1
Q
What are the ethical principles?
A
- Autonomy: individuals have the right to determine their own actions and the freedom to make their own decisions (Respect of this is important)
- Beneficience: “the doing of good”; one should always consider one’s actions in the context of promoting good for other (ex. putting a sitter in a patient’s room to make sure they don’t fall even if the patient doesn’t want it)
- Non maleficence: duty to do no harm; nurse must not act in a manner that would intentionally harm the patient; the patient may experience harm but it is for the own good (Ex. chemotherapy which causes pain but may cause remission)
- Justice: equals should be treated the same and the unequals should be treated differently
- Fidelity: faithfulness and honoring one’s commitments or promises
- Veracity: telling of the truth
2
Q
What are the ANA code of ethics?
A
- The nurse in all professional relationships practice with compassion and respect for the inherent dignity, worth, and uniqueness of every individuals, unrestricted by considerations of social or economic status, personal attributes, or the nature of health problems
- The nurses’ primary commitment is to the patient, whether an individual, family, group, or community
- The nurse promotes, advocates for, and strives to protect the health, safety , and rights of the patient
- The nurse is responsible and accountable for individual nursing practices and determines the appropriate delegation of tasks consistent with the nurse’s obligation to provide optimum patient care
- The nurse owes the same duties to self as to others, including the responsibility to preserve integrity and safety, to maintain competence and to continue personal and professional growth
- The nurse participates in establishing, maintaining, and improving health care environments and conditions of employment conductive to the provision of quality health care and consistent with the values of the profession through individual and collective action
- The nurse participates in the advancement of the profession through contributions to practice, education, administration, & knowledge development
- The nurse collaborates with other health professionals & the public in promoting community, national, & international efforts to meet health needs
- The profession of nursing, as represented by associations and their members, is responsible for articulating nursing values, for maintain the integrity of the profession and its practice, and for shaping social policy.
3
Q
What are the steps in analyzing an ethical dilemma?
A
- Clarify the Ethical Dilemma
- Gather Additional Data
- Identify Options
- Make a Decision
- Act
- Evaluate
4
Q
What is the ANA definition of nursing?
A
Nursing is the protection, promotion, and optimization of health and abilities, prevention of illness and injury, alleviation of suffering through the diagnosis and treatment of human response, and advocacy in the care of individuals, families, communities and populations
5
Q
What are characteristics of an occupation?
A
- Training may occur on job
- Length of training varies
- Work → manual
- Decisions → trial and error
- Value, beliefs, ethics = not a big deal
- Commitment and personal identification vary
- Supervised
- Often change jobs
- Material rewards = main motivation
- Accountability → employer
6
Q
What are characteristics of a professional?
A
- Education at college/university
- Length of education prolonged
- Work → mentally creative
- Decisions → evidence-based practice
- Values, beliefs, ethics = big deal
- Commitment and personal identification = strong
- Autonomous
- Unlikely to change jobs
- Commitment > material rewards
- Accountability → individual
7
Q
What is Flexner’s view on the idea of a Profession?
A
- ›Intellectual (verses physical)
- ›Individual responsibility
- ›Own body of knowledge developed through research
- ›Practical and theoretical
- ›Taught thru highly specialized education
- ›Strong organization of members
- ›Motivated by altruism & public interest
8
Q
How does Hall define professionalism?
A
- Use of professional organization as a point of reference
- Belief in the value of public service
- Belief in self-regulation
- Commitment goes beyond materialistic incentives
- Sense of autonomy in practice
9
Q
How does Kelly define professionalism?
A
- Services are vital to humanity and welfare of society
- Special body of knowledge that is continually enlarged through research
- Intellectual activities and individual accountability
- Education is college/universities
- Independent (autonomous)
- Altruism
- Code of Ethics
- Organization/association encourages high standards of practice (example: ANA)
10
Q
What are ways to influence policy change?
A
- Support the professional organization that advocates for policy change -ANA American Nurses Association. Out of 3 million nurses, only 150,000 are members.
- Professional organizations and professional nurses have much to offer in formulating policy decisions at federal, state, and local levels and in each branch of government.
- Organized nursing is involved in politics at many levels in promoting comprehensive health reform and creating a safer workplace.
- Becoming politically active is as easy as signing your name in support of an issue, registering to vote, organizing a project, or speaking out on an issue.
11
Q
What is Cohen’s levels of learning/socialization?
A
- Unilateral dependence: totally reliant on authority, doesn’t question
- Negativity/independence: cognitive rebellion
- Dependence/mutuality: more reasoned evaluation of others ideas
- Interdependence: collaborative decision making, role identity
12
Q
What is Benner’s levels of socialization/knowledge acquization?
A
- Novice: limited skills, relies totally on others
- Advanced Beginner: some skills, difficulty prioritizing
- Competent Practitioner: competent, organized, coordinates several tasks
- Proficient Practitioner: sees subtle changes, sets priorities easily, long term goals
- Expert Practitioner: performs fluidly, expertise comes naturally
13
Q
Who made the reality shock theory?
A
Kramer
- Absence of positive reinforcement and lack of frequent communication
- Lack of support (faculty availability)
- Gap between ideals in school and work setting
- Inability to implement desired nursing care because of circumstances such as a heavy case load or time constraints
14
Q
What are nurses primary duty?
A
- to promote health
- to prevent illness
- to restore health
- to alleviate suffering
15
Q
What are the 5 steps of the nursing process?
A
- Assessment
- Data gathering
- Planning
- Implementation
- Evaluation
16
Q
What are the 4 stages of team development?
A
- Forming: members introduced, goals/tasks established, politeness
- Storming: more comfortable, competition, arguments, sides
- Norming: issues resolved, agreement, trust/common interests, roles/objectives understood
- Peforming: contributions, motivated by results, abilities determine shared leadership, tasks accomplished effectively
17
Q
What is the NPA?
A
Nurse Practice Act
- Defines the practice of professional nursing
- Sets the minimum educational qualifications and other requirements for licensure
- Determines the legal titles and abbreviations nurses may use
- Provides for disciplinary actions of licensees for certain causes
Establishes state boards of nursing
18
Q
What must a patient fully comprehend for an informed consent?
A
- Purpose of the procedure
- Risk and Benefits
- Expected or Desired outcomes
- Side effects and potential complications
- Alternative treatment options
19
Q
What is civil law
A
- Deals with violation of a person’s rights by another
- Dispute is resolved by third party and compensation given
- Ex: tort
20
Q
What are some intentional torts?
A
- Assault
- Conduct making another person fearful of violence, may not actually carry it out
- Battery
- Contact with a person that involves an injury or offensive act, actual touching
- Defamation of Character
- May give an individual or a group a negative image, defaming, saying something that is false that ruins the reputation of another, slander
21
Q
What are some UNintentional torts?
A
- Negligence
- Failure to act as a reasonably prudent person would have acted in the same circumstances
- Omission of an act of care that a reasonably prudent person would exercise in like circumstance.
- Involves harm caused by carelessness, not intentional.
- Malpractice
- Negligence but applied to a professional.
- A professional fails to act as a reasonably prudent professional would have acted in a similar situation.
- Expert witnesses often testify.
22
Q
What are the core competencies of informatics?
A
- -provision of patient-centered care
- -work in interdisciplinary teams
- -employ evidence-based practice
- -apply quality improvement
- -utilize informatics
23
Q
What are the values of informatics?
A
- -improve health care quality
- -prevent medical errors
- -reduce health care costs
- -increase administrative efficiencies
- -decrease paperwork
- -expand access to affordable care
24
Q
What are the 6 QSEN?
A
- -patient-centered care
- -evidence-based practice
- -teamwork and collaboration
- -safety
- -quality improvement
- -informatics
25
Who was Florence Nightengale?
* Developed concept of sanitary conditions
* Understood value of food/nutrition. Milk source of nourishment.
* Practiced changing bedding (by having two beds and airing out one at a time)
* Understood the need for fresh air
* Understood the need for the cleanliness of the patient (bathing, grooming)
* Went to Kaiserwerth
* **Opened St. Thomas Hospital, London 1860**
26
AMA model of nursing training
* 1869 Dr. Samuel Gross recommended to AMA to open formal training programs for nurses
* Recommended that all hospitals have a training program taught by physicians
* 1872 first hospital training program by physicians at New England Hospital, NY. Linda Richards was first graduate
27
Florence Nightengale model of training
* 1878 Linda Richards opened Florence Nightingale Nurse Training Program at Boston College Hospital
* Spent life reorganizing hospital training programs that offered programs independent of hospitals and physicians
28
advocate for mentally ill, superintendent of women nurses of the army
Dorothea Dix
29
Matrons of hospitals Chimborazo. One of the earliest to be placed in charge
Pheobe Pember
30
* Director & founder of Johns Hopkins Nursing Program (first diploma school)
* Founded American Nurses Association (ANA)
Isabel Hampton Robb (1860-1910)
31
* Taught at Johns Hopkins
* Wrote History of Nursing
* Started public health & school nursing (Nurses Settlement)
* Women’s rights & birth control advocate
* Jailed 3 times!!
Lavina Lloyd Dock (1858-1956)
32
Who founded the International Council of Nurses (ICN)?
Bedford Fenwick
33
* Founder of Henry Street Settlement
* Founder of Public Health Nursing Organization
* Wrote Standards for Public Health Nursing
Lillian Wald
34
* Believed in university education of nurses- huge!
* founded Nursing School at Columbia University (1907)
* Wrote Standard Curriculum for Schools of Nursing
Adelaide Nutting (1858-1948)
35
* Worked with African American TB patients in NYC
* Bought community health to slums of NYC
* Established Stillman House, branch of Henry Street Settlement serving “colored”
Jessie Sleet Scales
36
Effects of Civil War on Nursing
* Not enough nurses, so appeals made
* Many women signed up and as a result, nursing advanced dramatically
* Little training
* Word “nurse” was vague
* Advancement of military hospitals and nursing care resulted in reform of civilian hospitals afterwards
37
Effects of Spanish War, WWI, WWII on nursing
* Spanish-American War
* 1901 Army Nurse Corp
* 1908 Navy Nurse Corp
* World War 1
* National Committee on Nursing
* Army school of nursing
* American Red Cross
* World War 2
* Cadet Nurse Corps
38
Formation of Nursing organizations
* 1883 - National League for Nursing **(NLN)** formed at Chicago World's Fair
* 1896 - American Nurses Association **(ANA)** founded by Isabel Hampton Robb
* 1899 - International Council of Nurses **(ICN)** united organizations of all nations
* 1908 - National Association of Colored Graduate Nurses formed in response to exclusion of African American nurses from ANA. Dissolved in 1951 when ANA admitted African Americans
39
Who sought licensure to protect public from incompetent nurses?
* **NLN**
* Opposed by AMA who wanted to keep control
* First permissive licensure laws passed in 1903 in several states.
* 1930 NY first state with mandatory licensure. Other states followed
* **ICN** passed a resolution asking each country and state to provide for licensure of the nurses working there.
40
* Florence Wald founded Hospice in 1971
* Nurse Practitioners
* CEUs required
* Divorce rates required full time employment with benefits and unions
1970's
41
* Increased technology
* Team nsg due to increased pt ratios
* Increased acuity and story stays
* AIDS
* Critical nursing shortage.
* Men in nursing
1980's
42
* Primary Nursing
* Creative shifts for 2nd jobs
* Nurses dissatisfied and leave hospitals
* Diseases associated with preventable causes led to mortality in U.S.
1990's
43
* Eminent nursing shortage a priority
* High patient acuity in hospitals
* Huge faculty shortage
* Focus on community and public health
* Doctorate of Nursing Practice (2004)
2000's
44
* Move from acute to chronic care
* Aging population
* Emphasis on prevention
* Community (Public) Health
* Shortage of Nurses and Primary Care Providers
* Infectious disease (AIDS, influenza, hepatitis)
* Bioterrorism & natural disasters
* Technology (informatics, telematics)
* Immigration (diverse cultures)
* Health Care Reform (ACA)
Present day
45
How can you become certified and who develops certification?
* Requires experience + exam
* ANA
46
* focused on the clinical learning experiences of students
* hospital control of the schools
* the desirability of establishing university schools of nursing
* the lack of funds specifically for nursing education, and the lack of prepared teachers
* Push for university-based nursing programs
* Launched beginnings of battle over whether nurses should be seen as professionals or technicians
Goldmark Report
47
* Sponsored by Carnegie Foundation
* Recommended schools of nursing be placed in universities/college
* Effort to recruit men & minorities
Brown Report
48
* The Future of Nursing: Leading Change, Advancing Health"
* Calls for increasing number of baccalaureate-prepared nurses to 80% & doubling number of nurses with doctoral degrees by 2020
IOM Report
49
* Proposal that states mandate that nurses work towards a BSN within 10 years of having their license in order to maintain their licensure
* Currently proposed in Rhode Island, New York and New Jersey
BSN in 10
50
What is required after you recieve your primary nursing education?
* Mandatory for license renewal
* Sometimes require proof
* Ensures up to date knowledge
* 30 hours every 2 years (CEU)
* Provider must be recognized by BRN
51
What do you need to become a NP?
* **MSN + board certified**
* Take hx, exam, tests, prescription, treat
* High demand in inner cities and rural
52
What do you need to do to become a certified nurse anesthetist?
* BSN + one year acute care experience + accredited nurse anesthesia program
53
civil rights law that prohibits discrimination against individuals with disabilities in all areas of public life, including jobs, schools, transportation, and all public and private places that are open to the general public.
The Americans with Disabilities Act (ADA)
54
* form of power that is not legitimated through official channels, that is, elections or appointments by one in authority, but influence is the action or process of producing effects on the actions, behavior, and opinions of others.
Influence
55
What state mobilized the public and other constituency groups to get the first legislation requiring specific nurse-to-patient ratios passed in 1999, not implemented until 2004?
California
* 16 states plus Dist. of Columbia implemented so far
56
How many specialty organizations are
represented in the Nursing Organizations Alliance?
66
57
What is a party, or business, intended to influence and determine decisions, actions, and other matters: American foreign policy or American health care policy?
Policy
58
“The science of government; that part of ethics which has to do with the regulation and government of a nation or state, preservation of its safety, peace and prosperity, the defense of its existence and rights against foreign control or conquest, the augmentation of its strength and resources, and the protection of its citizens in their rights, with the preservation and improvement of their morals.“
Politics
59
* An expression of knowledge (result of knowledge investigation or intellectual pursuit) that depicts a phenomenon.
* Creative and rigorous structuring of ideas that project a tentative, purposeful, or systematic view of phenomena.
Theory
60
What are the 4 concepts of theory?
* **Person:** theory applies to all individuals
* **Health:** learned behaviors of nurses, healthcare providers, and patient care
* **Environment:** whether positive or negative influence acceptable learned behavior
* **Nursing:** applicable to all stages of nurses from novice to expert in learning new skills or teaching
61
How can you minimize issues with delegation?
* right context
* right task
* right person
* right communications
* right resources
62
* a nationwide federal health insurance program established in 1965
* available to people age 65 years and older, regardless of the recipient's income
* covers certain disabled individuals and anyone with permanent kidney failure requiring dialysis or a kidney transplant
Medicare
63
* Social Security Act, is a group of jointly funded federal-state programs for low-income, elderly, blind, and disabled individuals.
* Eligibility depends on income and varies from state to state.
* Rates of payment also vary, with some states providing far higher payments than others.
* The amount the federal government contributes to Medicaid varies from a minimum of 50% of total costs to a maximum of 76.8%.
Medicaid
64
* law that gave hospitals, nursing homes and other health facilities grants and loans for construction and modernization.
* agreed to provide a reasonable volume of services to persons unable to pay and to make their services available to all persons residing in the facility’s area
* stopped providing funds in 1997, but about 170 health care facilities nationwide are still obligated to provide free or reduced-cost care
* Since 1980, more than $6 billion in uncompensated services have been provided to eligible patient
* Caused shortage \>team nursing
Hill Burton Act- outcome
65
* individual mandate (all eligible (except undocumented and incarcerated))
* health exchanges for comparing and buying insurance
* Medicaid expansion
* Employer mandate (for employers larger than 50 people)
* No denial of coverage for pre-existing conditions
* Increased emphasis on prevention and wellness
* children up to age 26 still covered under parents
ACA
66
* For anyone 18 and older
* Provides instructions for future treatment
* Appoints a Health Care Representative
* Does not guide Emergency Medical Personnel
* Guides inpatient treatment decisions when made available
Adv Directive
67
* a physician order that helps give seriously ill patients more control over their end-of life care.
* Produced ONLY on a bright pink, standardized form for entire state of CA.
* Has to be signed by both of the doctor and patient in order to be valid.
* Specifies the types of medical treatment that a patient wishes to receive toward the end of life.
* Helps prevent unwanted medical treatments, reduces patient/family suffering, and ensures patients’ wishes are met.
* No age specifications; can be used for adult and pediatric patients.
POLST
68
What is contained in a POLST?
* Section A: Cardiopulmonary Resuscitation (CPR)
* Attempt resuscitation (CPR) or Do not attempt resuscitation (DNR).
* Section B: Medical Interventions
* Comfort measures, limited treatment or full treatment.
* Section C: Artificially administered nutrition
* No artificial nutrition by tube, defined trial period of artificial nutrition by tube, or long term artificial nutrition by tube.
* Section D: Signature and summary of medical condition.
69
What are the guiding ethical principals for interpreting?
* Confidentiality
* Impartiality
* Respect for Individuals and their Communities,
* Professionalism and Integrity
* Accuracy and Completeness
* Cultural Responsiveness
70
* Called basic, bench science, fundamental
* Designed to expand base of knowledge or to build theory for a discipline
* Done just to obtain knowledge & doesn’t matter if it’s immediately useful
* Doesn’t seek to find a solution to a problem
* Ex: study of blood cells or how brain works in a lab
Pure Research
71
Steps of the research process
1. The Research Process:
2. Define the problem
3. Review literature
4. Hypothesis
5. Select a design
6. Implement
7. Draw conclusion
8. Discuss implications
9. Dissemination of findings
72
What's PICO?
P- Population, I-intervention, C-Comparison, O-Outcome.
73
Inductive research; conducted to discover the problems that exist; involves formulation, testing, & redevelopment of propositions until a theory is developed.
Grounded Theory
74
Levels of Partcipation
* **Student:** learning, consumers
* **Associate:** assists in identifying problems
* **BSN:** consumer, identifies problems, data collection
* **MSN:** assists others in applying research into practice, replicates early research, utilization consultant
* **Doctorate:** independent research, program director, theory generator
75
Population growth
* US
* one birth every 7 seconds
* one international migrant every 36 seconds
* one death every 13 seconds
* net gain of one person every 11 seconds
76
genetic variants that affect drug metabolism can help providers determine the correct dose of a particular drug and, possibly, even whether a particular drug will work at all
Pharmacogenetics
77
* focused on the importance of the nurse-patient relationship in 1952 book Interpersonal Relations in Nursing
* referred to the use of one's personality and communication skills to help patients as the “therapeutic use of self” (Peplau, 1952), a strategy that you can develop with practice
Hildegard Peplau
78
What are the phases of nurse patient relationships?
* Orientation phase:
* introductory phase. “getting to know you.” Nurse and patient assess each other, making impressions. Patient has the right to know nurse’s name, credentials, and extent of responsibility
* Developing trust
* The patient will have developed enough trust in the nurse to continue to participate in the relationship
* The patient and nurse will see each other as individual the patient’s perception of major problems and needs will have been identified the approximate length of the relationship will have been estimated
* Working Phase
* nurse and patient address tasks outlined in orientation phase
* Making and sustaining change/progress is difficult; nurses must be patient, self-aware, and mature
* Termination Phase
* includes those activities that enable the patient and the nurse to end the relationship in a therapeutic manner
* Feelings evoked by termination should be discussed and accepted. Patient may feel sad and vulnerable about ending the relationship
79
Common eye diseases in children
* amblyopia
* lazy eye; vision disorder where one eye fails to gain normal visual acuity
* strabismus
* crossed eye; inability to align both eyes in one direction simultaneously
80
Common eye diseases in adults
* eye injuries- trauma, foreign material
* diabetes-related vision problems
* diabetic retinopathy- damage to the blood vessels to the retina caused by uncontrolled hyperglycemia; can lead to total blindness
* cataracts- clouding of the lens of the eyes
* glaucoma- damage to the optic nerve, usually caused by increased pressure in the eye
81
Common eye problems in older adults
* cataracts- clouding of the lens of the eyes
* age-related macular degeneration- degeneration of the macula, a small area on the retina that allows you to see clearly
* diabetic retinopathy
* glaucoma
82
Alternative remedies in Hmong community
* _cupping-_ Burning cotton or tissues in a small glass jar, placing jar over a painful area on the back or chest and allowing the air in the jar to cool, producing a vacuum and resulting in a round ecchymotic area believed to draw out “bad blood”
* _coining-_ Using silver spoon or coin to stroke skin until an ecchymotic area appears. The silver is believed to absorb the sickness.
* _pinching_- Pinching the skin until a bruise appears, usually a narrow ecchymotic area will appear and may be found between eyes of a person with headache.
* _Zaws hno-_ A massage of the arms and hands followed by a finger prick believed to release built-up pressure within the body and release the sickness.
83
Common genetic Jewish diseases
* **Tay Sachs**
* Typically dx in children 2-4 years old
* Loss of neuron function leading to death. Typically within a year of dx.
* Telltale sign is red spot in eye
* **Hemophillia**
* Missing clotting factor in clotting cascade
* Leads to excessive bleeding
* Concern for surgery
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