American Nurses Association ANA – Professional organization for RNs in the US. Founded in 1800’s. Primary mission is to be involved in public education, clinical nursing standards, and lobbying of state and federal lawmakers to advance the profession of nursing. Addresses ethics, public policy and the economic and general welfare of nurses. Advanced Practice Registered Nurse an ___ is the most independently functioning nurse; has a masters degree in nursing, advanced education in pathophysiology, pharmacology, & physical assessment as well as certification & expertise in a specialized practice. Caregiver Help patient maintain and regain health, manage disease and symptoms, and attain a maximal level function and independence through the healing process Nursing promotion, protection, and optimization of health and abilities; prevention of illness and injury; alleviation of suffering through the diagnosis and treatment of human response; an advocacy in the care of individuals, families, communities and populations Code of ethics the philosophical ideals of right and wrong that define the principles you will use to provide care to your patients Registered Nurse completion of associate or baccalaureate degree program
graduates are eligible to take the national council licensure exam for rn’s Continuing education involves formal, organized educational programs offered by universities, hospitals, state nurses associations, professional nursing organizations, and educational and health care institutions In-service education programs are instruction or training provided by a health care agency or institution
designed to increase the knowledge, skills and competencies of nurses and other health care professionals employed by the institution Licensure NCLEX-RN administered by the individual State Boards of Nursing patient advocate you protect your patient’s human and legal rights and provide assistance in asserting these rights if the need arises
you act on behalf of your patient and secure your patient’s health care rights and stand up for them clinical nurse specialist an APRN who is an expert clinician in a specialized area of practice
specialty may be identified by a population, a setting, a disease specialty, a type of care, or a type of problem certified nurse-midwife an APRN who is also educated in midwifery and is certified by the American College of Nurse-Midwives
involves providing independent care for women during normal pregnancy, labor and delivery and care for the newborn nurse educator works primarily in schools of nursing, staff development departments of health care agencies, and patient education departments nurse administrator manages patient care and the delivery of specific nursing services within a health care agency nurse researcher investigates problems to improve nursing care and further define and expand the scope of nursing practice professional organization deals with issues of concern to those practicing in the profession National league for nursing advances excellence in nursing education to prepare nurses to meet the needs of a diverse population in a changing health care environment International council of nurses Objectives are parallel to those of ANA
promoting national associations of nurses, improving standards of nursing practice, seeking a higher status for nurses, and providing an international power base for nurses Quality and safety education for nurses initiative to respond to reports about safety and quality patient care by the IOM
QSEN addresses the challenge to prepare nurses with the competencies needed to continuously improve the quality of care in their work environments
initiative encompasses: patient-centered care, team-work and collaboration, evidence-based practice, quality improvement, safety and informatics genomics describes the study of all the genes in a person and interactions of these genes with one another and with that persons environment patient-centered care recognize the patient or designee as the source of control and full partner in providing compassionate and coordinated care based on respect for patient’s preferences, values, and needs teamwork and collaboration function effectively within nursing and inter-professional teams, fostering open communication, mutual respect, and shared decision making to achieve quality patient care Evidence-based practice integrate best current evidence with clinical expertise and patient/family preferences and values for delivery of optimal health care quality improvement use data to monitor the outcomes of care processes and use improvement methods to design and test changes to continuously improve the quality and safety of health care systems safety minimize risk of harm to patients and providers through both system effectiveness and individual performance informatics use information and technology to communicate, manage knowledge, mitigate error and support decision-making acute care Level of care that is a sudden short term need for services; trauma; intensive care, medical/surgical services, specialty services such as obstetrics, neurology, cardiology; diagnosis related groups; hospital is paid fixed fee based on DRGs, incentive; short stay. adult day care centers provide a variety of health and social services to specific patient populations who live alone or with family in the community. Services offered during the day allow family members to maintain their lifestyles and employment and still provide home care for their relatives. assisted living a living arrangement for elderly people that combines privacy and independence with medical supervision capitation Payment system under which the provider is paid prospectively (ie. on a monthly basis) a set fee for each member of a specific population (ie. health plan members) regardless if no covered health care is delivered or if extensive care is delivere diagnosis related groups DRGs – A system of analyzing conditions and treatments for similar groups of patients used to establish Medicare fees for hospital inpatient services discharge planning Centralized, coordinated, multidisciplinary process that ensures that the patient has a plan for continuing care after leaving the hospital extended care facility Institution devoted to providing medical, nursing, or custodial care for an individual over a prolonged period such as during the course of a chronic disease or the rehabilitation phase after an acute illness globalization Actions or processes that involve the entire world and result in making something worldwide in scope home care an alternative to the hospital, people stay in their homes and receive comfort and treatment from their families and visiting medical staff hospice A facility for the terminally ill that provides supportive care such as pain relief and symptom management to the patient and his/her family. Hospice care is covered under Part A of Medicare
patient stays in comfort of their home independent practice association the managed care organization contracts with physicians who usually are not members of groups and whose practices include fee for service and capitated patients integrated delivery networks include a set of providers and services organized to deliver a continuum of care to a population of patients at a capitated cost in a particular setting
an integrated system reduces duplication of services across levels or settings of care to ensure that patients receive care in the most appropriate settings managed care health care systems in which the provider or health care systems receives a predetermined capitated payment for each patient enrolled in the program medicaid A health care payment program sponsored by federal & state governments medicare A federal program of health insurance for persons 65 years of age and older minimum data sets residents background
cognitive, communication, vision patterns
physical functioning and structural problems
mood, behavior and activity patterns
psychosocial well being
bowel and bladder continence
health conditions
disease diagnosis
oral/nutritional and dental status
skin condition
medication use
special treatments and procedures nursing informatics uses information and technology to communicate, manage knowledge, mitigate error and support decision making nursing sensitive outcomes patient outcomes and select nursing workforce characteristics that are directly related to nursing care such as changes in patients’ symptom experiences, functional status, safety, psychological distress, registered nurse job satisfaction, total nursing hours per patient day and costs patient centered care providing care that is respectful of and responsive to individual patient preferences, needs, and values” and “ensuring that patient values guide all clinical decisions pay for performance programs and public reporting of hospital quality data are designed to promote quality, effective and safe patient care by physicians and health care organizations primary health care focuses on improved health outcomes for an entire population. it includes primary care and health education, proper nutrition, maternal/child health care, family planning, immunizations, and control of disease professional standards review organizations review the quality, quantity and cost of hospital care prospective payment system eliminated cost-based reimbursement
PPS grouped inpatient hospital services for medicare patients into DRGS. each group has a fixed reimbursement amount with adjustments based on case severity, rural/urban/regional costs, teaching costs rehabilitation restores a person to the fullest physical, mental, social, vocational, and economic potential possible resource utilization groups A system for reimbursement used in the long term care setting
manage costs so that the organizations remain profitable respite care a service that provides short term relief or time off for people providing home care to an ill, disabled, or frail older adult restorative care to help individuals regain maximal functional status and enhance quality of life through promotion of independence and self care skilled nursing facility offers skilled care from a licensed nursing staff this often includes administration of IV fluids, wound care, long-term ventilator management and physical rehab utilization review committees medicare-qualified hospitals had physician-supervised UR committees to review the admissions and to identify and eliminate overuse of diagnostic and treatment services ordered by physicians caring for patients on Medicare vulnerable populations children, women and older adults are vulnerable populations most threatened by urbanization work redesign more services are available on nursing units, this minimizing the need to transfer and transport patients across multiple diagnostic and treatment areas domain the perspective of the profession
it provides the subject, central concepts, values, and beliefs, phenomena of interest, and central problems of a discipline paradigm a pattern of thought that is useful in describing the domain of discipline nursing paradigm direct the activity of the nursing profession, including knowledge development, philosophy, theory, educational experience, research and practice person is the recipient of nursing care, including individual patients, groups, families and communities health has different meanings for each patient, the clinical setting and the health care profession
it is dynamic and continuously changing
your job as the nurse is to provide the best possible care based on the patients level of health and health care needs at the time of care delivery environmental/situation includes all possible conditions affecting patients and the settings in which their health care needs occur
theres a continuous interaction between a patient and the environment nursing theory is a conceptualization of some aspect of nursing that describes, explains, predicts or prescribes nursing care theory contains a set of concepts, definitions and assumptions or propositions that explain a phenomenon phenomenon is the term, description, or label given to describe an idea or responses about an event a situation, a process a group of events or a group of situations concepts can be simple or complex and relate to an object or event that comes from individual perceptual experiences assumptions are the taken for granted statements that explain the nature of the concepts, definitions, purpose, relationships and structure of a theory grand theories systematic and broad in scope, complex and therefore require further specification through research middle-range theories are more limited in scope and less abstract descriptive theories are the first level of theory of development
they describe phenomena, speculate on why they occur and describe their consequences
these theories explain, relate, and in some situations predict nursing phenomena prescriptive theories address nursing interventions for a phenomenon, describe the conditions under which the prescription occurs, and predict the consequences
are action oriented and test the validity and predictability of a nursing intervention
guide nursing research to develop and test specific nursing interventions interdisciplinary theory explains a systematic view of a phenomenon specific to the discipline of inquiry system composed of separate components
components are interrelated and share a common purpose to form a whole, two types of systems; open and closed
open: information is exchanged between system and environment
closed: such as a chemical test in a tube, system does not react with environment input for the nursing process is the data or information that come from a patients assessment output is the end product of a system; and in the case of the nursing process it is whether the patients health status improves, declines, or remains stable as a result of nursing care feedback serves to inform a system about how it functions content is the product and information obtained from the system PICOT question Patient population of interest
Intervention of interest
Comparison of interest
Outcome
Time peer-reviewed article reviewed by a panel of experts familiar with the topic or subject matter of the article before it was published clinical guidelines systematically developed statements about a plan of care for specific set of clinical circumstances involving a specific patient population hypothesis predictions made about the relationship or difference between study variables variables concepts, characteristics, or traits that vary within or among subject nursing research is a way to identify new knowledge, improve professional education and practice, and use resources effectively scientific method is the foundation of research and the most reliable and objective of all methods of gaining knowledge
provides support that the findings from a study are valid, reliable and generalizable bias the scientific method minimizes the chance that bias or opinion by a researcher will influence the results of research and thus the knowledge gained empirical data researchers gather the empirical data through the use of observations and assessments and use the data to discover new knowledge quantitative nursing research the study of nursing phenomena that offers precise measurement and quantification experimental study controlled conditions to eliminate bias and ensure that finding can be generalizable to similar groups of subjects evaluation research is a form of quantitative research that determines how well a program practice procedure or policy is working qualitative nursing research the study of phenomena that are difficult to quantify or categorize such as patients’ perceptions of illness
describes information obtained in a nonnumerical form inductive reasoning to develop generalizations or theories from specific observations or interviews research process is an orderly series of steps that allow a researcher to move from asking the research question to finding the answer informed consent means that research subjects..
are given full and complete info about the purpose of a study, procedures, data collection, potential harm and benefits and alternative methods of treatment
are capable of fully understanding the research and the implications of participation
have the power of free choice to voluntarily consent or decline participation in the research
understand how the researcher maintains confidentiality or anonymity confidentiality guarantees that any info a subject provides will not be reported in any manner that identifies the subject and will not be accessible to people outside the research team performance improvement an organization analyzes and evaluates current performance and uses the results to develop focus improvement actions health behaviors positive
activities related to maintaining, attaining or regaining good health and preventing illness
(immunizations, sleep, healthy diet, exercise)
negative
include practices actually or potentially harmful to health such as smoking, drug abuse, refusal to take medshealth belief model Rosenstoch’s and Becker and Maiman’s: adresses the relationship between a persons beliefs and behaviors
helps you understand factors influencing patients perceptions, beliefs and behavior to plan care that will most effectively assist patients in maintaining or restoring health and preventing illness holistic health model attempts to create conditions that promote optimal health
nurses recognize natural healing abilities of the body and incorporate complementary and alternative interventions (music therapy, therapeutic touch, relaxation therapy) health promotion activities such as routine exercise and good nutrition help patients maintain or enhance their present levels of health wellness education teaches people how to care for themselves in a healthy way and include topics such as physical awareness, stress management, and self-responsibility illness prevention activities such as immunization programs protect patients from actual or potential threats to health passive strategies of health promotion individuals gain from the activities of others without acting themselves active strategies of health promotion individuals are motivated to adopt specific health programs primary prevention is true prevention; it precedes disease or dysfunction and is applied to patients considered physically and emotionally healthy secondary prevention focuses on individuals who are experiencing health problems or illnesses and are at risk for developing complications or worsening conditions tertiary prevention occurs when a defect or disability is permanent and irreversible
it involves minimizing the effects of long-term disease or disability by interventions directed at preventing complications and deterioration risk factor any situation, habit, social or environmental condition, physiological or psychological condition, developmental or intellectual condition, spiritual condition or other variable that increases the vulnerability of an individual or group to an illness or accident health behavior changes stages range from no intention to change (precontemplation)
considering a change within the next 6 months
(contemplation)
making small changes
(preparation)
actively engaging in strategies to change behavior
(action)
maintaining a changed behavior
(maintenance stage)
relapse can occur- relapse is a learning process and the lessons learned from relapse can be applied to next attempt to change illness is a state in which a persons physical, emotional, intellectual, social, developmental or spiritual functioning is diminished or impaired acute illness usually reversible, has a short duration, and is often severe
symptoms appear abruptly, are intense, and often subside after a relatively short period chronic illness persists, usually longer than 6 months, is irreversible and affects functioning in one or more systems illness behavior how people monitor their bodies, define and interpret their symptoms take remedial actions and use the resources in the health care system
personal history, social situations, social norms and past experiences affect illness behavior caring universal phenomenon influencing the ways in which people think, feel and behave in relation to one another transcultural Multicultural nursing care that recognizes cultural diversity and is sensitive to the needs of the patient and family transformative relationship influences both the nurse and the patient for better or worse ethic of care is concerned with relationships between people and with a nurses character and attitude toward others presence is a person-to-person encounter conveying a closeness and sense of caring comforting reaches out to patients to communicate concern and support ethics study of conduct and character
determining what is good or valuable for individuals autonomy refers to freedom from external control beneficence refers to taking positive actions to help others nonmaleficence the avoidance of harm or hurt justice refers to fairness fidelity refers to the agreement to keep promises advocacy refers to the support of a particular cause responsibility refers to a willingness to respect ones professional obligation and follow through on promises
as a nurse, you are responsible for your actions and for the actions of those whom you delegate tasks value is a personal belief about that worth of a given idea, attitude, custom or object that sets standards that influence behavior deontology defines actions as right or wrong based on their right making characteristics such as fidelity to promises, truthfulness, and justice consequentialism main emphasis is on the outcome or consequence of action teleology study of ends or final causes (like consequentialism or utilitarianism) ethics of care may even address issues beyond individual relationships such as ethical concerns about the structures within which individual caring occurs such as health care facilities statutory law Law passed by the U.S. Congress or state legislatures nurse practice acts describe and deine the legal boundaries of nursing practice within each state regulatory law or administrative law reflects decisions made by administrative bodes such as state boards of nursing when they pass rules and regulations common law results from judicial decisions made in courts when individual legal cases are decided civil laws protect the rights of individuals within our society and provide for fair and equitable treatment when civil wrongs or violations occur criminal laws protect society as a whole and provide punishment for crimes which are defined by municipal state and federal legislation felony a crime of a serious nature that has a penalty of imprisonment for longer than 1 year or even death misdemeanor less serious crime that has a penalty of a fine or imprisonment for less than one year standards of care the legal requirements for nursing practice that describe minimum acceptable nursing care living wills represent written documents that direct treatment in accordance with a patients wishes in the event of a terminal illness or condition durable power of attorney for health care (DPAHC) a legal document that designates a person or persons of ones choosing to make health care decisions when the patient is no longer able to make decision on his or her own behalf privacy the right of patients to keep personal info from being disclosed tort a civil wrong made against a person or property intentional torts willful acts that violate another’s rights such as assault, battery and false imprisonment assault any action that places a person in apprehension of a harmful or offensive contact without consent battery any intentional touching without consent defamation of character is the publication of false statements that result in damage to a person reputation slander occur when one speaks falsely about another libel is the written defamation of character malpractice one type of negligence and often referred to as professional negligence
when nursing care falls below a standard of care negligence conduct that falls below a standard of care risk management an organizations system fo ensuring appropriate nursing care by identifying potential hazards and eliminating them before harm occurs occurrence reports risk management tool
sometimes called incident reports
