CHAPTER 1:
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Benner’s model p. 11
o The process by which a nurse acquires clinical skills and judgement
 Stage 1 Novice: has no experience of a situation, thus uses textbook rules
which have been learned objectively with no contextual meaning to apply
 Stage 2 Advanced Beginner: is able to give a marginally acceptable
performance, can perform a task as asked, but cannot think ahead,
change course or prioritize
 Stage 3 Competence: characterized by conscious deliberate planning,
able to make a long-range plans, to be efficient and organized has two to
three years of experience
 Stage 4 Proficient: can see beyond the moment, taking in the patients
total needs and care
 Stage 5 Expert: has an intuitive grasp - no longer needs to use analysis or
rules is able to recognize patterns and quickly make decisions
Contemporary Nursing: Education, Regulation, and Practice p. 10, 12, 6
o Education
 Informal involves a gradual progression and skill and clinical judgment
that allows the nurse to advance in the profession
 Formal consist of completing the initial and continuing education
required for licensure
 DSN/DNS/PhD are research focus degrees
o Regulation laws, standards of practice, and guidelines from professional
organizations regulate the practice of nursing
 The International Council of Nursing (ICN) definition of nursing includes
the autonomous and collaborative care of individuals of all ages, families,
groups and communities, sick or well and in all settings. In addition to
caring for ill, disabled, and dying persons, nurses are expected to
promote health and prevent illness. Key nursing roles include advocacy,
education, research, promotion of a safe environment, and participation
in shaping health policy and in healthcare systems management.
 According to the ANA Standards of Professional Performance, the RN
uses current evidence-based nursing knowledge, including research
findings, to guide practice decisions.
The ANA Standards of Professional Performance supports the RN to
critically analyze evidence-based practice and research findings for
application to nursing practice. The RN participates in the development
of evidence-based practice through research activities, and shares
research activities and/or findings with peers and others. The RN
incorporates evidence when initiating changes in nursing practice instead
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of randomly initiating changes that may or may not be safe, efficient, and
effective.
o Practice has identified quality and safety competencies that all health
professionals are expected to demonstrate in their practice
o Nurse practice act each state is responsible for enacting and enforcing the nurse
practice act of its state.
Continuing Education p. 11
o Is designed to help you stay current in your clinical knowledge after graduation
CE programs are offered at work sites, at educational settings, at professional
conferences, and needs to be renewed every two years.
How is Nursing Defined? p. 7-8
o 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
o Values and understanding of the nursing profession
Who Are the Members of the Interprofessional Healthcare Team? p. 16
o Physicians are licensed as medical doctors (MD) or doctors of osteopathy (DO).
Their primary role is to diagnose and treat illness through medical and surgical
services
o Nurse Practitioners (NP) are independent practitioners with advanced education
and training and are licensed to provide a broad range of medical and nursing
care based on their specialty area.
o Physician Assistants (PA) practice under the supervision of a physician to
diagnose and prescribe treatments and medications to treat certain diseases and
injuries
o Registered Nurse (RN) assess clients, administer treatments and medications,
provide education, and modify nursing care plans based on client responses to
treatment
o Licensed Practical Nurse (LPN) work under the supervision of the RN to provide
noncomplex care, administer certain medications, and communicate client
responses
o Unlicensed Assistive Personnel (UAP) covers nurse assistants, aides, and techs to
provide custodial care under the direction of nurses and providers
o Pharmacists prepare and dispense medications and therapeutic solutions. They
provide information about medication contraindications, side effects and
adverse reactions, dosage, and administration tips
o Therapists focus on a variety of rehabilitative needs of the client. The goal of the
rehabilitative team is to treat and maximize functioning and or assist the client
to adapt to limitations and achieve optimal outcomes
 Types of therapists:
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Physiatrists function as the rehabilitative team leaders to improve
mobility and strength and teach motor skills
 Physical therapists (PT) focus on the rehabilitation of muscles and
bones to help clients use assistive devices and gain self-care skills
for activities of daily living
 Occupational therapists (OT) work closely with PT's to help clients
regain function and independence in everyday activities
 Respiratory therapists (RT) provide prescribed treatments for
effective respiration and ventilation
 Speech therapists (ST) provide assistance to clients experiencing
swallowing and speech disturbances from developmental or
neurological impairment
 Recreational therapists use leisure activities to promote the
physical, social, and emotional well-being of clients
 Marriage and family therapists provide counseling services to
individuals, families, and groups
Technologists performs selected activities in hospitals, diagnostic centers, and
emergency care facilities (lab techs come up radiology techs)
Registered dieticians/ Licensed Nutritionists apply specialized knowledge of
nutrition science to plan food treatments and goals to promote client health and
treat illnesses
Social Workers throughout healthcare systems provide psychosocial support,
client services, and coordinate continuity of care for clients after discharge
Spiritual Care Providers offer organized religious services, client visits, and family
and staff support, particularly with serious illnesses or at the end of life
Alternative Care Providers such as chiropractors, naturopaths, and herbalists
offer health services that are primarily outside the traditional healthcare system
CHAPTER 2:
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Why is critical Thinking Important for Nurses? p. 33
o Critical thinking helps understand what is important about each client's situation.
You are constantly assessing your client to determine how they are responding
to nursing interventions and medical treatments.
How is Nursing Process Related to Critical Thinking? P. 37
o Nurses use critical thinking for decisions other than direct client care
o some nursing activities do not always require reflective critical thinking
o the nursing process is essentially a problem-solving process
What are Critical Thinking Attitudes? P 34
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o Intellectual autonomy. Critical thinkers do not believe everything they are told;
they listen to what others think, and they learn from new ideas. They do not
accept or reject an idea before they understand it.
o Intellectual curiosity. Critical thinkers love to learn new things. They show an
attitude of curiosity and inquiry, and they frequently think or ask, “What if . . .?”
“How could we do this differently?” “How does this work?” or “Why did that
happen?”
o Intellectual humility. Critical thinkers ask for help when they do not know; seek
the wisdom of mentors with knowledge, skill, and ability; and reevaluate their
conclusions or actions in light of new information.
o Intellectual empathy. Critical thinkers try to understand the feelings and
perceptions of others. They try to see a situation as the other person sees it.
o Intellectual courage. Critical thinkers consider and examine fairly their own
values and beliefs, as well as beliefs of others, even when this is uncomfortable.
They are willing to rethink, and even reject, previously ill-justified beliefs.
o Intellectual perseverance. Critical thinkers do not jump to conclusions or settle
for the quick, obvious answer. They explore effective solutions even when it
takes a great deal of effort and time.
o Fair-mindedness. Critical thinkers try to make impartial judgments, realizing that
personal biases, customs, and social pressures can influence their thinking.
o Confidence in reasoning. Critical thinkers rely on inductive and deductive
processes to have confidence in their own reasoning.
What is Critical thinking p. 33
o Critical thinking is an analysis process. It is a combination of reasoned thinking,
openness to alternatives, an ability to reflect, and a desire to seek truth.
o Critical thinking is linked to evidence-based practice.
o Critical thinkers are flexible, nonjudgmental, inquisitive, honest, and interested
in seeking the truth.
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What is clinical judgment defined as?
o Clinical judgment is defined as the processes that promote safe client care decisions and
outcomes.
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What are the phases of the nursing process? p. 38
o ADPIE:
 Assessment (recognize and analyze cues)
 Diagnosis (analyze cues and begin to prioritize hypothesis)
 Planning (prioritize hypothesis and generate solutions)
 Implementation (take action on solutions generated)
 Evaluation (evaluate implementation and outcomes)
Who are Some Important Nurse Theories? P 98
o Florence Nightingdale, she theorized that a clean environment would improve
the health of patients
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o Virginia Henderson, she was the first to define the purpose and function of
nursing
o Hildegard Peplau, psychiatric nurse who influenced the advancement of
standards in nursing education, promoted self-regulation and nursing through
credentialing, and was a strong advocate for advanced nursing practice. Her idea
was that health could be improved for psychiatric patients if there were a more
effective way to communicate with them. her research showed that developing
a relationship with patients with mental health issues does make their treatment
more effective.
o Patricia Benner, Her idea was to find out what makes an expert nurse
o Madeline Leininger, is the founder of transcultural nursing and was the first
nurse in the United States to earn a doctorate degree in cultural and social
anthropology. Her theory focuses on caring as cultural competence using
knowledge of cultures and of nursing to provide culturally congruent and
responsible care.
o What Are Some Barriers to Culturally Competent Care? p. 299-300, 301
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Bias. A lack of impartiality, one sidedness; can be positive or negative
Ethnocentrism. the tendency of people to believe their own beliefs and values
are right and that those of other cultures are wrong.
 Cultural stereotype. The unsubstantiated belief that all people of a certain racial
or ethnic group are alike in certain respects. A stereotype may be positive or
negative
 Prejudice. Negative attitudes toward other people based on faulty and
rigid stereotypes about race, gender, sexual orientation, status, and so
on
 discrimination. The behavioral manifestations of a prejudice
 Racism. Results in racial inequity
 Nurses can use strong advocacy skills to facilitate equitable treatment
and remove barriers to care or delays in care
 nurses must confront their internal biases; speak up when they observe
racism, discrimination, or injustices against vulnerable patients
o Public Speaking Nurses make presentations to various-sized groups to educate people about
health issues, to lobby for health legislation, and to address colleagues at professional
conferences.
o Group communication occurs when you engage in an exchange of ideas with two or more
individuals at the same time. Examples of small-group communication include staff meetings,
committee meetings, educational groups, self-help groups, and family teaching sessions.
o Interpersonal Communication Communication that occurs between two or more people is
interpersonal. Nurses use interpersonal communication to gather information during
assessment, to teach about health issues, to explain care, and to provide comfort and support.
Intrapersonal Communication Intrapersonal communication is conscious internal dialogue,
sometimes known as self-talk. For example, if you discover your patient is pale, diaphoretic
(perspiring profusely), and moaning, you may ask yourself, “What’s happened? This patient
appears to be in a lot of pain.”