Exam 1- Nursing Concepts

Therapeutic Process
desirable and beneficial
-assists idividuals to promote health, prevent illness, and cope with death

what is nursing?
-both an art and a science
-a discipline with a unique body of knowldge upon which diagnosis and treatment decisions are made
-critical thinking approach (nursing process)

What roles do nurses take on?
caregiver, manager, and a teacher of healthcare

Humanities in relation to nursing
history, ethics, performing arts, religon, philosophy, religon

Life Sciences in relation to nursing
biology, microbio, anatomy/physiology, pathophys

Communications in relation to nursing
informatics, therapeutics, english

Social Science in relation to nursing
health of populations, family ect.
-have to change society, not just individual

-Physicians=highly involved in traumatic injuries
primary goal is to CURE, treating diseases

physical therapist
-muscular/skeletal rehab, motility

-functional living-restoring
-occupational therapist

-respiratory therapist
-ventilation and respiration

-dispense meds, consults

social worker and pastoral care
reassurance and spirititual

Health Related discipline?
it is important to know other healthcare providers as a nurse… your teammates!!!

Wellness- state of well-being
Illness- diminished functioning ability

Health Promotion/Maintenance
Promotion- increasing wellness (eating habits/ physical activity)
Maintenance- preventing disease, immunizations, washing your hands, contamination of water in the enviorment you live in

Primary Healthcare Providers
family practicioner, NP, E.R. (those who dont have primarycare)
**they serve to treat common illnesses -basic routine care
ie…flu, virus

multi-disciplines=better outcomes!

Holistic Healthcare
treating patient physically, psychological, mentally, spiritually ect
Ex: yoga, accupuncture, relaxation, massage

-accountable=answerable to actions/decisions taken (outcomes)
-responsable=duties layed out in job description, nursing standards based on ANA

-ability to make decisions freely and dependently due to your education
-physicians used to be the only ones who could diagnos a patient
-more educated=more knowledgable=better autonomist

Patient’s Rights
Bill of rights 1973

Advanced Directives
-tell people what you want and dont want
-in patient’s bill of rights
-advanced preparation of healthcare directions (DNR)

What are the goals of the Healthcare system?

-avoid injury and harm from care that is meant to aid the patient (errors in the hospital are the 5th leading cause of death)
-duty as a nurse=not making medication errors

assuring the “evidence-based” care is actually deliverd (AVOID overuse of medically unproven care and underuse of medically sound care)
-give patient benefit/risk treatment

avoiding unwanted delays
-ER- 90% of uninsured go here for primary care, average time – 5 hours

about the patient, not the provider

seeking to reduce wastes
low value, added processes and products =timely and effective

closing racial, ethnic, gender, and socioeconomic gaps in care and outcomes

What is a characteristic to ALL professions?
**service to mankind

What are other characteristics of a profession?
-a body of knowledge (have to study/learn)
-formalized education process
-application of knowledge
-public recognition of the skill (trust from public)
-standards of conduct (ANA)
-a professional association

what are the oldest professions?
medicine, law, clergy
**nursing is a rather new profession

latin room means nourishing

Characteristics of the Nursing Profession
-serves the needs of society in the area of health
-addresses a range of health problems, both actual and potential
-recognizes patient as an autonomous human
-emphasis on science, evidence-based practice, and research findings of caring

what is a theory?
-a set of interrelated concepts that find a systematic view of a phenomenon that is explanatory and predictive in nature
-purpose=describe, explain, predict, and control events

nursing theory
=basis for professional nursing practice

in 2008, what was the overall national healthcare expenses? per person?
2.3 trillion
$7,681 per person

By 2015, what will the overall national healtcare expenses be?
$12,320 per person
$4 trillion overall

Healthcare expedentures as a percent of GNP in 2008?

Healthcare expedentures as a percent of GNP in 2015?

Percent of health expenditures using public funds?

Percent of health expenditures for hospital care?

how much $ does the US federal gov spend on health insurance programs?
$750 billion

how many people rely on medicaid? medicare?
medicaid= 47.8 million
medicaire= 43.4 M

Percent of health expenditures for nursing home care?

Percent of health expenditures for physician and clinical services?

Percent of health expenditures for perscription drugs?

how many Arkansans are uninsured?
17.8% of population

how many people are uninsured in the US?
45.6 Million (15.9% of the population)

how many people die each year for lack of access to care?
18,000 people

US spending on healthcare and quality?
the US spends more per captia on healthcare than any other country, but we are not in the top ten for “quality of care” and have a shorter life expectancy than any other country.

five primary methods of funding healthcare systems?
1) direct or out-of-pocket payment (90% of world)
2) general taxation (us)
3) social health insurance (fed gov income taxes -mediacaid, medicare)
4) voluntary or private health insurance
5) donation or free community health

Affordability Care Act (Health Care Reform)
2010 changes
-covers recommended preventive services w/o charging out of pocket costs: Provides an opportunity to appeal coverage decisions
-guarantees enrollees their choice of primary care provider
-adult dependent children can stay on parent’s plan

Single Payer Plan
one payer= the governement pays for all of the healthcare through individual taxes

Socialize Medicine
-gov owns all the hospitals and clinics (so as a nurse of physician, you are paid by the gov) -england, germany, canada

Universal Health Insurance
-everyone has access to Insurance

-lump sum -physician has to take care of a patient for overall health procedures…not getting a penny more
*a fee or payment of a uniform amount for each person.

DRG Perspective Payment System
“a patient is going to come in and get knee replacement surgery and were going to pay you 20,000 dollars for the procedure” – wont get more, even if patient has to stay longer in hospital=more costly

Greeks and nursing
(early period.. earliest to late 18th century)
-Greek “basket bearers” cared for the sick in a manner like nurses.
-Hippocrates- father of medicine

Middle Ages and Nursing
(early period) Dark era
-the rise of Christianity occured
-chuch was the powerhouse in this era
-charitable focus for the poor and the sick
-nursing treatments were based on folklore, home remedies and superstitions

Nursing care during the Holy Wars?
(early period)
-crusades occured and men (nurses) were trained in the healing arts accompanied the knights into battle
-Nurses staffed the hospital of St John
-Post war, the nurses went to their European home and served in the Catholic orders by aiding the ill

Nursing during the Reformation?
(early period)
-occured when Catholic nuns and monks were forced to leave the hosiptals
-former prostitudes and alcoholics provided nursing care
-no education for nursing
-low point in nursing

Florence Nightingale
*first dominant figure in organized nursing (Middle Period)
-got an education, well socially-connected, parents didnt support
-believed in cleanliness, but not the Germ Theory

-she changed the idea/stereotype that womem served as supportists for their husbands

Who and when was the first school of nursing built?
Nightingale… St Thomas Hospital in 1883 in London

what was nursing like in the US during the middle period?
-colonial times= very few nurses
-the largest hospitals employed men, however, General Washington hired women to serve meals and care for the wounded

What were the first organized Schools of Nursing?
(Middle Period in the US)
1) 1839 Nurse Society of Philadelphia – Quaker influenced, combined school and home

2) 1861 Women’s Hospital of Philadelphia – under direction of two female physicians opened a hospital for training

3) The Civil War interrupted plams for other schools to be developed

Revolutionary War and nursing corps?
*1775, there were no nurse corps
G. Washington stated “the sick suffered much for the want of good female nurses”
-Women did tend the sick in the army hospitals established, but they were not “nurses in the army”

The Civil War and Army Nursing Corps?
-Army Corps of Nursing established during Civil War
-both Union and Confederate armies used nurses, usually Catholic nuns
-focused on sanitary camps, adequate nutrients and pure water

Dorrthea Dix
supervised the Nurse Army Corps during Civil War

Lavina Dock
wanted practicing nurses to pass a written exam and be licesenced…need standards

Clara Barton
-a well known figure in nursing history, civil war nurse, founder of the American Red Cross

M. Adelaide Nutting
(1858-1958) – principal and superintendent of the School of Nursing at St Johns Hopkins Hospital in 1896
-advovated for University education for nurses

Luther Christman
-wrote a book
-nursing should not only classify females

Debra A Toney
-National Black Nurses Association
-our nurses due to race, should reflect our population
-better outcome if patient is same race

Angie Millian
National Association of Hispanic Nurses

The Alumnae Association
legacy for the excellence in nursing
-universities form

The American Society of Superintendents of Training Schools
This is the first organization for nursing in the United States of America. The society is formed for “the establishment and maintenance of a universal standard of training” for nursing

The American Nurses Association
1887 -ANA
-standards, ethical strandards, represents ALL nurses (all specializations)
**Nursing is the protection

The National League for Nursing
1952- accredidation program
The organization effectively assumes responsibility for accrediting nursing education programs.

American Association of Colleges of Nursing
AACN- our degree program is credited by this association

National Student Nursing Association
Organized exclusively for charitable and educational purposes, the Foundation awards scholarships to qualified nursing students.

Specialized Nursing Practice
(Later Period)
-intensive care units appeared in the 1960s and private duty nursing faded out
-public health nursing moved from the clinics to homecare, and then back to clinics when home health nursing expanded rapidly during the late 1980s and 90s

what were the earliest subspecialties into nursing after the public health nursing?
school nursing and industrial nursing care

Midevil Era
-in Europe, religous communities staffed by monks and nuns provided care for the poor

when was the modern hospital established?
-18th century
-the first large hospitals began to flourish
**symbolized the institutionalization of health care

when was the scientific method introduced?
20th century- introduced into medicine ie antibiotics, vaccinations, imaging

WWII’s importance in Healthcare System?
-major social, political and technical changes occured.
-growing interest in the social and organizational structure of healthcare
-Insurance plans became into being
-Hill-Burton funds
-Medicaire and NIH impacted healthcare

Current criticism of our healthcare system?
-too costly, millions not insured, healthcare error and injuries account for 100,000 deaths, ranked low in world health statistics and disparity**

Historical development leading to hospitals?
1) Almhouses (poorhouses/workhouses)- Midevil
2) Pesthouses- used to control disease
3) religous and public houses were finally established
3)first US hospital- Pennsylvania General Hospital 1751

what were major health problems during Medievil time?
-infectionous diseases
-chronic illness in the US
-epidemics to individual diseases (diff lifestyles)

when was there a rapid increase in technology?
after WWII
1860- stethoscope

Act for the Relief of Sick and Disabled Sea men
-provided care for merchant marines with no healthcare

Morrill Act
-provided every state with a land grant to purchase land for Universities *RESEARCH

Federal Food and Drug Act
-guidelines for slatering meat= sanitation
-drugs= labels, same amount, guidelines

Food and Drug Cosmetic Act
-approving drugs

Social Security Act
old age
Old-Age, Survivors, and Disability Insurance (OASDI) program
-covered by poll taxes
-under President Roosevelt

National Institues of Health
-discovering new knowledge and application to healthcare–RESEARCH (22 associations)

Hill-Burton Act
(1946)-hospital survey built beds
– President Truman’s proposals and was designed to provide federal grants and guaranteed loans to improve the physical plant of the nation’s hospital system. Money was designated to the states to achieve 4.5 beds per 1,000 people.

Patient Self-Determination Act
what treatments you as a patient will accept of reject**

Office of Public Emergency Preparedness
after 9/11= coordinated plan for terrorist attacks

short term vs long term stay in hospital
short= less than 30 days
long = more than 30 days- critical care units

How are hospitals classified?
-short/long term
-type of service- peds, general, psychiatric
-ownership- public, community, for profit

Magnet Hospitals
“the gold standard” for nursing excellence
American Nurses Credentialing Center (ANCC) program

Goals for Magnet Program
1 promote quality in a setting that supports professional practice
2 identifying excellence in delivery of nursing services to patients/residents
3 disseminating “best practices” in nursing services

Essentials of Magnetism
-work with clinically competent nurses
-good nurse physician relationship
-nurse autonomy and accountability
-control over nursing practice
-supprt of education
-adequate nurse staffing
-concern for the patient is paramount
-cultural overview

-prepares nurses to conduct research that advances nursing and healthcare
-gains knowledge and skills to apply analytical approaches to the discovery and application of knowledge in nursing and healthcare
-an intense research oriented program

-graduate school
-focuses on specializations
-educators, administrators, practitioners

Doctor of Nursing Practice
-prepares nurses who will apply and translate research into practice
-leads dissemination and integration of best nursing practice knowledge
-a practice oriented program of study

Factors affecting Nursing Education
-insufficent faculty
-students and faculty do not reflect the population
-lack of adequate clinical practices
-more candidates than space

National Council of State Boards of Nursing
Test plan = 4 major client needs

Client needs that make up NCLEX?
1) Safe and Effective Care Enviornment
-management of care 16-22%
-safety and infection control 8-14%

2)Health Promotion and Maintenance 6-12%

3)Psychosocial Integrity 6-12%

4) Physiological Integrity
-basic care and comfort 6-12%
-pharmacological/parenteral therapies 13-19%
-reduction of risk potential 10-16%
-physiological adaptation 11-17%

licensure by exam
1 complete degree
2 application
3 background check

license and be revoked if..?
-fraud in gaining licence
-felony conviction
-addiction to drugs
-harming or defrauding public
-willfully violating the Nurse Practice Act

written proof of qualifications

usually bestowed by a professional organization after course of study and upon completion of examination

bestowed by official gov organization`

Nursing Theory
“No Specific name”
Florence Nightingale

*Overall themer= person is influenced by enviornment
-nursing is a calling to help patients in a reparative process directly working with the patient or indirectly by affecting the enviornment to improve health or recovery from illness

“14 Basic Needs”-Nursing Theory
**Virginia Henderson
-basic nursing care involves 14 activities: physiological, spiritual, and sociological
-said to pay attention to the person and listen!!

Nursing Model- Behavioral Systems
*Dorothy Johnson
-behavioral subsystems- attachement, dependency, ingestive, eliminatice, sexual, aggressive, achievement

-nurse assesses the client’s needs in these subsystems. when the client is stressed, the subsystems are disrupted. the nurse provides care to resolve problems in the subsystems to meet the client’s needs

Goal Attainment Theory
*Imogene King
-the goal of nursing is to use communication to help the client reestablish positive adaptation to the enviornment
-grouped her theory into health concerns in three systems: social, personal, interpersonal
-theory states: Behavior>return behavior>disturbance>set goal>agree on goal>help attain goal

Dynamic Nurse-Patient Relationship Model
Ida Jean Orlando**
-describes a model revolving around 5 interrelated concepts:
1 the function of professional nursing
2 presneting behavior of the patient
3 immediate reaction of the nurse
4 the nursing process
5 improvement for the patient

Theory of Conversation
**Myra Levine
-her idea was that we need to help the person conserve energy; structural integrity; personal integrity; and social integrity
– very holistic theory
-she believed nursing is a discipline the basis of which is the person’s dependence and relation to others
-health is the ability to maintain integrity

Nursing is the Care, Core, and Cure Theory
**Lydia Hall
= depicted by circles
the care circle, core circle, and cure circle

Cultural Diversity and Universality Theory
Madeleine Leininger**
-caring is univeral phenomenon but varies transculturally
Level 1- the world view and social systems
Level 2- individuals, fams, groups, institutions
Level 3- folk systems, prof systems, and nursing
Level 4- decisions and actions

Humanistic Theory
**J Patterson and L Zderad
-nursing focus shifts from technical towrds the humanness of both the nurse and the patient
-nursing is a lived human act, a response to a human situation
-4 major concepts= person, enviornment, health and nursing

Human Caring Theory
**Jean Watson
-caring is amoral ideal and entails the body-mind-soal engagement with one another
*7 assumptions about science of caring:
1 can be demonstated and practiced
2 results in satisfying human needs
3 promotes health
4 accepts the person as is
5 gives person choices to act on his own
6 “healthogenic”
7 covers more of the person than curing; it is central to nurisng

Human Becoming Theory
**Rosemarie Parse
-new way to look at man, health, enviornment and nursing. health and meaning are co-created by indivisable human and their enviornment; nursing involves having patients share views of meaning
-her goal of nursing focuses on the quality of life from client’s perspective
-decision-making should be from client, not the nurse
-talks about rhythmicity; phenomena and transcendence in the person’s life

Self Care Model for Nursing
**Dorotheo Orem**
-self-care activities are what people do on their own behalf to maintain health and well-being; the goal of nursing is to help clients meet their own therapeutic self-care demands
-theory of self care
-theory of self care deficit
-theory of nursing systems

Nursing Model Adaptation
**Sister Calista Roy**
-Humans are adaptive systems that cope with change through adaptation
-nursing helps patients’ adaptation during health and illness
-basic assumption- the person is a bio-psycho-social person
-stress is produced by the environment
-coping behaviors have to be used
-the goal of nursing is promote adaptation by managing the environmental stimuli

Health Care Systems Model
**Betty Neuman
-each person is a complete system; the goal of nursing is to assist in maintaining client system stability
-types of stressors-intrapersonal, interpersonal, extrapersonal
-three types of prevention- preventive, corrective and rehabilitative
-lines of resistance- internal factors that defend against stressors
-nursing helps the person when stressors occur

The Science of Unitary Human Beings Theory
**Martha Rogers
-Unitary human beings are irreducible, four-dimensional, negentopic energy fields
-energy fields have no boundaries, are open, have patterns and the patterns change
-the purpose of nursing is to help all people achieve maximum well-being

Patient Care Approach
**Faye Abdellah
-21 nursing problems- promotes problem solving approach to practice
1-11 = physiological needs
-3 & 11 = safety needs
-14,15,16,19 = belonging and love needs
9,12,13,17,18, 20, 21 = esteem needs

Nursing Theory Prescriptive
**Ernestine Wiedenbach
-central purpose- the philosophy, culture, individuality of the patient and the nurse
-prescription- the interactive plan of care for the patient
-Realities- the patient, nurse, envioronment, goals ect
-nursing observes, ministers, validates

Interpersonal Relationship Theory
**Hildegard Peplau
-Orientation- patient seeks assistance from nurse
-Identidication- patient responds to nuse who intervenes to assist
-Exploitation- patient uses services offered
-Resolution- therapeutic relation ends

Health as Expanding Consciousness Theory
*Margaret Newman
-health encompasses conditions described as illness
-removal of patholgy in itself will not change the pattern of the individual
-health is the expansion of consciousness

Health Promotion Model
**Nola Pender
-focuses on what influences behavior and lifestyle changes related to health
-cognitive perceptual factors
-modifying factors
-participation in health

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