CHAPTER 1 Introduction to Nursing
Science of nursing: knowledge base for care that is provided.
Art of nursing: skilled application of knowledge.
Holistic approach to nursing: science of nursing + art of nursing.
Florence Nightingale: elevated the status of nursing to a respected occupation, improved the
quality of nursing care, and founded modern nursing education.
ANA Social Policy Statement: describes the social context of nursing, a definition of nursing,
the knowledge base for nursing practice, the scope of nursing practice, standards of professional
nursing practice, and the regulation of professional nursing.
STOP technique to reduce stress and be able to respond more skillfully during challenging
times.
S—Stop and take a step back
T—Take a few breaths
O—Observe inside yourself
P—Proceed after you pause
CHAPTER 3 Health, Wellness & Health Disparities
Health: state of complete physical, mental, and social well-being, not merely the absence of
disease or infirmity
Morbidity: how frequently a disease occurs
Mortality: numbers of deaths resulting from a disease
Wellness: an active state of being healthy, including living a lifestyle that promotes good
physical, mental, and emotional health.
Disease: pathologic changes in the structure or function of the body or mind.
Illness: response of the person to a disease; process in which the person’s level of functioning is
changed when compared with a previous level.
Acute illness: usually has a rapid onset of symptoms and lasts only a relatively short time.
Chronic illness: permanent change, causes, or is caused by, irreversible alterations in normal
anatomy and physiology; requires special patient education for rehabilitation.; requires a long
period of care or support
Remission: disease is present, but the person does not experience symptoms
Exacerbation: symptoms of the disease reappear
Stages of Illness Behavior:
Stage 1 Experiencing symptoms: first indication of an illness usually is recognizing one
or more symptoms that are incompatible with one’s personal definition of health.
Stage 2: Assuming the sick role: when people assume the sick role, they define
themselves as ill, seek validation of this experience from others, and give up normal
activities.
Stage 3: Assuming a dependent role: characterized by the patient’s decision to accept
the diagnosis and follow the prescribed treatment plan.
Stage 4: Achieving recovery and rehabilitation role: person gives up the dependent
role and resumes normal activities and responsibilities.
Health equity: attainment of the highest level of health for all people.
Health disparity: particular type of health difference that is closely linked with social,
economic, and/or environmental disadvantage
Social determinants of health: conditions in the environments in which people are born, live,
learn, work, play, worship, and age that affect a wide range of health, functioning, and quality of
life outcomes and risks
Vulnerable populations: racial and ethnic minorities, those living in poverty, women, children,
older adults, rural and inner-city residents, and people with disabilities and special health care
needs.
Risk factor: something that increases a person’s chances for illness or injury; modifiable (things
a person can change, such as quitting smoking) or nonmodifiable (things that cannot be
changed, such as a family history of cancer).
Health promotion: behavior of a person who is motivated by a personal desire to increase wellbeing and health potential.
Level of Health Promotion & Preventive Care
1. Primary: directed toward promoting health and preventing the development of disease
processes or injury.
2. Secondary: focus on screening for early detection of disease with prompt diagnosis and
treatment of any found.
3. Tertiary: begins after an illness is diagnosed and treated, with the goal of reducing
disability and helping rehabilitate patients to a maximum level of functioning.
Stages of Change Model: used today by counselors addressing a broad range of behaviors
including injury prevention, overcoming drug and alcohol addictions, and weight loss
CHAPTER 8 Communication
Communication: process of exchanging information and generating and transmitting meanings
between two or more people.
Sender or source (encoder): person or group who initiates or begins the communication process
Message: actual communication product from the source; speech, interview, conversation, chart,
gesture, memorandum, or nursing note.
Channel of communication: medium the sender has selected to send the message
•
•
•
Auditory—spoken words and cues (hearing & listening)
Visual—sight, observations, and perception
Kinesthetic—touch
Receiver (decoder): translate and interpret the message sent and received
Feedback (i.e., evidence): confirmation of the message, receiver has understood the intended
message.
Noise: factors that distort the quality of a message, interfere with communication at any point in
the process. (television, or from pain or discomfort)
Forms of Communication:
1. Verbal communication: exchange of information using words, including both the
spoken and written word; depends on language
2. Nonverbal communication or body language: transmission of information without the
use of words; (touch, facial expression, eye contact, posture, gait, gestures, physical
appearance, mode of dressing & grooming, sounds & silence).
Levels of Communication
1. Intrapersonal communication or self-talk: communication within a person.
2. Interpersonal communication: between two or more people with a goal to exchange
messages.
Group Communication
1. Small-group communication: occurs when nurses interact with two or more people.
2. Organizational communication: occurs when people and groups within an organization
communicate to achieve established goals.
3. Group Dynamics: involve how individual group members relate to one another during
the process of working toward group goals.
I-SBAR-R: Identification, Situation, Background, Assessment, Recommendations and Read
back, provides a consistent method for hand-off communication that is clear, structured, and easy
to use.
I (Identification): “yourself & your patient”
S (Situation) and B (Background): provide objective data.
A (Assessment) and R (Recommendations): presentation of subjective information.
R (Read back): opportunity to ask questions; at the close of the communication
Quality and Safety Education for Nurses (QSEN) Institute: identifies quality and safety
competencies for nursing, with the goal of preparing future nurses with the knowledge, skills,
and attitudes necessary to improve the quality and safety of the health care systems within which
they work.
CUS: I’m Concerned, I’m Uncomfortable, This is unSafe (This is a Safety issue).
Empathy: objective understanding of the way in which a patient sees his or her situation,
identifying with the way another person feels, putting yourself in another person’s
circumstances, and imagining what it would be like to share that person’s feelings.
Rapport: feeling of mutual trust experienced by people in a satisfactory relationship.
Interviewing Techniques
1. Open-ended question technique: allow the patient a wide range of possible responses
2. Closed question: provides the receiver with limited choices of possible responses and
might often be answered by one or two words, “yes” or “no.”
3. Validating Question or Comment: validate what the nurse believes he or she has heard
or observed.
4. Clarifying Question or Comment: use of the clarifying question or comment allows the
nurse to gain an understanding of a patient’s comment.
5. Reflective Question or Comment: involves repeating what the person has said or
describing the person’s feelings.
6. Sequencing Question or Comment: place events in a chronologic order or to investigate
a possible cause-and-effect relationship between events.
7. Directing Question or Comment: might become necessary at times to obtain more
information about a topic brought up earlier in the interview or to introduce a new aspect
of the current topic.
Assertive behavior: ability to stand up for yourself and others using open, honest, and direct
communication.
Aggressive behavior: involves asserting one’s rights in a negative manner that violates the
rights of others.
Non Therapeutic Comments & Questions
1. Cliché: stereotyped, trite, or pat answer
• “Everything will be all right.”
• “Don’t worry.
• “You will be just fine in another day or two.”
• “Your doctor knows best.”
• “Cheer up. Tomorrow is another day.
2. Questions Requiring Only a Yes or No Answer
3. Questions Containing the Words Why and How
4. Questions that Probe for Information
• “Let’s get to the bottom of this”
5. Leading Questions: suggests what response the speaker wishes to hear.
•
You aren’t going to smoke that cigarette, are you?
6. Comments that Give Advice: implies that the nurse knows what is best for patients and
denies them the right to make decisions and have feelings; advice does have a rightful
place when it is requested.
7. Judgmental Comments: instead use “Tell me”
• You aren’t acting very grown up. How do you think your husband would feel if
he saw you crying like this?
Solving Problems involves:
•
•
•
•
•
•
group decision making
group identity: ascertaining that the staff completes a task on time and that all
members agree the task
group patterns of interaction: honest communication and member support
group cohesiveness: occurs when members generally trust each other, have a
high commitment to the group, and a high degree of cooperation.
group leadership: occurs when groups use effective styles of leadership to meet
goals
group power: sources of power are recognized and used appropriately to
accomplish group outcomes.
CHAPTER 11 Health Care Delivery System
Types of Reimbursement
1. Capitation plans: give providers a fixed amount per enrollee in the health plan in an
effort to build a payment plan that consists of the best standards of care at the lowest cost.
2. Prospective payment system: groups inpatient hospital services for Medicare patients
into DRGs.
3. Bundled payments: providers receive a fixed sum of money to provide a range of
services.
4. Rate setting: means that the government could set targets or caps for spending on health
care services.
Mode of Healthcare Payment
1. Individual private insurance: members pay monthly premiums either by themselves or
in combination with employer payments; third-party payers because the insurance
company pays all or most of the cost of care.
2. Out-of-pocket payment: paying for health care with cash payments.
3. Employer-based private insurance: employer-sponsored coverage.
4. Government financing: provided through Medicare and Medicaid, and other federally
funded programs.
Type of Care
1. Hospice care: combines the skills of the home care nurse with the ability to provide daily
emotional support to dying patients and their families.
2. Respite care: provided for caregivers of homebound ill, disabled, or older adults.
3. Palliative care: used in conjunction with medical treatment and in all types of health care
settings, is focused on the relief of physical, mental, and spiritual distress.
4. Extended-care facilities: include transitional subacute care, assisted-living facilities,
intermediate and long-term care, homes for medically fragile children, retirement centers,
and residential institutions for mentally and developmentally or physically disabled
patients of all ages.
Advanced Practice Registered Nurse (APRN): registered nurse educated at the master’s or
post-master’s level in a specific role and for a specific population; (nurse practitioners, clinical
nurse specialists, nurse anesthetists, or nurse midwives)
CHAPTER 10 Leading, Managing & Delegating
Personal Leadership Skills
•
•
•
•
•
•
•
Commitment to excellence
Problem-solving skills, including a clear vision and strategic focus, that allow movement
forward toward a creative solution
Commitment to and passion for your work
Trustworthiness and integrity
Respectfulness Accessibility Empathy and caring
Desire to be of service
Responsibility to enhance the personal growth of all staff
Types of Leadership
1. Autocratic leadership: directive leadership; involves the leader assuming control over
the decisions and activities of the group, such as dictating schedules and work
responsibilities, and scheduling mandatory in-service training.
2. Democratic leadership: participative leadership; characterized by a sense of equality
among the leader and other participants, with decisions and activities being shared.
•
Example: polling other nurses; accomplish mutually set goals and outcomes
3. Laissez-faire leadership: non-directive leadership; leader relinquishes power to the
group and encourages independent activity by group members.
•
Example: allowing the nurses to divide up the tasks and encouraging them to
work independently; setting their own schedules and work activities.
4. Transactional leadership: based on a task-and-reward orientation.
•
Example: instituting a reward program and reminding workers that they have a
good salary and working conditions.
5. Transformational leadership: encouraging nurses to participate in health care reform.
•
Example: joining organization
6. Quantum leadership: ensuring that employees keep abreast of new developments in
nursing care.
7. Servant leadership: natural feeling that one wants to serve.
Three stages of change by Lewin:
1. Unfreezing: The need for change is recognized. (fail to develop lifestyle practices →
illness).
2. Moving: Change is initiated after a careful process of planning. (development of fitness
plan)
3. Refreezing: Change becomes operational. (becomes part of everyday life)
Delegating Nursing Care → STUDY: ATI p. 27
RN:
•
TAPE: should not delegate the teaching, assessment, planning, and evolution steps of the
nursing process.
•
RESPONSIBLE: initial patient assessment, discharge planning, health education, care
planning, triage, interpretation of patient data, care of invasive lines, administering
parenteral medications.
•
DELEGATE: basic care activities (bathing, grooming, ambulation, feeding) and things
like taking vital signs, measuring intake and output, weighing, simple dressing changes,
transfers, and postmortem care.
Before the RN delegates any nursing intervention should be considered:
(1) the stability of the patient’s condition
(2) the complexity of the activity to be delegated
(3) the potential for harm
(4) the predictability of the outcome
(5) the overall context of other patient needs
CHAPTER 12 Collaborative Practice & Care Coordination Across Settings
Discharge planner primary roles as patients move from acute to home care:
•
•
•
evaluating the nursing plan for effectiveness of care
making referrals for patients
assessing the strengths of patients and their families
The patients who are most likely to need a formal discharge plan or referral to another
facility:
•
•
•
•
•
•
•
•
emotionally or mentally unstable (e.g., those with dementia)
recently diagnosed chronic disease (e.g., Parkinson’s disease)
have a terminal illness (e.g., end-stage cancer
who do not understand the treatment plan
socially isolated
have had major surgery or illness
need a complex home care regimen
lack financial services or referral sources
Pre-entry phase of the home visit:
•
•
collects information about the patient’s diagnoses, surgical experience, socioeconomic
status, and treatment orders.
gathers supplies needed, makes an initial phone contact with the patient to arrange for a
visit, and assesses the patient’s environment for safety issues.
Entry phase of the home visit:
•
develops rapport with the patient and family, makes assessments, determines nursing
diagnoses, establishes desired outcomes, plans, and implements prescribed care, and
provides teaching.
Patient is legally free to leave the hospital AMA
•
must sign a form releasing the health care provider and hospital from legal responsibility
for their health status; becomes part of the medical record.
CHAPTER 13 Blended Competencies, Clinical Reasoning, Processes of Person-Centered
Care
Nursing process: systematic method that directs the nurse, with the patient’s participation, to
accomplish the following ADPIE
•
•
•
•
Systematically collect patient data (assessing)
Clearly identify patient strengths and actual and potential problems (diagnosing)
Develop a holistic plan of individualized care that specifies the desired patient goals and
related outcomes and the nursing interventions most likely to assist the patient to meet
those expected outcomes (planning)
Execute the care plan (implementing)
•
Evaluate the effectiveness of the care plan in terms of patient goal achievement
(evaluation)
Characteristic of Nursing Process
•
•
•
Systemic
Dynamic
Interpersonal
Problem Solving
1. Intuitive problem solving: direct understanding of a situation based on a background of
experience, knowledge, and skill that makes expert decision making possible; comes with
years of practice and observation.
2. Trial-and-error problem solving: involves testing any number of solutions until one is
found that works for that particular problem.
3. Scientific problem solving: systematic, seven-step problem-solving process that
involves: (1) problem identification, (2) data collection, (3) hypothesis formulation, (4)
plan of action, (5) hypothesis testing, (6) interpretation of results, and (7) evaluation,
resulting in a conclusion or revision of the hypothesis.
4. Critical thinking: contextual and changes depending on the circumstances, not on
personal preference.
QSEN Competency
1. Quality improvement: involves routinely updating nursing policies and procedures.
2. Providing patient-centered care: involves listening to the patient and demonstrating
respect and compassion.
3. Evidence-based practice: used when adhering to internal policies and standardized
skills.
4. Informatics: using information and technology to communicate, manage knowledge, and
support decision making.
CHAPTER 14 Assessing
Assessing: systematic and continuous collection, analysis, validation, and communication of
patient data, or information.
Types of Nursing Assessment
1. Initial assessment: performed shortly after the patient is admitted to a health care facility
or service.
2. Focused assessment: the nurse gathers data about a specific problem that has already
been identified
3. Emergency assessment: identify life-threatening problems.
4. Time-lapsed assessment: scheduled to compare a patient’s current status to the baseline
data obtained earlier.
Patient-Centered Assessment Method (PCAM): tool health care practitioners can use to assess
patient complexity using the social determinants of health
Collecting Data
1. Objective data: observable and measurable data that can be seen, heard, felt, or
measured by someone other than the person experiencing them.
2. Subjective data: information perceived only by the affected person; these data cannot be
perceived or verified by another person.
Physical assessment: examination of the patient for objective data that may better define the
patient’s condition and help the nurse plan care.
Review of systems (ROS): involves the examination of all body systems in a systematic
manner, commonly using a head-to-toe format.
Cue: something may be wrong. (“the patient does not respond when I speak to him on his left
side”)
Inference: judgment you reach about the cue (the patient’s hearing may be impaired on his left
side)
Validation: act of confirming or verifying; keep data as free from error, bias, and
misinterpretation as possible.
Model for Organizing Data
1. Gordon’s functional health patterns: begin with the patient’s perception of health and
well-being and progress to data about nutritional–metabolic patterns, elimination
patterns, activity, sleep/rest, self-perception, role relationship, sexuality, coping, and
values/beliefs.
2. Maslow’s model: based on the human needs hierarchy.
3. Human responses: include exchanging, communicating, relating, valuing, choosing,
moving, perceiving, knowing, and feeling.
4. Body system model: based on the functioning of the major body systems.
CHAPTER 14 Diagnosing
Diagnosing
(1) identify how a person, group, or community responds to actual or potential health and life
processes
(2) identify factors that contribute to or cause health problems (etiologies)
(3) identify resources or strengths that the person, group, or community can draw on to prevent
or resolve problems.
Medical diagnoses
•
•
•
identify diseases
describe problems for which the physician or advanced practice nurse directs the primary
treatment
remains the same for as long as the disease is present
Nursing diagnoses
•
•
•
focus on unhealthy responses to health and illness
describe problems treated by nurses within the scope of independent nursing practice
may change from day to day as the patient’s responses change
Problem → related to Etiology or Cause → as evidenced by S/S
Collaborative problems: “certain physiologic complications that nurses monitor to detect onset
or changes in status.
Nursing Conclusion
No Problem
•
•
•
•
No nursing response is indicated.
Reinforce the patient’s health habits and patterns.
Initiate health promotion activities to prevent disease or illness or to promote a higher
level of wellness.
Wellness diagnosis might be indicated.
Possible Problem
•
Collect more data to confirm or disprove a suspected problem.
Actual or Potential Nursing Diagnosis or Problem or Issue
•
•
Begin planning, implementing, and evaluating care designed to prevent, reduce, or
resolve the problem.
If unable to treat the problem because the patient denies the problem and refuses
treatment, make sure that the patient understands the possible outcomes of this stance.
Type of Nursing Diagnosis
1. Problem-focused nursing diagnosis: clinical judgment concerning an undesirable
human response to a health condition/life process that exists in an individual, family,
group, or community. (label, definition, defining characteristics, and related factor)
2. Risk nursing diagnoses: clinical judgment concerning the vulnerability of an individual,
family, group, or community for developing an undesirable human response to health
conditions/life processes.
3. Health promotion nursing diagnoses: clinical judgment concerning motivation and
desire to increase well-being and to actualize human health potential.
4. Syndrome: clinical judgment concerning a specific cluster of nursing diagnoses that
occur together and are best addressed together and through similar interventions.
(chronic pain syndrome).
5. Possible diagnoses: collect more patient data to confirm or rule out the problem.
Chapter 16 Outcome Identification & Planning
Comprehensive Planning
1. Initial planning: performed by the nurse with the admission nursing history and the
physical assessment.
•
Standardized care plans: prepared care plans that identify the nursing diagnoses,
outcomes, and related nursing interventions common to a specific population or
health problem.
2. Ongoing planning: carried out by any nurse who interacts with the patient.
3. Discharge planning: best carried out by the nurse who has worked most closely with the
patient and family, possibly in conjunction with a nurse or social worker with a broad
knowledge of existing community resources.
•
Begins when the patient is admitted for treatment—or even before admission.
Concept map care: diagram of patient problems & intervention
Maslow’s Hierarchy of Human Needs: basic needs must be met before a person can focus on
higher ones; patient needs may be prioritized according to the following hierarchy:
1. Physiologic needs
2. Safety needs
3. Love and belonging needs
4. Self-esteem needs
5. Self-actualization needs
Crossing the Quality Chasm, highlights six aims to be met by health care systems with
regard to the quality of care:
1. Safe: avoiding injury
2. Effective: avoiding overuse and underuse
3. Patient centered: responding to patient preferences, needs, and values
4. Timely: reducing waits and delays
5. Efficient: avoiding waste
6. Equitable: providing care that does not vary in quality to all recipients
SMART (Doran, 1981):
S—specific
M—measurable
A—attainable
R—realistic
T—time-bound
“Mr. Myer will drink 60-mL fluid every 2 hours while awake, beginning 2/24/20.”
CHAPTER 17 Implementing → STUDY: ATI p. 27
5 Rights of Delegation
1.
2.
3.
4.
5.
Task
Circumstance
Person
Direction & Communication
Supervision & Evaluation
NIC Taxonomy: lists nursing interventions, each with a label, a definition, a set of activities that
a nurse performs to carry it out, and a short list of background readings.
CHAPTER 18 Evaluating
Five classic elements of evaluation in order are:
(1) identifying evaluative criteria and standards (what you are looking for when you
evaluate—i.e., expected patient outcomes)
(2) collecting data to determine whether these criteria and standards are met
(3) interpreting and summarizing findings
(4) documenting your judgment
(5) terminating, continuing, or modifying the plan.
Types of Outcomes
1. Affective outcomes: pertain to changes in patient values, beliefs, and attitudes.
2. Cognitive outcomes: involve increases in patient knowledge
3. Psychomotor outcomes: describe the patient’s achievement of new skills; physical
changes are actual bodily changes in the patient (e.g., weight loss, increased muscle
tone).
The evaluative statement must contain: a date; the words “outcome met,” “outcome partially
met,” or “outcome not met”; and the patient data or behaviors that support this decision.
“1/21/20—Outcome not met. Patient reports no change in diet or activity level.”
Quality-assurance program: reveals a higher incidence of falls & other safety violation on a
particular unit.
•
Quality by inspection: focuses on finding deficient workers and removing them.
•
Quality as opportunity: focuses on finding opportunities for improvement and
fosters an environment that thrives on teamwork, with people sharing the skills
and lessons they have learned.
Chapter 9 Teaching & Counseling
Patient education: process of influencing the patient’s behavior to effect changes in knowledge,
attitudes, and skills needed to maintain and improve health.
Four assumptions about adult learners:
1. As people mature, their self-concept is likely to move from dependence to independence.
2. The previous experience of the adult is a rich resource for learning.
3. An adult’s readiness to learn is often related to a developmental task or a social role.
4. Most adults’ orientation to learning is that material should be useful immediately, rather than
at some time in the future.
Learning Domains
1. Cognitive learning: involves the storing and recalling of new knowledge in the brain
(e.g., the patient describes how salt intake affects blood pressure).
•
intellectual behaviors such as the acquisition of knowledge, comprehension,
application (using abstract ideas in concrete situations), analysis (relating ideas in
an organized way), synthesis (assimilating parts of information as a whole), and
evaluation (judging the worth of a body of information).
2. Psychomotor learning: learning a physical skill involving the integration of mental and
muscular activity (e.g., the patient demonstrates how to change dressings using clean
technique).
3. Affective learning: includes changes in attitudes, values, and feelings (e.g., the patient
expresses renewed self-confidence after physical therapy).
Ask Me 3 questions: brief tool intended to promote understanding and improve communication
between patients and their providers.
•
•
What is my main problem?
What do I need to do?
•
Why is it important for me to do this?
Teach-back tool: method of assessing literacy and confirming that the learner understands
health information received from a health professional.
NVS: reliable screening tool to assess low health literacy, developed to improve communications
between patients and providers.
TEACH acronym: used to maximize the effectiveness of patient teaching by tuning into the
patient, editing patient information, acting on every teaching moment, clarifying often, and
honoring the patient as a partner in the process.
Teaching Methods
1. Role Modeling: patients watch their nurses closely; use this as an opportunity to improve
a patient’s behavior.
2. Lecture: presentation of information by a teacher to a learner.
3. Discussion: involves a two-way exchange of information, ideas, and feelings between the
teacher and learners.
4. Panel discussion: involves a presentation of information by two or more people.
5. Demonstration and Return Demonstration: teach-back technique.
6. Discovery: a problem or situation is presented to the patient or group of patients, who are
then guided to discover the solution or approach.
7. Role playing: gives the learner a chance to experience, relive, or anticipate an event.
Health Teaching
1. Prevent illness: teaching first aid is a function of the goal.
2. Promoting health: involves helping patients to value health and develop specific health
practices that promote wellness.
3. Restoring health: occurs once a patient is ill, and teaching focuses on developing selfcare practices that promote recovery.
4. Facilitating coping: help patients come to terms with whatever lifestyle modification is
needed for their recovery or to enable them to cope with permanent health alterations.
Types of Counselling
1. Short-term counseling: used during a situational crisis, which occurs when a patient
faces an event or situation that causes a disruption in life, such as a flood.
2. Long-term counseling: extends over a prolonged period; a patient experiencing a
developmental crisis, for example, might need long-term counseling.
3. Motivational interviewing: evidence-based counseling approach that involves
discussing feelings and incentives with the patient; a caring nurse can motivate patients to
become interested in promoting their own health.
Contractual agreement: a pact two people make, setting out mutually agreed-on goals.
Chapter 6 Values, Ethics & Advocacy
Bill of Rights for Registered Nurses:
1. Nurses have the right to practice in a manner that fulfills their obligations to society and
to those who receive nursing care.
2. Nurses have the right to practice in environments that allow them to act in accordance
with professional standards and legally authorized scopes of practice.
3. Nurses have the right to a work environment that supports and facilitates ethical practice,
in accordance with the Code of Ethics for Nurses and its interpretive statements.
4. Nurses have the right to freely and openly advocate for themselves and their patients,
without fear of retribution.
5. Nurses have the right to fair compensation for their work, consistent with their knowledge,
experience, and professional responsibilities.
6. Nurses have the right to a work environment that is safe for themselves and their patients.
7. Nurses have the right to negotiate the conditions of their employment, either as individuals
or collectively, in all practice setting
ANA Code of Ethics for Nurses serves the following purposes:
•
•
•
It is a succinct statement of the ethical obligations and duties of every person who enters
the nursing profession.
It is the profession’s nonnegotiable ethical standard.
It is an expression of nursing’s own understanding of its commitment to society.
Value: belief about the worth of something, about what matters, which acts as a standard to
guide one’s behavior; influence beliefs about human needs, health, and illness
Value system: organization of values in which each is ranked along a continuum of importance,
often leading to a personal code of conduct.
Mode of Value Transmission
1. Rewarding and punishing: used to transmit values, children are rewarded for
demonstrating values held by parents and punished for demonstrating unacceptable
values
2. Modeling: children learn what is of high or low value by observing parents, peers, and
significant others.
3. Moralizing: taught a complete value system by parents or an institution (e.g., church or
school) that allows little opportunity for them to weigh different values.
4. Laissez-faire: leave children to explore values on their own (no single set of values is
presented as best for all) and to develop a personal value system.
Process of Value Clarification
1. Prizing: something one values involves pride, happiness, and public affirmation, such as
losing weight or running a marathon.
2. Choosing: one chooses freely from alternatives after careful consideration of the
consequences of each alternative, such as quitting smoking and working fewer hours.
3. Acts: combining choice and behavior with consistency and regularity, such as joining a
gym for the year and following a low-cholesterol diet faithfully/
Ethical Conflict
1. Ethical distress: results from knowing the right thing to do but finding it almost
impossible to execute because of institutional or other constraints (nurse fears the loss of
job).
2. Ethical uncertainty: results from feeling troubled by a situation but not knowing if it is
an ethical problem.
3. Ethical dilemmas occur when the principles of bioethics justify two or more conflicting
courses of action.
4. Ethical residue is what nurses experience when they seriously compromise themselves
or allow themselves to be compromised.
Advocacy
•
•
•
•
protection and support of another’s rights,
patients with special advocacy needs are the very young and the older adult, those who
are seriously ill, and those with disabilities
effective advocacy may entail becoming politically active.
responsibility of every member of the professional caregiving team—not just nurses.
CHAPTER 7 Legal Dimensions of Nursing Process
Type of Law
1. Criminal law: concerns state and federal criminal statutes, which define criminal actions
such as murder, manslaughter, criminal negligence, theft, and illegal possession of drugs.
2. Public law: regulates relationships between people and the government.
3. Private or civil law: includes laws relating to contracts, ownership of property, and the
practice of nursing, medicine, pharmacy, and dentistry.
Plaintiff: person or government bringing suit against another
Appellate: courts of law
Defendants: are the ones being accused of a crime or tort.
Attorneys: lawyers representing both the plaintiff and defendant
Type of Credentials
1. Certification: process by which a person who has met certain criteria established by a
nongovernmental association is granted recognition in a specified practice area
2. Licensure: legal document that permits a person to offer to the public skills and
knowledge in a particular jurisdiction, where such practice would otherwise be unlawful
without a license.
3. State board: approval ensures that nurses have received the proper training to practice
nursing.
Intentional Tort
1. Assault: threat or an attempt to make bodily contact with another person without that
person’s consent.
2. Battery: an assault that is carried out.
3. Invasion of privacy: a nurse who disregards the right of privacy and the right to be left
alone.
4. False imprisonment: unjustified retention or prevention of the movement of another
person without proper consent.
Liability involves four elements that must be established to prove that malpractice or
negligence has occurred:
1. Duty: an obligation to use due care (what a reasonably prudent nurse would do) and is
defined by the standard of care appropriate for the nurse–patient relationship.
2. Breach of duty is the failure to meet the standard of care.
3. Causation: most difficult element of liability to prove, shows that the failure to meet the
standard of care (breach) actually caused the injury.
4. Damages: actual harm or injury resulting to the patient.
Incident reports
•
•
•
used for quality improvement and should not be used for disciplinary action against staff
members.
identifying risks and are filled out by the nurse responsible for the injured party
documentation in the patient record should not include the fact that an incident report
was filed.
CHAPTER 19 Documenting & Reporting
Documentation: written or electronic legal record of all pertinent interactions with the patient:
assessing, diagnosing, planning, implementing, and evaluating.
Patient record: compilation of a patient’s health information (PHI).
Health Insurance Portability and Accountability Act (HIPAA) Privacy Rule: protects the
privacy of individually identifiable health information
•
•
•
•
patients have a right to see and copy their health record
update their health record; get a list of the disclosures a health care institution has made
independent of disclosures made for the purposes of treatment, payment, and health care
operations
request a restriction on certain uses or disclosures
choose how to receive health information
HIPAA Exception:
•
•
•
Health institution is not required to obtain written patient authorization to release PHI for
tracking disease outbreaks, infection control, statistics related to dangerous problems with
drugs or medical equipment, investigation and prosecution of a crime, identification of
victims of crimes or disaster, reporting incidents of child abuse, neglect or domestic
violence, medical records released according to a valid subpoena.
PHI needed by coroners, medical examiners, and funeral directors
PHI provided to law enforcement in the case of a death from a potential crime or
facilitating organ donations.
Documentation
•
•
complete, accurate, concise, current, and factual manner and indicate in each entry the
date and both the time the entry was written and the time of pertinent observations and
interventions.
Nurse should mark the entry “mistaken entry,” add the correct information, and date
and initial the entry.
CHAPTER 20 Nursing Informatics
Technology Testing Phases
Usability: refers to the extent to which a product can be used by specified users to achieve
specified goals with effectiveness, efficiency, and satisfaction in a specified context of use.