Fundamentals of Nursing Chapters 2, 6, 9, 15, 48, and 49
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Define comparative analysis
- Involves assessing study findings for their implementation potential.
- Three factors are considered:
- 1) How the study's findings compare to findings from other studies about the problem
- 2) How the study's findings will transfer from the research conditions to the clinical practice conditions in which they will be used
- 3) Practical or feasibility considerations that need to be addressed when applying the findings in practice
Means that any information a participant relates will not be made public or available to others without the participant's consent
Define content analysis
Data analysis that involves searching for themes and patterns.
Define cost-benefit analysis
Involves the consideration of the potential risks and benefits of both implementing a change based on a study's findings and not implementing a change
- Critically read and evaluate
- To determine whether the findings of a study are of sufficient quality to be used to influence practice decisions
Define dependent variable
A behavior, characteristic or outcome that the researcher wishes to explain or predict
Define descriptive statistics
Procedures that organize and summarize large volumes of data including measures of central tendency and measures of variability
Focuses on cultural patterns of thoughts and behaviors
Define evidence-based practice (EBP)
Clinical decision making based on the simultanious use of the best evidence, clinical expertise, and client's values.
Define extraneous variables
- Any variables that could influence the results of the study other than the specific variables being studied for their influence.
- Contaminating factors in the study environment, and an objective and distanced relationship between the researcher and what is being studied.
Define grounded theory
Focuses on social processes
A predictive statement about the relationship between two or more variables
Define independent variable
The presumed cause of or influence on the dependent variable
Define inferential statistics
- Allows researchers to test hypotheses about relationships between variables or differences between groups
- Particularly useful when a researcher wants to establish the effectiveness of an intervention
- COMMONLY USED INFERENTIAL STATISTICS:
- - 1. Independent t-test: Used to compare the mean performance of two independent groups (such as men and women)
- - 2. Depenfent (or paired) t-test: Used to compare the mean performance of two dependent or relatedgroups (such as a before and after test given to the same individuals)
- - 3. Analysis of variance (ANOVA): Used to compare the mean performance of three or more groups
- - 4. Pearson's product-moment correlation coefficient (Pearson's r): Used to describe and test the relationship etween two continuous variables (such as age and weight)
- - 5. Chi-squared: Used to compare the distribution of a condition across two or more groups
Define logical positivism
Maintains that "truth" is absolute and can be discovered by carful measurement. This perspective proposes that phenomena are best understood by examining their component parts; this is referred to as a reductionistic perspective. Positivism is the philosophical perspective of natural sciences such as biology and chemistry.
Define measures of central tendency
- Provide a single numerical value that denotes the "average" value for a variable
- Mean: The arithmetic average for a set of scores. Teh mean is calculated by summing all scores and dividing by the number of scores
- Median: The middle value in a distribution of scores or the value above and below which 50% of the scores lie
- Mode: The most common or frequently occurring value in a data set
Define measures of vaiability
- Describe how values for a variable are dispersed or spread out.
- Range: The difference or span between the lowest and highest value for a variable
- Standard deviation: The average amount by which a single score in a distribution deviates or differes from the mean score.
Logistics or mechanics
- Sometimes referred to as constructivism
- Maintains that reality is relative or contextual and constructed by individuals who are experiencing a phenomenon
- This philosophical perspective is reflected inteh human sciences such as anthropology, sociology, and existential phychology
Focuses on lived experiences
Define pilot study
- A "dress rehersal" before the actual study begins
- Helpful for detecting problems such as instructions or questionnaire items that can be misunderstood and for providing a chance to correct these problems before formal data collection procedures get under way
Define qualitative research
- The systematic collection and thematic analysis of narrative data
- The research collects and analyzes words, rather than numbers
- Rooted in the philosophical perspective of naturalism
Define quantitative research
- The systematic collection, statistical analysis, and interpretation of numerical data
- Characterized by planned and fixed study processes, careful attention to extraneous variables or contaminating factors in the study environment, and an objective and distanced relationship between the researcher and what is being studied
Consistency of measures
Using formal and systematic processes to address problems and answer questions
Define research design
Refers to the overall strcture or blueprint or general layout of a study
Define research process
A process in which decisions are made that result in a detailed plan or proposal for a study, as well as the actual implementation of the plan.
- Sources of information for a study may be humans, events, behaviors, documents, or biological specimens.
- They ar carefully selected so that they are as accurate representation as possible ofthe target population or the universe of elements to which the researcher wishes to be able to apply the study's findings.
- A carefully chosen segment of the target population
- A key factor in the usefulness of a study's findings for evidence-based practice, since findings ar emore likely to be replicated in practice settins when there isa close match between the characteristics of athe study sample and th char
Define scientific validation
A thorough critique of a study for its conceptual and methodological integrity. It means scrutinizing how the study ws conceptualized, designed, and conducted tin order to make a judgment about the overall quality of its findings
Define statistically significant
- Means that they are not likely to have occurred only by chance
- This is linked to probability
Define target population
The universe of elements to which the researcher wishes to be albe to apply the study's findings
- Refers to the completeness and conceptual accuracy of measures.
- The way in which it is established depends on the data collection procedure bing used and the nature of the data being collected.
- Running a pilot test allows a researcher to do a preliminary estimate of it.
Define case management
- Describes a range of models for integrating health care services for individuals or groups.
- Generally involves multidisciplinary teams that assume collaborative responsibility for planning, assessing needs, and coordinating, implementing, and evaluating care for groups of clients from preadmission to discharge or transfer and recuperation
The percentage share (usually 20%) of a government-approved charge that is paid by the client; the remaining percent is paid by thr plan
Define critical pathways
- An interdisciplinary plan or tool that specified interdisciplinary assessments, interventions, treatments, and outcomes for helath-related conditions across a time line.
- Also called critical paths, interdisciplinary plans, anticipated recovery plans, and action plans
Define diagnosis-related groups (DRGs)
A system that has categories that establish pretreatment diagnosis billing categories
Define differentiated practice
- A system in which the best possible use of nursing personnel is based on their educational preparation and resultant skill sets.
- Models consist of specific job descriptions for nurses acording to their education or training, for example, LVN, associate degree RN, BSN RN, MSN RN, or APN.
- The model is customized within each health care institution by the nurses employed there
Define health care system
- The totality of services offered by all health disciplines
- It is one of the largest inductries in the U.S.
- Previously the major purpose was to provide care to people who were ill or injured
- Now they are to increase awareenss of health promotion, illness prevention, and levels of wellness
Define health maintenance organization (HMO)
- A group health care agency that provides health maintenance and treatment service to voluntary enrollees
- A fee is set without regard to the amount or kind of services provided
- This plan emphasizes client wellness
- The fewer services that are needed nd the greater the agency's profit
Define independent practice associations (IPAs)
- Somewhat like HMO and PPOs, provides care in offices, just as the providers belonging to a PPO do
- Difference: Clients pay a fixed prospective payment to teh IPA and the IPA pays the provider
- Some instances: Teh health care provider bills the IPA for services
- In others: The provider receives a fixed fee for services given
- End of the fiscal year: Any surplus money is divided among the providers; any loss is assumed by the IPA
Define integrated delivery system (IDS)
- System incorporates acute care services, home health care, extended and skilled care facilities, and outpatient services
- Most integrated delivery systems provide care throughout the life span Insurers can contract with IDSs to provide all required services, rather than the insurer contracting with multiple agencies for the same services
- Enhances continuity of care and communication between professionalsand various agencies providing managed care
Define licensed vocational (practical) nurse (LVN/LPN)
Also known as a Licensed practical nurse (LPN) provides direct client care under the direction of a registered nurse, physician, or other licensed practitioner
Define managed care
- A healthcare system whose goals are to provide cost-effective, quality care that focuses on decreased costs and improved outcomes for groups of clients
- Healthcare providers adn agencies collaborate to render the most appropriate, fiscally responsible care possible
- Denotes an emphasis on cost controls, customer satisfaction, health promotion, and preventive services
- Established in 1965 under Title 19 of the Social Security Act
- A federal public assistanceprogram paid out of general taxes to people who require financial assistance, such as people with low incomes
- Paid by federal and state governments
- Each state program is distinct and some provide very limited coverage, while other pay for dental care, eyeglasses, and prescription drugs
- Established in 1965 under Title 18 to the Social Security Act
- Provided a national and state health insurance program for older adults
- Mid-1970s: Virtually everyone over 65 years of age was protected by hospital insurance under Part A, which also includes post-hospital extended care adn home health benefits
- 1972: Coverage was broadened to include workers with permanent disabilities and their dependents who are eligible for disability insurance under Social Security
- 1988: Congress expanded Medicare to include extremely expensive hospital care, "catastrophic care", and expensive drugs
- 1997: Balanced Budget Act, annual screening mamograms for women over age 40 are now a fully covered cost under Medicare
- Devided into four parts
- Part A: Available to people with disabilities and people 65 years and over - provides insurance toward hospitalization, home care, and hospice care
- Part B: Voluntary and provides partial coverage of outpatient and physician service to people eligible for part A
- Part D: The voluntary prescription drug plan begun in January 2006
- Does not cover dental care, dentures, eyeglasses, hearing aids, or examinations to prescribe and fit hearing aids. Most preventive care, including routine physical examinations and associated diagnostic tests, is also not included.
- NOTE: Most clients pay a monthly premium for parts B and D coverage and clients pay a deductible and coinsurance (usually 20%)
Define patient-focused care
A delivery model that brings all services and care providers to the clients. The supposition is that if activities normally provided by auxiliary personnel are moved closer to the client, the number of personnel involved and the number of steps involved to get the work done are decreased.
Define Preferred Provider Arrangements (PPAs)
- Similar to PPOs
- Difference: PPAs can be contracted with individual halth care providers, whereas PPOs involve an organization of health care providers
- Limited: Restricts the client to using only preferred providers of health care
- Unlimited: Permits the client to use any health care provider in the area who accepts the contractual agreement of the plan
- NOTE: More choices in health care providers may mean more cost to the enrollee
Define Preferred Provider Organization (PPO)
- Consist of a group of providers and perhaps a health care agnecy (often a hospital) that provide an insurance company or employer with health services at a discounted rate
- Advantage: It provides clients with a choice of health care providers and services; Providers can belong to one or several PPOs and the client can choose among the providers belonging to the PPO
- Disadvantage: They tend to be more expensive than HMO plans, and if individuals wish to join a PPO, they might have to pay more for hte additional choices.
Define Supplemental Security Income (SSI) benefits
- Special payments: Persons with disabilities or those who are blind
- Benefits: Available to people not eligible for Social Security, and payments are not restricted to health care costs
- Clients often use this money to purchase medicines or to cover costs of extended health care
Define team nursing
- The delivery of individualized nursing care to clients by a team led by a professional nurse
- The team consists of registered nurses, licensed practical nurses, and unlicensed assistive personnel
- This team is responsible for providing coordinated nursing care to a group of clients.
Define clinical decision support systems
- Electronic forms of these tools, which incorporate evidence from the literature into particular client situations in order to guide care planning
- The usefulness in nursing relates, in part, to the inability of humans to retain or recall sufficient quantitites of the immense amoutn of knowledge needed to provide safe care
- Many different computer systems exist:
- - 1: Simple alarms that appear when medicatl orders conflict with another aspect of the client's situation
- - 2: Others provide step-by-step online tools to assist emergency department nurses in determining which clients should receive the most immediate attention or are comprehensive programs integrated with a system-wide EMR
Define Computer-based Patient Records (CPRs)
Electronic client data retrievable by caregivers, administrators, accreditors, and other persons who require the data
Define data warehousing
The accumulation of large amounts of data that are stored over time
Define distance learning
learning in which people communicate effectively across long distances
Define electronic medical records (EMRs)
- electronic client data retrievable by caregivers, administrators, accreditors, and other persons who require the data
- NOTE: Same as computer-based patient records (CPRs)
Define Hospital Information System (HIS)
computer software program suite used to manage client, financial, and administrative data
Define managment information system (MIS)
software designed to facilitate the organization and application of data used to manage an organization or department
Define nurse informaticist
an expert who combines computer, information, and nursing science to develop policies and procedures that promote effective use of computerized records by nurses and other health care professionals
Define nursing informatics
the science of using computer information systems in the practice of nursing
The use of computers to systematically solve problems
technology used to transmit electronic medical data about clients to persons at distant locations
Define change-of-shift report
a report given to nurses on the next shift
a formal, legal document that provides evidence of a client's care
the process of making an entry on a client record
Define charting by exception (CBE)
a documentation system in which only significant findings or exceptions to norms are recorded
Define client record
- a formal, legal document that provides evidence of a client's care
- NOTE: same as chart
an informal oral consideration of a subject by two or more health care personnel to identify a problem or establish strategies to resolve a problem
The process of making an entry on a client record; charting, recording
Define flow sheet
A record of the progress of specific or specialized data such as vital signs, fluid balance, or routine medications; often charted in graph form
Define focus charting
A method of charting that uses key words or foci to describe what is happening to the client
Define handoff communication
Defined as a process in which information about patient/client/resident care is communicated in a consistent manner including an opportunity to ask and respond to questions
The trade name for a method that makes use of a series of cards to concisely organize and record client data and instructions for daily nursing care-especially care that changes frequently and must be kept up to date
Define narrative charting
A descriptive record of client data and nursing interventions, written in sentences and paragraphs
An acronym for a charting model that follows a recording sequence of problems, interventions, and evaluation of the effectiveness of the interventions
Define problem-oriented medical record (POMR)
Data about the client are recorded and arranged according to the client's problems, rather than according to the source of the information
Define problem-oriented record (POR)
- Data about the client are recorded and arranged according to the client's problems, rather than according to the source of the information
- NOTE: Same as POMR
Define progress note
Chart entries made by a variety of methods and by all health professionals involved in a client's care for the purpose of describing a client's problems, treatments, and progress toward desired outcomes
A written communication providing formal, legal documentation of a client's progress
The process of making written entries about a client on the medical record
Whether oral or written, it should be concise, including pertinent information but no extraneous detail
An acronym for a charting method that follows a recording sequence of subjective data, objective data, assessment, and planning
Define source-oriented clinical record
A record in which each person or department makes notations in a separate section or sections of the client's chart
A variation or deviation from a critical pathway; goals not met or interventions not performed according to the time frame
Reliability is the degree of consistency that an instrument measures.
In 1985, the ANA endorsed which level of nursing education for entrance into professional practice?
- To qualify as a profession, the entry level to nursing practice should be at a baccalaureate level.
Which educational program prepares the nurse for advanced clinical practice, administration, education, and research?
- Ph D, DNS, ND
- Doctoral programs prepare the nurse for advanced clinical practice, education, administration, and research. The greatest emphasis on any doctoral program is research.
Which action is most appropriate when an 85-year-old client tells a nurse, "I signed the papers for the research study because the doctor was so insistent, but I really don't understand it"?
1. Ask the physician to explain the study again to this client.
2. Ask the client what questions he has, and tell him that no one will be angry if he changes his mind.
Answer: Ask the client what questions he has, and tell him that no one will be angry if he changes his mind.
Rational: Asking the client about their questions regarding the study and indicating the right to withdraw protects the client's right of self-determination. The right of self-determination allows the subject to choose to take part in the study free from constraints, coercion, or undue influence. Reassuring the client that he will be fine and saying that the study will be ruined are forms of coercion. The client perceived undue pressure from the physician, so it would do no good to have this same physician explain the study again.
Define the situation, background, assessment, and recommendation (SBAR) process
A structured approach to documentation used when nurses communicate with primary care providers and other nurses about client status
Define evidence based practice
The process by which nurses make clinical decisions using the best available research evidence, their clinical expertise, and patient preferences
Who was Florence Nightingale?
- The first nurse researcher in the 1800's
- Convinced hospital administrators to improve conditions using statistics = handwashing was key
What are the 6 steps of evidence based practice?
- 1. Assess the need for change in practice
- 2. Locate best evidence
- 3. Critically analyze evidence
- 4. Design practice changes
- 5. Implement changes and evaluate the progress
- 6. Integrate and maintain changes in practice
What are concerns of using evidence based practice?
- Differs from real world
- Stiffles creativity
- Ignores significant life events
- Not all research is flawless
- Not always cost effective
- More relevant for physical problems
- May not consider organization culture or resources available
Define quantitative data
- Systematic collection
- Statistical analysis
- Interpretation of numerical data (numbers)
- Cause and effect relationship
- Statistically analyze/interpret
- Reality: Stable
- Data: Numbers = hard data
- Perspective: Outsider
- Approach to knowing: Reductionistic
- Sesearch considerations: ontrolled labratory
- Research approach: objective, structured rational, empirical
- Goal: Verification test theory
- Methods: Measurement
- Data analysis: Deductive stats
- Outcome: Facts
- Finding results: Replicable, reliable, generalizable
Define qualitative data
- Systematic collection
- Thematic analysis of narrative data
- Explores human experiences
- Qualitative traditions
- Phenomenology (lived experiences)
- Ethnography (cultural patterns)
- Grounded theory (social processes)
- View holistically (tells a story)
- Reality: Personal/contextual
- Data: Words (soft) data
- Perspective: Insider
- Approach to knowing: Contextual/holistic
- Research considerations: Naturalistic field work
- Research approach: Subjective artistic, intuitive
- Goal: Discovery generate theory
- Methods: Thick description
- Data analysis: Inductive, intuitive themes
- Outcome: meaning understanding
- Finding results: Valid, credible, transferrable
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