Transition to the Registered Professional Nurse Role
Who focused on hygiene and sanitation and believed strongly in continuing education?
Who organized the American Red cross and was responsible for relief operations during the Civil War?
Who was the nurse who became responsible for construction of state psychiatric hospitals?
Conductor of underground railroad who assisted Clara Barton to tend to wounded soldiers during the Civil War.
Harriet Ross Tubman
Born into slavery, nursed Union soldiers, worked to improve sanitary conditions, got food and clothing for black soldiers
Radical changes in nursing education, reduced student work day from 10 to 8 and eliminated FREE private duty services
Isabel Hampton Robb
Created FNS Frontier Nursing Service- 1st midwifery training school
did a study which resulted in establishment of associate degree nursing education
Nursing leader and women's right activist giving women the right to vote- also a key figure in community nursing and introduced nursing in schools
Early theorist who taught "a patient is a person who requires help toward independence"
America's first African American Nurse
a psychiatric nurse- described Nurse- Client relationships
America's first trained nurse- also key figure in development of nursing education, moved from hosp to hosp an improvement campaign
Melinda Ann (Linda) Richards
opened FIRST birth control clinic with her sister in Brooklyn
Founder of public health nursing - established a neighborhood nursing service in NYC
Religion- *R* Protestant Churches- women subordinate to men- nurse most menial of servants
Earliest counterpart to community health nurses- worldly items were of no concern to nurses, nurses required strict obedience, devotion, and setting aside themselves
Order of the Deaconesses
Roman Catholic society - sister nurses nursed cholera pt's Mercy Hospitals
Sisters of Mercy
Sisters that visited pt's in homes, hosp, and poorhouses and asylums. Developed educational programs for Nurses
Sisters of Charity
Earliest organization for Men in Nursing. Raised standards of education, culture. Care of the sick was above others duties of Monk. Emphasized Bathing
Founded during Crusades- staffed 2 hospitals in Jerusalem
Military Nursing Orders
*Military* *M* Military Nursing Service formed, Florence Nightingale cleaned up the hosp, orderlies scrubbed often, camp followers scrubbed clothes, and vermin were under control
Philadelphia Dispensary was formed for free pt care, homes and barns were makeshift hosp, women left during war were there to care for sick and injured Controlled disease and smallpox vaccination was given
Public saw the need for trained nurses, Clara Barton, Harriet Tubman, Sojourner Truth tended to the soldiers
American Civil War
Nursing schools were already established and Isabel Robb developed a plan for managing nurses
Spanish-American War and the Boer War
Increased demand for nurses, Army School of Nursing - nurses needed to be unmarried and of good moral character
World War 1
Bolton Act created the US Cadet Nurse Corps. Nurses got full military commission, post war- Hill Burton Act
World War 2
Korean War and Vietnam conflicts
Care focused on soldiers and victims of war
Gulf War- Afghanistan- Iraq
*Nursing Organizations Concerns itself with social and economic welfare of nurses, the role of the nurse, the nursing organizations and their their governing bodies
ICN- International Council of Nurses
For RN'S- Is involved in all issues that nursing has confronted with Legislation, Collective bargaining, advancement of profession
ANA- American Nurses Association
Was formed to assist collegiate schools of nursing to improve higher education for nursing.
AACN- American Association of Colleges of Nursing
Was formed to provide accreditation
CCNE- Commission on Collegiate Nursing Education
Provides a legal regulatory bodies of all states to act together re: boards, exams, licensing
NCSBN- National Council of State Boards of Nursing
First Nursing Organization in the US. 5 Goals- nursing education development and improvement, faculty development, nursing ed research, data collection, assessment & evaluation
NLN- National League for Nursing
Baccalaureate program honorary organization for exceptional standards
Sigma Theta Tau (STTI)
For those who have made significant contributions to nursing- honorary part of ANA
AAN- American Academy of Nursing
Student nursing organization
NSNA- National Student Nurses' Association
4 Purposes to 1. Speak for associate degree nursing education and practice 2. Reinforce the value of that degree 3. Maintain endorsement for grads with associate degree, 4. retain the RN exam for associate degree grads
NOADN- National Organization For The Associate Degree Nursing
Organization for nurses who design, facilitate, and manage care
AONE- American Organization of Nurse Executives
Purpose is to work toward uniform terminology and definitions in nursing diagnosis, and t share these ideas.
NANDA- North American Nursing Diagnosis Association
National Associations of Hispanic, Black Nurses American Assembly for men in nursing NAPNES- for LPN's American Associations of : Critical Care Nurses, Preoperative RN's, Occupational Health Nurses, Religious Oriented Organizations and Educational Ori
Free or low cost screens & health info
Different financial situations change ins. coverage, ability to get care and what type of care
Rationing of health care
Health Maintenance Program which are prepaid, group managed care, usually have to stay "in network of md's"
HMO- Health Maintenance Organizations
Healthcare provided in defined demo area. Is centered to individuals and family
Community based care
system in which the use of healthcare services are controlled and monitored there are usually protocols for tx and is usually preapproved
used by HMO's & PPO's to keep costs low - usually seen as a way to deny tx
wearable/ implantable monitors for medical conditions
wearable/ implantable insulin or glucose pumps, medicated stents
3 types of health organizations
Primary, Secondary and Tertiary
contact with pt. is minutes to hours
In and Out Care (ex- ER, office visits)
Provides care to pts where stay is less than 24 hours
care is more than 24 hours but less than 30 days
longer than 30 days for chronic illness may be for a lifetime or recovery period
Long term Care
services owned by state, federal or local gov't may use tax dollars
Government Owned facilities (ex-VA)
investor owned and operated by corp or stockholders
Operated by universities, religious organizations, and fraternal groups. All profit above that needed for maint. and operations must go to improvement and growth
Used to describe a client's condition
type of service that is often a special unit in a hospital usually less than 30 days
Sub Acute Care
service that does observation, assessment, teaching and training, direct skilled nursing such as tube feedings, vents, RN must be in charge of care
Skilled Nursing Care
refers to care focused on meeting deficits of ADL's
provides medical, nursing, social work, spiritual support, for pts and families during a terminal illness
designed to restore health and function
Care is provided and then the patient is discharged soon after
Ambulatory Care also called outpatient care
care that is provided outside of a health care clinic, hosp. usually provided in the home
Home Health Care
Med/ Surg, OB, ER and diagnostic center plus lab services
General or Community Hospital
Level 1 Trauma Center, Burn Center, Oncology, and other levels of care
Tertiary care hospital
Offers only a particular type of care such as Psych, or Peds
Places offering healthcare must be approved by the gov't agency, usually the Dept of Health they need this cert
agencies that seek Medicare/ Medicaid funding must meet specific standards and also have many DEEMED STATUS agencies that services need this certification
Medicare/ Medicaid Certification
Hosp and nursing homes get this accreditation
JCAHO- Joint Commission on Accreditation of Healthcare Organizations
Organization that provides voluntary accreditation. Has a peer-reviewed process
CHAP- Community Health Accreditation Program
This reviews and evaluates HMO's it provides HEDIS- Health Plan Employer Data & info Set to compare HMO's
National Committee for Quality Assurance (NCQA)
She used her contacts with powerful men in govt to obtain supplies and personnel needed to care for the wounded during Crimean War
Was able to fight incompetence & obtain decent care for the wounded Civil War soldiers by using influential people in Washington
used the buildup and excitement of the World's Fair to bring together nurses and form the first nursing organization
This document defines nursing legally, and the scope of nursing practice is outlined.
Nurse Practice Act
"The act of utilizing the environment of the patient to assist him in his recovery"
"The unique function of the nurse is to assist the individual, sick or well, in the performance of those activities contributing to the health or its recovery" that would do for themselves if they could
Defines nursing, describes what nurses do, and provides goals and outcomes of care
Nurses derive knowledge through Carpers patterns of knowing 4
Empirical (scientific), aesthetic (creative) knowledge, personal knowledge and ethical knowledge.
a particular viewpoint or perspective "a worldview"
the major concepts in a discipline that names the phenomena of concern
Made up of concepts and propositions
these are mental images of a phenomenon
this describes the relationship between concepts
The structure that links concepts together, representing a unified whole.
a symbolic representation of a theory, shown through diagrams, words, or notations,
This provides an overall framework for structuring ideas
This is used to address more narrowly defined phenomena and can be used to suggest an intervention
A meta-paradigm in nursing has 4 areas
Person, Health, Environment and Nursing
The individual, family or group in a meta-paradigm
The continuum of wellness to terminal illness in the meta-paradigm
The place or community where care is provided in a meta-paradigm
The actions; interactions of the nurse with the person in a meta-paradigm
There are 4 levels of KNOWING:
empirical, aesthetic, personal, ethical
She is recognized as the first nurse theorist. She describes nursing as both an art and science. She recommended adjusting the environment to improve a person's health.
She described 4 conservation principles for nursing, specifically the conservation of energy, structural integrity, personal integrity, and social stability. She also stated people need nursing when they are unable to care for themselves.
She developed the theory of Human Caring and described 10 carative factors.
She developed the theory of the Science of Unitary Human Beings, in which the person is a unified whole, greater than the sum of parts.
She emphasized understanding the person's lived experiences as related to health.
This is an example of middle-range theory and uses 11 functional health patterns to provide a framework for assessment, nursing dx, and a plan of car.
Gordon's Functional Health Patterns
Hildegard Peplau- Peplau's interpersonal relations model *environment not defined
P- Focus on the individual- they live in an unstable equilibrium & strive to reduce anxiety H- Moving toward a direction of being creative, constructive, productive, & personal and community living N- Sick person and nurse therapeutic communication
Virginia Henderson- definition of nursing
P- complete being who has 14 fundamental needs E- aggregate the external conditions & influences H- Requires independence 7 interdependence Must be able to do the 14 basics unaided N- to assist those who cannot do by themselves
14 fundamental needs
breathing, eat, drink, eliminate, move & maintain posture, sleep & rest, dress & undress, maintain body temp, keep clean, avoid danger, communicate, worship, work, play and learn
Madeleine Leininger - cultural care diversity & universality theory
P- Human beings are caring & capable of feeling concern E- *none* H- a state of well being that is culturally defined, valued & practiced N- uses problem solving approach, 3 models of action- see next card
3 models of action in Leininger's theory
culture care preservation, culture care accommodation, and culture care re-patterning
Orem's self care theory- Dorothea E. Orem
P- a unity who can be viewed as functioning biologically, symbolically & socially, and who initiates & performs on their own to maintain health and well being. H- Well being is used in the sense of the person's perceived condition of existence.
Orem's theory regarding Nursing
Nursing is a deliberate action, a function of the practical intelligence of nurses & action to bring mundanely desirable conditions.
Roger's science of unitary human beings- Martha E. Rogers
P- Different from the sum of its parts. Continuous repatterning. E- Each is specific to its given human field. H- + health= wellness.
Roger's theory regarding Nursing
A humanistic science dedicated to compassionate concern with maintaining & promoting health, preventing illness, & caring for & rehabilitating the sick and disabled.
Roy's adaption model- Sister Callista Roy
P- a bio-psycho-social being who is constantly interacting with the environment & who has 4 modes of adaption H- a state & process of being & becoming an integrated & whole person. N- care & well being of humans, rooted in beliefs about the human person
Roy's 4 modes of adaption based on
physiologic needs, self-concept, role function, and interdependence
Watson's human caring theory- Jean Watson
P- Person is greater than & different from the sum of parts. Individuality is important. H- High level of physical, mental, and social functioning. E- Social, cultural and spiritual influences of society. Sets goals
Watson's theory re: nursing-
Nursing combines the research process with his problem solving approach & is concerned with promoting and restoring health, preventing illness & caring for the sick.
King's goal attainment theory- Imogene King
P- 3 interacting systems, the personal systems is unified complex whole self who perceives, thinks, desires, imagines & decides, identifies goals & selects means to achieve it. E- is constantly changing H- continuous adaption to stress to achieve max pote
King's theory re: nursing-
A helping profession that assists individuals & groups in society to attain, maintain, & restore health or to help individuals die with dignity.
King’s 3 interacting systems
Individuals (personal), groups (interpersonal), and society (social) systems.
Neuman's systems model- Betty Neuman
P- The total person is mad of physiologic, socio-cultural & developmental variables. E- people maintain varying degrees of harmony & balance H- Illness = lack of harmony among parts & subparts of the system
Neuman's theory re: nursing
Unique profession in that it is concerned with all variables affecting an individual's response to stressors, which are intra, inter & extra personal in nature. The nurse helps the pt through primary, secondary & tertiary prevention to maintain stability
Florence Nightingale's Environmental theory
P- ind. with vital reparative processes to deal with disease & desirous of health but passive in terms of influencing the environment or nurse. E- See alt card H- Health is maintained through preventions of disease from envir. Factors.
Florence Nightingale’s major concepts of health
ventilation, warmth, light, diet, cleanliness, and
absence of noise
Florence Nightingale's theory re: nursing
Provision of optimal conditions to enhance the person's reparative process from being interrupted.
a set of guidelines for providing high-quality nursing care & criteria for evaluating care
Standards of nursing practice
who sets the standards for nursing practice
The American Nurse Associations Standards of Nursing Practice.
Laws in each state that are instrumental in defining the scope of nursing practice. They protect public health, safety and welfare. State boards of nursing oversee this statutory law
Nurse Practice Acts
Nursing care plans are based on nursing process
They outline the nursing care to be provided. It is a set of actions the nurse will implement to resolve nursing problems identified by assessment.
The creation of the nursing care plan is a? stage of the nursing process
Intermediate- it guides in the ongoing provision of nursing crew & assists in the evaluation of that care.
Characteristics of a quality nursing care plan
-It focuses on actions which are designed to solve or minimize the existing problem -it is a product of a deliberate systematic process -it relates to the future -it is based upon identifiable health & nursing problems
Elements of the nursing care plan
NANDA nursing dx with related factors & diagnostic criteria -nursing outcome classifications with specified outcomes to be achieved including deadlines -Nursing intervention classifications with specified interventions
Tools or guidelines that direct are by identifying expected outcomes
a plan of care based on standards that reflect optimal timing of sequential steps provided by all members of the team or managing chronic health problems
Care Map/ clinical pathways
Basics of a critical pathway
-represents a sequential, interdisciplinary, minimal practice standard for specific pt population -provides flexibility to alter care to meet ind. pt needs -abbreviated format, broad prospective -phase or episode driven -ability to measure cause & eff
Evidence based practice guidelines
Integrating individual clinical expertise with the best available external clinical evidence from systematic research.
These may be established for the care of pts with specific illness, treatments, or surgical procedures.
Evidence based guidelines
components of these guidelines
-identify a specific area of concern -review the published literature -critically analyze the lit to be certain it is accurate & relevant to area of concern
a process that uses observable & verifiable info, collected in a systematic manner to describe, explain, or predict events
a study in which items can be counted or measured & statistics can be used to analyze the results
pure or lab research that is designed to generate & refine theory
also called practical research, it is designed to directly influence or improve clinical practice
4 types of quantities research
Descriptive, correlation, Quasi-experimental, and Experimental
explores and describes events in real life situations, describing concepts
examines the type & degree of relationships between 2 or more variables
Examines cause & effect relationships between selected variables. Often conducted in nursing research t examine effects of interventions on pt outcomes
Quasi- Experimental Research
examines cause & effect relationships between variables under highly controlled conditions
something that varies and has different values that can be measured
the variable being studied, determined as a result of a study
causes or conditions that are manipulated or identified to determine the effects on the dependent variable
statement of relationships between the independent & dependent variables that the researcher expects to find
info the researcher collects from subjects in the study- expressed in numbers
devices used to collect & record the data
the systematic collection & analysis of more SUBJECTIVE narrative materials
Qualitative Research which is used to gain greater understanding of the experience of the pt & family and may help the nurse t identify areas to explore
with pt & family
4 types of Qualitative Research Methods
PHENOMENOLOGY- describes exp as they are lived by the subjects being studied GROUDED THEORY- how people describe their own reality & how their beliefs are r/t actions in a social scene other 2 on next card
* other 2 methods
-ETHNOGRAPHY- examines issues of a culture that are of interest to nursing -HISTORICAL- examines events of the past to generate understanding of nursing profession
QUANTITIVE RESEARCH -objective -deductive * tests theories -General sable -Numbers
QUALITATIVE RESEARCH -Subjective -inductive * generates theories -NOT general sable -Words
Keys to critiquing research reports
-Source -author -content -consensus
The pt's right to consent knowledgeably to participate in a study or tx without coercion or to refuse to participate without jeopardizing the care that he/ she will receive. The right to confidentiality, & to be protected from harm
any eval of services provided & the results achieved are compared with accepted standards
Quality Management/ Quality Improvement 1st- actual results are compared with standard results then any deficiencies noted or identified serve to prompt recommendations for improvement
a Medicare/ Medicaid review organization that evals preadmission, pre-procedure, concurrent or retrospective review.
PRO- Peer Review Organization. The purpose is to determine if care given was necessary & appropriate.
Are the actual health results in pts & communities served? Key indicators or QI (quality indicators) show effectiveness of the system as a whole & indicate whether access to services is available.
Include infection rates & morbidity/mortality rates associated with specific hospitals & procedures.
Hospital Healthcare Outcomes
3 groups under HCUP- Healthcare Cost & Utilization Project used to determine quality of care & access to care
There are 11 areas of care with 24 quality indicators. They represent common conditions & items that are important to residents & serve as the focus for surveyors.
Purpose of this was to establish national goals to serve as a focus by individuals, organizations, & the government.
National Health Indicators
National Health Indicators do this
Process-Identify Need- Assemble Team- Collect data- use nursing audits or peer review- establish outcomes- Evaluate
An effort to reduce & assess risks to pts, staff, & organizational assets within a health care institution. They identify risks and review & apprise safety protocols
In review & appraisal they do this
1. STRUCTURE EVAL or audit focuses on environment in which the care is provided. Standards describe physical facilities & equipment; organizational characteristics, policies & procedures, fiscal resources, personnel resources.
They then- PROCESS EVAL which is the nature & sequence of activities carried out by nurse implementing the nursing process. Criteria make explicit acceptable levels of performance for nursing actions r/t pt assessment, dx, planning, implementation, & eval
OUTCOME EVAL- focuses on measurable changes in the health status of the pt or the end results of nursing care. The proper environment for care & the right nursing actions are important; the critical element is demonstratable changes in pt health status
LEGAL- addresses the general welfare of the public. A violation of this law is a called a crime & is prosecuted by the gov't.
This law regulated conduct between private individuals or businesses & is enforced through the courts as damages or monetary compensation.
a rule or formal regulation established by the gov't legislative authority such as Congress, the state legislature or city council, that appears in writing
This is published in codes. It is broken down into specific rules. it includes constructional laws and enacted laws
Is derived from common usage, custom or judicial law. it is based on occurrences of events, it is less clear & exact that statutory law
Common law- ( FYI- statutory law & regulatory law carry more weight in court than common law does)
These are civil wrongs committed by 1 person against another person or their property. It can include physical harm, psychological harm, harm to livelihood, or some other less tangible value such as harm to reputation.
TORT- it can also be a crime- gross negligence that demonstrates that offender is guilty of complete disregard for another's life may be tried as both a civil & a criminal action & is prosecuted under criminal & civil law.
When the outcome is planned, although the person involved may not have believed the outcome would be harmful
When a wrong is committed against another person or property that was not intended to happen.
Unintentional tort. Most common cause of an unintentional tort is negligence.
the carelessness or failure to act as a prudent person would normally act under the same circumstance; unintended failure of a person to act or not act as a reasonable person would/would not act in a similar scenario
4 essential characteristics of negligence
1. Harm must have occurred. 2. The negligent person must have been in a situation where they held a duty toward the person harmed. 3. Breach of duty 4. The harm must be shown to have been caused by a breach of duty.
Breach of duty
Includes either doing or not doing what should have been done (commission of an inappropriate action) or not done. Failing to act as a reasonable prudent person. Failure to perform an act required by law or performing in an unlawful way
used to identify a specific type of negligence of a specifically trained or educated person in the performance of his/her job
Malpractice. To prevent this maintain a high standard of care, excellent communication with pt and family, be aware of policy & procedures. They are an adequate defense against a claim. Avoid short cuts & work around.
Therapeutic communication includes;
listening, clarifying, & problem solving
Elements of Malpractice
1. Harm to an individual 2. Breach of duty b the professional 3. Duty of a professional toward an individual 4. breach of duty as the cause of harm
Intentional & unlawful offer to touch a person in an offensive, insulting or physically intimidating manner.
The touching of another person without the person's consent.
invasion of privacy
All info re: pt's is confidential or private whether it is on paper, computer or spoken. this includes; unnecessary exposure of pt's during care, talking with pt's in rooms that aren't soundproof, sharing pt info, interacting with pt's family re: HIPPA
The willful & purposeful misrepresentation that could cause or has caused loss or harm to a person or property.
Fraud- Misrepresentation of a product is a common fraudulent act.
an intentional tort in which one party makes derogatory remarks about another that diminish the other party's reputation & is grounds for an award of civil damages
Defamation of character
written form of defamation
oral form of defamation
making a person stay in a place against their wishes
False Imprisonment- the law always requires the least restrictive measures in care including with restraints (physical or medical)
- Each state has different definitions. Nurses cannot leave their patients when they are needed.
an agreement between 2 parties or more, especially one that is written & enforceable by law
Contract- these are often implied with pts. Courts will uphold that an implied contract exists obligating the nurse to be competent & to provide responsible care.
Elements of a valid contract
PREAMBLE- an explanation or summary of the contract TERMINATION CLAUSE- a portion of a contract that explains the rights of the parties to terminate, or cancel, their contract.