Exam 1 Lecture 1 Contributions of Florence Nightingale - Known as founder of modern nursing Developed the first nursing theory Believed that nurses should improve a patient’s environment Linked patients’ health status with environmental factors Initiated improved hygiene and sanitary conditions during the Crimean War Professional Nursing Practice and Advocacy - Use critical thinking to administer high-quality evidence-based patient-centered care Recognize the importance of the role high quality nursing plays in a nation’s health care Robert Wood Johnson Foundation Future of Nursing: Campaign for Action Institute of Medicine publication on The Future of Nursing American Nurses Association Scope of Practice Who comprise the who constituency and have been educated, titled, and maintain active licensure to practice nursing What nursing is the protection, promotion, and optimization of health and abilities; prevention of illness and injury; facilitation of healing; alleviation of suffering through the diagnosis and treatment of human response; and advocacy in the care of individuals, families, groups, communities, and populations Where Wherever there is a patient in need of care When whenever there is a need for nursing knowledge, compassion, and expertise Why the profession exists to achieve the most positive patient outcomes in keeping with nursing social contract and obligation to society Changes in healthcare and how it affects patients - Changes in curriculum Meets the ever-changing needs of society, including an aging population, cultural diversity, bioterrorism, emerging infections, and disaster management - - - Advances in technology and informatics High acuity level of care of hospitalized patients, and early discharge from health care institutions require nurses in all settings to have a strong and current knowledge base New programs address current health concerns The educational programs focus on end-of-life care and practices in nursing curricula and professional continuing education programs for practicing nurses Leadership role in developing standards and policies Last act campaign, The end-of-life nursing education consortium Benner’s stages of clinical competence Novice Advanced beginner Competent Proficient Expert Beginning nursing student or any nurse entering a situation in which there is no previous level of experience; learns via a specific set of roles or procedures A nurse who has had some level of experience with the situation. May only be observational in nature, but this nurse is able to identify meaningful aspects or principles of nursing care A nurse who has been in the same clinical position for 2-3 years. Understands the organization and specific care required by the type of patients A nurse with more than 2-3 years of experience in the same clinical position. Perceives a patient’s clinical situation as a whole and can assess an entire situation, and can readily transfer knowledge gained from multiple previous experiences to a situation A nurse with diverse experience who has an intuitive grasp of an existing or potential clinical problem. Able to zero in on the problem and focus on multiple dimensions of the situation QSEN’s Six Competencies Patient-centered care Teamwork and collaboration Evidence-base practice Quality improvement Safety Informatics Lecture 2 Models of Health and Illness - - - - Health belief model Perception of susceptibility to illness Perception of seriousness of illness Likelihood that pt will take preventive action Health promotion model Positive, dynamic state Directed at increasing level of well being o Focuses on: Individual characteristics/experiences Behavior specific knowledge and affect Behavioral outcomes Holistic health models Thrust is to create conditions that promote optimal health The individual patient is ultimate expert concerning own health and are involved in the healing process Recognize natural healing abilities of human body Incorporate complementary and alternative interventions Maslow’s hierarchy of needs Basic human needs are elements necessary for survival and health Extent to which basic needs are met determines level of health Variables influencing health and health beliefs and practices - Internal Variables o Developmental stage Fear, anxiety common among ill children Emotional development o Intellectual background Knowledge, educational background Cognitive skills o Perception of functioning Fatigue, SOA, pain b/p, height, lung sounds - o Emotional factors Degree of stress, depression, fear vs. patient who is generally calm o Spiritual factors How a patient lives life Life values and beliefs Relationship with family and friends Ability to find hope and meaning in life External Variables o Family practices How family uses HC services History of preventive care o Socioeconomic factors Stability of key relationship Lifestyle habits Occupational environment Social networks/desire for approval and support Economic variables influence when the pt accesses care and whether he complies with care May try to decrease costs by taking meds every other day, or water down infant formula o Cultural background Influences Beliefs, values, customs Approach to HC system, personal health practices, nurse-patient relationship Beliefs about causes of illness Remedies/practices to restore health Theories of Caring - Leininger’s transcultural caring Domain that sets nursing apart from other health care disciplines For caring to be effective, nurses need to learn culturally specific behaviors and words that reflect human caring in different cultures to identify and meet the needs of all patients - Watson’s transpersonal caring Holistic model that supports a nurse’s conscious intention to care to promote healing and wholeness - Integrates the human caring process with healing environments, incorporating the life-generating and life-receiving processes of human caring and healing Describes a consciousness that allows nurses to raise new questions about what it means to be a nurse, to be ill, and to be caring and healing Rejects the disease orientation to health care and places care before cure Swanson’s theory of caring Guides nurses in developing caring interventions that improve patient satisfations Developed from three perinatal studies involving interviews with women who miscarried, parents and health care professionals in a newborn intensive care unit, and mother who were socially at risk and received long-term public health intervention Elements of Caring Providing presence Touch Listening Knowing the patient Spiritual caring Relieving pain and suffering Family-centered care 3 Types of Trust That Communicate Caring Task-oriented touch Skillful, gentle care Caring touch Enhances comfort, security, self-esteem, mental well-being Protective touch Prevents injury to pt Family Forms and Threats to Family Forms - Family forms o Nuclear family Consists of two adults o Extended family - Includes relatives in addition to the nuclear family o Single-parent family Formed when one parent leaves the nuclear family because of death, divorce, or desertion or when a single person decides to have or adopt a child o Blended family Formed when parents bring children from previous marriages or other parenting relationships into a new joint-living situation o Alternative family Include multiadult households, grand families, communal groups with children, nonfamilies, and cohabiting partners Threats Changing economic status Homelessness Domestic violence Presence of acute or chronic illnesses Family caregivers 4 Practices that Contribute to Family Centered Care Sharing of information/history Acceptance/understanding of family Plan workable in the daily lives? Delivery of therapy/care Nurses Role in Providing Family-Centered Care Responsibility to understand family constellation and basic dynamics Engage family in care; acknowledge impact of patient illness on entire family Nurses Role in Discharge Planning Evaluation of the patient by qualified personnel Discussion with the patient or his representative Planning for homecoming or transfer to another care facility Determining if caregiver training or other support is needed Referrals to home care agency and/or appropriate support organizations in the community Arranging for follow-up appointments or tests Lecture 3 Critical Thinking in the Nursing Practice Nurses must learn to question, wonder, and explore different perspectives and interpretations to find a solution that benefits the patient The ability to think in a systematic and logical manner with openness to question and reflect on the reasoning process A continuous process characterized by open-mindedness, continual inquiry, and perseverance Recognizing that an issue exists, analyzing information, evaluating information, and drawing conclusions Reflection in Critical Thinking Purposefully visualizing a past situation and taking the time to honestly review everything you remember about it Allows you to gain new knowledge and raise questions about your practice Improves ability to problem solve Model Components of a Critical Thinking Model 5 Terms of Health Ethics Autonomy: commitment to include patients in decisions Beneficence: talking positive action to help others Nonmaleficence: avoidance of harm or hurt Justice: being fair Fidelity: agreement to keep promises Characteristics of the Professional Nursing Code of Ethics Advocacy Responsibility Accountability Confidentiality Steps in Processing an Ethical Dilemma 1. 2. 3. 4. 5. 6. 7. Ask if this is an ethical dilemma Gather all relevant information Clarify values Verbalize the problem Identify possible courses of action Negotiate the outcome Evaluate the action Nursing Students Role in Legal Issues Nursing students are liable if their actions cause harm Student, instructor, hospital, and university share in liability Students should not engage in activities for which they are not prepared Students need 1:1 RN supervision for medication administration Should not perform tasks outside of their scope of practice SBAR Situation: what is going on with the patient Background: what is the clinical background or context Assessment: what do I think the problem is Recommendation: what would I do to correct it
