RN-BC: Medical-Surgical Certification
Review -Questions and Answers.
Nursing Code of Conduct -
\• Participating in intra-professional collaboration
• Avoiding conflicts of interests
• Maintaining respect for human dignity
• Integrating professional values with personal values
The Code of Ethics from the American Nurses Association (ANA) states in
point 5.3: "Nurses have both personal and professional identities that are
neither entirely separate, nor entirely merged, but are integrated. In the
process of becoming a professional, the nurse embraces the values of the
profession, integrating them with personal values. Duties to self involve an
authentic expression of one's own moral point-of-view in practice. Sound
ethical decision-making requires the respectful and open exchange of views
between and among all individuals with relevant interests."
Nursing Ethics -
\Ethics: moral principles that govern behavior; ideal, standards
Principles:
• Autonomy: duty to allow patient to make independent decisions
• Veracity: duty to tell the truth
• Fidelity: duty to keep promises and commitments
• Justice: duty to provide equal and fair distribution of resources
• Beneficence: duty to promote good and take positive actions
• Nonmaleficence: duty to do no harm and avoid negative actions
• Confidentiality: duty to keep some information from disclosure without
consent
• Privacy: duty to protect physical body or information from unauthorized
view
Ethical Dilemmas -
\Issues surrounding quality-of-life, end-of life, and DNR orders most often
trigger ethical dilemmas, when no clear course of action is apparent.
Obtain a referral to ethics committee for disagreements about treatments:
• Between family members
• Among healthcare providers
• Between healthcare providers and the patient or family
Advocacy -
\What it is: action or series of actions that argues for, speaks in favor of,
recommends, or supports another person, place, or thing
,Nursing Advocacy:
• Integrates individuality, professionalism, and empowering
• Involves a process of analyzing, counseling, responding, and shielding
An effective nursing advocate actively participates in supporting patients'
wishes and needs through listening, educating, and collaborating. The ANA
2001 Code of Ethics includes:
• The nurse's primary commitment is to the patient, whether an individual,
family, group, or community.
• The nurse promotes, advocates for, and strives to protect the health, safety,
and rights of the patient. (ANA, 2001)
Kubler-Ross Stages of Grief -
\Patients, families, and other caregivers can progress through these stages.
• Denial: avoiding the inevitable
• Anger: expressing emotions previously bottled-up
• Bargaining: trying to find a way out
• Depression: acknowledging the inevitable
• Acceptance: moving forward
Leadership Styles -
\Autocratic: unilateral, dictatorial, works toward single goal; meets resistance
from mature, experienced staff
Democratic/participative: team approach, staff participation, retains responsibility for
outcome
Laissez-faire: little control; leaves decision to others; works well with committed,
motivated staff who can analyze well
Charismatic: trigger emotional response; eloquent communicator and
persuader
Transformational: connection between leader and follower increases motivation for
problem -solving
Transactional: compliance via reward/ punishment system
Quantum: flexible, non-controlling, analytical, empathetic, visionary team player
Situational/Contingency: match style to situation; high-stress situations are best handled
by task-oriented leaders; moderate situations are best handled by relationship-oriented
leader
Shared Governance -
\What it is:
• A model of nursing practice designed to improve work environment, satisfaction, and
nurse retention
• Champions staff as most important asset of organization
• Encourages autonomy, empowerment, involvement, and participation
• Teams and groups are designed to be self-led and self-managed
Nursing Application:
,Bedside nurses are given equal footing with managers and leaders in the
creation of policies, procedures, and other decision-making processes that
directly affect nursing practice within the organization.
Adult Learning -
\The education process should reflect the nursing process (assess, plan, implement,
evaluate)
• Multiple sensory avenues for learning increases learning and retention.
• Doing and saying (teach-back) is more effective than reading and hearing.
• Learning needs: patient goals met through instruction
• Non-learning needs: patient goals met through something other than instruction or in
combination with instruction
Basic Learning Styles:
• Visual: reading instructions or watching demonstration
• Hearing: listening to instructions while performing
• Tactile: hands-on
Learning Barriers -
\Physical Impairments: inadequacies of the five senses; impaired mobility
• Cognitive: mental disability or impairment; dyslexia, phobias
• Language: aphasic; lack of fluency, reads at less than 8th grade level
• Emotional: fear/superstitions, anxiety, depression
• Religious/cultural: values differ, beliefs focus on healing from a higher power, dietary
restrictions
• Financial: patient perception that they are unable financially to follow recommended
plan of care
Teaching Strategies—Adults -
\Assess: mental and physical capabilities, perception of the problem, preferred
learning style
Plan: establish mutual goals with patient that are specific, practical, attainable, relevant,
and culturally sensitive
Intervene: use multiple methods to enhance learning; ensure methods use vocabulary
suited to learner's comprehension
- Oral, written, or electronic information via internet
- Visual/pictorial information such as DVDs and charts
- Demonstration and return demonstration
- Peer learning
- Group work
Evaluate: observe the patient/family implement new skills, request a "teachback"
from the patient; assess comments and conversations for misinformation or gaps in
learning
Maslow's Hierarchy of Needs -
, \Physiological: basic needs such as air, water, food, shelter, and freedom from pain
(comfort)
Safety: free from harm or threat of harm; stability
Love/Belonging: friendship, acceptance, affection; support system
Esteem: self-respect, self-confidence, rewarding work/relationships
Self-actualization: truth, justice, beauty, personal growth, "born to do"
These drives (needs) are met in order from physiological to self-actualization. Illness
can change a patient's focus to meeting basic needs as the priority.
Nursing Diagnoses, Domains -
\NANDA-II taxonomy, 13 Domains (47 Classes, 216 Diagnoses)
• Activity/Rest
• Comfort
• Coping/Stress Tolerance
• Elimination
• Growth/Development
• Health Promotion
• Life Principles
• Nutrition
• Perception/Cognition
• Role Relationships
• Safety/Protection
• Self-perception
• Sexuality
Nursing Diagnoses, Format -
\Diagnosis: (example) Imbalanced nutrition: Less than body requirements
Related to: (example) Insufficient caloric intake
Evidenced by: (example) Weight loss
Expected Outcomes: (example) The patient will achieve and maintain adequate weight
(use NOC terminology)
Nursing Interventions (independent/collaborative): Use words such as assess, monitor,
teach, assist, provide, and record. For collaborative, use words such as obtain consult
and administer medications, tube feedings, etc. (refer to NIC terminology)
Evaluation: (example) The patient achieves and maintains optimal weight.
Nursing Intervention Classification -
\What it is:
A list of 554 interventions (in 2013 6th ed.) that nurses perform; includes direct, indirect,
collaborative, and independent interventions that address both physiologic and
psychosocial aspects of patient care. Interventions fall into three categories: illness
prevention, illness treatment, and health promotion.
Nursing Application:
The standardized language of these interventions should be used when
Review -Questions and Answers.
Nursing Code of Conduct -
\• Participating in intra-professional collaboration
• Avoiding conflicts of interests
• Maintaining respect for human dignity
• Integrating professional values with personal values
The Code of Ethics from the American Nurses Association (ANA) states in
point 5.3: "Nurses have both personal and professional identities that are
neither entirely separate, nor entirely merged, but are integrated. In the
process of becoming a professional, the nurse embraces the values of the
profession, integrating them with personal values. Duties to self involve an
authentic expression of one's own moral point-of-view in practice. Sound
ethical decision-making requires the respectful and open exchange of views
between and among all individuals with relevant interests."
Nursing Ethics -
\Ethics: moral principles that govern behavior; ideal, standards
Principles:
• Autonomy: duty to allow patient to make independent decisions
• Veracity: duty to tell the truth
• Fidelity: duty to keep promises and commitments
• Justice: duty to provide equal and fair distribution of resources
• Beneficence: duty to promote good and take positive actions
• Nonmaleficence: duty to do no harm and avoid negative actions
• Confidentiality: duty to keep some information from disclosure without
consent
• Privacy: duty to protect physical body or information from unauthorized
view
Ethical Dilemmas -
\Issues surrounding quality-of-life, end-of life, and DNR orders most often
trigger ethical dilemmas, when no clear course of action is apparent.
Obtain a referral to ethics committee for disagreements about treatments:
• Between family members
• Among healthcare providers
• Between healthcare providers and the patient or family
Advocacy -
\What it is: action or series of actions that argues for, speaks in favor of,
recommends, or supports another person, place, or thing
,Nursing Advocacy:
• Integrates individuality, professionalism, and empowering
• Involves a process of analyzing, counseling, responding, and shielding
An effective nursing advocate actively participates in supporting patients'
wishes and needs through listening, educating, and collaborating. The ANA
2001 Code of Ethics includes:
• The nurse's primary commitment is to the patient, whether an individual,
family, group, or community.
• The nurse promotes, advocates for, and strives to protect the health, safety,
and rights of the patient. (ANA, 2001)
Kubler-Ross Stages of Grief -
\Patients, families, and other caregivers can progress through these stages.
• Denial: avoiding the inevitable
• Anger: expressing emotions previously bottled-up
• Bargaining: trying to find a way out
• Depression: acknowledging the inevitable
• Acceptance: moving forward
Leadership Styles -
\Autocratic: unilateral, dictatorial, works toward single goal; meets resistance
from mature, experienced staff
Democratic/participative: team approach, staff participation, retains responsibility for
outcome
Laissez-faire: little control; leaves decision to others; works well with committed,
motivated staff who can analyze well
Charismatic: trigger emotional response; eloquent communicator and
persuader
Transformational: connection between leader and follower increases motivation for
problem -solving
Transactional: compliance via reward/ punishment system
Quantum: flexible, non-controlling, analytical, empathetic, visionary team player
Situational/Contingency: match style to situation; high-stress situations are best handled
by task-oriented leaders; moderate situations are best handled by relationship-oriented
leader
Shared Governance -
\What it is:
• A model of nursing practice designed to improve work environment, satisfaction, and
nurse retention
• Champions staff as most important asset of organization
• Encourages autonomy, empowerment, involvement, and participation
• Teams and groups are designed to be self-led and self-managed
Nursing Application:
,Bedside nurses are given equal footing with managers and leaders in the
creation of policies, procedures, and other decision-making processes that
directly affect nursing practice within the organization.
Adult Learning -
\The education process should reflect the nursing process (assess, plan, implement,
evaluate)
• Multiple sensory avenues for learning increases learning and retention.
• Doing and saying (teach-back) is more effective than reading and hearing.
• Learning needs: patient goals met through instruction
• Non-learning needs: patient goals met through something other than instruction or in
combination with instruction
Basic Learning Styles:
• Visual: reading instructions or watching demonstration
• Hearing: listening to instructions while performing
• Tactile: hands-on
Learning Barriers -
\Physical Impairments: inadequacies of the five senses; impaired mobility
• Cognitive: mental disability or impairment; dyslexia, phobias
• Language: aphasic; lack of fluency, reads at less than 8th grade level
• Emotional: fear/superstitions, anxiety, depression
• Religious/cultural: values differ, beliefs focus on healing from a higher power, dietary
restrictions
• Financial: patient perception that they are unable financially to follow recommended
plan of care
Teaching Strategies—Adults -
\Assess: mental and physical capabilities, perception of the problem, preferred
learning style
Plan: establish mutual goals with patient that are specific, practical, attainable, relevant,
and culturally sensitive
Intervene: use multiple methods to enhance learning; ensure methods use vocabulary
suited to learner's comprehension
- Oral, written, or electronic information via internet
- Visual/pictorial information such as DVDs and charts
- Demonstration and return demonstration
- Peer learning
- Group work
Evaluate: observe the patient/family implement new skills, request a "teachback"
from the patient; assess comments and conversations for misinformation or gaps in
learning
Maslow's Hierarchy of Needs -
, \Physiological: basic needs such as air, water, food, shelter, and freedom from pain
(comfort)
Safety: free from harm or threat of harm; stability
Love/Belonging: friendship, acceptance, affection; support system
Esteem: self-respect, self-confidence, rewarding work/relationships
Self-actualization: truth, justice, beauty, personal growth, "born to do"
These drives (needs) are met in order from physiological to self-actualization. Illness
can change a patient's focus to meeting basic needs as the priority.
Nursing Diagnoses, Domains -
\NANDA-II taxonomy, 13 Domains (47 Classes, 216 Diagnoses)
• Activity/Rest
• Comfort
• Coping/Stress Tolerance
• Elimination
• Growth/Development
• Health Promotion
• Life Principles
• Nutrition
• Perception/Cognition
• Role Relationships
• Safety/Protection
• Self-perception
• Sexuality
Nursing Diagnoses, Format -
\Diagnosis: (example) Imbalanced nutrition: Less than body requirements
Related to: (example) Insufficient caloric intake
Evidenced by: (example) Weight loss
Expected Outcomes: (example) The patient will achieve and maintain adequate weight
(use NOC terminology)
Nursing Interventions (independent/collaborative): Use words such as assess, monitor,
teach, assist, provide, and record. For collaborative, use words such as obtain consult
and administer medications, tube feedings, etc. (refer to NIC terminology)
Evaluation: (example) The patient achieves and maintains optimal weight.
Nursing Intervention Classification -
\What it is:
A list of 554 interventions (in 2013 6th ed.) that nurses perform; includes direct, indirect,
collaborative, and independent interventions that address both physiologic and
psychosocial aspects of patient care. Interventions fall into three categories: illness
prevention, illness treatment, and health promotion.
Nursing Application:
The standardized language of these interventions should be used when
