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- Established the first nursing philosophy based on health maintenance and restoration
- Role of nursing is “having charge of someone’s health” based on the knowledge of “how to put the body in such a state to be free of disease or to recover from disease”
- First organized program for training nurses
- Major reforms in hygiene, sanitation, and nursing practice.
- Nursing Theory-
- Facilitate the body’s reparative processes by manipulating the patient’s environment
- Nurse manipulates client’s environment to include appropriate noise, nutrition, hygiene, light, confort, socialization,
- and hope.
Lillian Wald and Mary Brewster-
- opened the Henry Street settlement, which focused on the health needs of the poor people.
- Nurses working here were some of the first to demonstrate autonomy. Therapies aimed at wellness through proper care.
Brenner and Wrubel:
- Focus on client’s need for caring as a means of coping with stressors of illness.
- Caring is central to the essence of nursing.
- Caring creates the possibilities for coping and enables possibilities for connecting with and concern for others.
- Provide care consistent with nursing’s emerging science and knowledge with caring as central focus.
- Transcultural care theory- caring is the central and unifying domain for nursing knowledge and practice.
- Caring is the essence of nursing and the dominant, distinctive, and unifying feature of nursing.
- Goal is to provide the client with culturally specific nursing care.
- Promote health, restore client to health, and prevent illness.Involves the philosophy and science of caring.
- Caring is an interpersonal process comprising interventions to meet human needs.
- Views nursing as being responsible for developing interventions to prevent or reduce stressors on the client or to
- make them more bearable for the client.
- Assist individuals, families, and groups, in attaining and maintaining maximal level of total wellness by purposeful
- interventions.Stresses the importance of accuracy in assessment and interventions that promote optimal wellness using primary, secondary, and tertiary prevention strategies.
- develop interaction between nurse and client
- focuses on nursing as a significant, therapeutic interactive process between nurse and client- interpersonal relationship
goal is to help pt be as independent as possible by doing those activiities that contribute to health ,recovery or peaceful death
- unitary human being interacting with the universe.
- an energy field composed of a four dimensional energy field
- help client perform self care and only doing those things that the pt themselves cannot do; help pt get to point to independently meet their own needs
- help person adapt to changes in needs
- meet physiological needs, develop positive self concept, perform social roles, achieve balance between dependence and independence
use communication to reestablish positive adaptation to environment
provide service to individuals based on 21 nursing problems
- broad in scope, complex and therfor require furthe specification through research.
- provides streuctureal framwork for broad. abstract ideas about nursing
- limited in scope and are less abstract
- address a specific phenomenon and reflect practice
- first level of theory develpment
- describe phenomena, speculate on why phenomena occur, describe the consequences of phenomena
- explain, relate and in some situations predict nursing phenomena
- address nursing interventions for a phenomenon and predict the consequence of a specific nursing intervention
- test the validity and predictability of a nursing intervention
components of a theory:
concepts, definitions and assumptions or propositions
manages client care and the delivery of specific nursing services withing a health care agency
Community health care:
- Community-based health care is a model of care that reaches everyone in the community (including the poor and underinsured), focuses on primary rather than institutional or acute care, and provides knowledge about health and health promotion and models of care to the community.
- Community health issues include: Increase in homelessness, immigrant population, STDs, underimmunization of infants and children, and life threatening and emerging infectious diseases.
Public health nurse:
- requires understanding the needs of a population (collection of individuals who have in common one or more personal
- or environmental characteristics) i.e. high risk infants, older adults, NativeAmericans
- Understands factors that influence health promotion and health maintenance, the trends and patterns influencing the incidence of disease within populations, environmental factors contributing to health and illness, and the political process used to affect public policy
Community health nursing:
- practice in the community, with the primary focus on the health care of individuals, families and groups in a community.
- Like a public health nurse, they also provide direct care to subpopulations which is their specialty i.e. older adults, but they look at their care in the context of the entire community
- **In looking at community health nursing, the student recognizes that it includes direct care and services to subpopulations
Community based nursing:
- care that takes place in community settings such as the home or a clinic, where the focus is on the needs of the individual or family; enhances their capacity for self-care and promotes autonomy in decision making
- Nurse works with client, their family, friends, and coworkers
- **A student nurse visiting a nurse-managed clinic should expect to see which of the following services offered? Family Support Services
- **As a community health nurse assisting the client and family with nutritional needs the nurse should first: Ask the client and family what they think they should eat
- **In assessing the structure of the community in order to identify the needs of its population, the nurse will focus on:observing locations where services, such as water sanitation, are provided
- those clients who are more likely to develop health problems as a result of excess risks, who have limits in access to health care services, or who are dependent on others for care i.e. persons living in poverty, older adults, homeless persons, immigrant populations, abused people,
- substance abusers, mentally ill
- Homeless clients have even fewer resources than the poor (no job, no shelter, no food)
- **Thegreatest current health care challenge to nurses: homelessness
Nursing interventions for care of the homeless:(there are primary, secondary, and tertiary for each)
- 1- prevent or reduce frequency of homeless experiences
- 2-assist homeless in reducing factors that keep them homeless and in faining skills to move higher
- 3-increase amount of interaction with service proiders and acceptance of resources
A nurse is planning interventions for the clients of a homeless shelter. Which of theactivities represents a primary level intervention regarding sexually transmitted diseases?
sex ed for teenage residents
The nurse working in a free clinic is caring for a homeless client diagnosed with paranoid schizophrenia who has reported that, “I hurt my foot running away from them. It hurts so bad I can hardly walk now” On assessment the nurse notices bruising on the client’s back, arms, and thighs, a red rash on both neck and face, and poor personal hygiene, in addition to edema of the left ankle. The nurse should first realize that this client is at risk for:
physical abuse and assault
factors that support adoption of change:
- Clients are more likely to accept a change if it is more advantageous, compatible, realistic, and easy to adopt
- **In goal setting, the nurse is aware that the factor that is associated with available client resources and motivation is: Realistic
- Freud’s psychoanalytic model of personality development states individuals go through five stages of psychosexual development and that each stage was characterized by sexual pleasure in parts of the body: mouth,
- anus, and genitals.
Oral Stage, Anal Stage, Phallic Stage, Latent Stage,Genital Stage
According to Erickson’s eight stages of growth and development, individuals need to accomplish a particular task before successfully mastering the stage and progressing to the next one.
Trust/Mistrust, Autonomy/Sense of Shame, Initiative/Guilt, Identity/Role Confusion, Intimacy/Isolation, Generativity/Self-Absorbtion and Stagnation, Integrity/Despair
Piaget’s theory of cognitive development (Sensorimotor Development) includes four periods that are related to age and demonstrate specific categories of knowing and understanding
Sensorimotor, Preoperational, Concrete Operations,Formal Operations
- Level 1 -Preconventional Reasoning: Punishment/Obedience, Instrumental Relativist Orientation
- Level 2 -Conventional: Good boy/Nice girl, Society Maintaining
- Level 3 -Postconventional: Social Contract, Universal Ethical Principle
Maslow’s hierarchy of needs states that certain human needs are more basic than others; and that those needs need to be met before others
used in addition to conventional treatment recommended by the person’s health care provider (i.e. diet, massage therapy, meditation, therapeutic touch)
The goal of herbal therapy is to restore balance within the individual by facilitating the person’s self-healing ability. Very popular in Chinese and Ayurvedic medicine, herbal substances come from plants, animals, or minerals.
Multiple biologically bases therapies that use substances found in nature, such as herbs, foods, and vitamins (i.e. high protein diet, vegan diet, herbal therapy)
Naturopathic medicine: System of therapeutics based on natural foods, light, warmth, massage, fresh air, regular exercise, and avoidance of medications. Recognizes inherent healing ability of the body. Treatments integrate traditional natural therapies with modern diagnostic science; includes botanical medicine.
The holistic health model of nursing attempts to create conditions that promote optimal health. Clients are involved in their healing process, thereby assuming some responsibility for health maintenance. Nurses recognize the natural healing abilities of the body and incorporate complementary and alternative interventions, such as music therapy, relaxation therapy, therapeutic touch, and guided imagery.
model care of delivery that places the RN at the pts bedside
Total pt care:
An RN is responsible for all aspects of care for one or more clients. He/She may delegate aspects of care to LPN or unlicensed staff, but is ultimately responsible for all his/her clients.
Developed in response to a severe nursing shortage where an experienced RN coordinates care given by others
Approach that coordinates and links health care services to clients and their families while streamlining costs and maintaining quality
PPO: (Preferred provider organization)
- One that limits an enrollee’s choice to a list of“preferred” hospitals, physicians, and providers. An enrollee pays more
- out-of-pocket expenses for using a provider not on the list. Clients pay for services as they are provided.
- -Contractual agreement exists between a set of providers and one or more purchasers (self-insured employers or insurance plans). Comprehensive health services at a discount to companies under contract
- Traditional fee-for-service plan. Payment computed after client receives services on basis of number of services used.
- -Policies typically expensive. Most policies have deductibles that clients have to meet before insurance pays.
HMO: (health maintenance organization)
prepaid or fixed payment health plans where the insured is required to visit a primary care physician, who has a contract with the HMO. Insured can only visit the primary care physician, or specialists recommended by the primary care physician.
Third party payment:
The practice of an insurer paying providers directly for services rendered to an insured, as opposed to an indemnity contract which pays the insured person for the losses incurred.
**Regulatory interventions were initiated to reduce the rise in health care costs, These interventions include: Prospective Payment Systems
**The payment mechanism that Medicare uses within its health care financing is: Fixed Payments
**MCO allows the individual to go to any physician that they desire
cultural components and culture: (1)
- 33% of population is minority, 50% by 2050
- **One of the expectations in the U.S. by 2020 is increases in Hispanic and Latino populations
cultural components and culture: (2)
- From culture to culture time often takes on different meanings. In exploring the relationship of time to nursing
- interventions, the nurse should maintain a flexible attitude when the client requests procedures to be done at specific times (p. 117-118)
- **An Asian American client will accept hygiene care from only family members. The cultural origin of this behavior is most likely interdependency (p. 109)
**The primary problem with using English-Speaking children of immigrant families as interpreters is that the adults may resent their dependence upon the child (p. 113)
**Nurses are caring for clients from a variety of cultures primarily as a result of: increased ease of travel and mobility
shared identity related to social and cultural heritage such as values, language, geographical space, and racial characteristics (i.e. Brazilian, Irish)
- -**Ethnicity differs from race in that ethnicity
- includes more than biological identification (p. 107)
thoughts, communications, actions, customs, beliefs, values, and institutions of racial, ethnic, religious, or social groups
Healthy People 2010:
Goal is to eliminate disparities in health status of people from diverse racial, ethnic, and cultural backgrounds
Code of Ethics:
- Code of Ethics p.7 :accountability p.315, advocacyp.314, confidentiality p.315, responsibility p.314) (See ANA Code of Ethics Box 22-1, p 315)
- Code of ethics: philosophical ideals of right and wrong that define the principles you will use to provide care to your clients (p. 7)
- Code of ethics: set of guiding principles that all members of a profession accept and assists professional groups when questions arise about correct practice or behavior; has four constant principles responsibility,
- accountability, advocacy, confidentiality (p. 314)
- support of a cause. A nurse, advocates for the health, safety, and rights of a client. Safeguard client’s right to physical
- and auditory privacy.
a willingness to respect obligations and to follow through on promises. A nurse, is responsible for their actions.
the ability to answer for one’s own actions. Be able to explain your professional actions to your client and employer
Health Insurance Portability and Accountability Act of 1996 (HIPAA) mandates the confidential protection of clients’ personal health information. You cannot share health care information, including lab results, diagnosis, prognosis with others w/o specific client consent, unless the information is necessary in the course of providing care.
Kubler-Ross: stages of coping mechanism
Bowlby's Attachment Theory:
Numbing=>Yearning and searching=>Disorganization and despair=> Reorganization
transferring emotions, ideas, or wishes from stressful situation to a less anxiety-producing substitute.
making up for a deficiency in one aspect of self-image by emphasizing a feature considered to be an asset.
patterning behavior after that of another person and assuming that person’s qualities, characteristics, and actions
experiencing a subjective sense of numbing and a reduced awareness of one’s surroundings
unconsciously repressing an anxiety-producing emotional conflict and transforming it into nonorganic symptoms
transferring responsibility for the performance of an activity or task while retaining accountability for the outcome.
participating actively and autonomously in policies or events that affect one’s health or well being.
working together toward a common goal or working together to accomplish a task
includes clinical decision making, priority setting, use of organizational skills and resources, time management, and evaluation.
commitment to include clients in decisions about all aspects of care.
taking positive actions to help others
avoidance from harm or hurt
fairness, fair distribution of resources
keep promises and not abandoning clients even if disagreement occurs
any intentional threat to bring about harmful or offensive contact
any intetional touching without consent
unjustified restraining without legal warrant
conduct falling below standard of care
negligent care that falls below standards of profession
attitudes related to physical appearance, sexuality, etc
internal sense of individuality, wholeness and consistency of a person over time and in different situations
perception of ones ability to carry out responsibilites
overall feeling of self worth
a system of organized beliefs
an attitude of something to live for and look forward to
a relationship with a divinity, higher power, authority or spirit that incorporates a reasoning and a trusting faith
an inherent characteristic which includes an existential reality that provides unique and subjective experiences for all people