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A method used by nurses in dealing with patient problems in professional practice
When was the nursing process identified and named?
What does the nursing process involve?
- critical thinking competency that nursing uses to organize and plan patient care
- intertwining of thinking and doing
- a systemic approach
- a problem solving process
purposeful, disciplined, active process that improves clinical judgement and thereby improves patient care
Can critical thinking be a learned process?
What is the purpose of the nursing process?
to provide a framework within which nurses can identify client's health status and assist them in meeting their health needs
Who published the first list of nursing diagnoses in 1973?
- NANDA International
- has 206 diagnoses approved for clinical testing
What are the characteristics of the nursing process?
- dynamic and cyclic
- client centered
- planned and goal directed
- universally applicable
- patient status oriented
- cognitive process
What is the value of the nursing process?
- promotes collaboration
- cost efficient
- helps people understand what nurses do
- is required by professional standards
- promotes client autonomy
- promotes individualized care
- promotes effciency
- promotes continuity and coordination of care
- increases job satisfaction
What are some of the key points if the nursing process?
- accepted as the "core" of nursing
- central to all nursing actions
- assures quality of care
Has the nursing process been questioned and if so why?
- yes-some people view it as linear, rigid, and mechanistic
- despite reservations among some nurses about its use, the nursing process remains the cornerstone of nursing standards, legal definition, and practice and should be understood by EVERY nurse
What are the phases of the nursing process?
the systematic process of gathering, verifying, and communicating data about a client
the process of reviewing a situation for the purpose of identifying the client's needs or problems
What are the different types of assessment data?
data that the client tells you, his perceptions
The nursing history is consider what type of data?
Subjective data is also refered to as..?
"I am in pain" describes what type of data?
T/F Subjective data can be very private?
true-nurses must be sensitive to the patients needs for confidence in the nurses' trustworthiness
observations and measurements made by the clinician
Objective data is also refered to as...?
The physical assessment, vital signs, and lab values are all examples of what type of data?
T/F Objective and subjective are usually congruent?
- if data is incongruent, requires further carefull assessment
Primary source of data
Secondary Source of data
- significant others
- health professionals
- physical examination
How should data be gathered? (before, whhile you see the patient, after)
- before: charts, etc.
- while: interview, physical exam
- after: chart, literature review, etc.
What does the interview involve? What influences the quality of an interview?
- face to face interaction with the patient
- requires the nurse to use the skills of interviewing, observation, and listening
- quality of the interview: privacy, comfort, prescence of other family members
What does the physical exam require?
inspection, palpation, percussion, auscultation
discussing a patients needs with other health care workers and others who are directly involved in the care of the patient (patients family)
How do we organize the data collected during the assessment phase of the nursing process?
- abdellah's 21 nursing problems
- henderson's 14 nursing problems
- yura and walsh's human needs approach
- gordon's 11 functional health patterns
- nursing theorists
- personal preference
- agency method
during this step, the nurse analyzes and synthesizes the assessment data
Analysis/diagnosis phase is used to do what?
- draw specific conclusion
- identify areas of positive functioning
- identify areas at risk for developing problems
- identify areas that are problems
a clinical judgement about an individual, family or community group's response to actual or potential health problems or life processes
a nurse-prescribed intervention that a nurse may legally order or initiate independently...Carpenito
What does the nursing diagnosis identify?
the problems the patient is experiencing as a result of the disease process-the HUMAN RESPONSES to the illness, injury, or threat
Does the nursing diagnosis differ from a medical diagnosis and if so how?
yes-addresses the patients problems that the nurse can treat within their scope of practice
Which phase is considered to be a pivital point in the nursing process and why?
- nursing diagnosis
- the problems you identify in this phase are the basis for your plan of care
- the strengths you identify are invaluable when determining effective nursing interventions
In the analysis/diagnosis phase of the nursing process, data is analyzed and then what?
- compared to standards
- gaps and inconsistencies are identified
- next, a nursing diagnosis is determined
What does NANDA stand for and what is it?
- north american nursing diagnosis association
- a taxonomy of nursing diagnosis
- types of nursing diagnosis: actual, risk for
NANDA approved nursing diagnosis consist of what 5 components?
- label: concise term that names the diagnosis
- definition: term that clearly defines meaning and helps differentiate from similar diagnosis
- defining characteristics: clusters of observable cues
- risk factors: increase vulnerability to an unhealthy event
- related factors: related to the diagnosis
What is PES and who developed the term?
- P=description of the problem "ineffective breathing pattern"
- E=etiology or cause "related to"
- S=signs and symptoms "as evidenced by" "as manifested by"
How are nursing diagnosis prioritized?
- life threatening (1st priority)
- potential to cause harm or injury
- related to overall health of the patient
- disease or pathology of specific organs or body system
- cure disease
- based on assessment
- nursing needs of client's heath or illness
- assist to adapt to illness or resolve health care problem
- based on assessment
The nurse develops a plan of care that prescribes interventions to attain an expected outcome
Is planning an ongoing event?
yes-the initial plan is merely a beginning
Why are goals used during the planning phase of the nursing process?
to guide the patient and nurse in the selection of interventions and to evaluate the patients progress
What are the components of the planning phase?
- setting priorities
- est. expected outcomes or goals
- det. nursing interventions
- recording the plan of care
specific behavior or response by the client that the nurse anticipates from nursing care, serves as a guidepost to the selection of nursing interventions
measureable change in the client's status in response to nursing care, provides direction for nursing interventions
- set a general direction
- include an action verb
- be both attainable and realistic for the patient
Effective outcome criteria state...?
under what conditions, to what extent, and in what time frame the patient is to act
What are the different types of goals in the planning phase of the nursing process and who developed this?
- Bloom's taxonomy-describes the type of learning in terms of domains of educational acitivities
involves physical movement and increase complex activities in the motor skill arena
- psychomotor goals
- learning can be assessed by measures such as distance, time and speed
- i.e. patient will move from the bed to a chair 3x today without assistance"
involves knowledge and intellectual skills
- cognitive goals
- i.e. "patient will list 5 signs of illness in her newborn by the date of hospital discharge"
inolves emotions, feelings, values, attitudes
- i.e. "patient wil describe feeling more accepting of new colostomy within 1 week of providing ostomy self-care"
attainable goal within hours or days, specific and are small steps to achievement of a broader goal
- short term goal
- "patient will lose 2 lbs"
major changes or rehabilitation
- long-term goals
- "patient will lose 75 lbs"
T/F Setting realistic goals in terms of both outcomes and time is extremely important?
nursing outcomes classification
What are the guidelines for writing goals or outcomes?
- outcomes should: r/t the human response, be clear and concise, be measureable, be realistic, be time-limited
- -when possible should be determined by the client and nurse together
actions designed to assist the patient in achieving a stated goal
designed to treat a patients response to an illness or medical treatment
designed to treat the actual disease or illness
Nursing interventions are activities performed by the nurse to?
- monitor the client's health status
- prevent, control or resolve problems
- assist with ADLs
- promote optimum health and independence
requires no supervision or direction by others, what nurses are licensed to do (i.e. teaching a patient how to examine her breasts for lumps, ADLs, education, health promotion, counseling)
requires instructions, written orders, or supervision of another health professional with prescriptive authority (i.e. administering medications)
actions in which the nurse must collaborate or consult with another health professional before carrying out the action (i.e. protocols)
define under what conditions and circumstances a nurse is allowed to treat the patient, used in situations in which nurses need to take immediate action without consulting with a physician
nursing interventions classification
the process whereby the nurse implements interventions identified in the plan of care
The implementation phase of the nursing process is..?
- action-oriented and involves coordination of activities of the health care team
- puts the nursing care plan into action
- the process of doing, delegating and documenting
the nurse evaluates the client's progress toward attainment of goals/outcomes
What are the components of the evaluation phase of the nursing process?
- evaluating goal/outcome achievement (goal met, goal partially met, goal unmet)
- identify the factors affecting goal/outcome achievement
- decide whether to continue, modify or terminate the plan
consists of informed opinions and decision based on empirical knowledge and experience
What does clinical judgement involve?
- critical thinking and clinical reasoning
- knowing the limitations of your expertise
- applying the nursing process
- staying current with development in practice and research
The school of nursing curriculum is divided into 2 major components?
- non-clinical courses
- clinical courses
Non-clinical courses include?
english, math, natural sciences, arts and humanities
Clinical nursing courses are divided into what 3 levels?
What is involved in the foundations level of clinical nursing courses?
- first 2 semesters
- primary focuse is to provide students with the knowledge and skills necessary to progress to higher level clinical
- courses include: pathopharm, assessment skills (ind., family and community), basic clinical skills, asult-medical surgical nursing experiences, nursing research, and trend and issues in nursing
What is involved in the integrative level of clinical nursing courses?
- 3rd and 4th semesters
- students learn to incorporate theoretical nursing concepts into practice, while expanding and refining their knowledge
- courses include: clients across the lifespan (infants, children, adults, and elderly), special populations (childbearing and psychiatric)
What is involved in the synthesis level of clinical nursing courses?
- final semester
- student nurse explores the role of the nurse as a leader and manager, while demonstrating a comprehensive understanding of the knowledge base required for professional nursing practice
- community capstone project
the philosophical underpinning for the curriculum and provides a guideline for developing goals that will serve as measures for meeting the stated mission
inner urge to pursue an activity or perform a service, a calling-what one intends to do or achieve
What are some of the values implied in the school's mission statement?
How is the nursing profession regulated?
- at the state level by SBNs
- legislative body in each state sets practice law and then assigns authority to implement the law (professional practice acts)
What does the State Nurse Practice Act do?
- protects the public by broadly defining the legal scope of nursing practice
- most important law concerning YOUR nursing practice
- legal obligation to practice within the state's nursing practice act
Who is responsible fore enforcing the NPA in various states?
- state board of nursing (SBNs)
- publicizes rules and regulations that expand the law
What gives meaning to the NPA in each state?
the statutory law + the rules and regulations propagated by the SBN
Is SBNs authority limited and if so how?
- does not have the authority to enlarge the law
What are SBNs functions at the executive,legislative, and judicial levels?
- executive: authority to administer the NPA
- legislative: authority to adopt rules necessary to implement the act
- judicial: authority to deny, suspend, or revoke a license or to otherwise discipline a licensee or to deny an applicant for licensure
What are the functions of the NPA?
- defines the scope of practice
- establish requirements for licensure and entry into practice
- create and empower a board to govern licensure and practice
- identify grounds for disciplinary action
What is the purpose of the Nurse Practice Act?
to promote, preserve and protect the public health, safety, and welfare by regulating nursing education and practice ensuring that any individual practicing or offering to practice nursing or using the title "RN" or "APRN" shall be licensed before engaging in such practice
T/F The NPA is federal law?
What is the most common reason nurses are disciplined by the SBNs?
practicing while impaired
What are some disciplinary actions inforced by the NPA?
- denial of licensure
- placement of conditions
certification of an applicant who is duly licensed as a RN or APRN in another state, territory, or country for licensure to practice as a registered nurse or advanced practice registered nurse in this state
What are the qualification for licensure as a RN?
- good moral character
- completed requirements of nursing education program
- passes an examination
- completed certain course work
- not in violation of rule and regulations
- committed no acts or omissions which are grounds for disciplinary action
- is proficient in the English language
The Board is composed of how many nurses? Who submits their names? Who appoints them?
- 9 nurses (8 RNs, 1CRNA)
- LA State Nurses Association (headed by executive director-RN)
- LA Association of Nurse Anethetists
- appointed by the governor
- implements the NPA
The Board is composed of how many physicians? Who submits their names? Who appoints them? What is their purpose?
- 2 physicians
- LA State Medical Society
- appointed by the governor
- serve as advisors and can not vote
Is it a law that a license applicant should be proficient in the English language if he/she graduated from a nursing education program offered in a foreign country?
Who is the current President of the LA State Board of Nursing?
Lucie J. Agosta, PhD, RNC
How are board members compensated for their services?
- reimbursement for actual expenses and mileage
a group of tasks assigned to one individual
a group of positions that are similar in nature and level of skill that can be carried out by one or more individuals
a group of jobs that are similar in type of work and that are usually found throughout an industry or work environment
What are the 2 major differences between an occupation and a profession?
- professional preparation
- professional committment
an occupation that requires extensive education or a calling that requires special knowledge, skill and preparation
What are the approaches to defining a profession?
- process approach
- power approach
- trait approach
view all occupations as points of development along a continuum, ranging from position to profession (continuum)
approach to defining a profession that involves independence and power
identifies traits that define a profession
What are some of the changing perceptions of nursing as a profession?
- historically a woman's profession
- increasing age of the RN
- education requirement for entry into the profession
- shift from acute care to community and primary care focus
- 1996-American Association Colleges of Nursing issued a position statement
How and when did Flexner establish the criteria of a profession?
- involves a high degree of individual responisibility
- possesses a body of specialized knowledge and skills
- aims to provide a practical and define service
- is characterized by self-organization
- motivations tend to be altruistic
What are some common elements of a profession?
- specialized training programs (3 levels of education)
- unique service to socitey
- standards of practice and education
- a code of ethical conduct
- appropriate public safeguards (licensing exam, SBNs)
T/F A nurse must hold a valid license to practice?
requires any person who practices the profession or occupation to be licensed
protects the use of the title granted in the law but does not prohibit persons from practicing the profession if they do not use the title
T/F CNAs may not refer to themselves as nurses?
How is one elgible for the licensure examination?
eligible once successfully completed state-approved school of nursing education
What is the licensure exam called and what does it test?
- NCLEX (national council licensuring examination)
- tests critical thinking and nursing competency in all phases of the nursing process
Is the NCLEX a national exam?
- so states recognize the licensure awarded in other states
developed to improve the mobility of nurses, while still protecting the public health, safety, and welfare. allows an RN yo have a license (in state of residency) yet practice in other states without an additional license in the state of employment
- nurse licensure compact
- occurs in traveling nurses, crossing state lines, telehealth practices, and moving to another state
T/F Other professions have one pathway of educational preparation unlike nursing.
What are the 3 pathways to lead to licensure and profession status in nursing?
- diploms programs
- associate degree programs
- baccalaureate programs
- hospital based
- apprenticeship programs
- usually 24 months to 3 years in duration
- were the first nursing programs to emerge
- created first nursing diploma program
- St. Thomas Hospital in London (1860)
What programs were considered to be the "famous trio" of diploma programs in the U.S.?
- Bellevue Hospital in NY
- New England Hospital for Women and Children in New Haven, Conn.
- Massachusettes General Hospital in Boston, MA
Why has there been a decline in diploma programs?
- growth of AND BSN programs
- inability of hospitals to finance nursing education
- accreditation standards
- increasing complexity of health care
- students earn no college credit, but many have gateway course into an ADN program
- one diploma program remaining in LA (Baton Rouge General)
Associate Degree Nursing
(when was it est.? who founded it? length? what is the professional organization called? how many programs in LA?)
- developed in 1952 to help alleviate the nursing shortage, esp. experienced with WWII
- Mildred Montag-founder of Associate Degree Nursing Education
- primarily housed in community colleges
- usually 2 years in length (minimum of 60 college credits)
- NOADN- ADN professional organization
- 8 ADN programs in LA
What was the progression in developing Baccalaureate Nursing Programs?
- 1909-University of Minnesota (followed the 3 yr. diploma model)
- 1919-7 additional BSN programs (most were 5 yrs: 2 yr in liberal arts, 3 yr in nursing)
- 1924-Yale School of Nursing-first nursing school est. as a seperate university department with an independenet budget and its own dean
- current basic program-4 yrs. (minimum 120 college credits), combines general education and nursing courses
What influenced the growth of baccalaureate education?
- The Brown Report
- ANA Position Paper
- The Lysaught Report
- The NLN Position Statement
- The PEW Commission Report
The Brown Report
- Nursing for the Future-1948: report prepared for the National Nursing Council
- recommended that basic school of nursing be in universities and colleges and that efforts be made to recruit men and minorities into the programs
ANA Position Paper
1965-Educational Preparation for Nurse Practitioners and Assistants to Nursing: concluded that the BSN should be the foundation for nursing practice
What were the 4 recommendations of the ANA Position Paper?
- 1. education for all those licensed to practice should take place in institutions of higher learning
- 2. min. preparation for beginning professional nursing practice should be the BSN
- 3. min. preparation for beginning technical nursing practice should be the ADN
- 4. education for assistants in health service occupations should consist of short, intesive programs in vocational education programs rather than on the job training
What were some additional position statements of the ANA in 1979?
- proposed that by 1985 entry into practice should be the BSN level
- 2 levels of nursing practice should be identifies: professional and technical
- there should be an increased accessibility to high quality career mobility programs that use flexible approaches to individuals seeking academic degrees
The Lysaught Report
- a.k.a.-An Abstract for Action1981-conducted by the National Committee for the Stduy of Nursing and Nursing Education
- sponsored by the Kellogg Foundation
- recommended 2 licensures for nurses: one in acute care and one in distributive care
NLN Position Statement
- 1982-The Position Statement on Nursing Rolesreaffirmed the BSN as the minimum educational level for entry into practice for professional nursing, and the ADN as entry into practice for technical nursing
The PEW Commission Report
- 1995-5 major recommendations:
- change professional training to meet the demands of the new-health care system
- ensure that the health profession's workforce reflects the diversity of the nation's population
- require interdisciplinary competence in health professionals
- continue to move education into ambulatory practice
- encourage public service of health professionals, students, and graduates
Articulated Nursing Programs
- LPN to RN
- ADN to RN
- Diploma to ADN or RN
- ADN to MSN
Alternative Nursing Programs
on-line programs (University of Phoenix, Regents)
Licensed Practical Nurse (Vocational) Programs
- licensed as an LVN or LPN
- work under the supervision of an RN providing basic, direct patient care
- lasts 12 months
- must pass the NCLEX-PN to become licensed
- considered technical workers
a review process of an educational program by an external professional accrediting organization
- SBN, NLN-National League for Nursing, CCNE-Commission of Collegiate Nursing Education
Basic education prepares a nurse _____
(requirements? available through?)
- learned speciality occurs in a hospital program after basic education
- as nurses become more active, area of practice become more specialized
- certification programs-offer certification in different nursing specialities
- general requirements: specific # of practice hours in speciality, certification exam, periodic recertification
- available through ANA, NCC
planned learning experiences beyond a basic nursing program
Continuing Education (in LA? other states?)
- in LA, mandatory continuing education is required to maintain licensure (5CE's-practicing fulltime; 10CE's-practicing part-time; 20CE's-not practicing)
- varies by state (no CE requirements in MS, higher yearly CE requirements in TX)
What is considered to be advanced nursing education?
- master's degree
- doctoral degree
study in one particular subject area to assume advanced roles in practice, education, administration and research
History of Master's Level Degree
- 1899-Teacher's College, NYC (focused on administration and education)
- 1940s/1950s-saw an increase (return of nurses from military service with GI benefits)
- 1946-National Mental Health Act (provided funds for psych/mental health nurses)
- 1954-Rutger's University (1st clinical master's-psych/mental health), clinical nurse specialist
- 1965-University of Colorado (1st NP program-pediatric)
- 1970- 70 programs
- 1996- 321 programs
- currents statistics (National Sample Survey of RN, 2000)= MSN (7.5%); related field (2%)
What are the areas included in receiving a masters in nursing?
- nursing administration
- community health
- psychiatric/mental health
- adult health
- maternal/child nursing
- nursing education
What are the requirements for receiving a masters in nursing? Degrees awarded?
- entrance requirements: baccalaureate degree, licensure as an RN, completion of GRE, min. GPA of 3.0, recent work related to desired area of concentration
- most require 1 year of practice experience
- takes 18-24 months to complete, many have 2 focuses
- degrees awarded: MA, MN, MSN, MS
- can obtain more advanced areas of practice: CRNA, NP, CNS
What is the history of doctural education?
- 1910-Columbia Teacher's College (EdD, major-nursing education)
- 1934-NY University (1st PhD program for nurses)
- 1996- 66 programs
motivation for this degree stems from academic advancement or tenure in educational settings, also includes those nurses interested in research and the development of a body of nursing knowledge
What degrees can be obtained with doctual studies?
- DNSc-doctor of nursing science
- DSN-doctor of science in nursing (only one available in LA)
- DNEd-doctor of nursing education
- PhD-doctor of philosophy (not available in nursing in LA)
- EdD-doctor of education
- current statistics (0.3%-docorate in nursing, 0.3% doctorate in related field)
- collected detailed data on morbidity and mortality of soliders during the Crimean War
- used data to encourage reform in British army medical system
- founded 1st training school for nurses (St. Thomas Hospital in London)
Who established the first nursing training school? When? What was the name of the school?
- Florence Nightingale
- St. Thomas Hospital in London
American Civil War
- at beginning of war, no professional nurse available or organized system of medical care
appointed superintendent of women nurses of the army during the american civil war, created a 2 month long program at 2 NY hospitals for women who wished to serve
Dorothea L. Dix
established underground rr and led numerous slaves to freedom during the American Civil War
Susie King Taylor
black women who taught soldiers how to read and write during the American Civil War
- establsihed her own system of distribution of supplies to soldiers during the american civil war
- founded the American Red Cross
- "angel of the battlefield"
- assigned by President Jefferson Davis
- only women in the confederacy to hold a military rank
What resulted following the American Civil War?
movement toward formal education and licensure
Who were the first training schools for nurses modeled after?
Florence Nightingal's school at St. Thomas in London
"Famous Trio of Nursing Schools"
- the first nursing schools established in the US
- Bellevue Training School for Nurses in NYC
- Conneticut Training School for Nurses in New Haven
- Boston Training School for Nurses at Massachusettes General Hosptial
Who was the first trained nurse in the US and when did she graduate?
Who was the first african american educated nurse in the US?
Mary Eliza Mahoney
What was the first program established exclusively for african american students? Males?
- AA-Atlanta Baptist Femal Seminary
- Males-School for Male Nursing at NYC Training School
Who founded ANA? When? What was its mission?
- Isabel Hampton in 1911
- mission to enhance the collaboration among practicing nurses and educators
Internal Council of Nurses (ICN)
- dedicated to uniting nursing organizations of all nations
- first meeting held at Worl Exposition in Buffalo, NY in 1901
- changed practice of nursing dramatically: state registration of nurses
National Association of Colored Graduate Nurses
founded by Martha Franklin to break down discrimination but the group dissolved in 1951 when goals had been met and ANA accepted blacks into their organization
Henry Street Settlement
- founded by Lillian Wald
- first formalized public health nursing practice
safe contraception and family planning
Jessie Sleet Scales
african american nurse hired to work in the african american community to persuade people to accept TB treatment
- a branch of the Henry St. Settlement
- served colored people
- established by ELizabeth Tyler and Scales
- appointed head of the Hospital Corps during the spanish-american war
- lead to the development of the Army Nurse Corps and Navy Nurse Corps
When was licensure fully mandated?
When was the first nationwide state board exam and who administered the exam?
What happened during WWI?
- national campaign launched to recruit women to enter nursing training
- flu epidemic increased the public's awareness of the necessity of public health nursing
- 1920 congress passed a bill that provided nurses with military rank
- increase in the use of hospitals
study of nursing education that advocated the establishment of collegiate schools of nursing rather than hospital-basde diploma programs
Frontier Nursing Services
- established by Mary Breckinridge
- first organized midwifery program in the US
- traveled to serve the health needs of poverty-stricken mountain people
What challenges did nurses face during the great depression and WW2?
- hospitals were largely staffed by nursing students
- most graudate nurses worked as provate duty nurses in patients homes
- great depression caused many families not to be able to afford nursing services, forcing many nurse into unemployment
- President Franklin D. Roosevelt established the Civil Works administration for nurses to participate by providing rural and school health services
- many schools of nursing forced to close due to economic turmoil
- social security act enhanced the practice of public health nursing
What opportunities did nurses receive during WW2?
- inadequate supply of nurses
- congress enacted legislation to provide money for nursing education
Cadet Nurse Corps
program created during WW2 where students received tuition, book, a stipent, etc. in return for a promise to serve as nurses for the duration of the war
- funds to construct hospitals and lead to a surge in the growth of new facilities
- lead to a shortage of nurse and difficult working condition
- team nursing developed
When was Medicare and Medicaid established?
What developed in the field of nursing during the Vietnam War?
- clinical specialization: NP
- mobile hospital units in jungles
- many nurses suffered PTSD after returning home from the war
Agenda for health care reform in 1992
focused on reconstructing the health care system and to reduce costs and improve access to care
What are some of the challenges facing the field of nursing today?
- diagnostic-related groups
- third part reimbursement for advanced practice nurses
- electronic medical records
- issues similar to the past: war, epidemics, poverty, immigration
- language barriers with Latino immigrants in the US