure, losing their jobs and self-concept. Nursing Process: Assessment of patient’s mobility focuses on ROM, gait, exercise and activity tolerance, and body alignment. Range of Motion (ROM): is the maximum amount of movement available at a joint in one of the three planes of the body: sagittal, transverse, or frontal. LR When assessing ROM, ask questions about and physically examine the patient for stiffness, swelling, pain, limited movement, and unequal movement. Immobility affects multiple body systems. Possible nursing diagnosis include: Ineffective airway clearance. Ineffective coping. Impaired physical mobility. Impaired urinary elimination. Risk for impaired skin integrity. Risk for disuse syndrome. Social Isolation. Planning: Goals and outcomes: develop an individual plan of care for each nursing diagnosis. Setting priorities. Teamwork and collaboration. Implementation: Health promotion: include activities of a variety of intervention such as education, prevention, and early detention. Positioning Techniques: Trochanter roll: prevents external rotation of the hips when a patient is in supine position. Trapeze bar: is a triangular device that hangs down. From a securely fastened overhead bar that is attach to the bedframe. It allows patient to pull with the upper extremities to raise the trunk off the bed, assist in transfer from bed to wheelchair, or perform upper arm exercises. Supported Fowler’s position: in this position the head of the bed is elevated 45 to 60, and the patient’s knees are slightly elevated without pressure to restrict circulation in the lower legs. Supine position: patients rest in their backs. Side-lying position: (or lateral) position patients rest on the side with major portion of body weight on the dependent hip and shoulder. (30 degree recommended). Sims’ position: patient places the weight on the anterior ileum, humerus, and clavicle. Prone position: patient lies face or chest down. Moving Patients: When repositioning and moving patients, a safe transfer is always the first priority. Always ask patients to help to their fullest extent possible. Determine whether the patient comprehends what is expected. Restorative and Continuing Care: The goal of restorative care for the patient who is immobile is to maximize functional mobility and independence and reduce residual functional deficits such as impair gait and decrease endurance. Focus is not only on ADLs that relate to physical self-care but also on instrumental activities of daily living (IADLs); baking, preparing meals, banking, shopping, and taking medications. Range of Motion Exercises: ensure adequate joint mobility. Walking: assess activity tolerance, tolerance of the upright position, strength, and presence of pain, coordination, and balance to determine the amount of assistance needed. LR