Chapters 5, 6, 15, 22, 23, 25, 31, 34, 38, 39
Quiz yourself by thinking what should be in
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| Define Evidence-Based Practice. | a problem-solving approach to clinical practice that integrates the conscientious use of best evidence in combination with a clinician's expertise and client preferences and values in making decisions about client care.
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| List the 5 steps of Evidence Based Practice. | 1. ask the clinical question; 2. collect the most relevant/best data; 3. critically appraise the evidence; 4. integrate all evidence; 5. evaluate practice decision or change
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| List the 4 elements of a PICO question. | P=patient population of interest; I=intervention of interest; C=comparison of interest; O=outcome
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| List some examples of knowledge gaps. | diagnosis, prognosis, therapy, prevention, and education
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| Define clinical guidelines. | systematically developed statements about a plan of care for a specific set of clinical circumstances involving a specific client population
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| What are randomized controlled trials? | the highest level of experimental research, when researchers test interventions against the usual standard of care.
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| What is a systematic review? | when an independent researcher reviews all of the RCT conducted on the same clinical question or issue and reports on whether the evidence is conclusive and in favor of the intervention or whether further study is necessary and why.
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| What are hypotheses? | predictions made about the relationship or difference between study variables
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| What are variables? | concepts, characteristics, or traits that vary within subjects
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| Define research. | a systematic process that asks and answers questions that generate knowledge
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| Define nursing research. | a way to identify new knowledge, improve professional education and practice, and use resources effectively.
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| What is outcome research? | research designed to assess and document the effectiveness of health care services and interventions
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| What is the scientific method? | a systematic step-by-step process that provides support that the findings from a study are valid, reliable, and generalizable to subject similar to those researched.
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| What is quantitative nursing research? | the study of nursing phenomena that offers precise measurement and quantification
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| List some quantitative methods of study. | experimental research, surveys, evaluation research
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| What is qualitative nursing research? | the study of phenomena that are difficult to quantify or categorize; describes information obtained in nonnumerical form
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| List some qualitative methods of study. | ethnography, phenomenology, grounded theory
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| List the steps of the research process. | conceive the study; design the study; coduct the study; analyze the study; use the study
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| Phase 1: Conceive the study | identify the problem; review the literature; develop theoretical framework; formulate variables
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| Phase 2: Design the study | select research design; identify sample and setting; select the data collection methods; evaluate instrument quality
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| Phase 3: Conduct the study | get approval to use human subjects; recruit subjects; collect data
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| Phase 4: Analyze the study | describe the sample; answer the research questions; interpret the results
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| Phase 5: Use the study | recommend further research; state implications for nursing; disseminate results
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| Define confidentiality. | guarantees that any information the subject provides will not be reported in any manner that identifies the subject and will not be accessible to people outside the research team
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| When does anonymity occur? | when even the researcher cannot link the subject to the data
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| Define quality improvement. | an approach to the continuous study and improvement of the processes of providing health care services to meet the needs of clients and others
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| Define performance improvement. | an organization analyzes and evaluates current performance to use results to develop focused improvement actions
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| What is the PDSA cycle model for quality improvement and performance improvement? | plan, do, study, act
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| PDSA cycle: Plan | review available data to understand existing practice conditions or problems in order to identify the need for change
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| PDSA cycle: Do | select an intervention on the basis of the data reviewed, and implement the change
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| PDSA cycle: Study | study (evaluate) the results of the change
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| PDSA: Act | if the process change is successful with positive outcomes, act on the practices by incorporating them into daily unit performance
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| List the two overarching goals for Healthy People 2010? | 1. to increase quality and years of healthy life; 2. to eliminate health disparities
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| List the 4 areas of the Healthy People 2010 document. | 1. promoting healthy behaviors; 2. promoting healthy and safe communities; 3. improving systems for personal and public health; 4. preventing and reducing disease and disorders
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| Define health. | a state of complete physical, mental and social well-being, not merely the absence of disease or infirmity
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| What are health beliefs? | a person's ideas, convictions, and attitudes about health and illness
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| Health Belief Model | addresses the relationship between a person's beliefs and behaviors
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| List the 3 components of the health belief model. | 1. individual's perception or susceptibility to an illness; 2. individual's perception of the seriousness of the illness; 3. likelihood that a person will take preventive action
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| Health Promotion Model | defines health as a positive, dynamic state, not merely the absence of disease
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| List the 3 areas that the health promotion model focuses on. | 1. individual characterisitcs and experiences; 2. behavior-specific knowledge and affect; 3. behavioral outcomes
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| Maslow's Hierarchy of Needs | certain human needs are more basic than others; that is, some needs must be met before other needs
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| List Maslow's Hierarchy of Needs | 1. self-actualization; 2. self-esteem; 3. love and belonging; 4. physical activity and psychological safety; 5. physiological: oxygen, fluids, nutrition, body temp., elimination, shelter, sex
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| Holistic Health Model | nurses using the nursing process consider clients the ultimate experts regarding their own health and respect client's subjective experiences as relevant in maintaining health or assisting in healing
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| List the internal variables influencing health and health beliefs and practices. | developmental stage, intellectual background, perception of functioning, emotional factors, and spiritual factors
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| List the external variables influencing health and health beliefs and practices. | family practices, socioeconomic factors, and cultural background
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| List the stages of Health Behavior Change. | precontemplation, contemplation, preparation, action, and maintenance stage
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| Precontemplation: Definition | not intending to make changes within the next 6 months
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| Precontemplation: Nursing Implications | client will not be interested in information about the behavior and may be defensive when confronted with the information
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| Contemplation: Definition | considering a change within the next 6 months
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| Contemplation: Nursing Implications | ambivalence may be present, but clients will more likely accept information as they are developing more belief in the value of change
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| Preparation: Definition | making small changes in preparation for a change in the next month
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| Preparation: Nursing Implications | client believes advantages outweigh disadvantages of behavior change; may need assistance in planning for the change
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| Action: Definition | actively engaged in strategies to change behavior; this stage may last up to 6 months
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| Action: Nursing Implications | be aware of previous habits that may prevent action on new behaviors; identify barriers and facilitators of change
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| Maintenance Stage: Definition | sustained change over time; this stage begins 6 months after action has started and continues indefinitely
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| Maintenance stage: Nursing Implications | changes need to be integrated into the client's lifestyle
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| Define health promotion. | activities that help clients maintain or enhance their present levels of health; motivate people to act positively to reach more stable levels of health
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| Define wellness. | education teaches people how to care for themselves in a healthy way and includes topics such as physical awareness, stress management, and self-responsibility
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| Illness prevention | activities such as immunization programs protect clients from actual or potential health problems.
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| Passive strategies of health promotion | individuals gain from the activities of others without acting themselves
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| Active strategies of health promotion | individuals are motivated to adopt specific health programs
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| Primary prevention | true prevention; it precedes disease or dysfunction and is applied to clients considered physically and emotionally healthy
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| Give some examples of primary prevention. | health education programs, immunizations, and physical and nutritional fitness activities
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| Secondary prevention | focuses on individuals who are experiencing health problems or illnesses and who are at risk for developing complications or worsening conditions; activities are directed at diagnosis and prompt intervention, thereby reducing severity
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| Tertiary prevention | occurs when a defect or disability is permanent and irreversible; involves minimizing the effects of long-term disease or disability and deterioration
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| What is a risk factor? | any situation, habit, social, or env. condition, physiological or psychological condition, developmental or intellectual condition, or spiritual or other variable that increases the vulnerability of an individual or group to an illness or accident
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| What is the first step in health promotion, wellness education, and illness prevention activities. | identifying risk factors
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| Define illness. | a state in which a person's physical, emotional, intellectual, social, developmental, or spiritual functioning is diminished or impaired compared with previous experience.
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| acute illness | usually has a short duration and is severe; symptoms appear abruptly, are intense, and often subside after a relatively short period; may affect functioning in any dimension
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| chronic illness | persists, usually longer than 6 months, and can also affect functioning in any dimension
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| normalization | a process in which clients with chronic diseases and their families adapt to the disease
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| illness behavior | involves how people monitor their bodies, define and interpret their symptoms, take remedial actions, and use the health care system
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| What is the goal of nursing in regards to health and wellness? | to promote optimal functioning in all dimensions throughout an illness
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| Internal variables influencing illness and illness behavior | a client's perceptions of symptoms and the nature of the illness
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| External variables influencing illness and illness behavior | visibility of symptoms, social group, cultural background, economic variables, accessibility of the health care system, and social support
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| What does an individuals behavior and emotional reactions depend on in regards to illness? | the nature of the illness, the client's attitude toward it, the reaction of others to it, and the variables of illness behavior
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| What do the reactions of clients and families to changes in body image depend on? | the type of changes, their adaptive capacity, the rate at which changes take place, and the support services available
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| What is self-concept? | a mental self-image of strengths and weaknesses in all aspects of personality
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| What does self-concept depend on? | depends in part on body image and roles but also includes other aspects of psychology and spirituality
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| Role reversal | when an illness occurs, parents and children try to adapt to major changes resulting from a family member's illness
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| What is family dynamics? | the process by which the family functions, makes decisions, gives support to individual members, and copes with everyday changes and challenges
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| What is critical thinking? | an active, organized, cognitive process used to carefully examine one's thinking and the thinking of others
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| What separates professional nurses from technical personnel? | clincial decision making
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| Why is critical thinking central to professional nursing practice? | because it allows you to test and refine nursing approaches, to learn from successes and failures, and to apply new knowledge
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| What does critical thinking involve? | recognizing that an issue exists, analyzing information about the issue, evaluating information and making conclusions
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| evidence-based knowledge | knowledge based on research or clinical expertise
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| Critical thinking skills: interpretation | be orderly in data collection; look for patterns to categorize data; clarify any data you are uncertain about
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| Critical thinking skills: analysis | be open-minded as you look at information about a client; do not make careless assumptions; do the data reveal what you believe is true, or are there other options?
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| Critical thinking skills: inference | look at the meaning and significance of findings; are there relationships between findings?; Do the data about the client help you see that a problem exists?
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| Critical thinking skills: Evaluation | look at all situations objectively; use criteria to determine results of nursing actions; reflect on your own behavior
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| Critical thinking skills: Explanation | support your findings and conclusions; use knowledge and experience to choose strategies you use in the care of clients
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| Critical thinking skills: Self-regulation | reflect on your experiences; identify ways you can improve your own performance; what will make you feel that you have been successful?
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| What are the 3 levels of critical thinking? | basic, complex, and commitment
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| What is the scientific method? | a systematic, ordered approach to gathering data and solving problems
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| List the five steps of the scientific method. | problem identification; collection of data; formulation of a research question or hypothesis; testing the question or hypothesis; evaluating results of the test or study
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| What does effective problem solving involve? | evaluating the solution over time to make sure that it is effective
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| What is decision making? | a product of critical thinking that focuses on problem resolution
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| What is diagnostic reasoning? | a process of determining a client's health status after you assign meaning to the behaviors, physical signs, and symptoms presented by the client
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| What is inference? | the process of drawing conclusions from related pieces of evidence; part of diagnositc reasoning
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| What does clinical decision making require? | careful reasoning so that you choose the options for the best client outcomes on the basis of the client's condition and the priority of the problem
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| What is the nursing process? | a five-step clinical decision-making approach that includes assessment, diagnosis, planning, implementation, and evaluation
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| Kataoka-Yahiro and Saylor model of critical thinking | defines the outcome of critical thinking: nursing judgement that is relevant to nursing problems in a variety of settings
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| List the 5 components of critical thinking in the Kataoka-Yahiro and Saylor model. | knowledge base, experience, critical thinking competencies, attitudes, and standards
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| List the 11 attitudes that are central features of a critical thinker. | confidence; thinking independently; fairness; responsibility and authority; risk taking; discipline; perseverance; creativity; curiosity; integrity; humility
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| List the 14 intellectual standards universal for critical thinking. | clear; precise; specific; accurate; relevant; plausible; consistent; logical; deep; broad; complete; significant; adequate; fair
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| List the professional standards for critical thinking. | ethical criteria for nursing judgement; criteria for evaluation; professional responsibility
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| What is reflection? | the process of purposefully thinking back or recalling a situation to discover its purpose or meaning
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| What is a concept map? | a visual representation of client problems and interventions that shows their relationships to one another
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| What is ethics? | the study of conduct and character; concerned with determining what is good or valuable for individuals, for groups of individuals, and for society at large
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| Define autonomy. | the commitment to include clients in decisions about all aspects of care; e.g., signed consent
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| Define beneficence. | taking positive actions to help others; encourages the urge to do good for others; requires that the best interests of the client remain more important than self-interest
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| Define maleficence. | refers to harm and hurt
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| Define nonmalficence. | the avoidance of harm or hurt; HCP tries to balance the risks and benefits of a plan of care while striving to do the least harm possible
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| Define justice. | fairness
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| Define fidelity. | the agreement to keep promises; supports the reluctance to abandon clients, even when disagreement occurs about decisions that a client makes; obligation to follow through with care offered to clients
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| Define code of ethics. | a set of guiding principles that all members of a profession accept
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| List the basic principles of ethics. | advocacy, responsibility, accountability, and confidentiality
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| What is advocacy? | the support of a cause; as a nurse you advocate for the health, safety, and rights of the client; you safeguard the client's right to physical and auditory privacy
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| What is responsibility? | a willingness to respect obligations and to follow through on promises; as a nurse you are responsible for your actions
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| What is accountability? | the ability to answer for one's own actions
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| What is confidentiality? | confidential protection of a client's personal health information
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| HIPPA | Health Insurance Portability and Accountability Act of 1996; defines the rights and privileges of clients for protection of privacy without diminishing access to quality care
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| What is a value? | a personal belief about the worth of a given idea, attitude, custom, or object that sets standards that influence behavior; reflect cultural and social influences and vary among people and develop and change over time
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| Value formation | begins in childhood, shaped by experiences within the family unit; schools, governments, religious traditions and other social institutions reinforce or challenge family values; individual exp. influence value formation
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| Values clarification | used to resolve ethical dilemmas
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| Deontology | defines actions as right or wrong based on their "right-making characterisitics such as fidelity to promises, truthfulness, and justice."; specifically does not look at consequences; it examines a situation for the existence of rightness or wrongfulness
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| Utilitarianism | a system of ethics that proposes that the value of something is determined by its usefulness
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| Feminist ethics | focuses on the inequality between people; looks to nature of relationships for guidance in the processing of ethical dilemmas; proposes that principles distract you from dealing with larger issues of community
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| ethic of care | emphasizes the importance of understanding relationships, esp. as they are revealed in personal narrative
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| How to Process an Ethical Dilemma | ask if this is an ethical dilemma; gather all relevant info; clarify values; verbalize the problem; identify possible courses of action; negotiate a plan; evaluate the plan
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| quality of life | central to discussions about futile care, cancer therapy, physician-assisted suicide, and DNR; a quality of life measure helps a client/family decide on merits of a certain risky intervention
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| futile care | interventions unlikely to produce benefit for the client that outweighs risks
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| allocating scarce resources | a key issue in discussions about access to health care
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| genetic testing | alerts a client to a condition that is not yet evident but that is certain to develop in the future
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| the nursing shortage | produces difficult working conditions and affects clients outcomes
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| Where do the legal guidelines that nurses follow come from? | statutory law, regulatory law, and common law
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| Give an example of statutory law. | Nurse Practice Acts found in all 50 states
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| Nurse Practice Acts | describe and define the legal boundaries of nursing practice within each state
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| regulatory law, or administrative law | reflects decisions made by administrative bodies such as State Boards of Nursing when they pass rules and regulations
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| common law | results from judicial decisions made in courts when individual legal cases are decided; e.g., informed consent and client's right to refuse treatment
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| statutory law is either criminal or civil | criminal law: prevent harm to society and provide punishment for crimes; civil laws: protect the rights of individual persons within our society and encourage fair and equitable treatment among people
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| criminal law is either a felony or a misdemeanor | felony: a crime of a serious nature that has a penalty of imprisonment for greater than one year or even death; misdemeanor: a less serious crime that has a penalty of a fine or imprisonment for less than 1 year
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| standards of care | the legal guidelines for nursing practice and provide the minimum acceptable nursing care; standards reflect values and priorities of the profession
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| Americans with Disabilities Act (1990) | protects the rights of disabled people; also the most extensive law on how employers must treat HCPs and clients infected with HIV
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| Emergency Medical Treatment and Active Labor Act (EMTALA, 1986) | provides that when a client comes to the emergency department or the hospital, an appropriate medical screening occurs within the hospitals capacity before being discharged or transferred
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| Mental Health Parity Act (1996) | forbids health plans from placing lifetime or annual limits on mental health coverage that are less generous than those placed on medical or surgical benefits
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| Advance Directives | liviing wills and durable powers of attorney
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| What are living wills and powers of attorney based on? | values of informed consent, client autonomy over end-of-life decisions, truth telling, and control over the dying process
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| Patient Self-Determination Act | requires health care institutions to provide written information to clients concerning the client's rights under state law to make decisions, including the right to refuse treatment and formulate advance directives
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| decisional capacity | the ability to make right choices for oneself as it relates to medical care
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| living wills | represent written documents that direct treatment in accordance with a client's wishes in the event of a terminal illness or condition
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| Durable Power of Attorney for Health Care (DPAHC) | a legal document that designates a person or persons of one's choosing to make health care decisions when the client is no longer able to make decisions on his/her own behalf
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| DNR | do not resuscitate; must be written, not verbal
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| Uniform Anatomical Gift Act | an individual who is at least 18 years of age has the right to make an organ donation; gift needs to be in writing with signature
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| Required Request laws | mandate that at the time of admission to a hospital, a qualified HCP has to ask each client over age 18 whether he/she is an organ/tissue donor
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| National Organ Transplant Act of 1984 | prohibits the purchase or sale of organs
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| HIPPA of 1996 | provides rights to clients and protects employees; protects individuals from losing their health insurance when changing jobs by providing portability
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| Privacy section of HIPPA | standards regarding accountability in the health care setting; these rules create client rights to consent to use and disclose protected health information, to inspect/copy one's med record, and to amend mistaken/incomplete information
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| Privacy | the right of clients to keep information about themselves from being disclosed
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| Confidentiality | how HCPs treat client private information once it has been disclosed to others
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| Federal Nursing Home Reform Act (1987) | gave residents in certified nursing homes the right to be free of unnecessary and inappropriate restraints
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| Centers for Medicare and Medicaid Services (2004) | state that clients have the right to be free from restraints
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| TJC (2006) guidelines regarding use of restraints | HCP can only use restraints (1) to ensure physical safety of resident/other residents, (2) when less restrictive interventions are not successful, and (3) only on the written order of a physician or HCP
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| written order for restraints | must include a specific episode with start and end times
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| Licensure | state board of nursing licenses all RN's in the state they practice in
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| Good Samaritan Laws | nurses provide care at the scene of accidents; limit liability and offer legal immunity for nurses who help at the scene of an accident
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| Public Health Laws | under the health code, state legislature enacts statutes that describe the reporting laws for communicable diseases, as well as specify necessary school immunizations and mandate other measures that promote health and reduce risks in communities
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| Uniform Determination Death Act of 1980 | states that HCPs can use either the cardiopulmonary definition or the whole brain definition to determine death
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| cardiopulmonary definition of death | requires irreversible cessation of circulatory and respiratory functions
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| whole brain standard of death | requires irreversible cessation of all function of the entire brain, including the brain stem
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| Oregon Death with Dignity Act (1994) | the first statute that permitted physician-assisted suicide; stipulates that competent yet terminal clients could make an oral or written request for medication to end their life in a humane and dignified manner
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| What is a tort? | a civil wrong made against a person or property
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| How are torts classified? | as either intentional, quasi-intentional, or unintentional
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| Intentional torts | willful acts that violate another's rights, such as assault, battery, and false imprisonment
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| Quasi-intentional torts | acts where intent is lacking but volitional action and direct causation occur, such as found with invasion of privacy and defamation of character
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| Unintentional tort | includes negligence or malpractice
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| Assault | any intentional threat to bring about harmful or offensive contact; no actual contact is necessary
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| Battery | any intentional touching without consent; contact can be harmful to the client and cause injury, or it can be merely offensive to the client's personal dignity; a battery always includes an assault
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| False imprisonment | occurs with unjustified restraining of a person without legal warrant
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| Invasion of privacy | protects the client's right to be free from unwanted intrusion into his/her private affairs
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| List the 4 types of invasion of privacy torts. | seclusion; appropriation of name of likeness; publication of private or embarrassing facts; publicity placing one in a false light in the public's eye
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| Defamation of Character | the publication of false statements that result in damage to a person's reputation; statements must be published with malice in the case of a public official or public figure
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| Malice | means that the person publishing the information knows it is false and publishes it anyway or publishes it with reckless disregard as to the truth
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| Slander | occurs when one verbalizes the false statement
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| Libel | the written defamation of character
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| Negligence | conduct that falls below a standard of care; e.g., hanging wrong IV solution
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| Malpractice | one type of negligence and often referred to as professional negligence; when nursing care falls below a standard of care
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| List the criteria used to establish nursing malpractice. | the nurse owed a duty to client; the nurse did not carry out that duty; the client was injured; the nurse's failure to carry out the duty caused the injury
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| When is a signed consent form required? | for all routine treatment, hazardous procedures such as surgery, some treatment programs such as chemotherapy, and research involving clients
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| Informed consent | a person's agreement to allow something to happen, such as surgery or an invasive diagnostic procedure, based on a full disclosure of risks, benefits, alternatives, and consequences of refusal
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| What type of tort will result if a HCP fails to obtain consent in situations other than emergencies? | claim of battery; negligence lawsuit
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| 1973, Roe vs. Wade | the U.S. Supreme Court ruled that there is a fundamental right to privacy, which includes a woman's decision to have an abortion; could have abortion in 1st trimester
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| 1989, Webster v. Reproductive Health Services | some states require viability tests before conduction abortions if the fetus is over 28 weeks' gestational age; some states require a minor's parental consent or a judicial decision that the minor is mature and can self-consent
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| Risk management | a system of ensuring appropriate nursing care that attempts to identify potential hazards and eliminate them before harm occurs
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| What is one of the most important roles for a nurse in any health care setting? | client education
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| What is the goal of educating others about their health? | to assist individuals, families, or communities in achieving optimal levels of health
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| What is health education? | any combination of planned learning experiences based on sound theories that provide individuals, groups, and communities the opportunity to acquire the information and skills needed to make quality health decisions
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| List the 3 important purposes of client education. | 1. maintenance and promotion of health and illness prevention; 2. restoration of health; 3. coping with impaired functions
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| In what 3 domains does learning occur? | cognitive (understanding), affective (attitudes), and psychomotor (motor skills)
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| Define teaching. | an interactive process that promotes learning
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| Define motivation. | a force that acts on or within a person that causes the person to behave in a particular way
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| Define compliance. | a client's adherence to the prescribed course of therapy
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| Define self-efficacy. | refers to a person's perceived ability to successfully complete a task; a concept included in social learning theory
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| Readiness to learn vs. ability to learn | readiness means are they able to accept a diagnosis; the ability to learn depends on physical and cognitive attributes, developmental level, physical wellness, and intellectual thought processes
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| List some important factors when choosing a setting for learning. | # of persons the nurse will teach; need for privacy, room temperature, room lighting, noise, room ventilation, room furniture
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| What is an ideal environment for learning? | a room that is well-lit and has good ventilation, appropriate furniture, and a comfortable temperature; also important to choose a quiet setting because it offers privacy; infrequent interruptions are best
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| Teaching methods based on clients developmental capacity: Infant | keep routines consistent; hold infant firmly while smiling and speaking softly to convey sense of trust; have infant touch different textures
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| Teaching methods based on clients developmental capacity: Toddler | use play to teach procedure or activity; offer picture books that describe stories of children in hospitals/clinics; use simple words to promote understanding
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| Teaching methods based on clients developmental capacity: Preschooler | use role play, imitation, and play to make learning fun; encourage questions, and offer explanations (simple) and demonstrations; encourage children to learn together through pictures and short stories about hygiene
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| Teaching methods based on clients developmental capacity: School-Age Child | teach psychomotor skills needed to maintain health; offer opportunities to discuss health problems and answer questions
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| Teaching methods based on clients developmental capacity: Adolescent | help learn about feelings and need for self-expression; use teaching as collaborative activity; allow to make own decisions about health & health promotion; use problem solving to help make choices
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| Teaching methods based on clients developmental capacity: Young/Middle Adult | encourage participation in teaching plan by setting mutual goals; encourage independent learning; offer information so that adult understands effects of health problem
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| Teaching methods based on clients developmental capacity: Older Adult | teach when client alert and rested; involve adult in discussion or activity; focus on wellness and the person's strenght; use approaches that enhance sensorially impaired client's reception of stimuli; keep teaching sessions short
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| What is stress? | an experience a person is exposed to, through a stimulus or stressor
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| What is a stressor? | disruptive forces operating within or on any system
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| Define appraisal. | how people interpret the impact of the stressor on themselves, of what is happening, and what they are able to do about it
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| How is stress helpful? | by stimulating thinking processes and helping people stay alert to their environment; results in personal growth and facilitates development
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| What is a crisis? | when stress overwhelms a person's existing coping mechanisms and disequilibrium occurs
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| What is a trauma? | if symptoms of stress persist beyond the duration of the stressor
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| fight-or-flight response | Walter Cannon; arousal of the sympathetic nervous system
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