NR 501 Concept Analysis Essay

Chamberlain College of Nursing

NR 501: Theoretical Basis Advanced Nursing

Introduction

Nursing is a wonderful career. As a nurse, we do more than just pass medication, insert catheters, and fix burns and cuts. Nursing is becoming more involved in patient care. Nursing has gone from solving patient’s problems to enhancing patient’s involvement in their own care. There is becoming an increasing enhancement on centering care and empowerment for our patients. We are trying to offer our patients more information and involvement in their treatment and knowledge of their care. (Sitzman & Eichelberger, 2011) Care is more involved nowadays with the patient being the center focus. Allowing the patient to become more involved in their care is allowing our patient to have more control for their preferences, values, needs, and cultures.

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Purpose

Walker and Avant method will be used to discuss an analysis concept, using referenced articles to discuss more in depth patient centered care. Care centered around patients allows for more awareness and activity in their health care interventions and treatments (Scott, 2010). We live in a very diverse population and when providing care to our patients it is important that we take the differences in our patients very seriously.  The diversity among patient populations in healthcare are becoming more of a problem in healthcare and these differences can alter the outcomes and goals for our patients.

Uses

Care centered around the patient is enhanced by communication between the healthcare provider and patient. Communication is used as a tool to allow patients to speak on their wants and needs involving their healthcare and treatment. With communication patient can better understand and participate in their care. It is important that communication facilitates an understanding with patient’s healthcare treatment options as well. Other terms to be used for patient include client or resident. The different terms differ according to where the person works (ex. Hospital, nursing home, etc.). However, the term is used does not change the way the care is delivered. Care advocating is individualized to each person without mention of the setting (Morgan & Yoder, 2011).

Literature Review

Morgan and Yoder wrote an article using Walker and Avant’s model theory to explore care centered on the patient. There were four main analyses that assist in patient centered care, those being the care should be individualized to the patient, respectful, empowering, and holistic in order to enhance the health outcomes of our patients. Care centered on the patient is one of the key components of excellent quality care. Quality care is invested more so now in training then before within the healthcare industry. Morgan and Yoder explained how centered care around the patient can affect health outcomes (Morgan & Yoder, 2011).

Lusk and Fater researched the enhancement in quality of care for healthcare. They discussed how patient centered care is important of six improvements in healthcare. (Lusk & Fater, 2013) Through this research it is unknown how much effectiveness nursing has on patient centered care in the quantitative form. Patient centered care is effective based on the research but more data is needs to determine how effective nursing is with this. Lusk and Fater (2013) found that ‘more research of implemented concepts may contribute to determining the effectiveness of patient-centered care practices by linking the defined behaviors and attributes to improved outcomes’.

Hagan and Donovan wrote an article using Avant and Walker theory to determine the self-advocacy concept. Hagan and Donovan (2013) stated that ‘developmental process to achieve personally relevant goals’ is an important concept. This research was not able to consider certain concepts such as loss of control, health literacy, and coping (Hagan & Donovan, 2013). There needs to be further research on the comparison on the concepts of conceptual and clinical differences (Hagan & Donovan, 2013). I was unable to find more literature reviews within the five-year time frame.

Defining Attributes

Morgan and Yoder (2011) describe defining attributes of patient centered care as empowering, holistic, respectful, and individualized. Empowerment enhances the patient to be self-confident and self-doing, which is important in patient care (Morgan & Yoder, 2011). Holistic requires treating the whole person in biologically, socially, spiritually and psychologically ways (Morgan & Yoder, 2011). Respect is always the center of any relationship, even in healthcare. Respect recognizes that the patient makes their own decisions regarding the goals in their healthcare (Morgan & Yoder, 2011). Individualization occurs when the specific concerns and needs are considered. We must engage the person in their knowledge and experience (Morgan & Yoder, 2011).

Antecedents and Consequences

Antecedents happen before the concept, while consequences happen due to the results of the concept (Morgan & Yoder, 2011). The patient who has stage IV cancer of the ovaries concluded two antecedents founded by Lusker and Fater, 2013; intervention needs and ability of the patient to handle her own care. With the two antecedents if one was not foretold then patient centered care could not be maintained. There is an important correlation between antecedents and attributes (Lusk and Fater, 2013). For a patient to have autonomy they must be able to follow along in their own care. Without participation autonomy is not possible. NR 501 Concept Analysis Essay

Empirical Referents

Hagan and Donavan (2013) discussed how “empirical referents are instances that by their existence demonstrate the occurrence of the concept”.

Lusk and Fater (2013) discussed how “empirical testing lies in the ability to measure the patient’s autonomy, perception of a caring attitude and perception of individualization of care”.            Hagan and Donovan (2013) discuss two tools that enhance measuring patient centered care: Health Care Climate Questionnaire, which involves the patient’s perceptions and Schmidt Perception of Nursing Care Survey, which is a satisfaction tool for patients.

Morgan and Yoder (2011) discuss how they used four tools to measure care centered around the patient: The Person-Centered Climate Questionnaire (PCQ) which only focuses on the antecedents, Patient Satisfaction with Nursing Care Questionnaire (PSNCQQ) focuses on the consequences, Patient-Centered Inpatient Scale (P-CIS) and Functional Independence Measurement (FIM). Through their research, they could achieve results but more research is needed before specific outcomes are known (Morgan & Yoder, 2011). NR 501 Concept Analysis Essay

Model Case

A model case has all the definitions of a concept (Lusk & Fater) Lusk and Fater (2013) used a model case involving patient centered care. A woman finished chemotherapy for ovarian cancer. She had stage IV cancer and the prognosis was poor. Her life expectancy was limited along with treatment options. She was given the options of radiation, surgery and hospice. There was a discussion about the treatment options with the nurse. She had prior experience with these options and the nurse kept in mind her culture, religious background, preferences and knowledge of hospice (Lusk & Fater, 2013) The nurse noticed that through information and discussion the patient needed more education regarding her options. The nurse used active listening for the concerns the patient had and the information was clarified and the patient was allowed ample amount of time to go over what was discussed before making an informed decision. The goals regarding her healthcare regimen were discussed with the patient. Education was given to enhance participation regarding her treatment. After time to consider her treatment options the nurse discussed the patient’s decision. With all questions answered, needs discussed, values respected, and patient knowledgeable on all aspects of care, patient centered care was attained. Defining attributes of patient centered care are supportive of the patient and behaviors.
Alternative Cases

A contrary case demonstrates the opposite of the nursing concept. An example case discusses Anne a cancer patient (Hagan & Donovan, 2013). This patient felt that her symptoms were becoming worse due to the chemotherapy and she just wanted to get things back to normal. Through the feelings, the patient did not want to create a plan to make her life the way it was before the chemotherapy. The patient felt that she was not getting the support from her doctor and thus a “normal life” was not going to be possible. Through miscommunication and a lack of trust between the patient and healthcare provider caused the patient to be blinded in her healthcare. The chemotherapy side effects were treatable but Anne did not feel the urgency by her healthcare provider to treat them. The patient did not gather information and the healthcare provider did not try to help the patient either. Patient centered care could not be completed.

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The borderline case differs in that multiple attributes are different in some way. Once a NP decided to head over the patient census of an infant care outpatient clinic. The clinic served more of those that did not have much money and increase rate of teen pregnancy. There was a reputation for the patients to miss appointments based on different circumstances, which had a negative effect on patient’s long tern health outcomes. The NP implemented the secretary making same day phone calls as a reminder for the patient, and offering assistance with transportation such as bus tickets/vouchers. After implementation, an evaluation was made based on outcomes of the patients. The outcome showed there was an increase in attendance from the mothers, a decreased in negative patient outcomes, and more availability to attend o each patient in a timely manner. (Hagan & Donovan, 2013) NR 501 Concept Analysis Essay

Conclusion

Nursing is about caring for every aspect of the patient. It is about beneficence for the patient and planning care so that the patient can participate in their own care and have the outcome they desire. By allowing patients more participation in their healthcare, confidence is enhanced, allowing the patient to feel more aware of their options and plan. When the patients are uncertain of their goals and treatment it is our duty as the healthcare provider to offer all resources and thoroughly discuss them so that the patient can make an informed decision on their healthcare plan. Respect and support for our patients helps enhance healthcare outcomes. When there is open communication regarding healthcare options and treatments, patients gain more autonomy regarding their healthcare (Ruben and Tinetti, 2012). Ruben and Tinetti (2012) discuss how with the patient’s own selection of health outcomes combined with treatment options discussed with the healthcare provider, optimal healthcare is achieved. NR 501 Concept Analysis Essay

References

Dabney, B. W., & Tzeng, H. (2013). Service Quality and Patient-Centered Care. MEDSURG       Nursing, 22(6), 359-364.

Hagan, T. L., & Donovan, H. S. (2013). Self-Advocacy and Cancer: A Concept Analysis.                         Journal of Advanced Nursing, 69(10), 2345-2359. Retrieved from doi:             10.1111/jan.12084 NR 501 Concept Analysis Essay

Lusk, J. M., & Fater, K. (2013). A Concept Analysis of Patient-Centered Care. Nursing Forum,   48(2), 89-97. doi: 10.1111/nuf.12019

Morgan, S., & Yoder, L. H. (2011). A Concept Analysis of Person-Centered Care. Journal of       Holistic Nursing, 1-10. doi:10.1177/0898010111412189

Ruben, D. B., & Tinetti, M. E. (2012). Goal-Oriented Patient Care — An Alternative Health        Outcomes Paradigm. The New England Journal of Medicine, 366, 777-779. doi:          10.1056/NEJMp1113631

Scott, A. (2010). Quality lessons. Patient-Centered Care Vital to Outcomes, Cost. Modern            Healthcare, 40(46), 22.

Sitzman, K. L., & Eichelberger, L. W. (2011). Understanding the work of nurse theorists: A           creative beginning. (2^nd ed.). Sudbury, MA: Jones and Bartlett. NR 501 Concept Analysis Essay

Prevention of Cardiovascular Disease for Rural Women

Health Promotion and Disease Prevention

Prevention of Cardiovascular Disease for Rural Women

Introduction

Prevention of disease is more than just a reaction to events. It is a lifestyle change for a person that focuses on health. The focus of this paper is on the promotion of cardiovascular health for women in rural areas. Cardiovascular disease is the leading cause of death for women and has been for many years. Heart disease and stroke have been found to be the cause of one out of three deaths for women. It claims more lives than all cancers combined, and the majority of cardiovascular problems can be prevented (American Heart Association, 2017). Despite that knowledge women still suffer from cardiovascular problems and are statistically under diagnosed or under treated when compared with men (Heart Sister, 2016).   With that in mind an informational pamphlet was designed to educate women on the facts about their health, as well as the importance of regular screenings and available resources in the community. Spreading awareness about cardiovascular health can help women take charge of their health. With the support of family, community, and health organizations women can make positive changes in their own lives as well as those around them.

Meeting the needs of rural women

The content within the pamphlet was chosen to reach out to women in rural communities and create awareness of cardiovascular disease.  Heart disease is known as the silent killer, women may look and feel completely fine (American Heart Associations, 2017). Women are known to have atypical symptoms of heart disease that are commonly associated with other things.  Women may not experience any chest pain or pressure. Instead women may have symptoms including back pain, rapid heart rate, nausea, and fatigue (American Heart Association, 2017). Many of those symptoms can be attributed to stress, over extension, and flu. For this reason it is all too common that women miss the tell tale signs of heart disease Prevention of Cardiovascular Disease for Rural Women Nursing Capstone Project. Women are not the only ones who miss those signs. According to the American Heart Association women are under-diagnosed and under-treated for heart conditions when compared to men presenting with the same symptoms (American Heart Association, 2017). In addition to different symptoms women may have additional risk factors for heart disease such as birth control and hormone replacement.

For women to begin the process of improving cardiovascular health a person first needs to be aware of the reason why the change is needed. According to Hageman, Pullen, Walker, & Boeckner, a review of literature and studies suggest that a vast number of women are unaware of the symptoms and risks of cardiovascular disease. However women who are educated about their own personal risk of cardiovascular disease were found to take preventative action (Hageman, Pullen, Walker, & Boeckner, 2010).

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Barriers that women face related to heart disease and health promotion

Rural women are particularly vulnerable to heart disease due to a much lower occurrence of preventative health screenings when compared to women who reside in urban areas (Hageman, Pullen, Walker, & Boeckner, 2010). The limited access to care that rural communities suffer from significantly impairs their ability seek out medical help and results in poor health outcomes (Bale, 2010). “Health needs of women living in rural communities are typically not considered separately from those of men” (Paluck, Allerdings, Kealy, & Dorgan, 2006, p. 112). Poor access to health care services is not that only barrier that rural women face. The rural population in general has a higher likelihood of developing cardiovascular problems due to differences in income, education, acculturation, inactivity, and dietary factors (Bale, 2010).

In addition to a lack of some health promotion services women in rural areas may experience an increased problem staying physically active. This can be due to lack of time and lack of local fitness classes and gyms.  Finding the time to eat healthy is another problem along with access to variety in food selection at local grocery stores (Paluck, Allerdings, Kealy, & Dorgan, 2006). Women in particular have a different set of priorities when it comes to daily life and health.

The willingness to participate in improving health is another common barrier. Many women are juggling parenthood, work, continuing education, and household duties.  Women are busy, and it becomes easier to put their own health on a backburner. The majority of cases of heart disease are completely preventable, yet it still manages to afflict the lives of 6.6 million women each year (Heart Sisters, 2016).

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Overcoming Barriers

The heart disease pamphlet was designed to spread awareness and deal with some of the barriers that women living in rural communities face. The first barrier that is addressed is creating awareness. Women openly discuss and display pink ribbons for breast cancer awareness. This pamphlet encourages women to talk about heart disease and provides information needed to illicit change. “While all changes do not lead to improvement, all improvement requires change” (Institute for Healthcare Improvement, 2017, para. 1). The American Heart Association program go red for women is a recognizable symbol that women can display to help further promote awareness and prevention. In addition to simply providing an information sheet this pamphlet also attempts address the access to care problem by including supportive websites and questions to ask providers to ensure quality care.

The pamphlet was not designed to increase routine health services in rural areas, but to encourage residents to pursue available resources. Additional programs specifically designed to provide additional health care access in rural areas may be needed in the future. The Southern seven women’s initiative for cardiovascular health is a collaborative program designed to improve heart health for women living in southern Illinois. The study was specifically designed to deal with barriers that rural women experience. The study used a combination of several methods to increase awareness and provide support.  (Zimmermann, Khare, Huber, Moehring, Koch, & Geller, 2012). Prevention of Cardiovascular Disease for Rural Women Nursing Capstone Project.

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Effectiveness of Health Promotion at Local, National and Global Levels

Health care has been treating disease since the beginning by providing medical care and services to those who suffer from illness. The entire concept of health promotion is a change in that system. Health care providers no longer want to wait until a patient is sick. Preventative care is a collaboration of providers and community resources to support and guide people toward a healthier lifestyle. Targeting vulnerable populations and disease is a method to focus efforts and achieve the maximum patient outcome (Institute for Healthcare Improvement, 2017).  Barriers to receiving care can be universal to local and global initiatives to improve health. For organization the largest barrier to health promotion is cost, however recent studies have brought to light the long term financial benefits to preventative care and dealing with preventable chronic conditions (Mayes, & Armistead, 2013).  Many local strategies for health promotion are based on national programs, such as the Go Red for Women Campaign. However many of those national initiatives began as local community studies that yielded positive results and information such as the Southern Seven Women’s Initiative for Cardiovascular Health. In addition to learning from the development of health promotion programs, the bad habits and unhealthy lifestyles of people in the United States is spreading (Mayes, & Armistead, 2013). That suggests the need for further funding and promotion of health and disease prevention on local, national, and global levels.

Conclusion

Health promotion and disease prevention involves a great deal of assessment for barriers of a given population. To maintain future sustainability healthcare organizations must instigate change and develop new strategies to improve preventative care.  This paper has shown the need for promotion of cardiovascular health for women. The barriers to health can be similar no matter which population is targeted such as access to care, willingness to participate in change, and awareness of the problem. Local, national, and global programs all deal with the same sort of barriers and use similar methods to continue to develop improvements. Continued focus on health promotion is vital to the health of the nation Prevention of Cardiovascular Disease for Rural Women Nursing Capstone Project.

References

American Heart Association. (2017). Go red for women. Retrieved from https://www.goredforwomen.org/

Bale, B., (2010). Optimizing hypertension management in underserved rural populations. Journal of the National Medical Association,102(1), 7-10. Retrieved from http://search.proquest.com.library.capella.edu

Hageman, P., Pullen, C., Walker, S., & Boeckner, L. (2010). Blood pressure, fitness, and lipid profiles of rural women in the wellness for women project. Cardiopulmonary Physical Therapy Journal, 21(3), 27-32, 34. Retrieved from http://search.proquest.com.library.capella.edu

Heart Sisters. (2016). Women and heart disease. Retrieved from https://myheartsisters.org/

Institute for Healthcare Improvement. (2017). Using change concepts for improvement. Retrieved from http://www.ihi.org

Mayes, R. & Armistead, B. (2013). Chronic disease, prevention policy, and the future of public health and primary care. Medicine, Healthcare, and Philosophy. 16, 691–697. DOI 10.1007/s11019-012-9454-0

Paluck, E. C., Allerdings, M., Kealy, K., & Dorgan, H. (2006). Health promotion needs of women living in rural areas: An exploratory study. Canadian Journal of Rural Medicine, 11(2), 111-6. Retrieved from http://search.proquest.com.library.capella.edu

Zimmermann, K., Khare, M. M., Huber, R., Moehring, P. A., Koch, A., & Geller, S. E. (2012). Southern seven women’s initiative for cardiovascular health: Lessons learned in community health outreach with rural women. American Journal of Health Education, 43(6), 349-355. Retrieved from http://search.proquest.com.library.capella.edu Prevention of Cardiovascular Disease for Rural Women Nursing Capstone Project.

Study Guide for Final Exam

• Health promotion and maintenance –
• stages,
  • Primary prevention includes health promotion, wellness education programs, immunizations, hearing protection in occupational settings, training to develop good body mechanics, and health screening for prostate, breast, and colon cancer. Final Nursing Exam Study Guide
  • Secondary prevention is provided in the home, health care facility, or skilled nursing facility.
  • Tertiary prevention aims to help patients achieve as high a level of functioning as possible.
  • The HPM describes the multidimensional nature of people as they interact within their environment to pursue health (Pender, 1996; Pender et al., 2015). The model focuses on the following three areas: (1) individual characteristics and experiences; (2) behavior-specific knowledge and affect; and (3) behavioral outcomes, in which the patient commits to or changes a behavior.
  • Nursing incorporates health promotion activities, wellness education, and illness prevention activities rather than simply treating illness.
  • Health promotion activities help maintain or enhance health.
  • Wellness education teaches patients how to care for themselves.
  • Illness prevention activities protect against health threats and thus maintain an optimal level of health.

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• health disparities,
  • health disparity as “a particular type of health difference that is closely linked with social, economic, and/or environmental disadvantage”
  • People in marginalized groups are more likely to have poor health outcomes and die at an earlier age
  • Social determinants of health to explain the complexity of these interactions (McGovern et al., 2014). According to the World Health Organization (2013), social determinants of health are “the conditions in which people are born, grow, live, work and age…shaped by the distribution of money, power and resources at global, national, and local levels.” Income and wealth, family and household structure, social support, education, occupation, discrimination,
• Health disparities are unequal burdens of disease morbidity and mortality rates experienced by racial and ethnic groups. These disparities are often exacerbated by: Final Nursing Exam Study Guide
• vulnerable populations
  • Immigrants
  • Poor and homeless
  • Abused
  • Substance abusers
  • Mentally ill
  • Older adults

• Healthy People 2020 & WHO (purpose, definitions)
  • Goals are to increase life expectancy and quality of life, and to eliminate health disparities through improved delivery of health care services
  • Occurs in community settings
  • Involves acute & chronic care
  • Enhances individuals’ capacity for self-care
  • Promotes autonomy in decision making
  • Uses critical thinking skills
  • Reduces costs for the patient by providing care near homes
  • Requires knowledge of family theory, communication, group dynamics, and cultural diversity
  • Multilevel intervention –
    • Tier III – intensive intervention
    • Tier II – targeted small group instruction
    • Tier I – core intrustional program
• Maslow’s hierarchy of needs and prioritization
• Management of care – key components of nursing, cultural influences
  • Team nursing developed in response to the severe nursing shortage following World War II.
  • Total patient care delivery was the original care delivery model developed during Florence Nightingale’s time. This model disappeared in the 1930s and became popular again during the 1970s and 1980s, when the number of RNs increased.
  • The primary nursing model of care delivery was developed to place RNs at the bedside and improve the accountability of nursing for patient outcomes and professional relationships among staff members. The model became more popular in the 1970s and early 1980s as hospitals began to employ more RNs. Primary nursing supports a philosophy regarding nurse and patient relationships.
  • Case management is a care management approach that coordinates and links health care services to patients and their families while streamlining costs and maintaining quality. Final Nursing Exam Study Guide
• Theorists (Erikson) – normal development and assessment findings (health risks for each stage)
  • Stage 1: Trust versus mistrust
  • (birth to 1 year)
    • An infant’s successful resolution of this stage requires a consistent caregiver who is available to meet his needs. From this basic trust in parents, an infant is able to trust in himself, in others, and in the world (Hockenberry and Wilson, 2015). The formation of trust results in faith and optimism.
  • Stage 2: Autonomy versus shame and doubt
  • (1 to 3 years)
    • A toddler develops his or her autonomy by making choices. Choices typical for the toddler age-group include activities related to relationships, desires, and playthings.
    • A toddler who successfully masters this stage achieves self-control and willpower.
  • Stage 3: Initiative versus guilt
  • (3 to 6 years)
    • Fantasy and imagination allow them to further explore their environment. Also at this time they are developing their superego, or conscience. Conflicts often occur between a child’s desire to explore and the limits placed on his or her behavior. These conflicts sometimes lead to feelings of frustration and guilt.
    • Successful resolution of this stage results in direction and purpose. Teaching a child impulse control and cooperative behaviors helps a family avoid the risks of altered growth and development.
  • Stage 4: Industry versus inferiority
  • (6 to 11 years)
  • They learn to work and play with their peers. They thrive on their accomplishments and praise. Without proper support for learning new skills or if skills are too difficult, they develop a sense of inadequacy and inferiority. Children at this age need to be able to experience real achievement to develop a sense of competency. Erikson believed that an adult’s attitudes toward work are traced to successful achievement of this task
  • Stage 5: Identify versus role confusion
  • (puberty)
    • This stage, in which identity development begins with the goal of achieving some perspective or direction, answers the question, “Who am I?” Acquiring a sense of identity is essential for making adult decisions such as choice of a vocation or marriage partner. Each adolescent moves in his or her unique way into society as an interdependent member. There are also new social demands, opportunities, and conflicts that relate to the emergent identity and separation from family. Erikson held that successful mastery of this stage resulted in devotion and fidelity to others and to their own ideals (Hockenberry and Wilson, 2015). Elkind (1967) identified a notion of perceived invulnerability in adolescents that contributes to risk-taking behaviors.
  • Stage 6: Intimacy versus isolation
  • (young adult)
    • Erikson portrayed intimacy as finding the self and then losing it in another (Santrock, 2012a). If the young adult is not able to establish companionship and intimacy, isolation results because he or she fears rejection and disappointment
  • Stage 7: Generative versus self-absorption & stagnation (middle age)
    • Middle-age adults achieve success in this stage by contributing to future generations through parenthood, teaching, mentoring, and community involvement. Achieving generativity results in caring for others as a basic strength. Inability to play a role in the development of the next generation results in stagnation
  • Stage 8: Integrity versus despair
  • (old age)         
    • Older adults often engage in a retrospective appraisal of their lives. They interpret their lives as a meaningful whole or experience regret because of goals not achieved (Berger, 2011). Because the aging process creates physical and social losses, some adults also suffer loss of status and function (e.g., through retirement or illness). These external struggles are met with internal struggles such as the search for meaning in life. Meeting these challenges creates the potential for growth and the basic strength of wisdom (Figure 11-1).
• Normal physical assessment changes throughout lifespan (review of concepts from HA class)
• Develop a plan of care – nursing process Final Nursing Exam Study Guide
  • ADPIE
  • Collect data.
  • Cluster cues, make inferences, and identify patterns and problem areas.
  • Critically anticipate.
  • Be sure to have supporting cues before making an inference.
  • Knowing how to probe and frame questions is a skill that grows with experience.
• Selection and labeling of nursing diagnoses
  • A nursing diagnosis is a clinical judgment about individual, family, or community responses to actual and potential health problems or life processes that the nurse is licensed and competent to treat. What makes the nursing diagnostic process unique from medical diagnoses is having patients involved, when possible, in the process.
  • Selection of a nursing diagnosis provides the basis for choosing nursing interventions. Accurate diagnosis of patient problems ensures the selection of more effective and efficient nursing interventions.
  • Nursing diagnoses are listed according to the North American Nursing Diagnosis Association (NANDA). Selecting the correct nursing diagnosis on the basis of an assessment involves diagnostic expertise.
  • Assessment of patient’s health status:
  • Patient, family, and health care resources constitute database.
  • Nurse clarifies inconsistent or unclear information.
  • Critical thinking guides and directs line of questioning and examination to reveal detailed and relevant database.
  • n actual nursing diagnosis describes human responses to health conditions or life processes that exist in an individual, family, or community. Final Nursing Exam Study Guide
  • A risk nursing diagnosis describes human responses to health conditions or life processes that may develop in a vulnerable individual, family, or community.
  • A health promotion nursing diagnosis is a clinical judgment of a person’s, family’s, or community’s motivation, desire, and readiness to enhance well-being and actualize human health potential as expressed in their readiness to focus on specific health behaviors such as nutrition and exercise.
• Relationship of critical thinking and evaluation
  • Interpretation: Be orderly in data collection. Look for patterns to categorize data (e.g., nursing diagnoses [see Chapter 17]). Clarify any data you are uncertain about.
  • Analysis: Be open-minded as you look at information about a patient. Do not make careless assumptions. Do the data reveal what you believe is true, or are there other options?
  • Inference: Look at the meaning and significance of findings. Are there relationships between findings? Do the data about the patient help you see that a problem exists?
  • Evaluation: Look at all situations objectively. Use criteria (e.g., expected outcomes, pain characteristics, learning objectives) to determine results of nursing actions. Reflect on your own behavior.
  • Explanation: Support your findings and conclusions. Use knowledge and experience to choose strategies to use in the care of patients.
  • Self-regulation: Reflect on your experiences. Identify ways that you can improve your own performance. What will make you believe that you have been successful?
  • Level 1 is Basic: At the basic level, nurses think concretely on the basis of a set of rules or principles, following a step-by-step process without deviation from the plan. Following a procedure step by step without adjusting to a patient’s unique needs is an example of basic critical thinking.
  • Level 2 is Complex: Complex critical thinking analyzes and examines choices independently. Nurses learn to think beyond and synthesize knowledge. In complex critical thinking, a nurse learns that alternative and perhaps conflicting solutions exist.
  • Level 3 is Commitment: Commitment is the third level of critical thinking. Nurses anticipate needs and make choices without assistance from others.
• Abuse and neglect
• Cultural considerations, complementary and alternative therapies (invasive vs. non-invasive options)
  • Complementary therapies are therapies used in addition to or together with conventional treatment recommended by a person’s health care provider. As the name implies, complementary therapies complement conventional treatments. Many of them such as therapeutic touch contain diagnostic and therapeutic methods that require special training. Others such as guided imagery and breathwork are easily learned and applied. Complementary therapies also include relaxation; exercise; massage; reflexology; prayer; biofeedback; hypnotherapy; creative therapies, including art, music, or dance therapy; meditation; chiropractic therapy; and herbs/supplements (Lindquist et al., 2014). Another term that is used to describe interventions used in this fashion, particularly by licensed health care providers, is integrative therapies. Final Nursing Exam Study Guide
  • Alternative therapies sometimes include the same interventions as complementary therapies; but they become the primary treatment (Table 33-1). For example, a person with chronic pain uses yoga to encourage flexibility and relaxation at the same time that nonsteroidal antiinflammatory or opioid medications are prescribed. Both sets of interventions are based on conventional pathophysiology and anatomy while acknowledging the mind-body connection that contributes to the physiological pain response.
  • Several therapies are always considered alternative because they are based on completely different philosophies and life systems than those used by allopathic medicine. These are identified by the NIH/NCCIH as whole medical systems and include practices such as traditional Chinese medicine (TCM), Ayurveda, and naturopathy
• Nursing presence and caring
  • Providing presence is a person-to-person encounter conveying a closeness and sense of caring. Presence involves “being there” and “being with.” “Being there” is not only a physical presence; it also includes communication and understanding. Nursing presence is the connectedness between the nurse and the patient
• Triage
  • Routine screening to promote health and wellness
  • To determine eligibility for:
  • Health insurance
  • Military service
  • A new job
  • To admit a patient to a hospital or long-term care facility

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• The nursing profession
  • Nursing as a profession
  • Historical influences
  • Florence Nightengale:
    • First practicing epidemiologist
    • Organized first school of nursing
    • Improved sanitation in battlefield hospitals
    • Her practices remain a basic part of nursing today
  • The growth of nursing in the United States:
    • Clara Barton founded the American Red Cross.
    • Dorothea Lynde Dix – was the supervisor of female nurses in the Union Army.
    • Mother Bickerdyke – organized ambulance service, supervised nurses, and searched for abandoned, wounded soldiers on the battlefield.
    • Harriet Tubman – Tubman was a prominent female in the Underground Railroad movement to free slaves.
    • Mary Mahoney – was the first professionally educated African-American. She may be one of the first proponents of better relationships between cultures and races and respect for individuals regardless of background, race, color, or religion.
    • Isabel Hampton Robb – helped found the American Nurses Association in 1911. She was an influential author with the following titles:
    • Nursing: Its Principles and Practice for Hospital and Private Use; Nursing Ethics; and Educational Standards for Nurses. She was one of the original founders of the American Journal of Nursing. Final Nursing Exam Study Guide
    • Lillian Wald and Mary Brewster: Henry Street Settlement –
      • In 1893, nursing expanded in the community owing to the influence of Lillian Wald and Mary Brewster. Nurses working in the settlement they established were some of the first to demonstrate autonomy in practice because they frequently encountered situations that required quick and innovative problem solving and critical thinking without the supervision or direction of a health care provider.
    • 1906: Mary Adelaide Nutting, first professor of nursing at Columbia University
    • Another important development in nursing history occurred when the Rockefeller Foundation approached Nutting, along with Lillian Wald and Annie Goodrich, to study nursing education. Their study, conducted in 1920 and published in 1923, concluded that nursing education needed financial support and should be centered in university schools of nursing.
    • Contemporary influences
    • Nursing practice
    • Professional organizations
      • The American Nurses Association (ANA) (2010) develops standards for nursing practice, policy statements, and similar resolutions. These standards outline the scope, function, and role of the nurse in practice.
      • The Joint Commission (TJC) (2014) requires accredited hospitals to have written nursing policies and procedures.
      • NANDA
    • Nursing theories
    • Grand
      • Broad in scope, complex, require specification
    • Middle-range
      • More limited in scope and less abstract
    • Descriptive
      • Describe phenomena, speculate on why phenomena occur, and describe the consequences of phenomena.
    • Prescriptive
      • Address nursing interventions for a phenomenon, and predict the consequence of a specific nursing intervention.
    • Nightengale
      • Nightingale was one of the first to develop a nursing theory (1860) that is still in use today. Her concept of the environment was the focus of nursing care, and her suggestion that nurses need not know all about the disease process differentiated nursing from medicine. The focus of nursing is on caring through the environment and helping the patient deal with the symptoms and changes in function related to an illness.
      • Nightingale did not view nursing as limited to the administration of medications and treatments, but rather, it is oriented toward providing fresh air, light, warmth, cleanliness, quiet, and adequate nutrition. Through observation and data collection, she linked the patient’s health status with environmental factors and initiated improved hygiene and sanitary conditions during the Crimean War. Nightingale’s “descriptive theory” provides nurses with a way to think about patients and their environment.
    • Peplau
      • Peplau’s theory focuses on interpersonal relations between the nurse, the patient, and the patient’s family and developing the nurse-patient relationship. The patient is an individual with a need, and nursing is an interpersonal and therapeutic process. In developing a nurse-patient relationship, the nurse can serve as a resource person, counselor, and surrogate.
      • The patient gains from this relationship by using available services to meet needs, and the nurse helps the patient reduce anxiety related to health care problems.
      • Peplau’s theory is unique: The collaborative nurse-patient relationship creates a “maturing force” through which interpersonal effectiveness meets the patient’s needs.
    • Henderson
      • Henderson defines nursing as “assisting the individual, sick or well, in the performance of those activities that will contribute to health, recovery, or a peaceful death, and that the individual would perform unaided if he or she had the necessary strength, will, or knowledge.” Henderson organized the theory into 14 basic needs of the whole person and includes phenomena from the following domains of the patient: physiological, psychological, sociocultural, spiritual, and developmental. Final Nursing Exam Study Guide
      • Framing nursing care around the needs of the individual allows you to use Henderson’s theory for a variety of patients across the life span and in multiple settings along the health care continuum.
      • Based on 14 activities, the belief that the nurse should assist the patient with meeting needs until they are able to do so independently
    • Orem
      • Orem defines self-care as a learned, goal-oriented activity directed toward the self in the interest of maintaining life, health, development, and well-being. Nursing care is necessary when the patient is unable to fulfill biological, psychological, developmental, or societal needs. The nurse assesses and determines why a patient is unable to meet these needs, identifies goals to assist the patient, intervenes to help the patient perform self-care, and evaluates how much self-care the patient is able to perform.
      • According to Orem’s theory, the goal of nursing is to enhance the patient’s ability to independently meet these needs.
    • Leninger
      • Leininger’s background in anthropology informed her theory. Human caring varies among cultures in its expressions, processes, and patterns. Societal structure factors such as the patient’s religion, politics, culture, and traditions are significant forces affecting care and influencing the patient’s health and illness patterns.
      • The major concept of Leininger’s theory is cultural diversity, and the goal of nursing care is to provide the patient with culturally specific nursing care. To provide care to patients of unique cultures, the nurse safely integrates the patient’s cultural traditions, values, and beliefs into the plan of care. Leininger’s theory recognizes the importance of culture and its influence on everything that involves the patient and providers of nursing care.
      • In addition, symptom expression differs among cultures.
    • Neuman model
      • In the Neuman model, the patient is the individual, group, family, or community. The system is composed of five concepts that interact: physiological, psychological, sociocultural, developmental, and spiritual. These concepts interact with both internal and external environmental factors and all levels of prevention (primary, secondary, and tertiary) to achieve optimal wellness. Neuman considers any internal and external factors as stressors that affect the patient’s stability and any or all of the five system concepts.
      • When you apply the Neuman systems model, you assess the stressor and the patient’s response to the stressor, identify nursing diagnoses, plan patient-centered care, implement interventions, evaluate the patient’s response, and determine whether the stressor is resolved.
      • Based on the theory that focuses on wellness and prevention of disease
    • Roy
      • According to Roy’s model, the goal of nursing is to help the person adapt to changes in physiological needs, self-concept, role function, and interdependent relations during health and illness. The need for nursing care occurs when the patient cannot adapt to internal and external environmental demands. All individuals must adapt to the following demands: meeting basic physiological needs, developing a positive self-concept, performing social roles, and achieving a balance between dependence and independence.
      • The nurse determines which demands are causing problems for a patient and assesses how well the patient is adapting to them. Nurses direct care at helping the patient adapt to changes.
      • A nurse is caring for a patient who recently lost a limb in a motor vehicle accident. The nurse best assists the patient to cope with this situation by applying which of the following? – Roy
    • Watson
      • In Watson’s theory, nursing is concerned with promoting and restoring health and preventing illness. Watson designed the model around the caring process—assisting patients in attaining or maintaining health or dying peacefully. This caring process requires the nurse to be knowledgeable about human behavior and human responses to actual or potential health problems. The nurse also needs to know individual patient needs, how to respond to others, and strengths and limitations of the patient and family and those of the nurse. In addition, the nurse comforts and offers compassion and empathy to patients and their families.
    • King –
      • Based on the belief that nurses should work with patients to develop goals for care
    • Benner and wrubel
      • With Benner and Wrubel’s theory, caring is central to nursing and creates possibilities for coping, enables possibilities for connecting with and concern for others, and allows for giving and receiving help. Caring means that persons, events, projects, and things matter to people. It presents a connection and represents a wide range of involvement. This theory sees personal concern as an inherent feature of nursing practice. In caring for one’s patients, nurses help patients recover by noticing interventions that are successful and that guide future caregiving. Final Nursing Exam Study Guide
    • Legal principles
    • Risk management
    • For nursing
    • Statutory for nursing practice
      • Statutory laws include the Nurse Practice Act found in all states. The Nurse Practice Act describes and defines the legal boundaries of nursing practice in each state. The Nurse Practice Act of each state defines the scope of nursing practice and expanded nursing roles, sets education requirements for nurses, and distinguishes between nursing and medical practice.
      • Criminal laws are meant to prevent harm to society and to provide punishment for crimes. These are categorized as felonies or misdemeanors.
        • A felony is a serious offense that results in significant harm to another person or society
        • A misdemeanor is a crime that, although injurious, does not inflict serious harm
        • Civil laws protect the rights of individuals and provide for fair and equitable treatment when civil wrongs or violations occur
        • Regulatory law, also known as administrative law, defines your duty to report incompetent or unethical nursing conduct to the Board of Nursing.
        • Common law results from judicial decisions concerning individual cases. Most of these revolve around negligence and malpractice.
      • The American Nurses Association (ANA) (2010) develops standards for nursing practice, policy statements, and similar resolutions. These standards outline the scope, function, and role of the nurse in practice.
      • In a malpractice lawsuit, a nurse’s actual conduct is compared to nursing standards of care to determine whether the nurse acted as any reasonably prudent nurse would act under the same or similar circumstances.
      • The Joint Commission (TJC) (2014) requires accredited hospitals to have written nursing policies and procedures.
      • Patient Protection and Affordable Care Act (PPACA)
        • PPACA created a new Patient’s Bill of Rights that prohibited patients from being denied health care coverage because of prior existing conditions, limits on the amount of care for those conditions, and/or an accidental mistake in paperwork when a patient got sick.
      • The Patient Self-Determination Act (PSDA) enacted in 1991 requires health care institutions to provide written information to patients concerning their rights under state law to make decisions, including the right to refuse treatment and formulate advance directives.
      • DNRs and Living Wills – Advanced directives
      • Uniform Anatomical Gift Act
        • An individual who is at least 18 years of age has the right to make an organ donation.
      • HIPPA – privacy law
      • Health Information Technology Act (HITECH)
        • HITECH expands the principles extended under the HIPAA, especially when a security breach of personal health information (PHI) occurs.
      • Any health care professional who does not report suspected child abuse or neglect may be liable for civil or criminal legal action.
      • The Uniform Determination of Death Act of 1980 states that health care providers can use the cardiopulmonary definition or the whole brain definition to determine death
      • An autopsy or postmortem examination may be requested by the patient or patient’s family.
      • The Oregon Death With Dignity Act (1994) was the first statute that permitted physician-assisted suicide
      • A tort is a civil wrong made against a person or property
        • Assault is an intentional threat toward another person that places the person in reasonable fear of harmful, imminent, or unwelcome contact. No actual contact is required for an assault to occur.
        • Battery is any intentional offensive touching without consent or lawful justification.
        • The tort of false imprisonment occurs with unjustified restraint of a person without a legal reason
      • Defamation of character is the publication of false statements that result in damage to a person’s reputation.
      • Slander occurs when one speaks falsely about another.
      • Libel is the written defamation of character.
      • Negligence is conduct that falls below the generally accepted standard of care of a reasonably prudent person. Final Nursing Exam Study Guide
      • Malpractice is one type of negligence and often referred to as professional negligence.
        • The nurse (defendant) owed a duty of care to the patient (plaintiff).
        • The nurse did not carry out or breached that duty.
        • The patient was injured and the nurse’s failure to carry out the duty caused the injury.
      • Key elements of consent:
        • The patient receives an explanation of the procedure or treatment.
        • The patient receives the names and qualifications of people performing and assisting in the procedure.
        • The patient receives a description of the serious harm, including death, that may occur as a result of the procedure and anticipated pain and/or discomfort.
        • The patient receives an explanation of alternative therapies to the proposed procedure/treatment and the risks of doing nothing.
        • The patient knows that he or she has the right to refuse the procedure/treatment without discontinuing other supportive care.
        • The patient knows that he or she may refuse the procedure/treatment even after the procedure has begun.
      • Abortion laws:
        • In Roe vs. Wade, court ruled that during the first trimester, a woman could end her pregnancy without state regulation because the risk of natural mortality from abortion is less than with normal childbirth.
        • During the second trimester, the state has an interest in protecting maternal health, and the state enforces regulations regarding the person performing the abortion and the abortion facility.
        • By the third trimester, when the fetus becomes viable, the state’s interest is to protect the fetus; thus, the state prohibits abortion except when necessary to save the mother.
    • Ethics
    • Nursing Codes
    • Ethics and philosophy
    • Terms and meaning for nursing
      • Respect for patient autonomy refers to the commitment to include patients in decisions about all aspects of care as a way of acknowledging and protecting a patient’s independence.
      • Beneficence – positive action for others
        • The agreement to act with beneficence implies that the best interests of the patient remain more important than self-interest
      • nonmaleficence is the avoidance of harm or hurt. In health care, ethical practice involves not only the will to do good, but an equal commitment to do no harm.
      • Justice refers to fairness. It is used most often in discussions about access to health care resources, including the just distribution of resources
      • Fidelity – agreement to keep promises
      • patient autonomy refers to the commitment to include patients in decisions about all aspects of care as a way of acknowledging and protecting a patient’s independence
      • Deontology: proposes a system of ethics that is perhaps most familiar to health care practitioners. Deontology defines actions as right or wrong based on their “right-making characteristics,” such as fidelity to promises, truthfulness, and justice. Deontology depends on a mutual understanding of justice, autonomy, and goodness. But it still leaves room for confusion to surface. Final Nursing Exam Study Guide
      • Utilitarianism: A utilitarian system of ethics proposes that the value of something is determined by its usefulness. This philosophy is also known as consequentialism because its main emphasis is on the outcome or consequence of an action. A third term associated with this philosophy is teleology, from the Greek word telos, meaning “end,” or the study of ends or final causes. The greatest good for the greatest number of people is the guiding principle for determining right action in this system.
      • Feminist Ethics: Feminist ethics critiques conventional ethics such as deontology and utilitarianism. It looks to the nature of relationships to guide participants in making difficult decisions, especially relationships in which power is unequal, or in which a point of view has become ignored or invisible. Writers with a feminist perspective tend to concentrate more on practical solutions than on theory. Feminist ethicists propose that the natural human urge to be influenced by relationships is a positive value.
      • Ethics of Care: The ethics of care and feminist ethics are closely related. Both promote a philosophy that focuses on understanding relationships, especially personal narratives. An early proponent of the ethics of care used the term the one-caring to identify the individual who provides care, and the cared-for to refer to the patient or patients. In adopting this language, the author hoped to emphasize the role of feelings.
      • Casuistry, or case-based reasoning, turns away from conventional principles of ethics as a way to determine best actions and focuses instead on an “intimate understanding of particular situations.” This approach to ethical discourse depends on finding consensus more than an appeal to philosophical principle. As a strategy for solving dilemmas, consensus building promotes respect and agreement rather than a particular philosophy or moral system itself.
    • EBP
    • Critical thinking
    • Nursing process -ADPIE
    • Informatics and documentation
      • Source records
      • A separate section for each discipline
      • Charting by exception (CBE)
      • Focuses on documenting deviations
      • Case management plan and critical pathways
      • Incorporate a multidisciplinary approach to care
      • Variances
      • The source-oriented record is organized according to discipline. Each discipline charts in its defined section of the chart. The problem-oriented record is organized around a patient problem list. All disciplines chart on shared notes that are referenced to the identified problem. Final Nursing Exam Study Guide
      • An occurrence report is a formal record of an unusual occurrence or accident. This is an agency report and is not part of the patient’s chart. An occurrence report is filed in many circumstances. Examples of reportable events include falls or other patient injury, loss of patient belongings, or administration of the wrong medicine.
    • Communication

• Preinteraction phase: occurs before meeting the       patient
• Orientation phase: when the nurse and the patient             meet and get to know each other
• Working phase: when the nurse and the patient work together to solve problems and accomplish goals
• Termination phase: occurs at the end of a relationship Final Nursing Exam Study Guide
• S—This posture (sitting) conveys the message that you are there to listen and are interested in what the patient is saying.
• O—Observe an open posture (i.e., keep arms and legs uncrossed). This posture suggests that the you are “open” to what the patient says. A “closed” position conveys a defensive attitude, possibly provoking a similar response in the patient.
• L—Lean toward the patient. This posture conveys that you are involved and interested in the interaction.
• E—Establish and maintain intermittent eye contact. This behavior conveys your involvement in and willingness to listen to what the patient is saying. Absence of eye contact or shifting the eyes gives the message that you are not interested in what the patient is saying.
• R—Relax. It is important to communicate a sense of being relaxed and comfortable with the patient. Restlessness communicates to the patient lack of interest and a feeling of discomfort.

• Patients education
  • Affective learning deals with expression of feelings and development of values, attitudes, and beliefs. Affective learning includes the following:
  • Psychomotor learning involves acquiring motor skills that require coordination and the integration of mental and physical movements such as the ability to walk or use an eating utensil. Psychomotor learning includes the following:
  • Cognitive learning requires thinking and encompasses the acquisition of knowledge and intellectual skills. The revised taxonomy of six cognitive behaviors is hierarchical and increases in complexity as in the following list:
• Health Assessment
• Stress and coping
• Exercise and activity
• Patient Safety and quality
• Final Nursing Exam Study Guide

Introduction to Health Information Systems Course Competencies

To successfully complete this course, you will be expected to:

1. Apply emerging models or best practices to implement a health information system that improves operations and patient outcomes.
   

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2. Analyze administrative, clinical, management, and decision-support information technology tools.
3. Conduct a comprehensive financial assessment into the implementation of an electronic health record system.
4. Apply evidence to obtain buy-in from all stakeholders for implementation of an integrated electronic health record system.
5. Communicate in a manner that is scholarly, professional, and consistent with expectations for professionals in health care administration.

Economics and Decision Making in Health Care Course Competencies

To successfully complete this course, you will be expected to:

1. Analyze the effects of financial and economic factors (such as cost-benefit, supply and demand, return on investment, and risks) in a health care system on patient care, services offered, and organizational structures and operation.
   

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2. Develop ethical and culturally equitable solutions to economic problems within a health care organization in an effort to improve the quality of care and services offered.
3. Justify the qualitative and quantitative information used to guide economic decision making to stakeholders and colleagues.
4. Develop ethical and culturally equitable economic strategies to address dynamic environmental forces and ensure the future security of an organization’s resources and its ability to provide quality care.
5. Apply various communication methods in order to clearly, effectively, and efficiently relate information to stakeholders and colleagues related to economic data, findings, and strategies.