Intro to Nursing/Nursing Process

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kathleenagrace
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Intro to Nursing/Nursing Process
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2010-12-05 16:02:25
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nursing
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Exam 1
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  1. Florence Nightingale
    • · Founder of modern nursing
    • · Role of nurses: recover and remain free of disease
    • · Sanitation and healing
    • · ENVIRONMENT: believed in this influence
    • · During 1860s Crimean War
    • · Founded school of nursing
    • · Had a list of nurse requirements (sober, honest, etc..)
    • · Practicing epidemiologist
    • · Kept and analyzed statistics, making recommendations based on data
    • · HOLISTIC nursing
    • · By 1950s, ideas totally accepted
    • · Nursing field transitioned into a mostly female career
  2. Trends/Issues in Nursing
    • * Nursing Shortage
    • * Evidence Based Practice
    • * Comunity Based Nursing
    • * Decreased Length of Hospital Stay
    • * Aging population
    • * IncreaPed Chronic Health Issues
    • * Independent Nursing Practice
    • * Culturally Competent Care
  3. 6 Standards of Practice (ANA) [ADOPIE]
    • A: Assessment
    • D: Diagnoses
    • O: Outcomes identification
    • P: Planning
    • I: Implementation
    • E: Evaluation
  4. 9 Standards of Professional Performance [PPEECCRRL]
    • P: Practice Quality
    • P: Practive Evaluation
    • E: Education
    • E: Ethics
    • C: Collegiality
    • C: Collaboration
    • R: Research
    • R: Resource Utilization
    • L: Leadership
  5. Nurse Practice Act
    • Each state has its own
    • identifies scope of practice
    • Protects patients of that state
  6. Domain
    • perspective of a profession
    • provides practical/theoretical orientation for a discipline
  7. Paradigm
    • main concepts overlapping
    • *Nursing
    • *Evironment
    • *Health/Illness
    • *Individual
  8. Descriptive
    • Describes event
    • Further identifies properties/components
    • Circumstances of occurence
  9. Prescriptive
    • addresses nursing interventions
    • consequences of each
    • control, promote, &change clinical nrsg practice
  10. Nursing Hx: Early Civilization
    • Illness was supernatural
    • Doctor: medicine man, priest
    • Nurse: "slaves"
    • males gave nrsg care and bury dead
  11. Nrsg Hx: 16-19th Century
    • Religious warfare, exploration, expansion
    • Nurse: criminal women serving sentence
    • Social Reform in 18-19th century
  12. Nrsg Hx: Social Reform [Florence Nightingale]
    • Socal Reform/Crimean War
    • Challenged femal prejudice
    • training school, wrote books
    • Health/Illness different from medicine
    • Nutrition, Therapies
    • Continued Education, managing documentation
  13. Nrsg Hx: 19-21st century
    • Civil War: need for nurses
    • School based on Nightingale
    • WWII: women increased independent, increased education
    • School objective: degrees
    • Nrsg knowledge base for Nrsg practive
  14. 4 Aims of Nursing
    • 1. Promote Health: optimal fxn + wellbeing; desire to increase wellbeing
    • 2. Prevent Illness: decrease risk, early detection, promote good habits
    • 3. Restore Health: inidiv. focus from early detection to rehab
    • 4. Facilitate Coping: cope w/altered fxn, maximize strengths
  15. Practical Vocational (LPN)
    • varied settings
    • usually 1 year
    • 1/3 class, 2/3 clinical
    • Test: NCLEX-LPN
  16. Registered Nurse (RN)
    • 1. Diploma: 3 yrs
    • 2. ADN: 2 yrs, faster, comm/jr college, non-trad. students
    • 3. BSN: 4 yrs, admin manager, community health, collaborative, research
  17. Graduate (Masters, Doctorate)
    • Master: national cert, manager, ARNP, clinical specialist
    • Doctorate: carry out research necessary to advance nrsg theory + practice
  18. ICN (Intn'l Council of Nrsg)
    • 1st intn'l org of prof women
    • maintain standards
    • promote ethics
    • natn'l nrsg orgs work together
  19. ANA (American Nurses' Assoc)
    • late 1800s
    • State level
    • Standards of Practice
    • Research to Advance Nrsg Practice
    • Rep Nrsg for Legislative Axn
  20. NLN (Natn'l League for Nrsg)
    • 1953
    • Voluntary accredication
    • Develop nrsg services + educ
    • Largest prof. testing service
    • Primary research source for data (surveys)
  21. AACN (Amer. Assoc. of Colleges in Nrsg)
    • late 1800s
    • Natn'l Voice for BSN or higher
    • Estab. quality educ. standards
    • Influence prof. + improve HC
    • Promote public support of Bach/Grad educ.
    • Natn'l accreditation based on CCNE
  22. NSNA (Natn'l Student Nurses' Assoc.)
    • Voluntary participation
    • Students: self governance, advocate for student + patient's rights
    • Collective responsible axn on social/political issues
  23. Deductive Reasoning
    examines general idea, then considers specific actions/ideas
  24. Inductive Reasoning
    builds from specific ideas/axns to conclusions about general ideas
  25. Adaptation Theory
    • adjustment to other living things and evironmental conditions
    • Internal (self)
    • Social (others)
    • Physical
  26. Developmental Theory
    • Process is orderly/predictable
    • Each stage highly individualized
    • Erikson: socialization, 8 stages in life
    • Maslow: psychosocial, 5 Basic Needs
  27. General Systems Theory
    • Universal application
    • One element affects all other aspects of the system
  28. Quantitative Research
    • Basic: (pure/lab) generate/refince theory, often not directly useful in practice
    • Applied: (practical) directly influence/improve clinical practice
    • TYPES: Descriptive, Correlational, Quasi-Experimental, Experimental
  29. Qualitative Research
    • Discovers meanings
    • Reality if based on perceptions, thus always changes
    • Focus on Words rather than #s
    • TYPES: Phenomology, Grounded, Theory, Enthnography
  30. Model for EBP [ALSDII]
    • A: Assess need for change in practice
    • L: Link problem intrvn + outcome
    • S: Synthesize best evidenct
    • D: Design practice change
    • I: Implement + Evaluation change in practice
    • I: Integrate + Maintain change in practice
  31. 3 steps of EBP
    • 1. Identify a specific area of concern
    • 2. Review the published literature to determine if enough research has been done
    • 3. Critically Analyze the published literature to be sure it is accurate/relevant
  32. Public Hospital
    • non-profit
    • funded by local/state/natn'l orgs
  33. Private Hostpital
    • for- or non-profit
    • funded by communities, churches, corporations, charitable orgs
  34. Ambulatory Care
    • kind of like walk-in clinic
    • come for just procedure, then leave
  35. Case Management
    • continuity of care
    • critical pathway
  36. Primary HC
    • essential HC
    • scientific, socially acceptable
    • accessible to community
  37. Medicare
    • Social Security Act
    • Elderly, Disabled, their Dependents
    • DRG paid for
  38. Medicaid
    any age w/ low income
  39. HMO: Health Maintenance Org
    • prepaid group managed plans
    • only affiliated providers
    • pay zero or small copay
  40. PPO: Preferred Provider Org
    • allows payer to contract w/group of HC provider
    • provide low cost service in return for prompt payment/guaranteed business
    • pay out of pocket if choose own provider
  41. Private Insurance
    • large, nonprofit, tax exempt
    • small, for profit, private
    • monthly premiums
    • 3rd part payer (insurance pays all/most of care)
    • choose own provider
  42. LTC Insurance
    • 90% paid by Medicaid + out of pocket
    • Medicare + private only pays minimally
  43. Specialized Care Centers/Settings
    • Daycare
    • Mental Health
    • rural
    • Schools
    • Industry
    • Homeless Shelters
    • Rehab
  44. 5 Rights of Delegation
    • 1. Right Task
    • 2. Circumstances
    • 3. Person
    • 4. Direction/Communication
    • 5. Supervision
  45. Autocratic Leadership
    • Directive
    • Complete control
  46. Democratic Leadership
    • Participative
    • Sense of equality
    • decisions/activities shared
    • mutually set goals/outcomes
    • used most often
  47. Laissez-Faire Leadership
    • relinquish power to group
    • encourages independent activity
    • difficult to successfully achieve
  48. Transformational Leadership
    • creates revolutionary change
    • charismatic
    • inspires/motivates
    • vulnerable: care, express ideas/emotions/concerns, willing to take risks
  49. Situational
    • comprehensive approach to considering leadership style, work group's maturity, situation at hand
    • often lacks in depth and responsiveness to challenges
  50. Quantum Leadership
    • Old vs. New
    • moves beyond traditional modea
    • change is dynamic, everpresent, continually unfolding
  51. Functional Nursing
    • increased efficiency, but impersonal care
    • assigned specific tasks
    • like industrial "assembly line"
  52. Team Nursing
    • focus on individual care (personal)
    • team of RN + caregivers care for designated group on specific shift
    • delegation
  53. Total Care Nursing
    • patient-centered
    • nurse as caregive (all aspects of care)
    • lack of continuity between shifts
    • expensive
  54. Primary Nursing
    • comprehensive, individualized, consistent care
    • expensive
    • nurse plans, evaluates, directs care of a pt 24 hrs/day thru entire stay
  55. Case Management Nursing
    • one nurse oversees quality and financial outcomes of pt care
    • works collaboratives along agreed-upon clinical pathway
  56. Cognitive Skills
    ability to think critically and evaluate a situation systematically and accurately based on data
  57. Technical Skills
    • practice to achieve confidence
    • familiarize yourself w/procedure and equipment
    • seek help if needed
  58. Interpersonal Skills
    • building a positive nurse-patient caring relationship by interacting with them, not viewing them as an object or job to be done
    • rewarding to both counterparts
  59. Ethical/Legal Skills
    • develop accountability for your knowledge and implementation
    • practice altruism
    • always prioritizing needs of patient
    • remain within legal rights and scope of practice
    • advocating for your patient, self, peers, etc.
  60. Types of Assessment
    • Initial: shortly after admittance (baseline)
    • Focused: gather data about specific problem identified
    • Emergency: in phys/psych crisis (conditions are life-threatening)
    • Time-Elapsed: present data compared to baseline data (reassess, make necessary revisions)
    • Medical: target data pointing to pathological conditions
    • Nursing: focus on pt's responses to health problems (Holistic)
  61. 5 Types of Nursing Diagnoses
    • Actual: Label, Definition, Def. Charac, Related Factors
    • Risk: potential for developing actual
    • Possible: additional data needed
    • Wellness: "readiness for.." higher level
    • Syndrome: cluster of actual/risk data all defined by a particular event
  62. Subjective Data
    • info perceived only by affected person
    • cannot be perceived/verified by anyone else
  63. Objective Data
    • observable, measurable by someone other than pt
    • can be measured on a diff pt as well, or on the same pt but by a diff person
  64. 4 Phases of Interview
    • Preparatory: review info w/open mind
    • Introduction: expectations
    • Working: gather info for database
    • Termination: key points, what to expect, any questions?
  65. 3 Part Nursing Diagnosis
    • Problem: describes health state/problem
    • (related to)
    • Etiology: factors/causes
    • (evidenced by)
    • Defining Characteristics: obj/subj data
  66. Goal vs. Outcome
    • Goal: aim or end
    • Outcome: expected conclusion to helath problem/expectation
    • Expected Outcome: specific measurable criteria used to evaluate extent to which patient has met outcome
  67. Comprehensive Planning: 3 Times
    • Initial: admission
    • Standardized Care Plan: common to specific problem
    • Ongoing: develop new diagnoses as old outcomes are met
    • Discharge: begin at admission, teaching/counseling, leaves w/knowledge
  68. Maslow's Hierarchy of Needs: Life Threatening always the priority
    • 1. Physiologic
    • 2. Saftey & Security
    • 3. Love & Belonging
    • 4. Self-Esteem
    • 5. Self-Actulization
  69. Writing Outcomes
    • Nursing: outcomes derived from problem statement in nrsg Dx
    • Patient Goals: suggested by problem statement
    • Nrsg Intrv: suggested by etiology/cause
  70. 3 Types of Outcomes
    • Cognitive: increase in patient knowledge/intellect
    • Psychomotor: new skill
    • Affective: change in pt value/belief/attitude
    • Physiologic: physical change is targeted
  71. Implementation: Organize Clinical Responsibilities
    • Patient Profile: hx bckgrnd info, strength/problems
    • Patient's Preferred Name: many be diff
    • Chief Complaint/Reason for Admission
    • Patient's current health status: phys/emotional changes requiring modification
    • Routine assitance pt needs to meet basic human needs
    • Priorities for nursing care
    • Special "Events": diagnostic studies, consultations, therapies
    • Special teaching, counseling, advocacy needs
    • Special needs of family
  72. Prioritization of Nursing Care
    • 1. Life threatening
    • 2. What's important to the patient
    • 3. What you know needs to be done, regardless
    • 4. Last: Long-term goals, patient teaching
  73. Quality Assurance Programs
    • specially designed to promote excellence
    • enable accountability of care to society
    • Quality by Inspection: find/remove deficient workers
    • Quality by Opportunity: find opportunities for improvement, thrives on tmwrk & fixing probs in the system
  74. ANA 3 Essential Components of Quality Care
    • STRUCTURE evaluation: describe physcial facility/equip, organization characterisitics/policies, resources avail
    • PROCESS evaluation: nature/sequence of activities of nurses/nursing process
    • OUTCOME evaluation: focus on measurable changes in patient health status; end results
  75. Concurrent vs. Retrospective Evaluation
    • Concurrent: during pt care: observations, patient interviews, chart review
    • Retrospective: post discharge: questionaire, pt interview, chart review

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