Download Nursing History, Standards, and Practice: Key Concepts and Milestones and more Exams Health sciences in PDF only on Docsity!
Standards of Care and Client Care
Delivery
Fundamentals of Nursing 10th Edition Potter
Perry Test Bank
Florence Nightingale's Theory
Florence Nightingale's theory of nursing introduced the concept that nursing care focuses on health maintenance and restoration. Nightingale believed the role of the nurse was to put the client's body in the best state in order to remain free of disease or to recover from disease. Her theory did not focus on achieving a maximal level of wellness or on interpersonal interactions with the client. Instead, the goal of Nightingale's theory was to facilitate the body's reparative processes by manipulating the client's environment.
Nursing Education Accreditation
Nursing education programs in the United States may seek voluntary accreditation by the National League for Nursing (NLN), the professional nursing organization concerned with nursing education. The NLN provides accreditation to nursing programs that seek and meet the NLN accreditation requirements.
Nurse Practitioner Education
The minimum educational requirement for a nurse practitioner is a master's degree in nursing. Diploma programs in nursing require 3 years of education after which the graduate may become a registered nurse, but not a nurse practitioner. Doctoral programs focus on the application of research findings to clinical practice, while baccalaureate degree programs generally require 4 years of study in a college or university, after which the graduate may become a registered nurse, not a nurse practitioner.
Nursing Advocacy and Legislation
The American Nurses Association (ANA) hires lobbyists at the state and federal level to promote the advancement of health care and the economic and general welfare of nurses. This group lobbies for the advancement of nursing's role, economic interests, and health care.
Nursing Practice Across States
When a nurse moves to another state, the most important factor to consider is the Nurse Practice Act of that state, as each state has its own regulations
that govern the licensure and practice of nursing. Knowledge of the Nurse Practice Act is necessary to provide safe and legal nursing care.
Nursing Roles and Coordination of Care
In caring for a client with chronic renal failure, the nurse fulfills the role of manager by coordinating the activities of other members of the health care team, such as nursing assistants, nutritionists, and the client themselves, to best meet the client's needs.
Nursing Practice Settings
The practice setting where the majority of nurses continue to work is the hospital setting, providing direct client care. Opportunities for providing patient care in the client's home are increasing, but the majority of nurses are not employed in this setting.
Occupational Therapy and Client Care
When a client is receiving Dilantin to prevent seizure activity, the nurse should refer the client to an occupational therapist. Occupational therapists provide assessment and intervention to ameliorate physical and psychological deficits that interfere with the performance of activities and tasks of living, including one's employment.
Nursing Education Milestones
Key milestones in the development of nursing education include: - The Goldmark Report of 1923, which identified the need for increased financial support to university-based schools of nursing. - The National Commission on Nursing and Nursing Education Report of 1965, which recommended that nursing roles and responsibilities be clarified in relation to other health care professionals. - The requirement by the National League for Nursing in 1975 that nursing education programs have a theory-based curriculum for accreditation.
Contributions to Nursing
In 1893, Lillian Wald and Mary Brewster made significant contributions to the nursing profession through their work involving the establishment of the Henry Street Settlement, the first community health service for the poor in New York.
Nursing Certification
To obtain certification in a specialty area, the nurse must complete an examination and meet the minimum practice requirements for that certification. Certification does not require a master's degree in nursing, but rather passing the specialty-specific examination and maintaining ongoing continuing education and clinical or administrative practice.
Nursing in the Twentieth Century
Nursing Education and Practice
In the early twentieth century, a movement toward a scientific, research- based defined body of nursing knowledge and practice was evolving. Nurses began to assume expanded and advanced practice roles, and nursing education became affiliated with universities. Mary Adelaide Nutting was instrumental in this process.
Isabel Hampton Robb helped found the Nurses Associated Alumnae of the United States and Canada in 1896, which later became the American Nurses Association (ANA) in 1911. Robb authored many nursing textbooks and was one of the original founders of the American Journal of Nursing (AJN).
Nursing Concepts
The twentieth century is recognized for the formalization of university-based nursing education, the development of specialized nursing textbooks, and the expansion of nursing roles and practice.
The Human Rights Movement
The human rights movement changed the way society views the rights of all its members, including minorities, clients with terminal illness, pregnant women, and older adults. This directly impacted nursing practice, as nurses are responsible for advocating the rights of all clients and ensuring they receive quality care.
Cultural Diversity in Nursing
Increased ease of travel and mobility has led to a more culturally diverse client population that nurses must manage and deliver care for. Nursing practice requires the ability to provide care for clients from many different cultural backgrounds.
Client Transfer and Safety
To minimize the risk of injury during client transfer, evidence-based practices for safe client handling, such as the use of mechanical lifts, are essential. Yearly training sessions for caregivers are also important, but the specific training should be determined by evidence-based research.
Health Promotion and Wellness
Nursing responds to the greater concern for health promotion by providing programs in the community, such as health fairs and wellness programs, educational programs for specific diseases, and client and family teaching activities in various health care settings.
Nursing Process: Planning
Changes in Recent Population Demographics
Demographic changes have significantly impacted the delivery of nursing care in recent decades. These changes include:
Increased life expectancy Increased incidence of chronic, long-term illnesses Increased incidence of diseases such as alcoholism and lung cancer Population shift from rural areas to urban centers
Nursing has responded to these changes by exploring new methods of care delivery, adjusting educational emphases, and establishing practice standards. However, advances in medical modalities and the availability of free public education do not directly reflect changes in population demographics, but rather represent advancements in healthcare and social services.
Regulatory Interventions to Reduce Healthcare Costs
To address the rising healthcare costs, several regulatory interventions have been implemented:
Prospective payment system: In 1983, Congress established this system, where hospitals are reimbursed a set dollar amount for each diagnosis-related group (DRG), regardless of the length of stay or use of services. State limits on healthcare fees: This approach has not been used nationwide to reduce healthcare costs. Federal guidelines for treatment: This intervention has not been used to reduce the cost of healthcare. Court review of insurance coverage: This has not been a primary intervention to lower healthcare costs.
Levels of Prevention and Health Promotion Services
Nurses use levels of prevention to guide their interventions, focusing on the client's needs and the care or service provided. Examples of health promotion services include:
Aerobic dance class Prenatal care Well-baby care Nutrition counseling Family planning
An immunization clinic is an example of an illness prevention service, while a diabetic support group may be an example of a rehabilitation service to help clients adapt to a change in lifestyle. A smoking cessation clinic can be part of rehabilitation or offered as an illness prevention service.
Discharge Planning
Discharge planning should begin at the time of admission to the hospital, using the client's strengths and resources, providing resources to meet the client's limitations, and focusing on improving the client's long-term outcomes.
Managed Care Organizations (MCOs)
In an MCO, a primary care physician provides all care, and the focus is on health maintenance and primary care. Referral by the primary care physician is necessary for access to specialists and for hospitalization.
Health Care and Managed Care
Health Promotion, Disease Prevention, and Levels of
Prevention
Systems of managed care focus on containing or reducing costs, increasing client satisfaction, and improving the health or functional status of the individual (Sultz and Young, 2004).
Health promotion refers to activities that develop human attitudes and behaviors to maintain or enhance well-being. Disease prevention involves activities that protect people from becoming ill because of actual or potential health threats.
There are four levels of prevention:
Primary prevention: Focuses on health maintenance and primary care. Secondary prevention: Involves early diagnosis and treatment of illness (e.g., screening for hypertension). Tertiary prevention: Aims to prevent further progression of disease. Quaternary prevention: Focuses on preventing overmedication and unnecessary interventions.
Community-Based Nursing Practice
Community health nursing strives to safeguard and improve the health of populations in the community as well as providing direct care services to subpopulations within a community. Community health nursing has a broader focus, with an emphasis on the health of a community, compared to public health nursing, which is concerned with trends and patterns influencing the incidence of disease within populations.
The community health nurse merges public health knowledge with nursing theory and considers the needs of populations, while also being prepared to provide direct care services to subpopulations within a community. Nurses who become expert in community health practice may have advanced nursing degrees, yet the baccalaureate-prepared generalist also can become
competent in formulating and applying population-focused assessments and interventions.
Assessing and Addressing Client Needs
When assisting clients with nutritional needs, the community health nurse should first ask the client and family what they think they should eat. This helps assess the client's level of knowledge regarding nutrition as well as their food preferences, enabling the client to become a participant in their care.
Clients from vulnerable populations, such as those with substance abuse issues, may avoid health care due to fear of judgmental attitudes and concerns about legal consequences. The community health nurse should work to build trust and connect these clients with appropriate resources.
When assessing the structure or locale of a community, the nurse should observe the locations of services, such as water and sanitation, as well as where residents congregate. This helps identify the needs of the population.
As a change agent, the community health nurse should work with clients and groups to select alternative health care sites and treatments, empowering individuals to take responsibility for their health care decisions.
Continuity of Care and Home Health
When a client is discharged from an acute care facility following a total hip replacement, the nurse should discuss a referral to a physical therapist in addition to a home health care nurse. This helps ensure continuity of care and address the client's movement needs.
The largest contributing factor for the rise in the need and use of home care is that clients are returning home more acutely ill due to shortened hospital stays aimed at controlling health care costs.
Healthy People 2010
One of the overall goals of Healthy People 2010 is to increase the life expectancy and quality of life and to eliminate health disparities. This initiative aims to improve the delivery of health care services to the general public, rather than focusing on reducing health care costs or increasing the number of managed care organizations.
Promoting Managed Care Organizations in
Vulnerable Populations
Assessing Vulnerable Populations
When assessing members of a vulnerable population, the primary need for the community health nurse is to promote managed care organizations. This
In contrast, treatment of the disease would be considered a tertiary-level intervention, as it focuses on managing the condition rather than preventing it.
Assessing Clients with Mental Illness and Potential Abuse
When caring for a homeless client with paranoid schizophrenia who has reported a foot injury and exhibits signs of physical abuse, the nurse should first realize that the client is at risk for physical abuse and assault.
Clients with severe mental illnesses like schizophrenia often face multiple health and socioeconomic challenges, including a greater risk of abuse and assault. The client's reported foot injury and observable bruising support the possibility of abuse or assault.
While drug abuse may be a consideration, it does not represent the primary concern in this case, as there is no indication that the client is drug-seeking. Similarly, the risk of communicable diseases and the need for hospitalization are concerns, but they do not represent the primary issue compared to the potential for abuse.
Providing Community-Based Interventions for Older Adults
with Osteoarthritis
When identifying a need for educational programming among residents of an assisted living facility dealing with osteoarthritis, the best example of such programming is information on being an informed consumer and not falling for false arthritis cures.
This type of broad-based, community-level intervention is appropriate for addressing the needs of the entire resident population diagnosed with osteoarthritis. In contrast, planning the best exercise program or providing information on proper self-administration of anti-inflammatory medication would be more individualized interventions.
Advocating for Clients to Ensure Appropriate Follow-Up
Care
When a homeless client with a bacterial hand infection has received initial treatment in the emergency department, the nurse must first act as the client's advocate to ensure the client receives the appropriate follow-up care.
As an advocate, the nurse can help the client navigate the healthcare system, identify where to go for services, and provide guidance on how to access the necessary resources, such as filling the antibiotic prescription and receiving a dressing change in 3 days.
The nurse's role as an educator is to help the client assume responsibility for their own healthcare, which has already been addressed in this case. The
nurse's role as a caregiver has been fulfilled by providing the initial treatment. The role of a counselor is not the primary need in this situation.
Promoting Client Compliance with Specialized Care
When a client prefers using "plain old soap and water" instead of a specialized cleansing agent recommended by the nurse for an infected hand, the primary factor that will affect client compliance is the client's acceptance of the need for the specialized care.
Client compliance is primarily a result of the client's understanding and acceptance of the need for the recommended change, rather than factors like the ease of use, availability, cost, or the use of incentives.
Identifying the Impact of Environmental Factors on Client
Health
When assessing a client with chronic bronchitis who lives near a factory emitting pollution, the nurse's primary concern should be identifying a correlation between the pollution and the client's increased dyspnea.
Determining the client's exposure to the pollution and its effects on the client's breathing is the nurse's primary concern in this situation. Performing a complete health history and assessment, providing access to required breathing treatments, or determining the availability of alternate housing are important considerations, but they are not the nurse's primary concern in this case.
Recognizing Community-Based Health Concerns
Community health nurses should be concerned with clients who are homeless, have a history of sexually transmitted diseases, are underimmunized, or are living with HIV or other emerging infections.
These clients possess risk factors that are community-based and require specialized, community-focused interventions. In contrast, an elderly gentleman who fell while disembarking from a bus or a 15-year-old injured at a public swimming pool, while important, do not necessarily represent the primary concerns of the community health nurse.
Factors Affecting Life Expectancy in Clients Living in
Poverty
Clients living in poverty have a lower life expectancy compared to the general population due to factors such as inadequate nutritional diets, high-risk work environments, hazardous living environments, and addictive or abusive lifestyles.
Neuman's Theory
In Neuman's theory, the nurse approaches the client to strengthen the line of defenses at the secondary level of prevention. Neuman's framework for practice includes nursing actions as primary, secondary, or tertiary levels of prevention in caring for clients holistically. Secondary prevention strengthens internal defenses and resources by establishing priorities and treatment plans for identified symptoms.
Henderson's Theory
In Henderson's theory, nurses help the client to perform 14 basic needs.
Orem's Theory
The goal of Orem's theory is to promote attainment of self-care.
Roy's Theory
Roy's theory focuses on adaptation.
Watson's Theory
The key emphasis of Watson's theory is that caring is the moral ideal: mind- body-soul engagement with another.
Systems Theory
According to systems theory, a system is made up of parts that rely on one another, are interrelated, share a common purpose, and together form a whole. A client's interaction with the environment is an example of an open system.
Orem's Self-Care Theory
The goal of Orem's theory is to help the client perform self-care.
Rogers' Theory
The framework for practice according to Martha Rogers' theory is the unitary human continuously changing and coexisting with the environment.
Neuman's Theory and Stress Reduction
Stress reduction is the goal of the systems model of nursing practice according to Neuman's theory.
Leininger and Benner & Wrubel's Theories
Caring is a central focus in the theories of Leininger and Benner & Wrubel.
Orem's Theory and Client Independence
According to Orem, the goal of nursing is to increase the client's ability to independently meet biological, psychological, developmental, or social needs.
Definition of Health
Health is dynamic and ever-changing. The definition of health is unique to each client.
Nursing Diagnoses
Nursing diagnoses are the way nurses identify what specific needs a client has. They are the diagnosis and treatment of human responses to actual or potential health problems.
Orem's Theory and Diabetes Management
If a nurse uses Orem's theory in practice, the nurse assesses and interprets the data to determine the client's self-care needs, self-care deficits, and self- care abilities in the management of a disease. The theory then guides the design of individualized nursing interventions.
Swanson's Theory of Caring
Swanson's theory of caring defines five components of caring: knowing, being with, doing for, enabling, and maintaining belief. Offering to stay with the client is an intervention directly reflected in the "being with" component of Swanson's theory.
Neuman's Theory and Lung Cancer
The Neuman System Model most directly addresses the client's response to stress, which is a key aspect of caring for a client recently diagnosed with lung cancer.
The Neuman Systems Model and Nursing
Practice
The Neuman Systems Model
The Neuman Systems Model (1995) is a comprehensive, open systems-based perspective that provides a unifying focus for approaching a wide range of nursing practice, education, and research. In this model, phenomena include all client responses, environmental factors, and nursing actions.
Nursing Process Input
Input for the nursing process is the data or information that comes from a client's assessment, such as how the client interacts with the environment and the client's physiological function.
Prioritizing Client Needs
The second level of Maslow's hierarchy, which includes safety and security needs, has the highest priority when compared to the other options presented. The client's concern about securing the medication needed to minimize the potential for breathing problems has the highest priority.
Primary Goal of Nursing Practice
The primary goal of nursing practice is to provide effective, research-based nursing care specifically tailored to each client's needs.
Elaboration of the Text
Measurement Type and Study Section
The methods section of a study includes the description of the sample (what or who was studied), type of data collected, and the device or instrument used to measure empirical information. The results section contains a description of the results obtained in the study, including appropriate statistical tests used to analyze the data. The introduction section presents the purpose, a summary of literature used to formulate the study, and the hypothesis tested or the research questions posed.
Research Process Steps
After identifying the problem, the next step in the research process is to review the literature to determine what is known about the problem. Following identification of the problem and review of the literature, the researcher will design the study protocol. Selecting the population is a component of this phase of the research process. Obtaining necessary approvals is part of conducting the study, which follows the design phase in the research process. Identifying the instrument to use for data analysis occurs during the process of designing the study protocol. This step would occur during the study design phase of the research process after problem identification and literature review have taken place.
Nursing Research Types
Correlational research explores the interrelationships among variables of interest (such as factors affecting client comfort) without any active intervention by the researcher. Historical research is designed to establish facts and relationships concerning past events. It would not use prospective groups of clients. Evaluation research tests how well a program, practice, or
policy is working. In experimental research, the investigator controls the study variable and randomly assigns subjects to different conditions.
Experimental Research Topics
In experimental research, the investigator controls the study variable (use of humor) and randomly assigns subjects to different conditions (those who receive humor as an intervention, and those who do not). The effect of therapeutic touch on a geriatric client with Alzheimer's disease lends itself to the nursing process as a nursing intervention to perhaps assist a client in meeting a goal of preventing social isolation. Determining the blood pressure patterns of a client who recently had a cerebrovascular accident is a part of the assessment phase of the nursing process. In contrast to an experimental research study, no variable is being controlled by the nurse.
Knowledge Acquisition Strategies
Trying different types of colostomy dressings for maximum therapeutic effect is an example of the problem-solving strategy for knowledge acquisition. Practicing skills is an example of gaining experience to increase one's knowledge. Information-seeking is a strategy used to obtain knowledge from experts in a particular field. Reviewing Maslow's hierarchy in a reference textbook or on the internet is another example of acquiring knowledge through information-seeking.
Research Report Sections
A description of the clients used is found in the methods section of the research study. The results section contains a description of the results obtained in the study, including appropriate statistical tests used to analyze the data. The discussion section presents the authors' interpretation of the results, including conclusions and implications that can be drawn from the study. The introductory section presents the purpose of the study, a summary of literature, and the hypotheses tested or questions posed.
Research Utilization Considerations
Determination of whether the subjects and environment in the study are similar to the clients for whom the nurse provides care in the particular practice setting is necessary before research can be considered for use in practice. Cost may be a consideration in determining the feasibility of applying research findings, but it is not the priority consideration for research utilization. The number of journals that published the research results of the study should not be the priority consideration in implementation of its findings. To judge the scientific worth of the study, it is important to examine the amount of supportive evidence provided by other scientific studies that have obtained similar results.
actively involved in measures to improve their present and future levels of wellness.
Health Beliefs
Health beliefs are a person's ideas, convictions, and attitudes about health and illness. An example of a health belief would be if the client stated, "Heart disease runs in our family. I know I will have heart disease anyway, so why exercise?"
Negative Health Behaviors
A negative health behavior is a behavior that may negatively impact one's health. An example of a negative health behavior would be consistently drinking alcohol in excess.
Stages of Health Behavior Change
Contemplation Stage
During the contemplation stage, the client is considering a change within the next 6 months. The client may be ambivalent initially, but will more likely accept information as he or she develops more belief in the value of change.
Action Stage
During the action stage, the client is actively engaged in strategies to change behavior.
Preparation Stage
During the preparation stage, the client is making small changes in preparation for a change in the next month. At this point, the client believes advantages outweigh disadvantages in behavior change.
Maintenance Stage
During the maintenance stage, the client has sustained change over time.
External Variables Influencing Health Beliefs
and Practices
External Variables
External variables influencing a person's health beliefs and practices include family practices, cultural background, and socioeconomic factors, such as income. Economic variables may affect a client's level of health by increasing the risk for disease and influencing how or at what point the
client enters the health care system. A person's compliance with the treatment to maintain or improve health is also affected by economic status.
Internal Variables
Religious practices are one way that people exercise spirituality. Educational background is an internal variable that can influence the health beliefs and practices of a client. An example of an internal variable that can influence health beliefs and practices of a client includes emotional factors, such as the reaction to heart disease.
Levels of Prevention
Secondary Prevention
The secondary prevention level focuses on early diagnosis and prompt treatment as well as disability limitations. Adequate treatment for the electrolyte imbalance is sought to prevent further complications.
Primary Prevention
The primary prevention level focuses on health promotion and specific protection measures such as immunizations and personal hygiene.
Tertiary Prevention
The tertiary prevention level focuses on restoration and rehabilitation.
Examples of Nursing Activities
Tertiary Prevention
Care of the hospice nurse at the tertiary prevention level aims to help the client and the client's family achieve as high a level of functioning as possible despite the limitations caused by the cancer.
Secondary Prevention
Teaching a client how to irrigate a new colostomy would be an example of secondary prevention.
Primary Prevention
Providing a class on hygiene for an elementary school class would be an example of the primary level of prevention.
