UNIT 1 (NU 105)
CHAPTER 1: Introduction to Nursing
Historical Perspective
Theory of animism
● Good spirits brought health; evil spirits brought sickness and death
● Role of nurses and physicians are separate and distinct; physician as medicine man; nurse
as caring mother
Ancient Greek Civilization
● Temples became center of medical care
● Nurses cared for the sick in the home and community; practiced as nurse-midwives
Early Christian period
● Nursing has formal and more clearly defined role; deaconesses made visits to the sick
● Nursing developed purpose, direction, and leadership
16th Century
● Shift from a religious orientation to an emphasis on warfare, exploration, and expansion
of knowledge
● Nursing had a poor reputation; nurses received low pay and worked long hours in
unfavorable conditions
18th – 19th Century
● Social reforms changed the roles of nurses and of women in general
● Many nursing practices are based on Florence Nightingale:
o Challenged prejudices against women and elevated the status of all nurses
o Established first training school for nurses
o Wrote books about health care & nursing education
19th – 21st Century
● Hospital schools organized to provide more easily controlled and less expensive staff for
the hospital
● Female nurses were under the control of male hospital administrators and physicians
● World War II
o Large numbers of women worked outside the home and became more
independent and assertive
o Explosion in medicine and technology broadened the roles of nursing
o Growth of nursing as a professional discipline
UNIT 1 (NU 105)
1950’s to Present
● Nursing broadened in all areas:
o Practice in a wide variety of health care settings
o Development of specific body of knowledge
o The conduct and publication of nursing research
o Recognition of the role of nursing in promoting health
o Growth of nursing as a professional discipline
Contributions of Florence Nightingale: “the lady with the lamp”
1. Identified personal needs of patients and role of nursing in meeting them
2. Established standards for hospital managements
3. Established nursing education and nursing as a respected occupation for women
4. Established nursing education
5. Recognized the two components of nursing: health and illness
6. Believed that nursing is separate and distinct from medicine
7. Recognized that nutrition is important to health
8. Instituted occupational and recreational therapy for sick people
9. Stressed the need for continuing education for nurses
10. Maintained accurate records, recognized as the beginnings of nursing research
NURSING
● Latin word nutrix = “to nourish”
● Nurse:
o A person who nourishes, fosters, and protects and who is prepared to take care of
sick, injured, aged, and dying people.
● ICN (International Council of Nurses) definition:
o Promotion of health, prevention of illness, collaborative care
● ANA definition:
o Social policy statement
● Patient is a central focus of all definition:
o Included physical, emotional, social, and spiritual dimension of the patient
Four Blended Competencies:
1. Cognitive
2. Technical
3. Interpersonal
4. Ethical / legal
QSEN Competencies
1. Patient-centered care
2. Teamwork and collaboration
3. Quality improvement
4. Safety
5. Evidence-based practice
6. Informatic
UNIT 1 (NU 105)
Nursing Aims
1. To promote health
● Health: state of optimal functioning or well-being
● Wellness: active state of being health
● Identifying, analyzing, and maximizing each patient’s own individual strengths as
components of preventing illness, restoring health, and facilitating coping with
disability or death
● Factors affecting health:
a. Genetic inheritance
b. Cognitive abilities
c. Educational level
d. Race and ethnicity; culture
e. Age and gender
f. Developmental level
g. Lifestyle; environment
h. Socioeconomic status
● Healthy People 2020 health promotion guidelines:
o Attain high-quality, longer lives free of preventable disease, disability,
injury, and premature death.
o Achieve health equity, eliminate disparities, and improve the health of all
groups.
o Create social and physical environments that promote good health for all.
o Promote quality of life, healthy development, and healthy behaviors across
all life stages
2. To prevent illness
● Nurses prevent illness primarily by teaching and by personal example:
o Educational programs in areas such as prenatal care for pregnant women,
smoking-cessation programs, and stress-reduction seminars
o Community programs and resources that encourage healthy lifestyles, such
as aerobic exercise classes, “swimnastics,” and physical fitness programs
o Literature, television, radio, or Internet information on a healthy diet,
regular exercise, and the importance of good health habits
o Health assessments in institutions, clinics, and community settings that
identify areas of strength and risks for illness
3. To restore health
● Performing assessments that detect an illness (e.g., taking blood pressure,
measuring blood sugars)
● Referring questions and abnormal findings to other health care providers as
appropriate
● Providing direct care of the person who is ill by such measures as giving physical
care, administering medications, and carrying out procedures and treatments
● Collaborating with other health care providers in providing care
UNIT 1 (NU 105)
● Planning, teaching, and carrying out rehabilitation for illnesses such as heart
attacks, arthritis, and strokes
● Working in mental health and chemical-dependency programs
4. To facilitate coping with disability or death
● Maximizing person’s strengths and potentials
o Patient teaching
o Referral to community support system
● Providing end-of-care
o Hospice programs
Interrelated roles of nurses:
● Communicator
● Teacher
● Counselor
● Leader
● Researcher
● Advocate
● Collaborator
Nursing as a Professional Discipline:
● Well-defined body of specific and unique knowledge Strong service orientation
● Recognized authority by a professional group
● Code of ethics (p19)
● Professional organization that sets standards
● Ongoing research
● Autonomy and self-regulation
Educational Preparation for Nursing Practice
● Practical and vocational nursing education
● Registered nursing education
o Diploma in nursing
o Associate degree in nursing
o Baccalaureate in nursing
● Graduate education in nursing
● Continuing education
● In-service education
UNIT 1 (NU 105)
Guidelines for Nursing Practice
● Standards of Nursing Practice
● Nurse Practice Acts and Licensure
o Define legal scope of nursing practice
o Create a state board of nursing to male and enforce rules and regulations
o Define important terms and activities in nursing, including legal requirements and
titles for RNs and LPNs
o Establish criteria for the education and licensure of nurses
● Nursing Process
o Assessing, diagnosing planning, implementing, and evaluation
o One of the major guidelines for nursing practice
o Helps nurses implement their roles
o Integrates art and science of nurses
o Allows nurses to use critical thinking and clinical reasoning
o Defines the areas of care that are within the domain of nursing
NLN Ten Trends to Watch for Nursing Education
1. Changing demographics and increasing diversity
2. The technologic explosion
3. Globalization of the world’s economy and society
4. The era of the educated consumer, alternative therapies, and genomic and palliative care
5. The shift to population-based care and the increasing complexity of patient care
6. The cost of health care and the challenge of managed care
7. The impact of health policy and regulation
8. The growing need for interdisciplinary education and for collaborative practice
9. The current nursing shortage, and opportunities for lifelong learning and workforce
development
10. Significant advances in nursing science and research
UNIT 1 (NU 105)
CHAPTER 2: Theory Research, and EBP
Nursing social policy statements of issues nurses address:
● Promotion of health and wellness
● Promotion of safety and quality of care
● Care, self-care processes, and care coordination
● Physical, emotional, and spiritual comfort, discomfort, and pain
● Adaptation to physiologic and pathophysiologic processes
● Emotions related to the experience of birth, growth and development, health, illness,
disease, and death
● Meanings ascribed to health, illness, and other concepts
● Linguistic and cultural sensitivity
● Health literacy
● Decision making and the ability to make choices
● Relationships, role performance, and change processes within relationships
● Social policies and their effects on health
● Health care systems and their relationships to access, cost, and quality of health care
● The environment and the prevention of disease and injury
Sources of Knowledge
● Traditional knowledge
o Passed down from generation to generation
● Authoritative knowledge
o Comes from an expert, accepted as truth based on person’s perceived expertise
o Authoritative knowledge generally remains unchallenged as long as presumed
authorities maintain their perceived expertise
● Scientific knowledge
o Obtained through the scientific method (research)
Types of Nursing Knowledge and Influences
● Types:
o Science:
▪ Knowledge in and of nursing
o Philosophy:
▪ The study of wisdom, fundamental knowledge, and the processes used to
construct life
o Process:
▪ Conceptual frameworks and theories
UNIT 1 (NU 105)
● Influences
o Historical:
▪ Florence Nightingale, societal changes
o Societal:
▪ School of nursing
Framework of Nursing Theory
● Theory:
o Group of concepts that describe a pattern of reality
o Can be tested, changed, or used to guide research
● Concepts
o Abstract impression organized into symbols of reality (putting together a puzzle)
o Conceptual framework or model (blue print)
o Looking at specific ideas or actions to conclusions about general ideas
Types of Reasoning:
● Deductive reasoning
o Examines general ideas and consider specific actions or ideas
● Inductive reasoning
o Builds from specific ideas or actions to conclusions about general ideas
Interdisciplinary Base for Nursing Theories
● General System Theory
o Theory for universal application; break whole things into parts to see how they
work together in systems
● Adaptation Theory
o Adjustments of living matter to other living things and environment
● Developmental Theory
o Orderly and predictable growth and development from conception to death
Benefits of Nursing Theory
● Directs nurses towards common goal
● Leads to improved patient care
● Provides rational and knowledgeable reasoning for nursing actions
● Give nurses knowledge base necessary for appropriate actions
● Helps resolve current nursing issues
● Prepares nurses to question assumptions and values
● Serves research, education, and practice
UNIT 1 (NU 105)
Goal of Theoretical Framework
● Holistic patient care
● Individualized care to meet needs of patients
● Promotion of health
● Prevention and treatment of illness
Goals of Research
● Develop explanations (in theories)
● Find solutions to problems
Goals of Nursing Research
● Improve care of people in clinical setting
● Study people and the nursing process
o Education
o Policy development
o Ethics
o Nursing history
● Develop greater autonomy and strength as a profession
● Provide evidence based nursing practice
National Institute of Nursing Research
● Build scientific foundation for clinical practice
● Prevent disease and disability
● Manage and eliminate symptoms caused by illness
● Enhanced end-of-life and palliative care
Goals of Research
● Build the scientific foundation for clinical practice
● Prevent disease and disability
● Manage and eliminate symptoms caused by illness
● Enhanced end-of-life and palliative care
Methods of Nursing Research
● Quantitative
o Involves concept of basic and applied research
o Types:
▪ Descriptive
▪ Correlational
▪ Quasi-experimental
▪ Experimental
o Steps
1. State the research problem.
2. Define purpose of the study.
UNIT 1 (NU 105)
o
3.
4.
5.
6.
7.
8.
9.
Terms
▪
▪
▪
▪
Review related literature.
Formulate hypotheses and variables.
Select research design.
Select population and sample.
Collect data.
Analyze data.
Communicate findings and conclusions.
Variable
- Dependent
- Independent
Hypothesis
Data
Instruments
● Qualitative
o Conducted to gain insight by discovering meanings
o Based on belief that reality is based on perceptions that differ for each person and
change over time
o Research methods
▪ Phenomenology
▪ Grounded theory
▪ Ethnography
▪ Historical
Evaluating the Ethics of Clinical Research Studies
● Value
● Scientific validity
● Fair subject selection
● Favorable risk-benefit ration
● Independent review
● Informed consent
● Respect for enrolled subjects
Impediments to Nursing Research
● Restricted access to resources
● Limited time to participate in research
● Lack of education preparation
UNIT 1 (NU 105)
Evidence-Based Practice (EBP)
● Problem-solving approach to making clinical decisions, using the best evidence available
● Blends both the science and the art of nursing so that the best patient outcome is achieved
● May consist of specific nursing interventions or may use guidelines established for the
care of patients with certain illnesses, treatments, or surgical procedures
● The use of EBP mandates the analysis and systematic review of research findings
Implementing EBP
1. Ask a question about a clinical area of interest or intervention
2. Collect the most relevant and best evidence
3. Critically appraise the evidence
4. Integrate the evidence with clinical expertise, patient preferences, and values in making a
decision to change
5. Evaluate the practice decision or change
Asking questions in PICO format:
● P = patient, population, or problem of interest
● I = intervention of interest
● C = comparison of interest
● O = outcomes of interest
Components of a Research Journal
● Abstract
● Introduction
● Method
● Results
● Discussion
● References
UNIT 1 (NU 105)
Chapter 3: Health, Wellness, and Health Disparities
Health
● An active process in which a person moves toward his or her maximum potential
Holistic health care
● Care that addresses the many dimensions that comprise the whole person
Americans fare worse in nine key health areas:
1. Infant mortality and low birth weight
2. Injuries and homicides
3. Teenage pregnancies and sexually transmitted infections
4. Prevalence of HIV and AIDS
5. Drug-related deaths
6. Obesity and diabetes
7. Heart disease
8. Chronic lung disease
9. Disability
Concept of Health and Wellness
Health
● State of complete physical, mental, and social well-being, not merely the absence of
disease or infirmity
The health of the public is measured by morbidity and mortality
● Morbidity = how frequent a disease occurs
● Mortality = the number of deaths resulting from a disease
Human dimensions
● Physical
● Intellectual
● Emotional
● Sociocultural
● Spiritual
● Environmental
Wellness
● An active state of being healthy, including living a lifestyle that promotes good physical,
mental, and emotional health
UNIT 1 (NU 105)
Concept of Illness and Disease
● Disease
o Referring to pathologic changes in the structure or function of the body or mind
o Traditionally diagnosed and treatment is prescribed by a health care provider or
advanced practice nurse
● Illness
o Response of the person to a disease
o A process in which the person’s level of functioning is changed when compared
with a previous level
Classifications of Illness
1. Acute illness
● Usually has a rapid onset of symptoms and lasts only a relatively short time
● Ex: appendicitis, pneumonia, diarrhea, common cold
2. Chronic illness
● Broad term that encompasses a number of different physical and mental
alterations in health
● Usually have a slow onset, and have periods or remission and exacerbation
o Remission: disease is present, but not symptoms
o Exacerbation: symptoms appear
● Characteristics:
o It is a permanent change
o It causes, or is caused by, irreversible alterations in normal anatomy and
physiology.
o It requires special patient education for rehabilitation.
o It requires a long period of care or support.
● Most common:
o Heart disease, stroke, cancer, T2DM, obesity, and arthritis
● Risk factors:
o Tobacco use, poor diet, physical inactivity, excess alcohol consumption,
uncontrolled BP, and hyperlipidemia
● CDC use 4 cross-cutting strategies:
a. Epidemiology
b. Environmental approaches
c. Health system interventions
d. Community resources
UNIT 1 (NU 105)
Illness behaviors
● Influenced by age, biological sex, family values, economic states, culture,
educational level, and mental status
● Stages:
1. Experiencing symptoms
2. Assuming the sick role
3. Assuming a dependent role
4. Achieving recovery and rehabilitation
Effects of Illness on the Family
● Creates stress for the patient and family due to:
● Some may want to stay with patients, some want to avoid visiting
Disparities in Health Care
● Health equity
o Attainment of the highest level of health for all people
● Health disparity
o “particular type of health difference that is closely linked with social, economic,
and/or environmental disadvantage” - Health People 2020
o Common in racial and ethnic minorities (higher rates of obesity, cancer, DM, and
AIDS)
● Social determinants of health
o The 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
The Health Equity Institute urges the following measures to eliminate avoidable health
inequities and health disparities:
● Attention to the root causes of health inequities and health disparities— specifically,
health determinants, a principal focus of Healthy People 2020. Particular attention to
groups that have experienced major obstacles to health associated with socioeconomic
disadvantages and historical and contemporary injustices.
● Promotion of equal opportunities for all people to be healthy and to seek the highest level
of health possible.
● Distribution of socioeconomic resources needed to be healthy in a manner that
progressively reduces health disparities and improves health for all.
● Continuous efforts to maintain a desired state of equity after avoidable health inequities
and health disparities are eliminated.
UNIT 1 (NU 105)
Vulnerable populations
● Racial and ethnic minorities
● Those living in poverty
● Women, children, older adults, rural and inner-city residents
● People with disabilities
● Special health care needs
Basic Human Needs
● Something essential that must be met for emotional and physiologic health and survival
o A person whose needs are met may be considered to be healthy
o A person who has one or more unmet needs is at an increased risk for illness
Human Dimensions
● Factors influencing a person’s health–illness status, health beliefs, and health practices
● Each interrelates with each of the others and influences the person’s behaviors in both
health and illness
1. Physical
2. Emotional
3. Intellectual
4. Environment
5. Sociocultural
6. Spiritual
Self-Concept
● Incorporates both how they feel about themselves (self-esteem) and the way they perceive
their physical self (body image)
● Has both physical and emotional aspects
● Important factor in the way a person reacts to stress and illness
● Results from past experiences, interactions, influences, and education
Risk Factors for Illness / Injury
Risk Factor
● Something that increases a person’s chances for illness or injury
● Often interrelated
● Modifiable
o Things a person can change (ex: smoking)
● Nonmodifiable
o Things that cannot be changed (ex: history of cancer)
● As it increases, the possibility of illness also increases
UNIT 1 (NU 105)
● Major Areas
o Age
o Genetic factors
o Physiologic factors
o Health habits
o Lifestyle
o Environment
● Nursing activities by level of health promotion & preventive care
o Primary
▪ Health promotion
- Behavior of a person who is motivated by a personal desire to
increase well-being and health potential
▪ Health protection
- Illness or disease prevention
- Behavior motivated by a desire to avoid or detect disease
- Maintain functioning within the constraints of an illness or
disability
o Secondary
▪ Focus on screening for early detection of disease with prompt diagnosis
and treatment of any found
▪ The goals are to identify an illness, reverse or reduce its severity or
provide a cure, and thereby return the person to maximum health as
quickly as possible.
o 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
Models of Health Promotion and Illness Prevention
Health Belief Model
● Focuses on what people perceive or believe to be true about themselves in relation to their
health
● Based on three components of individual perception of threat of a disease
a) Perceived susceptibility to a disease
- Belief that one either will or will not contract a disease
- Ranges from being afraid of developing a disease to completely
denying that certain behaviors may cause illness
b) Perceived seriousness of a disease
- Concerns the person’s perception of the threat that disease poses to
health and its effects on the person’s lifestyle
- Depends on how much the person knows about the disease and can
result in a change in health behavior
UNIT 1 (NU 105)
c) Perceived benefits of action
- Person’s beliefs about how effectively measures will prevent illness
- Influenced by the person’s conviction that carrying out a
recommended action will prevent or modify the disease and by the
person’s perception of the cost and unpleasant effects of
performing the health behavior
Health Promotion Model
● Developed to illustrate how people interact with their environment as they pursue health
● Incorporates individual characteristics and experiences, as well as behavior- specific
knowledge and beliefs, to motivate health-promoting behavior
● Major motivators:
o Behavior-specific knowledge
o Beliefs
o Relationships
● A revised health promotion model includes three additional variables:
o activity-related affect
o commitment to a plan of action
o immediate competing demands and preferences
The Health-Illness Continuum
● One way to conceptualize a person’s level of health
● Views health as a constantly changing state, with high- level wellness and death at
opposite ends of a graduated scale, or continuum
● Illustrates the ever-changing state of health as a person adapts to changes in internal and
external environments to maintain a state of well-being
The Agent-Host-Environment Model
● Developed by Leavell and Clark (1965)
● Views the interaction between an external agent, a susceptible host, and the environment
as causes of disease in a person
● Explains how certain factors place some people at risk for an infectious disease
o A model that is currently helpful in addressing the Zika virus
● Limited when dealing with noninfectious disease
Stages of Change Model
● Developed by Prochaska and DiClemente in late 1970s and 1980s while trying to help
people with addictions
● Widely used today by counselors addressing a broad range of behaviors including injury
prevention, overcoming drug and alcohol addictions, and weight loss
● Stages:
UNIT 1 (NU 105)
a.) Precontemplation
- In this stage, people are not even thinking about trying to change their
behavior
- Four R’s: reluctance, rebellion, resignation, and rationalization
b.) Contemplation
- People ambivalently consider the need to change the problematic behavior.
Counselors can help by focusing on educating about the pros and cons of the
behavior and change, and clarify that the decision to change is one that only
the individual can make.
c.) Determination: Commitment to Action
- Now the decision is made to move forward and preparation ensues.
Counselors are most helpful in this stage by helping people make realistic
plans, with small steps that anticipate difficulties, and by identifying creative
strategies to address the difficulties. It is helpful to affirm that the individual
has the ability to change behaviors.
d.) Action: Implementing the Plan
- When someone publicly begins to implement the plan and begins to achieve
success, it reinforces the decision to change behavior. If family, friends, and
co-workers understand that the person has decided to eat differently or stop
drinking, they can become supporters. Counselors can bolster the person’s
ability to change by reiterating long-term benefits
e.) Maintenance, Relapse, and Recycling
- When someone publicly begins to implement the plan and begins to achieve
success, it reinforces the decision to change behavior. If family, friends, and
co-workers understand that the person has decided to eat differently or stop
drinking, they can become supporters. Counselors can bolster the person’s
ability to change by reiterating long-term benefits
UNIT 1 (NU 105)
UNIT 1 (NU 105)
CHAPTER 4: Health of the Individual, Family, and Community
Meeting Basic Human Needs
● People’s behaviors, feelings about self and others, values, and priorities all relate to
physiological and psychosocial needs
● Common to all people; meeting these needs is essential for the health and survival of all
people
● A person can meet some needs independently, but most needs require relationships and
interactions with others for partial or complete fulfillment.
● Satisfying one’s needs often depends on the physical and social environment, especially
one’s family and community.
Abraham Maslow (1968)
● developed a hierarchy of basic human needs that describe which needs of a person are the
most important at any given time
Characteristics of Basic Needs / Maslow:
● Its lack of fulfillment results in illness.
● Its fulfillment helps prevent illness or signals health.
● Meeting it restores health.
● It takes priority over other desires and needs when unmet.
● The person feels something is missing when the need is unmet.
● The person feels satisfaction when the need is met.
UNIT 1 (NU 105)
Physiological Needs
● Oxygen, water, food, elimination, temperature, sexuality, physical activity, and rest
○ most essential = oxygen
● Must be met at least minimally to maintain life
● These needs are the most basic in the hierarchy of needs and the most essential to life,
and therefore have the highest priority
Safety and Security Needs
● Have both physical and emotional components
● Physical safety and security means being protected from potential or actual harm
● Nurses carry out a wide variety of activities to meet patients’ physical safety needs
○ Using proper hand hygiene and sterile techniques to prevent infection Using
electrical equipment properly
○ Administering medications knowledgeably
○ Skillfully moving and ambulating patients
○ Teaching parents about household chemicals that are dangerous to children
Love and Belonging Needs
● “Higher level of need”
● Include the understanding and acceptance of others in both giving and receiving love
● The feeling of belonging to groups such as families, peers, friends, a neighborhood, and a
community.
● Unmet needs produce loneliness and isolation
● Examples of interventions to meet these needs:
○ Including family and friends in the care of the patient
○ Establishing a nurse–patient relationship based on mutual understanding and trust
(by demonstrating care, encouraging communication, and respecting privacy)
○ Referring patients to specific support groups (such as a cancer support group or
Alcoholics Anonymous)
Self-esteem
● Include the need for a person to feel good about himself or herself, to feel pride and a
sense of accomplishment, and to believe that others also respect and appreciate those
accomplishments
● Positive self-esteem facilitates the person’s confidence and independence.
● Factors affecting self-esteem:
○ Role changes
○ Body image changes
UNIT 1 (NU 105)
Self-actualization
● Highest level on the hierarchy
● Include the need for people to reach their full potential through development of their
unique capabilities
● Each lower level of need must be met to some degree before this need can be satisfied
● Maslow lists the following qualities that indicate achievement of one’s potential:
○ Acceptance of self and others as they are
○ Focus of interest on problems outside oneself
○ Ability to be objective
○ Feelings of happiness and affection for others
○ Respect for all people
○ Ability to discriminate between good and evil
○ Creativity as a guideline for solving problems and pursuing interests
UNIT 1 (NU 105)
Family Structures
● Family
○ Any group of people who live together and depend on one another for physical,
emotional, and financial support
● Nuclear Family
○ Traditional family; two parents and their children
● Extended Family
○ Includes aunts, uncles, and grandparents
● Blended Family
○ Two parents and their unrelated children from previous relationships
● Single-Parent Family
○ May be separated, divorced, widowed, or never married
Family Functions
● Physical
○ Provides a safe, comfortable environment necessary for growth, development, and
rest or recuperation
● Economic
○ Provides financial aid to family members and also helps meet society’s needs
● Reproductive
○ To have and raise children
● Affecting and coping
○ Provide emotional comfort to family members and help members establish their
identity and maintain it in times of stress
● Socialization
○ Provide emotional comfort to family members and help members establish their
identity and maintain it in times of stress
Family stages
● Couple and family with children
● Family with adolescents and young adults
● Family with middle-aged adults
● Family with older adults
UNIT 1 (NU 105)
Risk Factors for Altered Family Health
● Lifestyle risk factors
● Psychosocial risk factors
● Environmental risk factors
● Developmental risk factors
● Biologic risk
Community Factors Affecting Health
● Social support system
● Community health care structure
● Economic resources
● Environmental factors
Characteristics of Community Influence on the Health of a Member
● Education and recreation programs
● Production of services and goods
● Protection, safety, and aesthetic concerns
● Transportation and communication facilities
● Health care resources
● Prevailing values and beliefs
UNIT 1 (NU 105)
CHAPTER 5: Cultural Diversity
Cultural diversity
● The coexistence of different:
○ culture
○ racial and ethnic origin
○ religion
○ biological sex
○ physical size and age
○
○
○
○
sexual orientation
disability
socioeconomic and occupational status
geographic location
Cultural respect
● Enables nurses to deliver services that are respectful of and responsive to the health
beliefs, practices, and cultural and linguistic needs of diverse patients
● Critical to reducing health disparities and improving access to high-quality health care
Culture
● An integral component of both health and illness because of the cultural values and
beliefs that we learn in our families and communities
● Shared system of beliefs, values, and behavioral expectations that provides social
structure for daily living
● Provide social structure for daily living
● Define roles and interactions with others and in families and communities
● Apparent in the attitude and institutions unique to the culture
● Elements:
○ personal identification, language, thoughts, communications, actions, customs,
beliefs, values, and institutions that are specific to ethnic, racial, religious,
geographic, or social groups
● Characteristics:
○ Culture helps shape what is acceptable behavior for people in a specific group. It
is shared by, and provides an identity for, members of the same cultural group.
○ Culture is learned by each new generation through both formal and informal life
experiences. Language is the primary means of transmitting culture.
○ The practices of a particular culture often arise because of the group’s social and
physical environment.
○ Cultural practices and beliefs may evolve over time, but they mainly remain
UNIT 1 (NU 105)
constant as long as they satisfy a group’s needs.
○ Culture influences the way people of a group view themselves, have expectations,
and behave in response to certain situations. Because a culture is made up of
people, there are differences both within cultures and among cultures.
Subcultures
● A large group of people who are members of the larger cultural group
● Have certain ethnic, occupational, or physical characteristics that are not common to the
larger culture
Groups in Society
● Dominant group (largest group)
○ Group has the most authority to control values and sanctions of society
● Minority group (smaller group)
○ A physical or cultural characteristic identifies the people as different from
dominant group
Cultural assimilation
● “acculturation”
● A process when a minority group lives within a dominant group
● Members may lose the cultural characteristics that once made them different, and they
may take on the values of the dominant culture
Culture shock
● When a person is placed in a different culture he or she perceives as strange
● May result in psychological discomfort or disturbances
Ethnicity
● Sense of identification with a collective cultural group
● Largely based on the group members’ common heritage
● One belongs to a specific ethnic group or groups either through birth or through adoption
of characteristics of that group
● Groups share unique cultural and social beliefs and behavior patterns
● Largely develop though day-to-day life with family and friends in the community
UNIT 1 (NU 105)
Race
● Not the same with the term “ethnicity”
● Typically based on specific physical characteristics such as skin pigmentation, body
stature, facial features, and hair texture
● 5 categories for race classification:
○ American Indian or Alaska Native
○ Asian
○ Black, or African American
○ Native Hawaiian or Other Pacific Islander
○ White
Factors Inhibiting Sensitivity to Diversity
● Stereotyping
○ The assumption that all members of culture or ethnic group act like
○ May be positive
○ May be negative: racism, ageism, and sexism
○ Identifying prejudices = first step to eliminating them
● Cultural imposition
○ Belief that everyone should conform to the majority belief system
● Cultural conflict
○ People become aware of differences and feel threatened
○ Response: ridiculing beliefs and traditions of others
● Cultural blindness
○ Ignores differences and proceeds as if they did not exist
● Ethnocentrism
○ Belief that one’s ideas, beliefs, and practice that are the best or superior, or are
most preferred to those of others
Cultural Influences on Health Care
● Physiologic variations
○ Certain racial and ethnic groups are more prone to certain diseases and conditions
● Reactions to pain
○ Many of the expressions and behaviors exhibited by people in pain are culturally
prescribed
○ Some cultures allow or even encourage the open expression of emotions related to
pain, whereas other cultures encourage suppression of such emotions
UNIT 1 (NU 105)
● Mental health
○ Many ethnic groups have their own norms and acceptable patterns of behavior for
psychological well-being
● Biological sex roles
○ In some cultures, the man is the dominant figure and generally makes decisions
for all family members
● Language and communication
○ Linguistic competence: ability of caregivers and organizations to understand and
effectively respond to the linguistic needs of patients
● Orientation to space and time
● Food and nutrition
● Family support
● Socioeconomic factors
● Health disparities
Culturally Competent nursing Care - Patient in Pain
● Recognize that each person hold various beliefs about pain and that pain is what the
patient says it is
● respect the patient’s right to respond to pain in one’s own fashion
● Never stereotype a patient’s responses to pain based on the patient’s culture
● Be sensitive to nonverbal signal of discomfort, such as holding or applying pressure to the
painful area or avoiding activities that intensify the pain
Culture of Poverty
● Feelings of despair, resignation, and fatalism
● Day-to-day attitude toward life; no hope for future
● Unemployment and need for financial or government aid
● Unstable family structure possibly characterized by abusiveness and abandonment
● Decline in self-respect and retreat from community involvement
Elements of cultural competence:
● Developing self awareness
● Demonstrating knowledge and understanding of the patient’s culture
● Accepting and respecting cultural differences
● Not assuming that the health care provider’s beliefs and values are the same as the
patient’s
● Resisting judgmental attitudes such as “different is not as good”
UNIT 1 (NU 105)
● Being open to and comfortable with cultural encounters
● Accepting responsibility for one’s own education in cultural competency
Factors that Affect Culturally Diverse Interactions
● Cultural background of each participant
● Expectations and beliefs of each person about health care
● Cultural context of the encounter
● Degree of agreement between the sets of beliefs and values of the two persons
Guidelines for Providing Culturally Competent Nursing Care
● Develop cultural self-awareness
● Develop cultural knowledge
● Accommodate cultural practices in health care
● Respect culturally based family roles
● Avoid mandating change
● Seek cultural assistance
Cultural Assessment / Areas Nurses Need to Understand
● Beliefs, values, traditions and practices of a culture
● Culturally defined, health-related needs of individuals, families, and communitied
● Culturally based belief systems of the etiology of illness and disease and those related to
health and healing
● Attitudes toward seeking help from health care providers
UNIT 1 (NU 105)
CHAPTER 6: Values, Ethics, and Advocacy
Values
● Beliefs about the worth of something, about what matters, that act as a standard to guide
one’s behavior
Value system
● An organization of values in which each is ranked along a continuum of importance,
often leading to a personal code of conduct
● A person’s values influence beliefs about human needs, health, and illness; the practice of
health behaviors; and human responses to illness
3 Main Activities of the Valuing Process
● Choosing
○ choosing free
● Prizing (treasuring)
● Acting
Development of Values
● A person is not born with values; rather, values are formed during a lifetime involving
influences from the environment, family, and culture
Professional Values
● Altruism
● Autonomy
● Human dignity
● Integrity
● Social justice
UNIT 1 (NU 105)
UNIT 1 (NU 105)
Ethics
● Systematic study of principles of right and wrong conduct, virtue and vice, and good and
evil as they relate to conduct and human flourishing
● The ability to be ethical, to make decisions and act in an ethical manner, begins in
childhood and develops gradually
● Morals
○ Refers to personal or communal standards of right and wrong
○ Similar in meaning to ethics
Types of Ethics
Nursing Ethics
● A subset of bioethics
● Formal study of ethical issues that arise in the practice of nursing and of the analysis used
by nurses to make and evaluate ethical judgements
Bioethics
● Number of fields and disciplines grouped broadly under the rubric “the life sciences.”
● 3 paramount questions:
○ What kind of person should I be in order to live a moral life and make good
ethical decisions?
○ What are my duties and obligations to other people whose life and well- being
may be affected by my actions?
○ What do I owe the common good or the public interest in my life as a member of
society?
Feminist Ethics
●
Theories of Ethics
● Systems of thought that attempt to explain how we ought to live and why
● Two main categories:
○ Utilitarian
■ The rightness or wrongness of an action depends on the consequences of
the action.
○ Deontologic
■ An action is right or wrong based on a rule, independent of its
consequences
● Principal-Based Approach
○ Combines elements of both utilitarian and deontological theories
○ offer specific action guides for practice
○ 4 key principles:
UNIT 1 (NU 105)
■ Autonomy
- Respect rights of patients to make health care decisions
■ Nonmaleficence
- Avoid causing harm
■ Beneficence
- Benefit the patient
■ Justice
- Give each his or her due and act fairly
■ Fidelity
- Keep promises
■ Veracity, accountability, privacy, and confidentiality
○ Ethical dilemmas
■ Arise when attempted adherence to basic ethical principles results in two
conflicting courses of action
● Care-Based Approach
○ Directs attention to the specific situations of individual patients viewen within the
context of their narrative
○ Nurse-patient is central
○ Essential to person-centered care
○ Characteristics
■ Centrality of the caring relationship
■ Promotion of the dignity and respect of patients as people
■ Attention to the particulars of individual patients
■ Cultivation of responsiveness to others and professional responsibility
■ A redefinition of fundamental moral skills to include virtues
● Feminist Ethics
○ An approach that is popular among nurses, both male and female
○ It critiques existing patterns of oppression and domination in society, especially as
these affect women and the poor.
○ Promote social policy that reflects a fundamental trust in women and those on the
margins
Ethical Conduct
● Practice based on professional standards of ethical conduct as well as professional values
● Nurses should:
○ Cultivate the virtues of nursing
○ Understand ethical theories that dictate and justify professional conduct
○ Be familiar with codes of ethics
UNIT 1 (NU 105)
Purposes of Codes of Ethics for Nurses
● It is a succinct state
ICN Guidelines to Achieve Purposes of Code of Ethics
● Study the standards under each element of the code
● Reflect on what each standard mean to you
● Discuss the code with coworkers and other
● Use a specific example from experience to identify ethical dilemmas and standards of
conduct as outlined in the Code.
● Work in groups to clarify ethical decision making and reach a consensus on standards or
ethical conflict.
● Collaborate with their national nurses’ association, coworkers, and others in continuous
application of ethical standards in nursing practice, education, management, and research.
Measurement Criteria for Standard 7 (ANA Standards) / Registered Nurse:
● Use Code of Ethics for Nurses with Interpretive Statement to guide practice
● Deli
7 Basic Tenets of Bill of Rights for RNs Must Be Able to:
1. Practice in a manner that fulfills obligations to society and to those who receive nursing
care
2. Practice in environments that allow them to act in accordance with professional standards
and legally authorized scope of practice
3. Work in an environment that supports and facilitates ethical practice, in accordance with
the Code of Ethics for Nurses and its interpretive statements.
4. Freely and openly advocate for themselves and their patients, without fear of retribution.
5. Receive fair compensation for their work,consistent with their knowledge, experience,
and professional responsibilities.
6. Practice in a work environment that is safe for themselves and their patients.
7.
8.
Ethical Dilemma
● Two or more clear moral principles apply but support mutually inconsistent courses of
action
Ethical Distress
● Occurs when the nurse knows the right thing to do but either personal or institutional
factors make it difficult to follow the correct course of action
UNIT 1 (NU 105)
UNIT 1 (NU 105)
Using the Nursing Process to Make Ethical Decisions
● Assess the situation (gather data)
● Diagnose (identify) the ethical problem
● Plan:
○ Identify options
○ Think ethical problem through
○ Make a decision
● Implement your decision
● Evaluate your decision
Examples of Ethical Problems
● Paternalism
● Deception
● Privacy and social media
● Confidentiality
● Allocation of Scarce Nursing Resources
● Valid Consent or Refusal
● Conflicts Concerning New Technologies
● Unprofessional, Incompetent, Unethical, or Illegal Physician Practice
● Unprofessional, Incompetent, Unethical, or Illegal Nurse Practice
● Short Staffing Issues
● Beginning-of-life Issues
● End-of-life Issues
Four Function of Ethics Committees
● Education
● Policy making
● Case review
● Consultation
Advocacy in Nursing Practice
● primary commitment to the patient
● Prioritization of good individual patient rather than society in general
● Evaluation of competing claims of patient’s autonomy and patient well-being
UNIT 1 (NU 105)
CHAPTER 7: Legal Dimensions of Nursing Practice
Law
● Standard or rule of conduct established and enforced by the government
● Intended chiefly to protect the rights of the public
● Public law
○ Law in which the government is involved directly
○ It regulates relationships between people and the government
● Private law (civil law)
○ Regulates relationships among people
○ Includes laws relating to contracts; ownership of property
○ Includes the practice of nursing, medicine, pharmacy and dentistry
● Criminal law
○ Concerns state and federal criminal statutes
○ Defines criminal actions
Sources of Law
● Constitutions
○ Serves as guides to legislative bodies
○ Federal and state constitutions indicate how the federal and state governments are
created
○ They give authority and state the principles and provisions for establishing
specific laws
● Statutory Law
○ Enacts by legislative body
○ Must be in keeping with both the federal constitution and the state constitution
○ Nurse practice acts
● Administrative Law
○ Empowered by executive officers
○ Executive officers administer facilities that, among other functions, are
responsible for law enforcement
○ Regulation and operation of SSA
● Common Law
○ It interprets legislation at the local, state, and national levels as it has been applied
in specific instances and makes decisions concerning law enforcement
○ Evolved form these accumulated judiciary decisions
○ Court-made law; most malpractice cases
UNIT 1 (NU 105)
The Court System
● Lawsuit
○ Civil action brought in a court of law
● Litigation
○ Process of bring and trying a lawsuit
● Plaintiff
○ The person or government who claims to have incurred losses as a result of an
action by a defendant
○ Person bringing suit
● Defendant
○ Person being accused of a crime
○ Presumed innocent until proven guilty of a crime or tort
● Prosecutor (district attorney)
○ Brings charges against a person, persons, or corporate entity believed to have a
committed a crime
Two Levels of Courts
● Trial courts
○ First-level court
○ Hears all the evidence in a case and make decisions based on facts, usually
through a jury
● Appellate courts
○ Hears only questioning a point of law decided by the trial court
○ No witnesses testify at the appellate court level
○ The opinions of appellate judges are published and become common law
Nurse Practice Acts
● Your state’s nurse practice act is the most important law affecting your nursing practice
● Acts list the violations that can result in disciplinary actions against a nurse
● Also intend to prevent untrained or unlicensed people from practicing nursing
Standards
● Voluntary standards
○ Developed and implemented by the nursing profession itself
○ Not mandatory but are used as guidelines for peer review
● Legal standards
○ Developed by a legislature and are implemented by authority granted by the state
to determine minimum standards for the education of nurses
UNIT 1 (NU 105)
Credentialing
● Refers to ways in which professional competence is ensured and maintained
● 3 processes in nursing:
1. Accreditation
- Process by which an educational program is evaluated and recognized as
having met certain standards
2. Licensure
- Process by which a state determines that a candidate meets certain
minimum requirements to practice in the profession and grants a license to
do so
3. Certification
- Process by which a person who has met certain criteria established by a
nongovernmental association is granted recognition in a specified practice
area.
Reasons for Suspending or Revoking a License
● Drug or alcohol abuse
● Fraud
● Deceptive practice
● Criminal acts
● Previous disciplinary actions
● Gross or ordinary negligence
● Physical or mental impairments, including age
Due Cause for Revoking a License
● Notice of investigation
● Fair and impartial hearing
● Proper decision based on substantial evidence
Nurse’s Best Defense of License Investigation
● Early legal counseling
● Character and expert witness
● Thorough
Crimes and Torts
● A wrong committed against a person or that person’s property
● Crime: a violation punishable by the state
● Tort: subject to action in a civil court with damages usually being settled with money
Crime
● A wrong committed against a person or that person’s property
● Acts are considered to be against the public as well
● “the people” = the government; prosecuting the offensor
UNIT 1 (NU 105)
● Criminal law is in most cases statutory law
● Classified as:
○ Misdemeanor
■ Less serious crime
■ Punishable with a fine, imprisonment for less than 1 year, or both, or with
parole
○ Felony
■ Punishable with a fine, imprisonment for less than 1 year, or both, or with
parole
Tort
●
●
●
●
A wrong committed by a person against another person or that person’s property
Tried in civil court
May be intentional or unintentional acts of wrongdoing
Intentional:
○ Considered to have knowledge of the permitted legal limits of his or her words or
acts
○ Grounds for prosecution
○ Examples:
■ Assault and battery
■ Defamation of character
■ Invasion of privacy
■ False imprisonment
■ Fraud
● Unintentional:
○ Referred to as negligence
○ Examples:
■ Negligence
- Performing an act that a reasonably prudent person under similar
circumstances would not do
■ Malpractice
- Generally used to describe negligence by professional personnel
- Common malpractice (categories of claims):
a. Failure to follow standards of care
b. Failure to use equipment in a responsible manner
c. Failure to assess and monitor
d. Failure to communicate
e. Failure to document
f. Failure to act as a patient advocate or to follow the chain of
command
UNIT 1 (NU 105)
HIPAA-Ensured Patient Rights
● To see and copy their health records
● To update their health record
● To request correction of any mistakes
● To get a list of the disclosure a health care institution has made independent of disclosure
made for the purposes of treatment, payment, and healthy care operations
● To request a restriction on certain uses or disclosures
● To choose how to receive health information
Liability
● Involves four elements that must be established to prove that malpractice or negligence
has occurred:
1. Duty - obligation to use due care
2. Breach of duty - failure to meet the standard of care
3. Causation - failure to meet the standard of care (breach) actually caused the injury
4. Damages - actual harm or injury resulting to the patient
3 Outcomes of Malpractice Litigation
● All parties work toward fair settlement
● Case is presented to malpractice arbitration panel
● Case is brought to trial court
Roles of Nurses in Legal Proceedings
● Nurse as defendant
○ Do not discuss the case with those involved in it
UNIT 1 (NU 105)
○ Do not alter patient records
○ Cooperate fully with your attorney
○ Be courteous on witness stand
○ Do not volunteer any information
● Nurse as fact witness
● Nurse as expert witness
Legal Safeguards for Nurses
● Competent practice
● Informed consent or refusal
● Contracts
● Collective bargaining
● Patient education
● Executing physician orders
● Documentations
● Adequate staffing
●
●
●
●
Whistle-blowing
Professional liability insurance
Risk management programs
Incident, variance, or occurrence
reports
● Sentinel events and Never events
● Patients’ rights
● Good Samaritan Laws
Elements of Informed Consent
● Disclosure
● Comprehension
● Competence
● Voluntariness
Safeguards to Competent Practice
● Respecting legal boundaries of practice
● Following institutional procedures and policies
● Owning personal strengths and weaknesses
● Evaluating proposed assignments
● Keeping current in nursing knowledge and skills
● Respecting patient rights and developing rapport with patients
● Keeping careful documentation
● Working within agency for management policies
Types of Risk Management Programs
● Safety program
● Product safety program
● Quality assurance programs
Information Contained in Incident Report
● Complete name of person and names of witnesses
● Factual account of incident
● Date, time, and place of incident
UNIT 1 (NU 105)
●
●
●
●
Patient characteristics of person involved
Any equipment or resources being used
Any other important variables
Documentation by physician of medical examination of person involved
OSHA Legal Regulations
● Use of electrical equipments
● Use of isolation techniques
● Use of radiation
● Use of chemicals
Laws Affecting Nursing Practice
● Occupational Safety and Health
● National Practitioner Data Bank
● Reporting obligations
● Controlled substances
● Discrimination and sexual harrasment
● HIPAA Restraints
● People with disabilities
● Legal issues related to death and dying (wills, advance directives)
UNIT 1 (NU 105)
CHAPTER 8: Communication
Communication
● Process of exchanging information and generating and transmitting meanings between
two or more people
● Foundation of society; basic to human functioning & well-being
Communication process:
1. Stimulus or referrent
2. Source (encoder)
3. Message
4. Channel or medium of communication
5. Receiver (decoder)
Feedback = confirmation of message (evidence)
Noise = factors that distort the quality of message
Forms of Communication:
● Verbal
○ Using words (spoken or written)
○ Depends on language
● Nonverbal
○ “body language”
○ Without the use of words
○ Touch, eye contact, facial expression
○ Posture, gait, gestures
○ General physical appearance
○ Mode of dress & grooming
○ Sounds, and silence
● Electronic
○ Social media, e-mail, & text message
■ With guidelines from ANA & NCSBN
Levels of Communication
● Intrapersonal
○ “self-talk”
○ Communication within a person
● Interpersonal
○ Occurs between two or more people with a goal to exchange messages
● Group
○ Small-group
○ Organizational
UNIT 1 (NU 105)
○ Group dynamics
Characteristics of Effective and Ineffective Groups
● Group identity
● Cohesiveness
● Patterns of interaction
● Decision making
● Responsibility
● Leadership
● Power
Factors Influencing Communication
● Level of development
● Biological sex
● Sociocultural differences
● Roles & responsibilities
● Space & territoriality
● Physical, mental, & emotional state
● Environment
Effective Professional Communication
● Hand-off Communication: SBAR
● Rising level or concern communication: CUS
UNIT 1 (NU 105)
Helping Relationship
● Refer to such relationships between nurses and patients
● Helping relationship vs Social relationship
○ Common:
■ Components of care, concern, trust, and growth
○ Difference:
■ The helping relationship does not occur spontaneously
■ The helping relationship is characterized by an unequal sharing of
information
■ The helping relationship is built on the patient’s needs, not on those of the
helping person
■ Nurse is the helper, the patient is the one being helped
■ Communication Is the means used to establish rapport & help-trust
relationship
● Characteristics (intangible):
○ Dynamic
○ Purposeful and time limited
○ The person providing assistance is professionally accountable
● Goals
○ Increased independence for the patient
○ Greater feelings of worth
○ Improved health & well-being
● 3 phases:
○ Orientation phase
■ Establish tone and guidelines for the relationship
■ Identify each other by name
■ Clarify roles of both people
■ Establish an agreement about the relationship
■ Provide the patient with orientation to the health care system
○ Working phase
■ Work together to meet the patient’s needs
■ Provide whatever assistance is needed to achieve each goal
■ Provide teaching & counseling
○ Termination phase
■ Examine goals of helping relationship of attainment
■ Make suggestions for future efforts if necessary
■ Encourage patient to express emotions about the termination
■ If appropriate, help the patient establish a helping relationship with
another nurse
■ Assist the patient transferring from one agency to another or from one unit
in an agency to another
UNIT 1 (NU 105)
Factors Promoting Effective Communication Within the Helping Relationship
● Dispositional traits
○ Warmth and friendliness
○ Openness and respect
○ Empathy
○ Honesty, authenticity, and trust
○ Caring
○ Competence
● Rapport Builders
○ Specific objectives
○ Comfortable environment
○ Privacy
○ Confidentiality
○ Patient vs Task Focus
○ Using nursing observations
○ Optimal pacing
Developing Professional Therapeutic
● Communication skills
○ Control the tone of your voice
○ Be knowledgeable about the topic of conversation
○ Be flexible
○ Be clear and concise
○ Avoid words that might have different interpretations
○ Be truthful
○ Keep an open mind
○ Take advantage of available opportunities
● Listening skills
○ Sit when communicating with a patient
○ Be alert and relaxed and take your time
○ Keep the conversation as natural as possible
○ Maintain eye contact if appropriate
○ Use appropriate facial expressions and body gestures
○ Think before responding to the patient
○ Do not pretend to listen
○ Listen for themes in the patient’s comments
○ Key: listening attentively
● Silence
● Touch
● Humor
● Interviewing techniques
○ Open-ended question or comment
○ Closed question or comment
UNIT 1 (NU 105)
○ Validating question or comment
○ Clarifying question or common
○ Reflective question or comment
○ Sequencing question or comment
○ Directing question or comment
● Assertive vs Aggressive behaviors & communication
○ Assertive:
■ Confident
■ Use of clear, concise “I” statements
■ Ability to share effectively one’s thoughts, feelings, and emotions
■ Working to capacity with or without supervision
■ Remain calm under supervision
■ Giving and accepting compliments
■ Admitting mistakes and taking responsibility
○ Aggressive:
■ Involves asserting one’s right in a negative manner that violates the rights
of others
■ Can be verbal or physical
■ Communication is marked by tension and anger
■ Include using an angry tone of voice, making accusation, and
demonstrating belligerent and intolerance
■ Focus is usually “winning at all cost”
Blocks to Communication
● Failure to perceive the patient as a human being
● Failure to listen
● Nontherapeutic comment & questions
○ Cliche
○ Questions requiring only a yes or no answer
○ Questions containing the words why and how
○ Questions that probe for information
○ Leading questions
○ Comments that give advice
○ Judgemental comments
● Changing the subject
● Giving false assurance
● Gossip and rumor
● Disruptive interpersonal behavior and communication
○ Incivility
○ Bullying
○ Organizational response to disruptive behaviors
UNIT 1 (NU 105)
CHAPTER 9: Teaching and Counseling
AIMS of Teaching and Counseling
● Maintaining and promoting health
● Preventing illness
● Restoring health
● Facilitating coping
● Promoting outcomes
○ High-level wellness and related self–care practices
○ Disease prevention or early detection
○ Quick recovery from trauma or illness with minimal or no complications
○ Enhanced ability to adjust to developmental life changes and acute, chronic, and
terminal illness
○ Family acceptance of lifestyle necessitated by illness or disability
Teaching Acronym
● T = tune into the patient
● E = edit patient information
● A = act on every teaching moment
● C = clarify often
● H = honor the patient as partner in the education process
Factors Affecting Patient Learning
● Age & developmental level
● Family support networks and financial resources
● Cultural influences and language deficits
● Health literacy
Critical Developmental Areas
● Physical maturation and abilities
● Psychosocial development
● Cognitive capacity
● Emotional maturity
● Moral and spiritual development
Ask me 3 questions:
1. What is my main problem?
2. What do I need to do?
3. Why is it important for me to do this?
UNIT 1 (NU 105)
COPE Model
● C = creativity
● O = optimist
● P = planning
● E = expert information
Assessment Parameters
● Knowledge, attitudes, and skills needed to be independent
● Readiness to learn
● Ability to learn
● Learning strengths
Promoting Compliance
● Be certain that instructions are understandable and support patient goals
● Include the patient and family as partners in the process
● Utilize interactive teaching strategies
● Develop interpersonal relationships with patients and their families
Providing Culturally Competent Education
● Develop an understanding of the patient’s culture
● Work with multicultural team
● Be aware of personal assumptions, biases, and prejudices
● Understand the core cultural values of the patient or group
● Develop written material in native language of the patient
● Use testimonials of persons with same cultural background as the patient
Learning Domains
● Cognitive learning
○ Storing and recalling of new knowledge in the brain
○ Lecture, panel, discovery, written materials
● Psychomotor learning
○ Learning a physical skill
○ Demonstrative, discovery, printed material
● Affective learning
○ Changing attitudes, values, and feelings
○ Role modeling, discussion, audiovisual
Knowles (1990) Four Assumption about Adult Learners
● As a person matures, one’s self-concept is likely to move from dependence to
independence
● The previous experience of the adult is a rich resource for learning
● An adult’s readiness to lean is often related to a developmental task or a social role
UNIT 1 (NU 105)
● Most adults’ orientation to learning is that material should be useful immediately, rather
than at some time in the future
Teaching Plans for Older Adults
● Identify learning barriers
● Allow extra time
● Plan short teaching sessions
● Accommodate for sensory deficit
● Reduce environmental distractions
● Relate new information to familiar activities or information
Effective Communication Techniques
● Be sincere and honest; show genuine interest and respect
● Avoid giving too much detail; stick to the basics.
● Ask if the patient has any questions.
● Be a “cheerleader” for the patient.
● Avoid lecturing.
● Use simple words.
● Vary your tone of voice.
● Keep the content clear and concise.
● Listen and do not interrupt when the patient speaks.
● Ensure that the environment is conducive to learning and free of interruptions.
● Be sensitive to the timing of teaching sessions
Sources of Information
● Primary
○ Patient
● Secondary
○ Medical record, family member
Consideration for Successful Patient Teaching
● Formal contractual agreements
● Considering time constraints
● Scheduling
● Group vs individual teaching
● Formal vs informal teaching
● Manipulating the physical environment
Nurse Coaching Process:
● Establishing relationships and identifying readiness for change Identifying opportunities,
issues, and concerns
● Establishing patient-centered goals
UNIT 1 (NU 105)
● Creating the structure of the coaching interaction
● Empowering and motivating patients to reach goals
● Assisting the patient to determine progress toward goals
Obtaining Feedback About Learning
● Reinforcing and celebrating learning
● Evaluating teaching
● Revising the plan
Documentation of the Teaching-Learning Process
● Summary of the learning need
● The plan
● The implementation of the plan
● Evaluating reports
Guidelines to Patient Counseling
● Make everyone feel comfortable in the situation and surroundings
● Counseling: formal or informal
● Use interpersonal skills of warmth, friendliness, openness, and empathy
● Caring is fundamental in the counseling role
Types of Counseling
● Short-term counseling
○ For situational
● Long-term counseling
○ For developmental crisis
● Motivational counseling
UNIT 1 (NU 105)
CHAPTER 10: Leading, Managing, and Delegating
Types of Power:
● Explicit: power by virtue of position
● Implied: power due to other factors, such as personality
Leadership Qualities
● Charismatic
● Dynamic
● Enthusiastic
● Poised
● Confident
● Self-directed
● Flexible
● Knowledgeable
● Politically aware
Leadership skills
● Commitment to excellence
● Problem-solving skills
● Commitment to and passion for one’s work
● Trustworthiness and integrity
● Respectfulness
● Accessibility
● Empathy and care
Achieving Self-Knowledge
● Identify your strengths
● Evaluate how you accomplish work
● Clarify your values
● Determine where you belong and what you can contribute
● Assume responsibility for relationships
Leadership Styles
● Autocratic leadership
○ directive leadership or authoritarian leadership, involves the leader assuming
control over the decisions and activities of the group
● Democratic leadership
○ participative leadership, is characterized by a sense of equality among the leader
and other participants
UNIT 1 (NU 105)
● Lissez-fair leadership
○ nondirective leadership, the leader relinquishes power to the group, such that an
outsider could not identify the leader in the group
● Transactional leadership
○ based on a task-and-reward orientation
● Transformational leadership
Role of Nurse Manager
● Planning
● Organizing
● Directing
● Controlling
Management Structure
● Centralized
○ Senior managers generally make decisions with little input from the group
● Decentralized
○ Decisions are made by those who are most knowledgeable about the issues being
decided
Factors Prompting Change in Health Care Industry
● Increased number of chronically ill and older people
● Increased role of government and industry in healthcare
● Rising cost of health care
● Changing patterns of health care delivery
Conflict Resolution Strategies
● Avoiding
● Collaborating
● Competing
● Compromising
● Cooperating or accommodating
● Smoothing
Lewin’s Theory of Change
● Unfreezing
○ The need for change is recognized
● Moving
○ Change is initiated after a careful process of planning
● Refreezing
○ Change becomes operational
UNIT 1 (NU 105)
Considerations for Planned Change
● What is amenable to change?
● How does the group function as a unit?
Planned Change: An Eight-Step Process
1. Recognize symptoms that indicate a change is needed and collect data
2. Identify a problem to be solved through change
3. Determine/analyze alternative solutions to the problem
4. Select a course of action from possible alternatives
5. Plan for making the change
6. Implement the selected course of action to effect change
7. Evaluate the effects of change by comparing them with objectives stated in the plan for
change
8. Stabilize the change
Reasons for Resistance to Change
● Threat to self
● Lack of understanding
● Limited tolerance for change
● Disagreements about the benefits of change
● Fear of increased responsibility
Overcoming Resistance to Change
● Explain the proposed change to all affected people.
● List the advantages of the proposed change
● Relate the proposed change to the person’s or group’s existing beliefs and values.
● Help overcome resistance by providing opportunities for open communication and
feedback.
● Indicate clearly how the change will be evaluated.
● Introduce change gradually
● Provide incentives for commitment to change
Steps for Using Time Effectively
● Establish goals and priorities for each day
● Evaluate goals in terms of your ability to meet needs of patients
● Establish a time line
● Evaluate your success or failure in managing time
● Use the results to direct your next day’s
Factors Increasing the Power Base of Nursing
● Right timing
● Size of the nursing profession
● Nursing’s referent power
UNIT 1 (NU 105)
● Nursing’s unique perspective
● Desire of consumers and providers for change
Evidence-Based Strategies to Improve Leadership Skills
● Strive to become an authentic leader
● Develop leadership skills
● Promote a health work environment
● Engage staff to commit to their best effort at work
● Assist new graduates to transition into the RN roles
Clinical Nurse Leader Role
● Position was created by AACN as a leadership role
Considerations when Delegating Nursing Care (UAP)
● Patient’s condition
● Complexity of the activity
● Potential harm
● Degree of problem solving and innovation necessary
● Level f interaction requiring with the patient
● Capabilities of the UAP
● Availability of professional staff to accomplish workload
ANA Principles for Delegating Care
● The nursing profession determines the scope of nursing practice
Developing Leadership Responsibilities
● Mentorship
● Preceptorship
● Nursing organizations
● Continuing education