New User Special Price Expires in

Let's log you in.

Sign in with Facebook


Don't have a StudySoup account? Create one here!


Create a StudySoup account

Be part of our community, it's free to join!

Sign up with Facebook


Create your account
By creating an account you agree to StudySoup's terms and conditions and privacy policy

Already have a StudySoup account? Login here

Final exam review

by: Lauren Potter

Final exam review NURS 3290

Lauren Potter


Preview These Notes for FREE

Get a free preview of these Notes, just enter your email below.

Unlock Preview
Unlock Preview

Preview these materials now for free

Why put in your email? Get access to more of this material and other relevant free materials for your school

View Preview

About this Document

Everything that was on test 1 and 2, and then additional information
Intro to Nursing
Study Guide
50 ?




Popular in Intro to Nursing

Popular in NURSING

This 35 page Study Guide was uploaded by Lauren Potter on Friday August 5, 2016. The Study Guide belongs to NURS 3290 at The University of Texas Medical Branch taught by beckworth in Fall 2016. Since its upload, it has received 8 views. For similar materials see Intro to Nursing in NURSING at The University of Texas Medical Branch.


Reviews for Final exam review


Report this Material


What is Karma?


Karma is the currency of StudySoup.

You can buy or earn more Karma at anytime and redeem it for class notes, study guides, flashcards, and more!

Date Created: 08/05/16
NURS 3290 Introduction to the Profession Final Study Guide Test 1 Focus 1. Review the nursing theorists (Peplau, Leninger, Watson, etc) a. Nightingale’s Environmental Theory: focus in on a patient’s environment that a nurse should manipulate (ventilation, light, decreased noise, hygiene, nutrition) so that nature is able to restore a patient to health b. Peplau’s Interpersonal Theory: interpersonal relations among a nurse, a patient, and a patient’s family and developing the nurse-patient relationship… nurse’s reduce anxiety by converting it into constructive actions… develop therapeutic relationships that are respectful, empathetic and non-judgmental… phases are preorientation (data gathering), orientation (defining issue), working (therapeutic activity), resolution (termination of relationship) c. Orem’s Self-Care Deficit Nursing Theory: nurse continually assesses a patient’s ability to perform self-care and intervenes as needed to ensure that the patients meet physical, psychological, sociological and developmental needs… people who participate in self-care activities are more likely to improve their health outcomes… nursing is necessary when patients are unable to fulfill biological, psychological, developmental or social needs d. Leininger’s Culture Care Theory: human caring varies among cultures in its expressions, processes and patterns… social structures (patient’s politics, culture, traditions) are significant forces affecting care and influencing the patient’s health and illness patterns… major concept – cultural diversity and the goal of nursing care is to provide a patient with culturally specific nursing care… to help provide care to patients of unique cultures, nurses integrate their cultural traditions, values, and beliefs into a plan of care… recognizes importance of culture and its influence on everything that involves a patient (health beliefs, role of family and community, dietary practices) e. Henderson (principles and practice of nursing): nurses assist patients with 14 activities (breathing, eating/drinking, elimination movement/positioning, sleep/rest, clothing, body temperature, hygiene, safety, communication/socialization/play, practice of faith, learning) until patients can meet the needs themselves or have a peaceful death f. Johnson (behavioral system): nurses perceive patients as begin more important than their disease… viewed as a collection of subsystems that form an overall behavioral system focused on meeting basic drives of achievement, affiliation, aggression/protection, dependence, elimination, ingestion, sex, restoration… goal of nursing is to help the patient attain/maintain balance, function and stability in each of the subsystems g. Neuman (systems): nurses view a patient (physical, psychological, sociocultural, developmental, spiritual) as being an open system that is in constant energy exchange with both internal and external environments… help a patient cope with intrapersonal, interpersonal, and extra-personal stressors that can break through the patient’s line of defense and cause illness… role of nursing is to stabilize a patient or situation and focus is on wellness and prevention of disease h. Abdellah (patient centered care): nurses address 21 nursing problems to meet patients’ physical, psychological and social needs and should strive to know each patient… use knowledge constructed from previous experiences to determine a general plan of care and then personalizes the plan to provide patient-centered care… nurse should involve family in plan of care i. Levine (conservation): nurses promote balance between nursing interventions and pt participation to help pts conserve energy needed for healing… conserve structural integrity by limiting the extent of tissue involvement/damage… conserve personal integrity by involving them in their care decision… conserve social integrity by facilitating patient interactions with family and loved ones j. King (goal attainment): nurses view pt as a unique personal system that is constantly interacting/transacting with other systems (nurse, family, friends)… help pts become active participants in their care by working with them to establish goals for attaining, restoring, or maintaining health k. Erickson-Tomlin-Swain (modeling/role-modeling): nurses understand a pt’s model of the world or world view (how the pt thinks, acts, feels, communicates) and help a pt use internal and external resources to make appropriate changes to attain optimal health l. Watson (caring): nurses understand that caring is a fundamental component of professional nursing practice and is based on 10 carative factors… purpose of nursing is to understand the interrelationship among health, illness, and human behavior rather than focus on the disease- cure model… caring occurs when a nurse and pt engage in transpersonal relationship that facilitates that pt’s ability for self-healing m. Rogers/Parse/Newman (unitary beings/human becoming/expanding consciousness): nurses view a pt as a unique, dynamic energy field in constant energy exchange with the environment… nursing care focuses on helping apt use his or her own potential to identify and alter personal rhythms/patterns (eating, breathing, sleeping, communicating, touching) to promote and maintain health… understand that pts are responsible for their own health and that health stems from how pts live their lives in accordance with their own values… nurse’s role is to be truly present with the pt and accepting of his or her view of reality while providing guidance to the patient in making health-related choices in accordance with his or her belief system n. Benner (skill acquisition): nurses progress through 5 stages of skill acquisition (novice, advanced beginner, competent, proficient, expert) o. Kolcaba (comfort): nurses facilitate health-seeking behavior in pts by striving to relieve physical, emotional, social, environmental and/or spiritual distress p. Pender (health promotion): nurses understand that a pt’s personal characteristics, experiences, and beliefs affect his or her motivation for adopting healthy behaviors q. American Association of Critical-Care Nurses (synergy): matching nurse competencies to pt needs in the critical care environment improves pt outcomes r. Mishel (uncertainty in illness): nurses facilitate pt coping and adaptation by performing interventions aimed at helping pts process and find meaning related to their illness s. Eakes, Burke and Hainsworth (chronic sorrow): nurses understand that the disparity between desired and actual reality often leads to continuous cycles of grief 2. Review history of nursing (Wald, Mahoney, etc) a. Florence Nightingale – established first nursing philosophy based on health maintenance and restoration… saw role of nursing as being in charge of somebody’s health… developed first organized program for training nurses (the Nightingale Training School for Nurses in St. Thomas’ Hospital in London)… first practicing nurse epidemiologist (stat analyses connected poor sanitation with cholera and dysentery – mortality rates decreased from 42.7% to 2.2%)… known as “lady with the lamp” b. Clara Barton – founder of American Red Cross c. Mother Bickerdyke – organized ambulance services and walked abandoned battlefields at night looking for wounded soldiers d. Harriet Tubman --- active in the Underground Railroad movement and helped lead over 300 slaves to freedom e. Mary Mahoney – first professionally trained African-American nurse… concerned with the effect culture had on health care and brought forth awareness of cultural diversity and respect for each individual f. Dorthea Dix – superintendent of the female nurses of the Union Army… organized hospitals, appointed nurses and oversaw supply distribution… champion for mental health g. Lillian Wald and Mary Brewster – opened Henry Street Settlement (focused on health needs of poor people who lived in tenements in NYC) h. Lillian Wald – first to demonstrate autonomy in nursing because there were often situations where quick decisive thought was necessary without supervision health care provider i. Linda Richards – first professionally trained American nurse… established nursing training programs in the US and Japan… creased the first system for keeping individual medical records for hospitalized pts j. Mary Adelaide Nutting – first nursing professor at Columbia Teacher’s College in 1906… was instrumental in moving nursing education into universities k. Loretta Ford and Henry Silver – created first NP program l. 20 century: Army and Navy Nurse Corps were established m. By 1920s nursing specialization began… graduate nurse-midwifery programs began… in last half of century, specialty-nursing organizations were created n. 21 century: nursing practice and school curricula are changing to meet needs of society (including aging population, bioterrorism, emerging infections, disaster management) 3. Review the Essentials for Baccalaureate Education and the Differentiated Essential Competencies. a. Solid base in liberal education provides the cornerstone for the practice and education of nurses… knowledge and skills in leadership, quality improvement and pt safety are necessary to provide high quality health care… professional nursing practice is grounded in the translation of current evidence into one’s practice… knowledge and skills in information management and pt care technology are critical in the delivery of quality pt care… healthcare policies (including financial and regulatory) directly and indirectly influence the nature and functioning of the healthcare system and thereby are important considerations in professional nursing practice… communication and collaboration among healthcare professionals are critical to delivering high quality and safe pt care… health promotion and disease prevention at the individual and population level are necessary to improve population health and are important components of baccalaureate generalist nursing practice… professionalism and the inherent values of altruism, autonomy, human dignity, integrity, and social justice are fundamental to the discipline of nursing… the baccalaureate graduate nurse is prepared to practice with pts, including individuals, families, groups, communities, and populations across the lifespan and across the continuum of healthcare environments… the baccalaureate graduate understands and respects the variations of care, the increased complexity, and the increased use of healthcare resources inherent in caring for pts 4. Review the ATI nurse logic clinical reasoning and issues for referrals. 5. Review the laws (civil & common) and examples of what a nurse should not commit (assault, battery, etc) a. Statutory law: created by elected legislative bodies (state legislatures and US congress) i. Ex – Nurse Practice Acts: describe and define the legal boundaries of nursing practice within each state… defines the scope of nursing practice and expanded nursing roles, sets education requirements for nurses, and distinguishes between nursing and medical practice ii. Either civil or criminal law 1. Civil law: protect the rights of individuals and provide for fair and equitable treatment when civil wrongs or violations occur a. Ex – nursing negligence or malpractice b. Consequences: fines or specific performance of good works (public service) 2. Criminal law: protect society as a whole and provide punishment for crimes… defined by municipal, state and federal legislation… separated into misdemeanors or felonies a. Misdemeanor: crime that causes injury but does not inflict serious harm i. Ex – parking in a no-parking zone ii. Consequences: penalty of monetary fine, forfeiture, or brief imprisonment b. Felony: serious offense that results in significant harm to another person or society in general i. Ex – misuse of a controlled substance or practicing without a license ii. Consequences: penalties of monetary restitution, imprisonment for greater than 1 year, death b. Regulatory law: aka administrative law… reflects decisions made by administrative bodies (State Boards of Nursing) when rules and regulations are passed i. Ex – requirement to report incompetent or unethical nursing conduct to the State Board of Nursing c. Common law: results from judicial decisions made by courts when individual legal cases are decided i. Ex – informed consent, pt’s right to refuse treatment, negligence, malpractice ii. Nursing practice is also regulated by common law of torts (civil wrongful acts or omissions made against a person or property)… classified by intentional, quasi-intentional or unintentional 1. Intentional torts: deliberate acts that violate another’s rights a. Assault: intentional threat toward another person that places the person in reasonable fear of harmful, imminent, or unwelcome contact… no actual contact is required b. Battery: intentional offensive touching without consent or lawful justification… contact can be harmful and cause an injury or be offensive to the pt’s dignity… results if the health care provider performs a procedure that goes beyond the scope of a patient’s consent (but in some situations it’s implied) c. False imprisonment: occurs with unjustified restraint of a person without a legal reason… requires that the pt be aware of the confinement 2. Quasi-intentional torts: acts in which intent is lacking but volitional action and direct causation occur a. Invasion of privacy: protects a pt’s right to be free from unwanted intrusion into his or her private affairs… pt must authorize the release of information and designate to whom the health care information may be released b. Defamation of character: publication of false statements that result in damage to a person’s reputation i. Slander: occurs when one speaks falsely about another ii. Libel: written defamation of character 3. Unintentional torts a. Negligence: conduct that falls below the generally accepted standard of care of a reasonably prudent person… establishes the standard of care to protect others against an unreasonably great risk… ex: hanging the wrong IV b. Malpractice: aka professional negligence… type of negligence… certain criteria must be met: nurse owed a duty of care to the pt; nurse did not carry out or breached that duty; pt was injured; nurse’s failure to carry out the duty caused the injury… nursing malpractice: failure to use that degree of skill or learning ordinarily used under the same or similar circumstances by members of the nursing profession 6. Review the BON a. Membership i. 13 members (6 nurses – 1 advanced practice nurse, 2 RNs, 3 vocational nurses… 3 members who are nurse faculty members of schools of nursing – 1 from a BSN program, 1 from an ADN program, 1 from a higher education school preparing vocational nurses… 4 members of the public) b. Authority i. Appointed by the governor with the advice and consent of the senate c. RN licensure i. Graduate from an approved school, successfully take the NCLEX- RN exam, pass Texas nursing jurisprudence examination prior to being issued a permanent license, criminal background check ii. There are bars to licensure, but most depend on the situation (ex: misdemeanor, felony, arrested, etc.) d. Scope of practice i. Defined by NPA… professional nursing: performance of an act that requires substantial specialized judgment and skill, the proper performance is based on knowledge and application of the principles of biological, physical and social science as acquired by a completed course in an approved school ii. Basically you know exactly what you’re able to do with your license iii. Ex: perform comprehensive nursing assessment, making nursing diagnoses, develop a plan of care based on the assessment and nursing diagnosis, and delegate tasks to unlicensed personnel in compliance e. Standards of nursing practice i. Standards of care: legal requirements for nursing practice that describe minimum acceptable nursing care… standards reflect knowledge and skill ordinarily possess and used by nurses actively practicing in the profession ii. Found in ANA (2010) which outlines the scope, function and role of the nurse in practice iii. Failure to meet standards may result in action against the nurse’s license f. Unprofessional conduct i. Rules are designed to protect clients and public from incompetent, unethical or illegal conduct of a nurse ii. Rules are to identify unprofessional or dishonorable behavior of a nurse the board believes are likely to “deceive, defraud or injure client to the public” iii. Ex: improper management of a client’s records, inability to practice safely, falsifying reports, violating professional boundaries g. Delegation i. 5 rights: right task, right circumstances, right person, right direction/communication, right supervision/evaluation h. Nurse Practice Act i. Nurse Practice Acts: describe and define the legal boundaries of nursing practice within each state… defines the scope of nursing practice and expanded nursing roles, sets education requirements for nurses, and distinguishes between nursing and medical practice 7. Review Healthy People 2020 a. Created to establish ongoing health care goals… strives to ensure that it is relevant to diverse public health needs and seizes opportunities to achieve its goals… broad-based, public engagement initiative with thousands of citizens helping to shape it at every step along the way… overall goals are to increase life expectancy and quality of life and eliminate health disparities through improved delivery of health care services b. Promotes a society in which all people live long, healthy lives c. Overarching goals: attain high-quality, longer lives free of preventable disease, disability, injury and premature death; achieve health equity, eliminate disparities and improve the health of all groups; create social and physical environments that promote good health for all; promote quality of life, healthy development, and healthy behaviors across all life stages 8. Review the models of health & illness. a. Health belief model: addresses the relationship between a person’s beliefs and behaviors… Rosenstoch (1974) and Becker and Maiman’s (1975)… helps you understand factors influencing pt’s perceptions, beliefs and behavior to plan care that will most effectively help pts maintain or restore health and prevent illness… first component involves an individual’s perception of susceptibility to an illness… second component is an individual’s perception of the seriousness of the illness (influenced and modified by demographic and sociopsychological variables, perceived threats of the illness, and cues to action)… third component is the likelihood that a person will take preventive action (results from pt’s perception of the benefits of and barriers to taking action) b. Health promotion model: designed to be a complementary counterpart to the models of health protection... Pender (1996)… defines health as a positive, dynamic state, not merely the absence of disease… health promotion is directed at increasing a pt’s level of well-being… describes the multidimensional nature of people as they interact within their environment to pursue health… focuses on: individual characteristics and experiences; behavior-specific knowledge and affect; behavioral outcomes in which the pt commits to or changes a behavior… health promoting behaviors is the desired behavioral outcome and the end point in HPM c. Maslow’s Hierarchy of Needs: model that nurses use to understand the interrelationships of basic human needs… certain human needs are more basic than other needs… self-actualization is the highest expression of one’s individual potential and allows for continual self-discovery… takes into account unique individual experiences… provides a basis for nurses to care for pts of all ages in heath setting… emergent physiological need takes precedence over a higher-level need… important to not assume needs of pt d. Holistic Health Models: attempts to create conditions that promote a pt’s optimal level of health… nurses using the nursing process consider pts to be the ultimate experts concerning their own health and respect pt’s subjective experience as maintaining health or assisting in healing… pts are involved in their healing process assuming responsibility… recognize the natural healing abilities of the body and incorporate complementary and alternative interventions (mediation, music therapy, reminiscence, relaxation therapy, therapeutic touch, guided imagery)… use holistic therapies either alone or in conjunction with conventional medicine 9. Review living will, advanced directives, durable power of attorney, & do not resuscitate. a. Living will: represent written documents that direct treatment in accordance with a pt’s wishes in the event of a terminal illness or condition… pt is able to declare which medical procedures he wants or doesn’t want when terminally ill or in a persistent vegetative state b. Durable power of attorney for health care (DPAHC): legal document that designates a person or people of one’s choosing to make health care decisions when a pt is no longer able to make decisions on his or her own behalf c. DNR: “do not resuscitate” or “no code” order… health care provider needs to review DNR orders routinely in case the pt’s condition demands a change d. CPR: emergency treatment provided without pt consent… is performed unless there is a DNR order in the pt’s chart 10.Review informed consent and witnessing a consent. a. Consent is necessary for admission to a health care agency, invasive procedures (IV central line insertion), surgery, some treatment programs (chemo), participation in research studies… it is a pt’s right to refuse care or treatment b. Informed consent: patient’s agreement to have a medical procedure after receiving full disclosure of risks, benefits, alternatives, consequences of refusal… requires a health care provider to disclose information in terms a pt is able to understand to make an informed choice… failure to obtain consent in situations (other than emergencies) can result in a claim of battery… bc nurses don’t perform surgeries or direct medical procedure’s obtaining doesn’t fall within the nurse’s responsibility (person responsible for performing the procedure is responsible for obtaining the informed consent)… key elements: pt receives an explanation of the procedure or treatment; the pt receives names and qualifications of people performing and assisting in the procedure; pt receives a description of the serious harm that may occur as a result of the procedure and anticipated pain/discomfort; pt receives an explanation of alternatives therapies and the risks of doing nothing; pt knows that he has the right to refuse without discontinuing other supportive care; pt knows that they can refuse even after the procedure has begun c. The nurse’s signature as a witness to the consent means that the pt voluntarily gave consent, the pt’s signature is authentic, and the pt appears to be competent to give consent… when giving the pt the consent form, the nurse must ask the pt if they understand the procedure 11.Review primary, secondary, and tertiary care. a. Primary prevention: true prevention… precedes disease or dysfunction and is applied to pts considered physically and emotionally healthy i. Aimed at health promotion includes health education activities, immunizations, nutritional programs, physical fitness activities ii. Includes all health promotion efforts and wellness education activities that focus on maintaining or improving the general health of individuals, families and communities iii. Includes specific protection (immunizations and hearing protection) b. Secondary prevention: focuses on individuals who are experiencing health problems or illnesses and are at risk for developing complications or worsening conditions i. Activities are directed at diagnosis and prompt intervention to reduce the severity and enable the pt to return to a normal level of health as early as possible ii. Happens in homes, hospitals or skilled nursing facilities iii. Includes screening techniques and treating early stages of disease to limit disability by averting or delaying the consequences of advanced disease 1. Screening is a key opportunity for health teaching as a primary prevention intervention c. Tertiary prevention: occurs when a defect or disability is permanent and irreversible i. Involves minimizing the effects of long-term disease or disability by interventions directed at preventing complications and deterioration ii. Care helps pts achieve as high a level of functioning as possible, despite limitations caused by illness or impairment 12.Review: a. HIPPA i. Federal legislation that mandates confidentiality about and protection of patients’ personal health information… defines the rights and privileges of pts for protection and privacy… creates pt right to consent to the use and disclosure of their protected health information, to inspect and copy one’s medical record, and to amend mistaken or incomplete information… limits who is able to access a pt’s record… establishes basis for privacy and confidentiality concerns ii. Privacy: right of pts to keep personal information from being disclosed iii. Confidentiality: protects private pt information once it is disclosed in health care settings b. Nursing Code of Ethics i. Code of ethics: set of guiding principles that all members of a profession accept… collective statement about the group’s expectations and standards of behavior ii. ANA established the first code of nursing ethics decades ago… it is reviewed and revised periodically iii. Main principles: responsibility, accountability, advocacy and confidentiality 1. Advocacy: support of a particular cause a. Nurses advocate for pt’s health, safety, and rights 2. Responsibility: willingness to respect one’s professional obligations and to follow through 3. Accountability: refers to the ability to answer for one’s actions 4. Confidentiality: act of keeping information private or secret… information is only shared with other nurses or health care providers who need to know private information about a pt to provide care for c. Moral dilemma i. A part of Kohlberg’s theory of moral development… moral reasoning develops in response to a series of moral dilemmas… six stages of moral development under three levels d. Deontology i. Defines actions as right or wrong on the basis of their “right- making characteristics” such as fidelity to promises, truthfulness and justice… does not look at consequences of actions to determine right or wrong ii. Looks to the presence of principles regardless of outcome e. Principalism i. Aka ethical principles ii. Emphasizes for ethical principles (autonomy, beneficence, non- malificence, and justice) which most ethical theories share and blends with virtues and practical wisdom… attempt to bring together the best elements of ethical theories which are compatible with most societal, individual or religious belief systems f. Utilitarianism i. Relies on the application of a certain principle (measures of “good” and “greatest”) ii. Measures the effect that an act will have g. Virtue i. Moral excellence… trait or quality deemed to be morally good and thus valued as a foundation of principle and good moral being h. Fidelity i. Refers to the agreement to keep promises… as a nurse you keep promises by following through on your actions and interventions i. Justice i. Refers to fairness… most often used in discussions about access to health care resources, including the just distribution of scarce resources… issues of justice: discussion about health insurance, hospital locations and services, organ transplants j. Beneficience i. Refers to taking positive action to help others… principle is fundamental to the practice of nursing and medicine… agreement to act with beneficence implies that the best interests of the pt remain more important than self-interest k. Non-maleficence i. Refers to the avoidance of harm or hurt… ethical practice involves not only the will to do good but the equal commitment to do no harm… a health care professional tries to balance the risks and benefits of care while striving at the same time to do the least harm possible l. Autonomy i. Refers to freedom from external control… concept applies to provider respect for the autonomy of pts m. WHO (World Health Organization) i. Specialized agency of the UN that is concerned with international public health… established in 1948 ii. Played a leading role in the eradication of smallpox… current priorities: communicable diseases (HIV/AIDS, Ebola, malaria, TB) iii. Responsible for the World Health Report (leading international publication on health), worldwide World Health Survey, and World Health Day (April 7) n. Accountability i. Refers to the ability to answer for one’s actions… ensure that your professional actions are explainable to your pts and your employer ii. Institutions exercise accountability by monitoring individual and institutional compliance with national standards  TJC o. Knowledge worker i. Workers whole main capital is knowledge… a person whose job involves handling or using information Test 2 Focus 1) Ethics – Chapter 22: pages 286-295 a) What is morality? i) Principles concerning the distinction between right and wrong or good and bad behavior ii) Determined by whether an action was done according to impartial, objective principle… conformity to ideals of right human contact b) What is ethics, morals, values? i) Ethics: the study of the moral principles of our interaction with other people (1) Concerned with determining what is good or valuable for individuals and society at large… commitment to standards ii) Morals: conduct or behavior of person which reveals values or assumptions about good and evil… in according with principles of right and wrong behavior iii) Values: personal beliefs about the worth of a given idea, attitude, custom, or object that sets standards that influence behavior (1) The values that an individual holds reflect cultural and social influences… vary among people and develop/change over time (2) Value formation begins in childhood and is shaped by experiences (3) To negotiate differences of values, it is important to be clear about your own values: what you value, why, and how you respect your own values, even as you try to respect those of others whose values differ from yours (a) This process helps you to explore values and feelings and decide how to act on personal beliefs and respect the values of others c) What is a code of ethics? ANA, ICN codes i) Code of ethics: formal statement of a group’s ideals and values… is a set of ethical principles that: (1) Are shared by members of the group (2) Reflects their moral judgements over time (3) Serves as a standard for their professional actions (4) Includes advocacy, responsibility, accountability and confidentiality ii) ANA: nurse practices with compassion and respect for the inherent dignity, worth and unique attributes of every person; primary commitment is to the pt, whether an individual, family, group, community, population; nurse promotes, advocates for, and protects the rights, health and safety of pt; nurse has authority, accountability and responsibility for nursing practice… makes decisions and takes action consistent with the obligation to promote health and to provide optimal care iii) ICN codes: has four elements  the nurse and people, the nurse and the practice, the nurse and the profession, the nurse and co-workers iv) Common theme of ANA and ICN codes: focus on the importance of nurses’ delivering compassionate pt care aimed at alleviating suffering… nurses support pt self-determinations… interests of organization must not be put above pt d) What is accountability? i) Ability to answer for one’s actions… actions are explainable to your pts and employer… TJC plays a part in monitoring individual and institutional compliance with national standards e) What is the ethical decision making process? How should it start? i) Ethical decision making process are similar to the nursing process… deals with dilemmas and conflicts… uses a team approach… care-based approach using four topics method (medical indications, pt preferences, QOL, contextual features) ii) Steps: (1) Clarify the ethical dilemma (what is the exact problem? What values of the pt related to issue? (2) Gather additional data (may need to check legal cases) (3) Identify options (most have several possible solutions… more available, the more likely one will be acceptable) (4) Make a decision (think through options and their impact) (5) Act (carry out the decision) (6) Evaluate (determine the short and long term consequences) f) What is moral distress? Identify situations where it might occur. i) Moral distress: pain or anguish of a person who unwillingly participates in perceived moral wrongdoing (1) Occurs when you know the ethically appropriate action to take, but you are unable to act upon it or you act in a manner contrary to your personal and professional values, undermining your integrity and authenticity (2) Causes suffering, may lead to burnout, and may result in resignation if left unresolved… groups of people that work together in situations that cause distress may experience poor communication, lack of trust, high turnover rates, defensiveness, and lack of collaboration across disciplines ii) Sources of moral distress: end-of-life challenges, nurse-physician conflict, disrespectful interactions, workplace violence, and other ethical dilemmas (1) Sources may be personal, interpersonal, and/or environmental g) Know the ethical theories and the ethical principles and how they are applied. (Utilitarianism, beneficence, justice, veracity, etc.) Be able to identify situations when these would be applied. i) Utilitarianism: looks at consequences of action to judge if it is right or wrong… do the most good with the least harm (1) Consequence-based theory (2) Applied in ED, disaster situations, and how to spend financial resources ii) Deontology: involves logical and formal processes… emphasizes individual rights, duties, and obligations… morality of action is judged by whether it was done according to impartial, objective principle… doing ones duty or obligations to others (1) Principle-based theory (2) Deontological thinking is based on the idea that we have a duty to do certain things and to not do certain things (3) For example, if a nurse doesn’t lie, a nurse may believe she should tell the truth to a dying patient even though the family doesn’t wish to iii) Virtue ethics: judges a person by his character rather than by an action that may deviate from his normal behavior… stresses courage, generosity, honesty, commitment… judge acts according to caring and responsibility (1) Relationship-based theory iv) Autonomy: people have the right to make their own decisions… each pt is unique and has the right to make personal choices about healthcare v) Beneficence: “doing good” … nurses are obligated to do actions that benefit pt… by doing this she could put the pt in harm (advise pt about exercise program to improve general health, but shouldn’t advise if the pt is at risk of a MI) vi) Non-maleficence: “do no harm” … this can be complex (1) Holding an arm of a pt who is falling and leaving a bruise vii)Fidelity: honoring one’s commitment and being faithful to agreements and promises (1) Used when a nurse tells a pt she will “be right back with pain med” and comes back viii) Veracity: telling the truth ix) Justice: actions that are fair to those involved… equal and fair distribution of resources based on analysis of benefits and burdens of decision (1) In US, we all have rights to services from postal service, firefighters, police, and access to public schools, safe water, and sanitation x) Values: enduring beliefs or attitudes about the worth of something (1) Ex: abortions xi) Beliefs: interpretations or conclusions that people accept as true (1) Ex: Santa Clause, life after death xii)Attitudes: mental positions or feelings toward a person, object, or idea h) Know about Kohlberg’s theory of moral development. i) Level 1: preconventional reasoning – limited cognitive thinking and an individual’s thinking is mainly egocentric… thinking is mostly based on likes and pleasures… view illnesses as punishment for fighting with siblings or disobeying parents (1) Stage 1: punishment and obedience orientation – child’s response to a moral dilemma is in terms of absolute obedience to authority and rules… avoiding punishment is characteristic motivation to behave (2) Stage 2: instrumental relativist orientation – child recognizes that there is more than one right view… decision to do something morally right is based on satisfying one’s own needs or the needs of others (occasionally)… child perceives punishment not as proof of being wrong, but of something they want to avoid ii) Level 2: conventional reasoning – person sees moral reasoning based on his own personal internalization of societal and others expectations… “what’s in it for me” attitude… person wants to fulfill the expectations of the family, group, or nation and also develop a loyalty to and actively maintain, support, and justify the order… nurses see this when family members make end-of-life decisions for loved ones (1) Stage 3: good boy-nice girl orientation – individual wants to win approval and maintain expectations of one’s immediate group… one earns approval by “being nice” (2) Stage 4: society-maintaining orientation – moral decisions take into account societal perspectives… right behavior is doing one’s duty, showing respect for authority and maintaining social order iii) Level 3: postconventional reasoning – finds a balance between basic human rights and obligations and societal rules and regulations… move away from moral decisions based on authority/conformity to groups to define their own moral values and principles… start to look at what an ideal society would be like (1) Stage 5: social contract orientation: follows societal law but recognizes the possibility of changing the law to improve society… recognizes that different social groups have different values but believes that all rational people agree to basic rights (liberty and life) … US constitution is based on this morality (2) Stage 6: universal ethical principle orientation: defines “right” by the decision of conscience in accord with self-chosen ethical principles… principles are abstract and appeal to logical comprehensiveness, universality, and consistency… civil disobedience distinguishes stage 5 from 6 (in 5 a person follows a law even if it isn’t fair to a certain racial group and in 6 a person may not follow if it doesn’t seem just to the racial group) i) What is informed consent? i) Process of obtaining permission from a pt to perform a specific test or procedure after describing all risks, side effects, and benefits j) How is the concept of client advocacy incorporated into the study of ethic? i) Advocacy is the support of a particular cause ii) Nurses advocate for health, safety, and rights of pts, including right to privacy and right to refuse treatment… have a special relationship with pt gives a unique understanding of a pt’s POV 2) Patient-Centered Care – Chapters 7, 9 & 24 a) What is patient centered care? i) Includes multiple factors and activities ii) Support of pt-centered care: (1) IOM rules for redesigning pt care: (a) Based on continuous health relationships (b) Care is customized (c) Patient is source of control (d) Knowledge is shared (i) Managed care plans are a way of compensating for providers b) What are the components of patient centered care? i) Identify, respect, and care about pts’ differences, values, preferences, and needs ii) List to and communicate with pt iii) Share decision-making iv) Advocate disease prevention and health promotion (1) Healthcare provider should talk WITH the patient not AT the patient (2) Be centered around mutuality c) Why would the IOM make patient centered care a core competency for health professionals and what are their rules for redesign of patient care? i) Primary drivers: (1) Leadership – focused on pt and family (2) Hearts and minds – fully engaged in commitment to pt-centered care (3) Respectful partnership with pt (4) Reliable care – focus on quality (5) Evidence-based care ii) Core elements: (1) Education (2) Involvement of family and friends (3) Collaboration (4) Sensitivity to spirituality and nonmedical issues (5) Respect for pt needs/preferences (6) Accessibility of information d) Know some of the major theorists: i) Watson’s theory on caring (1) Watson’s theory: defined nursing as the science of caring (2) Nurse-patient relationship (3) Four aspects of offering self: intellectual, psychological, spiritual and physical aspects the nurse possesses (4) Caring among nurse, environment, and pt is essential to healing (5) Holistic outlook addresses the impact and importance of altruism, sensitivity, trust, and interpersonal skills ii) Orem’s self-care theory (1) Facilitates pt self-care by measuring the pt’s deficit relative to self-care needs (2) Nurse implements appropriate measures to assist the pt in meeting needs by matching with an appropriate supportive intervention iii) Leininger’s cultural diversity theory (1) Explored interpersonal relationship of the nurse and pt (2) Identified the pt’s feelings as a predictor of positive outcomes r/t health and wellness (3) Identified phases of nurse-pt relationship (4) Leininger states that caring is the essence of nursing and unique to nursing (a) Care is essential to curing and healing, for there can be no curing without caring (b) Every human culture has lay (generic, folk or indigenous) care knowledge and practices and usually some professional care knowledge and practices (vary transculturally) (c) Culture care values, beliefs, and practices are influenced by and tend to be embedded in the worldview, language, philosophy, religion and spirituality, kinship, social, political, legal, educational, economic, technology, ethnohistorical and environmental contexts of cultures (d) A pt who experiences nursing care that fails to be reasonably congruent with his beliefs, values, and caring life-ways will show signs of cultural conflict, noncompliance, stress and ethical or moral concern iv) Peplau’s interpersonal relations theory (1) Culturally congruent nursing care leads to health and well-being for the pt (2) Planning nursing care based on knowledge that is culturally defined (3) Culture impacts all aspects of human life (4) Caring is the central theme of nursing care, knowledge, and nursing practice e) What is culture? What is cultural self-awareness? i) Culture is a pattern of learned behavior and values that are reinforced through social interactions of members of a particular group… the sum total way of living… includes values, beliefs, standards, language, thinking patterns, behavioral norms, communication styles, etc.… guides decisions and actions of a group through time (1) Culture groups are those related to religion, ethnicity, national origin, gender, age, education, educational status, mobility (2) Culture of Western Medicine (very different than other cultures’ medicine) (a) Meliorism – make it better (we tend to want to fix the problem ASAP and make the pain/illness go away) (b) Dominance over nature – do something and take control (we believe that medical practices can control the illness through medical practice) (c) Activism – do something (take an active role in treatment) (d) Timeliness – sooner than later (e) Therapeutic aggressiveness – stronger = better (f) Future orientation – plan, newer = better (research is done to develop new treatments and medicine) (g) Standardization – treat similar the same (standard protocols) ii) Cultural competence: culture may guide the pt’s response to healthcare providers and their interventions (1) To be culturally competent: have an awareness of your own values and beliefs (2) To begin development of cultural competence: do a cultural self- assessment and low at your own unique heritage f) Know these terms: i) Acculturation: process of adapting to and adopting a new culture ii) Assimilation: to become absorbed into another culture and adopt its characteristics iii) Ethnocentricism: tendency to hold one’s own way of life as superior to that of others iv) Cultural competence (1) A set of congruent behaviors, practices, attitudes and policies that come together in a system or agency or among professionals, enabling effective work to be done in cross-cultural situations (a) Knowledge of a pt’s culture directs the nurse in understanding behaviors and planning appropriate approaches to problems (b) Key is to develop awareness of culture… will increase as you increase knowledge… polish skills through cross-cultural encounters (c) Acquiring: starts with awareness, grows with knowledge, enhanced with specific skills, polished through cross-cultural encounters v) Ethnicity: shared identity r/t social and cultural heritage such as values, language, geographical space, and racial characteristics g) What is transcultural nursing? What is the mission of the Transcultural Nursing Society i) Founded by Dr. Madeleine Leininger ii) Mission: enhance the quality of culturally congruent, competent and equitable care that results in improved health and well being for people worldwide iii) Goals: to advance cultural competence for nurses worldwide, to advance the scholarship (substantive knowledge) of the discipline, and to develop strategies for advocating social change for cultural competent care h) How should nurses approach patients of different cultures? i) Culture is something we all share. Everyone has a unique cultural background. Culture is a pattern of learned behavior and values that are reinforced through social interactions of members of a particular group ii) Different countries and their cultural signs: (1) United States (a) Direct eye contact in social and business settings is very important. Gaps in conversation are uncomfortable. While dining, left hand is placed in lap, and right hand is used to eat with. Wrists are permitted on the table (while at a meal), but elbows are not. (b) By either raising the index finger or the hand (facing palm up) and waggling the finger(s) back toward the body means to beckon for someone. (c) Insulting gestures are the middle finger trust and forearm jerk. (d) Lines are treated with respect. (e) Extending the arm, palm facing down and waving the hand up and down at the wrist (f) It is proper to use a firm handshake with direct eye contact. (g) Women may briefly hug other women, and men may quickly kiss the cheek of a woman. (2) Canada (a) It is polite to maintain good eye contact. Men rise when women enter the room. It is considered bad manners to eat while on the street. (b) No excessive gesturing. (c) People stand about a half-meter apart when conversing. (d) Women greet with a slight nod. (e) Men greet with a firm handshake. (3) Mexico (a) Hands on hips is a sign of hostility. (b) Patience is important. (c) Women (initiate the handshake) and men greeting with a warm and soft handshake. (d) With friends, men greet with the abrazo, a slight hug with a few pats on the back; women lightly hug and pretend to kiss the cheek. (4) Chile (a) Men rise when women enter the room. (b) Yawns should be stifled or covered. (c) Wine must be poured with the right hand. (d) Holding the palm upward and then spreading the fingers signals that someone is stupid. (5) Columbia (a) To suggest that someone is stingy, tap the underside of the elbow with the fingers of the other hand. (b) Place the knife and fork horizontally across the plate when you are finished eating. (c) Women hold forearms instead of shaking hands. (6) Iran (a) Remove shoes when entering a home or mosque. (b) To signal to someone, put your hand out with your palm down, and curl your fingers in a scratching motion. (c) The thumbs up sign is vulgar. (d) To signal yes, dip your head down with a slight turn. To signal no, move your head up and back sharply. (e) Shaking hands with a child shows respect toward the parents. (7) Israel (a) People stand close, and friends will touch while conversing. (b) Point down at the upturned palm of one hand with the forefinger of the other hand; this means that "grass will grow on my hand" before what has been said will happen. (c) There are warm handshakes. (8) Lebanon (a) To signal that someone is a homosexual, lick the little finger and brush it across the eyebrow. (b) People of the same gender stand closer together. (c) Raising a closed fist into the air is making a rude gesture. (d) To nod your head means yes. To signal no, point your head sharply upward and raise your eyebrows. (9) Saudi Arabia (a) Women are not allowed to drive. (b) Avoid showing the sole of the shoe; it is considered the lowest and dirtiest part of the body. (c) It is not proper to expose bare shoulders, stomach, or legs. (d) It is disrespectful to cross legs. To place the palm down, fingers spread, with your index finger bent down and pointing outward is to insult someone. (e) Elders tend to greet by saying, Salaam; men greet with a hug and a cheek kiss. Veiled women are not introduced. (10) Nigeria (a) Respect punctuality. Sometimes important guests are greeted with applause. (b) Wink at children to signify them to leave the room. (c) A vulgar sign is to hold the hand forward at shoulder or head level, with the fingers spread. (11) Zimbabwe (a) Applauding denotes appreciation and politeness. (b) It is rude to maintain eye contact. (c) Women and girls may often curtsey in greeting. (12) Australia (a) Men do not express emotions. Cover your mouth when yawning, and then say, Excuse me. Good sportsmanship is highly respected. (b) By turning the glass upside down and placing the glass squarely on the bar, you are saying that you can win a fight against anyone at the bar. (13) Japan (a) Listening is a sign of politeness. When you receive the business card from the Japanese host, be sure to examine it carefully and avoid quickly putting it away. Place it on the table in front of you for further reference. (b) The ok sign is a money sign in Japan. (c) Waving a hand, palm outward, in front of your face conveys, I don’t understand or I don’t deserve this. (14) China (a) People stand extremely close when conversing. (b) Surprise is expressed with a quick and loud inhalation of air. (c) Silence is respected. (d) Hosts will often refuse a gift many times before acceptance; this is proper. (e) Greeting is usually just a slight nod and bow. Sometimes people will applaud; this should be responded with applause. (15) England (a) To signal a waiter for the bill, make a motion with both hands of signing your name on a paper. (b) Privacy is very important; do not stare. (c) Tipping at bars is rare. (d) The victory sign with your palm facing in is considered vulgar. (e) Never cut in line. (16) France (a) Eat sandwiches and fruit with a knife and fork. (b) The ok sign means, zero. (c) To indicate someone is drunk, form a circle with your thumb and forefinger and place it over your nose. (d) Chewing gum, yawning, scratching, having loud conversations, and resting feet on furniture are all considered rude. (e) To make a vulgar gesture, snap the fingers of both hands, or slap an open palm over a closed fist. (17) Spain (a) It is proper for men to cross their legs; it is considered unfeminine for women to. Eye contact may denote romantic interest. (b) Stretch your arm out, with your palm downward, and make a scratching motion toward your body with the fingers to beckon for someone. (c) The ok sign is obscene. (d) Both men and women use the abrazo to greet; women may accompany that with a check kiss. 3) Therapeutic Communication a) How does a nurse demonstrate a nonjudgmental attitude? i) Nurses acknowledge all pts’ rights to be different and express these differences ii) Nurse conveys acceptance to pts b) What are the phases of the nurse-patient relationship and what happens in each phase? i) Orientation phase – introductory phase – “getting to know you” (1) Begins the development of trust (2) Four tasks: (a) Trust enables participation in the relationship (b) Each other as individuals (c) Identification of major problems and needs (d) Approximate length of the relationship will be estimated ii) Working phase – accomplishes tasks toward goals (1) Nurse and pt tackle tasks outlined in phase 1 (2) Pts may exhibit alternating periods of intense effort and periods of resistance to change (3) Regression in an ego defense mechanism that occurs as a reaction to stress (4) Regression often precedes positive change iii) Termination phase – ends the relationship constructively (1) Nurse and pt take on those activities that enable them to end the relationship in a therapeutic manner (2) Positive and negative feelings often accompany the termination process (a) Positive feelings about gains made (b) Negative feelings of sadness, anger, fear (i) Must be discussed toward acceptance c) What is therapeutic use of self? d) Recognize and utilize the techniques of therapeutic communication and what would block communication. Refer to the handouts on Techniques of Therapeutic Communication and Barriers to Effective Communication 4) Care of Self: Stress Management, Burnout – Chapter 37 a) What is stress? i) Stress: process beginning with an event that evokes a degree of tension or anxiety… as stress increases, there is an increased risk for infection, high BP, diabetes, cancer ii) Stressors: tension producing stimuli operating within or on any system (1) Nurses need to recognize S&S of stressors and how they impact nurse, pt, and pt family iii) Positive stress: stimulates thinking process, helps people stay alert to their environment, can result in personal growth and development iv) Negative stress: lack of coping mechanisms, loss of emotional balance, crisis results v) Types: work, family, daily hassles, trauma (PTSD, STS), crisis (developmental, situational – illness, adventitious – disasters) vi) Anxiety: a feeling of worry, nervousness, or unease, typically about an imminent event of something with an uncertain outcome b) What are the stages of general adaptation syndrome


Buy Material

Are you sure you want to buy this material for

50 Karma

Buy Material

BOOM! Enjoy Your Free Notes!

We've added these Notes to your profile, click here to view them now.


You're already Subscribed!

Looks like you've already subscribed to StudySoup, you won't need to purchase another subscription to get this material. To access this material simply click 'View Full Document'

Why people love StudySoup

Jim McGreen Ohio University

"Knowing I can count on the Elite Notetaker in my class allows me to focus on what the professor is saying instead of just scribbling notes the whole time and falling behind."

Jennifer McGill UCSF Med School

"Selling my MCAT study guides and notes has been a great source of side revenue while I'm in school. Some months I'm making over $500! Plus, it makes me happy knowing that I'm helping future med students with their MCAT."

Bentley McCaw University of Florida

"I was shooting for a perfect 4.0 GPA this semester. Having StudySoup as a study aid was critical to helping me achieve my goal...and I nailed it!"

Parker Thompson 500 Startups

"It's a great way for students to improve their educational experience and it seemed like a product that everybody wants, so all the people participating are winning."

Become an Elite Notetaker and start selling your notes online!

Refund Policy


All subscriptions to StudySoup are paid in full at the time of subscribing. To change your credit card information or to cancel your subscription, go to "Edit Settings". All credit card information will be available there. If you should decide to cancel your subscription, it will continue to be valid until the next payment period, as all payments for the current period were made in advance. For special circumstances, please email


StudySoup has more than 1 million course-specific study resources to help students study smarter. If you’re having trouble finding what you’re looking for, our customer support team can help you find what you need! Feel free to contact them here:

Recurring Subscriptions: If you have canceled your recurring subscription on the day of renewal and have not downloaded any documents, you may request a refund by submitting an email to

Satisfaction Guarantee: If you’re not satisfied with your subscription, you can contact us for further help. Contact must be made within 3 business days of your subscription purchase and your refund request will be subject for review.

Please Note: Refunds can never be provided more than 30 days after the initial purchase date regardless of your activity on the site.