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Nursing Standards of Care:
Improving Client Outcomes
Fundamentals of Nursing 10th Edition Potter
Perry Test Bank
Chapter 1. Nursing Today
Multiple Choice
Contemporary nursing practice is based on knowledge generated through nursing theories. Florence Nightingale's theory introduced the concept that nursing care focuses on: Psychological needs A maximal level of wellness Health maintenance and restoration Interpersonal interactions with the client
ANS: 3 Florence 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 focused on facilitating the body's reparative processes by manipulating the client's environment, rather than on meeting psychological needs, achieving a maximal level of wellness, or interpersonal interactions.
Nursing education programs in the United States may seek voluntary accreditation by the appropriate accrediting commission council of the: National League for Nursing American Nurses Association Congress for Nursing Practice International Council of Nurses
ANS: 1 The National League for Nursing (NLN) is the professional nursing organization concerned with nursing education and provides accreditation to nursing programs that seek and meet the NLN accreditation requirements.
The minimum educational requirement for a nurse practitioner is: Diploma in nursing Masters in nursing Doctorate in nursing Baccalaureate in nursing
ANS: 2 A master's degree in nursing is required to become a nurse practitioner. Diploma programs, baccalaureate programs, and doctoral
programs do not meet the minimum educational requirement for a nurse practitioner.
A group that lobbies at the state and federal level for advancement of nursing's role, economic interest, and health care is the: State Board of Nursing American Nurses Association American Hospital Association National Student Nurses Association
ANS: 2 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.
A nurse moves from Seattle to Boston and begins working in a hospital. The most important factor for the nurse to consider when moving to another state is the: Massachusetts Nurse Practice Act Standard for nursing practice in Boston Clinical ladder of mobility in the new hospital Requirement for continuing education units (CEU) in Massachusetts
ANS: 1 Knowledge of the Nurse Practice Act in the new state is the most important factor, as it regulates the licensure and practice of nursing within that state.
A nurse is caring for a client who has chronic renal failure. The nurse states, "We will do everything possible to return you to the optimum level of self-care possible." In coordinating an approach to best meet the needs of this client, the nurse is fulfilling the role of: Manager Educator Counselor Communicator
ANS: 1 The nurse, in caring for this client, will coordinate the activities of other members of the health care team, such as nursing assistants, nutritionists, and the client themselves, to meet the client's needs.
Nurses have the opportunity to work in a wide variety of health care agencies around the world. The practice setting where the majority of nurses continue to work is: Acute care Home care Long-term care Ambulatory care
nurse's decisions and actions on behalf of clients are determined in an ethical manner?"
Acts as client advocate Participates in the collection of client data Seeks experiences to maintain clinical skills Consults with appropriate health care providers
ANS: 1 Acting as a client advocate, protecting the client's human and legal rights, and providing assistance in asserting those rights fulfills a measurement criterion for the professional performance standard of ethics.
In looking at the nineteenth century, the growth of professional nursing was stimulated by:
The Civil War Federal legislation Florence Nightingale The women's suffrage movement
ANS: 1 The Civil War stimulated the growth of nursing in the United States, as nurses were in high demand to tend to the soldiers on the battlefield.
The Growth of Nursing in the Nineteenth
Century
Legislation and Florence Nightingale's Impact
Legislation was not responsible for the growth of nursing in the nineteenth century. Although Florence Nightingale had a great impact on the practice of nursing, she was not the cause for the growth of nursing in the United States during the nineteenth century.
The Women's Movement and Nursing
The women's movement has encouraged nurses to seek greater autonomy and responsibility in providing care, and has caused female clients to seek more control of their health and lives. However, the women's movement was not responsible for the growth of nursing in the nineteenth century.
In-Service Education
An in-service education program is instruction or training provided by a health care agency or institution for its employees. A workshop at a nursing convention is an example of a continuing education program.
Credit courses at a college are examples of continuing education that could possibly be applied toward furthering one's degree. Noncredit courses offered via the internet are an example of a continuing education program.
Trends in Health Care Delivery
A major trend that is influencing nursing practice today is the increased incidence of chronic disease processes. With shortened hospital stays, client acuity has increased, not decreased. Hospital stays have decreased, not increased. With increased public awareness and rising health care costs, greater emphasis has been placed on health promotion and illness prevention.
Nursing Practice and Health Promotion
The nurse may educate the client in such areas as exercise, nutrition, and healthy lifestyles to assist the client in health promotion and illness prevention. By administering medication, the nurse is assisting to restore a person to health or maintain their health. Treating a foot ulcer is assisting a client to restore their health, rather than promoting healthy behaviors. Obtaining an operative consent pertains to legal aspects of care and is not considered a health promotion activity.
Integrating the Science and Art of Nursing
Nursing is an art and a science. When you integrate the science and art of nursing into your practice, the quality of care you provide to your clients is at a level of excellence that benefits clients and their families. Caring is one part of the art of nursing. Awareness of the standards of care does not guarantee quality care.
Nightingale's Nursing Philosophy
Florence Nightingale studied and implemented methods to improve battlefield sanitation, which ultimately reduced illness, infection, and mortality. Awareness of the connection between hospital-acquired infections (nosocomial) and nursing practice is the best example of her nursing philosophy.
Nursing Concepts in the Twentieth Century
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.
Monitoring blood pressures at a community health fair: Providing free health screenings and assessments is an important aspect of health promotion.
Consulting a teenage mother on breastfeeding techniques: Educating and supporting new mothers on healthy practices contributes to the well-being of both the mother and child.
Providing literature on smoking cessation to client families: Offering educational resources and information helps empower individuals to make healthier choices.
While organizing a foot race to benefit national cancer research is admirable, it is not directly focused on health promotion and wellness for specific individuals. Similarly, presenting a nursing workshop on the care of diabetic ulcers is more oriented towards professional development rather than community-based health promotion.
Changes in Population Demographics and
Nursing Care Delivery
Demographic Shifts Impacting Nursing Care
Significant changes in population demographics have influenced the delivery of nursing care in recent decades. These include:
Increased life expectancy: The aging population has led to a higher incidence of chronic, long-term illnesses that require specialized nursing care.
Decreasing rural population and expanding urban settlement: The shift from rural to urban areas has necessitated adaptations in nursing practice to address the unique needs of diverse urban communities.
Advances in medical modalities: Technological and medical advancements have transformed the healthcare landscape, requiring nurses to stay up-to-date with new treatment options and care delivery methods.
Nursing Responses to Demographic Changes
In response to these demographic shifts, nursing has explored new methods to provide care, adjusted educational emphases, and established practice standards to meet the evolving needs of the population.
Health Care Delivery System
Regulatory Interventions to Reduce Health Care Costs
One key regulatory intervention aimed at reducing the rise in healthcare costs is the prospective payment system. Introduced in 1983, this system reimburses hospitals a set dollar amount for each diagnosis-related group, regardless of the length of stay or services used.
Other approaches, such as state limits on healthcare fees, federal guidelines for treatment, and court review of insurance coverage, have not been as widely implemented as nationwide strategies to lower healthcare costs.
Levels of Prevention and Health Promotion Services
Nurses utilize the framework of levels of prevention to guide their interventions. An example of a true health promotion service is an aerobic dance class, which focuses on enhancing overall well-being.
In contrast, an immunization clinic represents an illness prevention service, while a diabetic support group may be considered a rehabilitation service to help individuals adapt to a change in lifestyle. A smoking cessation clinic can be categorized as either an illness prevention or rehabilitation service.
Health Care Delivery Agencies and Levels of Care
Health care delivery agencies can be classified into different levels of care. A state-owned psychiatric hospital is an example of a secondary level of care, where individuals with signs and symptoms of disease are diagnosed and treated.
Other examples of health care delivery agencies include schools (primary care), nursing homes (continuing care), and drug rehabilitation centers (restorative care).
Occupational Safety and Health Considerations
Occupational safety and health encompasses various environmental hazards within the workplace, such as noise exposure. This category does not include aspects like firearms safety, swimming lessons, or motorcycle helmet use, as they are not directly related to occupational health and safety.
Health Care Financing and Payment Mechanisms
Health care financing involves various payment mechanisms, such as:
Preferred Provider Organizations (PPOs): Contractual agreements between providers and purchasers (e.g., corporations) to offer comprehensive health services at a discounted rate. Medicaid: A state-regulated, federally funded healthcare program for individuals with low incomes.
Referral by the primary care physician is necessary for access to specialists and for hospitalization MCOs do not allow the individual to go to any physician they desire
Importance of Health Promotion in Managed Care
Health promotion is of primary importance when dealing with managed care Staying healthy helps reduce the cost of medical care Managed care systems focus on containing or reducing costs, increasing client satisfaction, and improving the health or functional status of the individual
Assisting a Homeless Family with a Disabled Child
Medicaid is the appropriate service to assist the homeless family with the disabled child's health care needs Medicaid is a federally funded, state-operated program that provides health insurance to low-income families and health assistance to low- income people with long-term care disabilities
Community Health Nursing
Community health nursing includes direct care and services to subpopulations within a community Community health nurses consider the needs of populations and are prepared to provide direct care services to subpopulations Baccalaureate-prepared generalists can also become competent in formulating and applying population-focused assessments and interventions
Assessing Nutritional Needs in Community Health Nursing
The community health nurse should first ask the client and family what they think they should eat to assess their level of knowledge and food preferences This enables the client to become a participant in their care
Identifying Clients at Greatest Risk
A substance abuser who shares drug paraphernalia is currently at the greatest risk compared to a physically abused client in a shelter, a schizophrenic client in outpatient therapy, or an older adult taking medication for hypertension
Levels of Prevention
Dietary management that keeps a client's gastrointestinal symptoms suppressed corresponds to tertiary prevention The goal of tertiary prevention is to preclude further deterioration of physical and mental function in a person who has an existing illness
Client Advocacy in Home Health Nursing
The home health nurse can best demonstrate client advocacy by calling the regional dialysis center and exploring options for reducing the cost of the client's home dialysis
Assessing the Structure of a Community
When assessing the structure or locale of a community, the nurse should observe the locations where services, such as water sanitation, are provided
Facilitating Change within a Community
The nurse working as an effective change agent should work with clients and groups to select alternative health care sites and treatments This enables clients and their families to take responsibility for their health care decisions
Referrals for a Client Discharged After a Total Hip
Replacement
In addition to a home health care nurse, the client should be referred to a physical therapist to follow up on their rehabilitation and exercise plan
The Nurse's Role in Recognizing Factors
Contributing to the Rise in Home Care Needs
Factors Contributing to the Rise in Home Care Needs
Clients are more acutely ill when discharged from the acute care facility. This is the largest contributing factor for the rise in the need and use of home care.
Shortened hospital stays to control healthcare costs have led to clients returning home in a more acutely ill state.
Government funding of the home care setting has not increased greatly.
Government funding of home care is not the largest contributing factor for the rise in the need and use of home care.
There are 7 days/week services for the elderly in a variety of settings, not just in the home care setting.
The existence of more 7 days/week services for the elderly is not the largest contributing factor for the rise in the need and use of home care.
While drug abuse, communicable diseases, and hospitalization may also be concerns, the evidence points primarily to the risk of abuse or assault.
Educational Programming for Residents of an Assisted
Living Facility with Osteoarthritis
The best example of such programming is: "Be an informed consumer - don't fall for false arthritis cures." This type of broad-based, informative programming is more applicable to the entire resident population diagnosed with osteoarthritis. Specific exercise programs or medication administration instructions would be more tailored to individual client needs.
Ensuring Appropriate Follow-up Care for a Homeless Client
with a Bacterial Infection
The nurse must first act as the client's advocate. The nurse needs to help the client navigate the healthcare system, identify where to go for services, and facilitate the necessary follow-up care. The roles of educator, caregiver, and counselor are also important, but advocacy is the primary need in this situation.
Factors Affecting Client Compliance with a Specialized
Cleansing Agent
The primary factor 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 change, rather than factors like ease of use, cost, or incentives.
Assessing a Client with Chronic Bronchitis and Exposure to
Factory Pollution
The nurse's primary concern is identifying a correlation between the pollution and the client's increased dyspnea. Determining the client's exposure to pollution and its effects on their breathing is the nurse's main priority. Comprehensive assessment, access to treatments, and alternate housing are also important considerations, but identifying the pollution- dyspnea link is the primary concern.
Theoretical Foundations of Nursing Practice
Defining Nursing Theories
Theories are defined as concepts, definitions, relationships, and assumptions that project a systematic view of phenomena. Theories can be classified into different types based on their purpose: Descriptive theories: Describe phenomena and speculate on why they occur. Grand theories: Provide a broad, abstract framework for nursing. Prescriptive theories: Address nursing interventions and predict their consequences. Middle-range theories: Address specific phenomena or concepts and reflect nursing practice.
The Nursing Paradigm
The nursing paradigm consists of four key linkages of interest: Person: The recipient of nursing care, including individuals, families, and communities. Health: The goal of nursing care. Nursing care: The diagnosis and treatment of human responses to actual or potential health problems. Environment/situation: The conditions affecting the client and the setting in which health care needs occur, such as the home, school, workplace, or community.
Applying Nursing Theories in Practice
Neuman's theory: Focuses on strengthening the client's line of defenses at the secondary level of prevention to assist with physiological adaptation to internal changes. Watson's theory: Emphasizes that caring is central to the essence of nursing, with a focus on mind-body-soul engagement with the client. Systems theory: Focuses on the client's interaction with the environment, understanding that factors changing the environment can impact the system. Orem's theory: Aims to help the client perform self-care, such as in wound management. Rogers' theory: Views the unitary human being as continuously changing and coexisting with the environment. Leininger's and Benner and Wrubel's theories: Both emphasize caring as a central focus. Orem's theory: Supports a client's ability to live independently, which aligns with the goal of the client diagnosed with multiple sclerosis.
Nursing Theories and Models
Swanson's Theory of Caring
Swanson's theory of caring defines five components of caring: knowing, being with, doing for, enabling, and maintaining belief. These components provide a foundation for identifying and testing nurse caring behaviors to determine their impact on client health outcomes.
Neuman Systems Model
The Neuman Systems Model uses a systems approach to describe how clients deal with stressors in their internal or external environments. Nurses using this model focus their care on client responses to stressors and design interventions to address those responses.
Nursing Process and Assumptions
Nursing Process
Input for the nursing process is the data or information gathered during the client assessment. Feedback serves to inform the nurse about how the client responds to the nursing interventions. Output is the end product of the nursing process, which is the client's improved or stabilized health status.
Nursing Assumptions
Assumptions are the taken-for-granted statements that explain the nature of the concepts, definitions, purpose, relationships, and structure of a nursing theory or model. Appropriate nursing assumptions are reasonable and reflect the client's needs and expectations.
Prioritizing Client Needs
Maslow's Hierarchy of Needs
Maslow's hierarchy of needs provides a framework for understanding and prioritizing client needs. The most pressing need is the client's concern about securing the medication needed to minimize the potential for breathing problems, as it relates to the safety and security level of the hierarchy.
Nursing Practice and Goals
Primary Goal of Nursing Practice
The primary goal of nursing practice is to provide effective, research- based nursing care that is specifically tailored to each client's needs. This involves identifying client needs, facilitating improved health and wellness, and addressing both the physical and psychosocial needs of the client and their family.
Elaboration of the Given Text
Research Approaches
Exploratory Research : An example of an exploratory type of research is to develop or refine a hypothesis about the relationships among phenomena.
Historical Research : An example of a historical type of research is to establish facts and relationships concerning past events.
Evaluation Research : An example of an evaluation type of research is to test how well a program, practice, or policy is working.
Descriptive Research : An example of a descriptive type of research is to accurately portray characteristics of persons, situations, or groups and the frequency with which certain events or characteristics occur.
HIPAA and Nursing Research
The Health Information Portability and Accountability Act (HIPAA), implemented in 2003, may influence nursing research in the area of how the data will be obtained and protected. HIPAA regulations identify how protected health information of potential research subjects is to be managed.
Research Roles of Baccalaureate-Prepared Nurses
The expected research role for the baccalaureate-prepared nurse is to identify clinical nursing problems in practice. Nurses with a baccalaureate degree are prepared to read research critically and use existing standards to determine the readiness of the findings for clinical practice. They also participate in research activities through identification of clinical problems in nursing practice.
Ethical Principles in Nursing Research
Informed Consent : When a nurse researcher distributes an explanatory information sheet to subjects solicited for participation in her study, the researcher is using the ethical principle of informed
Types of Nursing Research
Correlational Research : Correlational research explores the interrelationships among variables of interest (such as factors affecting client comfort) without any active intervention by the researcher.
Experimental Research : In experimental research, the investigator controls the study variable and randomly assigns subjects to different conditions.
Strategies for Learning and Incorporating New
Information
Trying different types of colostomy dressings for maximum therapeutic effect is an example of the problem-solving strategy for knowledge acquisition.
Sections of a Research Report
The description of the clients used in a study would best be written in the methods section of the research report.
Case Study on Early Stimulation of Post-Head Injury
Clients
The nurse reading about a case study involving the potential positive effects of the early stimulation of post-head injury clients is engaging in a form of descriptive research, as case studies provide an in-depth examination of a single individual or group.
Health and Wellness
Defining Health
When formulating a definition of health, the nurse should consider that health, within its current definition, is a state of well-being involving the whole person, not just the absence of disease or a function of the physiological state. Health is considered to be more than merely the absence of disease, and the definition has broadened beyond the physiological state to include mental, social, and spiritual well-being. An individual who has the ability to pursue activities of daily living may not define himself or herself as being healthy, as life conditions such as environment, diet, and lifestyle practices may negatively impact one's health long before the person is unable to perform activities of daily living.
Healthy People 2010
The main, overarching goals for Healthy People 2010 were to increase quality and years of healthy life and to eliminate health disparities. Reducing health care costs, investigating substance abuse, and determining
acceptable morbidity rates were not the main, overarching goals for Healthy People 2010.
Holistic Nursing Approach
When using a holistic approach in nursing care, the nurse should consider all factors that may impact the client's level of well-being in all dimensions, not just physical health. This includes factors such as diet, exercise, and their effect on the client's health. A holistic approach may involve a discussion with the client about these lifestyle factors and how they can take responsibility for their health and choices that may impact their well-being.
Risk Factors and Health Beliefs
Risk factors are anything that increases the vulnerability of an individual or group to an illness or accident, such as a genetic predisposition to heart disease. Health beliefs are a person's ideas, convictions, and attitudes about health and illness, which can influence their health behaviors.
Stages of Health Behavior Change
During the contemplation stage of the Stages of Health Behavior Change, the client is considering a change within the next 6 months and may be more likely to accept information about diet changes and an exercise program. In the action stage, the client is actively engaged in strategies to change behavior, while in the preparation stage, the client is making small changes in preparation for a change in the next month. In the maintenance stage, the client has sustained the change over time.
External and Internal Variables
External variables that can influence a client's health beliefs and practices include socioeconomic factors, such as income. Internal variables include educational background, religious practices, and emotional factors, such as the reaction to a health condition.
Levels of Prevention
When a paraplegic client is admitted for an electrolyte imbalance, the client is receiving care at the secondary prevention level, which focuses on early diagnosis and prompt treatment as well as disability limitations. Primary prevention focuses on health promotion and specific protection measures, while tertiary prevention focuses on restoration and rehabilitation, such as the care provided by a hospice nurse for a client with lung cancer.
