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  • Test Bank for Role Development in Professional Nursing Practice 5th Edition by Masters

Test Bank for Role Development in Professional Nursing Practice 5th Edition by Masters

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TEST BANK FOR ROLE DEVELOPMENT IN PROFESSIONAL NURSING PRACTICE 5TH EDITION MASTERS VALUES CLARIFICATION can occur individually or in groups and helps us to understand who we are and what is important to us. Its positive and the outcome is growth. It helps people to discern their individual values and leads to self-actualization. It helps us to maintain non-judgmental attitude about the values of others is very vital to nurse-patient relationship. What is the main purpose of value clarification? the main purpose of value clarification is understanding self (what is important and meaningful to us). Health is dynamic and every changing, not a stagnant state Beliefs is what we value What are the three categories of beliefs? Existential - shown to be true or false Evaluative - Beliefs that makes judgment Prescriptive/Proscriptive beliefs what people schould or schould not do. Existential beliefs shown to be true or false Evaluative beliefs Beliefs that makes judgment Prescriptive beliefs what people schould do Proscriptive beliefs what people should not do Paradigm the lens through which you see the world Realism the world is static, seeing is believing, the social world is a given, reality is physical and independent, logical thinking is superior Idealism the world is evolving, there is more that meets the eye, the social world is created, reality is conception perceived in the mind, thinking is dynamic and constructive Values the principles and ideals that give meaning and direction to our social, personal, and professional lives. Nursing values have been identified: as the fundamentals that guide our standards, influence practice decisions, and provide the framework used for evaluation. The process of nursing involves three steps choosing values prizing values acting on values intrinsic value is required for living (food water) extrinsic value not required for living and is originated external to the person. value acquisition when a new value is assumed value abandoment when a value is relinquished value redistribution occurs when society changes views about a particular value. contextualism understanding is embedded in context; meaning is subjective and ope to change and dependent on the moment in time and the persons perspective. formism understanding events in relationship to their similarity to and ideal or objective standard comes categorization (classification of plants and animals in biology. mechanism understanding is in terms of cause-and-effect relationships, the common approach used by modern medicine organicism understanding comes from patterns and relationships; must understand the whole to understand the parts(cannot look at a child's language development without looking at his or her overall development history. What are Dowds and Marcel explanations of an event contextual ism, mechanism, organicism, formism values clarification can occur in a group or individually and helps us understand who we are and what is most important to us. values clarification is done : for the purpose of understanding self to discover what is important and meaningful. What is nursing philosophy? is a statement of foundational and universal assumptions, beliefs and principles bout the nature of knowledge and truth (epistemology) Ethics the study of ideal human behavioral and ideal ways of being. Bioethics is a specific domain of ethics focused on the moral issue in the field of health care - Evolved from life-and-death moral dilemmas - The aim of bioethicists today is to continue to search for answers about life, death, and significant human being to help guide and control public policy. Nursing Ethics the study of ideal human behavior and ideal ways of being - Usually begins with cases or problems in practice - Viewed as a separate field because of unique ethical problems in the relationship between nurses and patient moral reasoning in general, reasoning involves using abstract thought process to solve problems and to formulate plans. moral reasoning pertains to making decisions about how humans ought to be and act * Pertains to making decisions about how humans should act * Aristotle called moral reasoning "the intellectual virtue of wisdom". This is focused on the good that can be achieved by being wise. * We (as nurses) do not have our own independent moral reasoning. This means we cannot just decide ourselves that pt. John Doe is suffering and just take him off life support. Virtue Ethics virtue ethics pertains to questions of "what sort of person must I be to achieve my life's purpose" and "What makes one a good or excellent person" rather than"what is right or good to do based on my duty or to achieve good consequences. deontology refers to the actions that are duty based, not based on their rewards, happiness or consequences. He also defined rational human being with freedom, moral worth, and ideally having a good will, which means a person should act from a sense of duty. - There are two types of duties: o Hypothetical imperatives are duties or rules people ought to serve if certain ends are achieved. They are 'if-then" statements. o categorical imperatives, one can never tell a lie for no reason - Example: o. Reporting a mistake in a timely manner. o Following through on the patient's wishes even if you do not agree. What are the two types of duties that Immanuel Kant distinguished? hypothetical imperatives categorical imperatives hypothetical imperatives are duties or rules people ought to observe if certain ends are to be achieved. Sometimes called"if=then" imperatives which are conditional. example If I want to pass this nursing course, than I should be diligent in my studies. categorical imperatives moral maxims or duties when acting according to a categorical imperative, one schould ask the is question. If I perform this action, would it become a universal law? Example: Kant's ethics would impose a categorical imperative that no one can ever tell a lie for any reason because if a person lies in any instance, the person cannot rationally wish permission to lie should it universally become a law for everyone. utilitarianism to promote the greatest good that is possible in situations (contrasted to deontology) ethic of care has a history in feminist ethics which has a focus in the moral experiences of women. Ethic of Care is personal relationships and relationship responsibilities are emphasized. Important concepts in this approach are compassion, empathy, sympathy, concern for others, and caring for others. - It forces on each individual situation - It requires critical thinking - Ensuring needs and wants over others. - Practicing according to the nursing code of ethics. ethical principlism a popular approach to ethics in healthcare, involves using a set of ethical principles drawn from the common or widely shared conception of morality. What are the 4 most common principles used in bioethics" autonomy, beneficence, non maleficence, and justice benefience "the actions taken by nurses to facilitate a patient's wellbeing" Paternalism - overriding a patient's autonomy; doing what you believe is best for the patient (Ex: a nurse having patient ambulating regardless of the patient's pain, etc) Ex: lifting side rails on patient's side rails of bed to prevent fall paternalism the deliberate overriding of a patient's autonomy nonmalefience "to do no harm" non- maleficence involved refraining from actions that might harm others. (avoid actions that might cause harm) justice refers to the fair distribution of benefits and burdens Distributing scarce health care resources; fair healthcare Ex: National shortage of a medication, decide what patient may need that medication in regard to changing a medication; triaging patients Provision 1 The nurse practices with compassion and respect for the inherent dignity, worth, and unique attributes of every person. Provision 2 The nurse's primary commitment is to the patient, whether an individual, family, group, community, or population. Provision 3 The nurse promotes, advocates for, and protects the rights, health, and safety of the patient. Provision 4 The 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. Provision 5 The nurse owes the same duties to self as to others, including the responsibility to promote health and safety, preserve wholeness of character and integrity, maintain competence, and continue personal and professional growth. Provision 6 The nurse, through individual and collective effort, establishes, maintains, and improves the ethical environment of the work setting and conditions of employment that are conducive to safe, quality health care. Provision 7 The nurse, in all roles and settings, advances the profession through research and scholarly inquiry, professional standards development, and the generation of both nursing and health policy. Provision 8 The nurse collaborates with other health professionals and the public to protect human rights, promote health diplomacy, and reduce health disparities. Provision 9 The profession of nursing, collectively through its professional organizations, must articulate nursing values, maintain the integrity of the profession, and integrate principles of social justice into nursing and health policy. nursing social contract nursing has a responsibility to society and in turn society grants the profession the authority to practice, grants the profession authority over functions, and autonomy over professional affairs. Incivility bullying. The ANA supports a zero tolerance policy. 1. communicating in a way that manages conflict 2. contributing to environments that support and maintain respect, trust, and dignity. Leads to burnout, turnover, dropout, suicide nurse to nurse, faculty to student, student to faculty criticism, humiliation, undervaluing, teasing violence *desensitization due to constant exposure=alarming *nurses must become socially aware and politically involved in preventing violence(using assessment skills to identify people at risk and to promote reporting treatment to rehab) *sexual assault nurse examiner and forensic nurse=report, provide quick compassionate care to victims . Factors contributing to differences in access to health care lack of health insurance continuity of care economic barriers geographic barriers sociocultural barriers roles refers to duties expected of a nurse to competently perform such as stand of practice The components of nursing practice are: compassion and respect for the inherent dignity worth unique attributes of every person values are beliefs or ideals that guide interactions of patients, colleagues, other professionals and public found in ANA code of ethics *commitment to public service *autonomy *commitment to lifelong learning and education *a belief in teh dignity and worth of each person epitomize the caring, professional care IOM Institute of medicine states that nurses needs requisite competencies including: leadership health policy system improvement research and evidence based practice teamwork collaboration to meet the needs of the current dynamic healthcare environment what are the 5 stages of Benner's states of professional clinical practice? novice advanced beginner competent proficient expert novice lack of knowledge and experience advanced beginner the nurse can dictate action and formulate principles, eg to know rationale behind why different medications require different injection techniques. New graduate can be referred as advance learner. competent ability to look at situations in terms of principle analyze problems and prioritize. A nurse at this stage has improved time management, diagnostics reasoning, and organizational skills as well as technical skills. the nurse schould have 1-2 years of experience. (ethical comportment) proficient has solid grasp of the norms as well as solid experiences that shed light on the variations from the norm. The nurse begins to break the rules because he/she believes it does not exist. takes about 3-5 years of practice (salience) expert that are based on the nurse's experience in practice. Nurse can manage multiple tax simultaneously, has moved beyond set of fixed rules. ethical comportment good conduct born out of an individualized relationship with the patient that involves engagement in a particular situations and entails a sense of membership in the relevant professional group. (competent) Salience is a perceptual stance or embodied knowledge whereby aspects of a situation stand out as more or less important; therefore the nurse knows at this point what can wait and what can not wait.. (proficient) culture of saftey one that promotes trust and empowers staff to report risks, near misses and errors. IOM report to err is human what are the three key attributes in a culture of safety trust of peers and management, reporting unsafe conditions and improvements. just culture examines the fallibility of the system as well as inevitable human error and flawed behavioral choices. error is defined as the "failure of a planned action to be completed as intended or the use of a wrong plan to achieve an aim with the goal of preventing, recognizing and mitigating harm classification of error and root cause analysis root cause analysis is one method to review error that has real occurred and along with actions to eliminate risks, it is required by the joint commission for all sentinel events. A common approach to root cause analysis is a cause and effect diagram or fishbone diagram STEEP performance expectations: Safe Timely Effective Efficient Equitable Patient-centered sentinel events Unexpected occurrences involving death or serious physical or psychological injury, or the risk thereof. medication errors make up the largest category of erro4rs with 3-4% of patients experiencing a serious error during hospitalization keeping patients safe identified 6 major concerns monitoring patient status and surveillance physiological therapy helping patients compensate for loss of function emotional support education for patients and families integration and coordination of care critical thinking critical thinking is the competent use of thinking skills and abilities to make sound clinical judgements and safe decisions clinical judgment is complex and includes: *critical thinking *problem solving *ethical reasoning *decision making Interpretation or conclusion about a patients needs, concerns, or health problems and/or the decision to take action (or not) use to modify standard approaches, or improvise new ones as deemed appropriate by the patients response clinical reasoning the processes by which nurses and other clinicians make their judgments and includes both the deliberative process of generating alternatives, weighing them against the evidence, and choosing the most appropriate and those patterns that might be characterized as engaged practical reasoning including recognition of a pattern and intuitive clinical grasp of response without evident forethought mindfulness a rich awareness of discriminatory detail. "the combination of ongoing scrutiny of resisting expectations and continuous refinement and differentiation of expectations based on newer experiences. Also involves willingness and capability to invent new expectations that make sense of unprecedented events. The stages of the nursing process are: Assessment Diagnosis Planning Implementation Concept mapping /Evaluation/Reassessment Assessment gathering information Diagnosis/Conclusion identify patients health needs Planning Outcomes & Interventions with patient, decide goals you can achieve with nursing activities and select interventions to help client meet their goals Implementation Carry out the actions you've planned Evaluation judge whether our actions have helped meet the outcome goals or prevented complications SBAR S: Situation B: Background A: Assessment R: Recommendation QSEN Patient-Centered Care Teamwork and Collaboration Evidence-Based Practice Quality Improvement Safety Informatics patient centered care Recognize the patient or designee as the source of control and full partner in providing compassionate and coordinated care based on respect for patient's preferences, values, and needs. evidence-based practice Integrate best current evidence with clinical expertise and patient/family preferences and values for delivery of optimal health care. Teamwork and Collaboration Function effectively within nursing and interprofessional teams, fostering open communication, mutual respect, and shared decision making to achieve quality patient care Quality Improvement (QI) Use data to monitor the outcomes of care processes and use improvement methods to design and test changes to continuously improve the quality and safety of health care systems. Saftey Minimize risk of harm to patients and providers through both system effectiveness and individual performance. Informatics use information and technology to communicate, manage knowledge, mitigate error, and support decision making quality the degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge Quality Improvement (QI) Use data to monitor the outcomes of care processes and use improvement methods to design and test changes to continuously improve the quality and safety of health care systems. what are the roles of nursing in QI quality quality improvement regulation public protection holding systems and individuals accountable for their actions safer care for patients health care transparency is defined as making information on the healthcare systems quality efficient and consumer satisfaction available to the public. transparency tends to improve care because the public availability of data allows patients to make informed decisions. This influences the behavior of providers payers and other to achieve better outcomes. accountability measures are evidence based care process closely linked to positive patient outcomes. The 4 criteria to determine if an indicator is an accountability measure are: *research: strong scientific evidence *proximity: closely connected to patient outcome *accuracy: the measure accurately assesses whether the care process has actually been provided *Adverse Effects: implementing the measure has little to no chance of inducing and unintended adverse consequences. continuous quality improvement Structured organizational process that involves personnel in planning and implementing the continuous flow of improvements in the provision of quality health care that meets or exceeds expectations fishbone diagram assist in identify problems popular by William Edward Deming. The most commonly used quality improvement methodology in health care. what are pros of evidence based care less patient care errors better patient outcomes innovation decreases variations of care and boosts confidence for decision making What is evidence based practice? a mechanism that allows nurses to provide safe high-quality patient care bases on evidence grounded in reseals and professional expertise rather than tradition, myths, hunches, advice from outdated textbooks, or even what the nurse learned in previous schooling. clinical practice guidelines are standards developed to guide clinical practice and represent and effort to put a large body of evidence into a manageable form. They address relevance, risk and benefits. what are barriers to evidence based practice? lack of value of research in practice lack of research lack of administration support insufficient time lack of education and awareness what are the five phases of the Six Sigma methodology: Define, Measure, Analyze, Improve, Control car bundle a small set of evidence based interventions for a defined population of patients and care setting. Benchmarking seeking out and implementing best practice or seeking to attain an attribute or achievement that serves as standard for other institutions to emulate. may be internal or external. the 4 criteria used to determine if an indicator is an accountability measure as as follows. research proximity accuracy adverse effects Classical era No specialized nurses role in early civilization however human culture recognized the need for nursing care. The sick and week needed to be cared for and to care for the mother and infant. In most societies this role was filled by a female: compassion, health promotion and kindness Egyptian and Hebrews - 4,000 years ago - Egyptians physicians and nurses used over 700 remedies from herbs and preparations to care for the ill and injured and embalmed the dead. - Hebrews practiced hygiene associated with personal and community care - food preparation and sanitation. Greek Era Hippocrates is the father of medicine (460-370 BC) He documented his remedies and was used for centuries. Plato emphasis the importance of recreation and balanced mind body, nutrition and exercise. Also saw distinction between male and astrocracy. During the wars nursing care was provided by the princes (men) and good nursing care was provided to the wounds based on the learnings from Hippocrates, Egyptians and Hebrews. However, illness was still considered caused by an evil spirit Roman Era (31 BC-AD 476) Greek culture was a strong influence. Galen of Pergamum known as the greatest Greek physician after Hippocrates. Roman armies developed the mobile war nursing units because their battles took them far from home. Many transitioned into early military hospitals Middle Ages Transition between ancient and modern civilizations. Many of the advancements of Greco-Roman era were reversed. Myth, magic and religion again were explanations and cures for illness and health problems. Beginning of the deaconesses, female servants, doing the work of God and caring for women. Deacons cared for men. This was considered a forward step for nursing and strongly influenced Nightengale. Nursing roles were carried out primarily by religious orders. Communicable diseases was rampant due to the walled cities and almost impossible to control. The Black Death or bubonic plague (1300) took more than half their population. The people did not understand this disease but did recognize that it was communicable so they understood to avoid anyone with the disease and began isolation techniques. (ships set to sale) Hospitals begin to appear and care for the aged, sick or orphans. The Renaissance Rebirth of political, social and economic advances. Curse and blessing. Columbus new world, Newton gravity, da Vinci provided numerous anatomical drawings helped provide knowledge of human anatomy. The Reformation Occurred during the Renaissance era. Religious changes greatly influenced nursing, especially the rise of Protestantism as a result of both Martin Luther and John Calvin. Key was the abolition of the monastic and cloistered career which meant that nursing by deacons and deaconess was dissolved. This led to a lack of adequate nursing care. As a result, Luther advocated each town develop a fund to support hospitals and "nurse visitors". Laywomen became nurses, however they were difficult to find. To fill the gap judges then offered prostitutes and drunk women to option to work in the hospitals instead of jail. Nursing care in the hospitals became unorganized, filthy and the nurses were not trained. People went to die. Most of the monastic hospitals closed as a result of the reformation but a few survived. One was St. Thomas which eventually becomes the Nightingale School of Nursing The Dark Period For Nursing (1500-1860) Nursing conditions at the worst as a result of the reformation. Nurses were no longer trained by experienced Nuns. Nurses were illiterate classes, rough, inconsiderate, drunk, prostitutes, thieves. Considered a low status position, a position of servitude and menial. In the US, hospitals were used to care for the poor and those with contagious diseases (pesthouses) in order to protect the public. Outbreak of contagious disease was constant and nursing was also considered a low class profession Industrial Revolution - (mid 1700's) - Capitalism emerged resulting in mass production in contrast to the previous system of individual workers and craftsmen. Application of machine power to processes formerly done by hand. Exploitation of workers occurred, including children, health hazards and lack of social controls resulted. John Stuart Mill (1806-1873) championed education, emancipation for women, trade unions and religious tolerance. Other reforms issues of the era were abolition of slavery and more humane care for the sick, poor and wounded. Urbanization increased the effects of epidemics, highlighted the lack of sanitation and lack of sewage disposal. Typhus and Typhoid fever claimed huge numbers of lives - Chadwick report more than half the children of of labor-class workers died by age 5 indicating poor living conditions affecting the health of the most vulnerable. Laborers lived half as long as upper class. As a result, in 1848, the first General Board of Health for England was established led to reform of child welfare, elder care, sick and mentally ill. - Shattuck Report 1850 issued a report similar to Chadwick highlighting the unsanitary conditions, high infant mortality and made recommendation for public health reform in Boston that included bookkeeping of population statistics and development of monitoring systems that would provide information to the public about environment, food and drug safety and infectious disease control. Crimean Experience Asked to oversee a group of nurses in Turkey during the Crimean War. Set up laundry, medications, recreation room, canteen, cleaned the barracks of lice and filth and cared for the wounded. Nightingale believed many of the illness that the soldiers died from were preventable. She demanded clean dressings, bedding, well cooked food, proper sanitation and fresh air. (environmental theory) She is credited with reducing the mortality rate from 42-73% to 2%! Nightingale conducted research and kept journals of her learnings. Published Notes on Hospitals provided the template for military health care. Political Reformer Nightingale's work during the war created heroes of both herself and the soldiers. She brought honor to both professions and changed nursing's image into a respected and honored position. Post war she never was seen in public again. ? PTSD? She believed that not only do nurses care for the sick they must also be social reformers. She was known to use her contacts in parliament or the local paper to make changes to public health care. Military Reform Nightingale was asked advice on the organization of hospitals and the care of the sick and wounded in the Civil War. Based on her recommendations the Union set up a sanitation commission. School of Nursing The British honored Nightingale with $$ that eventually was used to create the Nightingale School of Nursing at St. Thomas, which is the beginning of professional nursing. Nightingale wrote Notes on Nursing: What it is and What it is not (Nightingale 1860). Students needed to be of high moral character and intelligent to continue to gain respect for the profession. Her students were expected to journal daily (just as we do now). Nightingale distinguished between sick nursing and health nursing. She was a leader in the wellness movement and believed the nurse was a key figure in establishing a health community Community Health Rathbone (wealthy) received care from nurses at home for his ill wife. He was so impressed he developed a corp of nurses trained to care for the sick and poor in their homes. He did not have enough nurses so he contacted Nightingale for assistance. She recommend more nurses be trained by adding another nursing school. Nightingale believed the ultimate goal was to care for the sick in their homes The legacy She suffered after the war however she became a dedicated writer and influenced sanitation in England and the training for nurses. She believed nurses must be trained differently and instructed specifically. She also wrote about the "health nurse" being good teachers about hygiene and helping families to learn better care. Goldmark report Nursing and Nursing Education in the United States 1922 advocated for establishment of university schools of nursing to train nurses. Josephine Goldmark's report stated that her research made it clear that basic undergraduate training is needed for all nurses leading to a nursing diploma. First Univ was University of Minnesota 1909 (3 year program) Brown Report Nursing for for Future 1948 led to the accreditation of educational programs through the National Ligue of Nursing in an effort to address the quality and structure of nursing programs. Mildred Montag 1952 established the first 2 year Associate Degree in Nursing program to add in the post WW II nursing shortage. State Board Test Pool examination 1950 same licensing exam used throughout the nation to license RNs American Nurse Association Founded by Isabel Hampton Robb in 1896 (Nurses Association Alumnae). Them became the ANA in 1911. Journal of Nursing founded in 1900! Nursing now had a professional journal and a professional organization. More Great women in nursing Margret Sanger 1912 credited with founding Planned Parenthood Lillian Wald credited with creating the title of "public health nurse" and the Visiting Nurse Association of NYC. She was motivated by the poor conditions in New York (child asked her to visit her sick mother). Established the Henry Street Settlement in this neighborhood in NY. An independent nursing service where she lived and worked. Evolved into the VNA laying the foundation for public health nursing in the US. Educated families on disease transmission and good hygiene, Provided preventive, acute and long term care. Nursing practice was autonomous and professional and they enjoyed recognition as specialist in preventative health. Also is credited with the first school nurse program. Dorothea Dix advocated for the humane treatment of the "insane and and imprisoned" and pioneered mental health reform. She also was appointed as the superintendent of the female nurses of the Army during the Civil War. She helped recruit more than 2,000 nurses to serve in the army and organized the hospitals. Clara Barton founder of the American Red Cross (1882) during the Civil War. This was neutral relief that could be activated in time of war. She actually provided care to Col Teddy Roosevelt during the Spanish-American War in Cuba and was considered a hero for the services provided to both the US and Cuba. Because of the great success US recommended a permanent reserve corps of nurses leading to the Army Nurse Corps (1901). Nursing code of ethics - defines the personal and performance standards that represent what is best, spells the role and relationship of the nurse with the patients and the community, and defines behavioral expectations. - Written by the ANA, nine provisions - Foundation for ethical analysis, decision making and professional behavior Mary Brechinridge in 1925 founded the Frontier Nursing Service the first organized midwifery service in the US. Women have always assisted in the birth of babies. With the advent of nursing in England, RNs became associated with safer child birth, however, in the US, physicians prevented this practice seeing midwives as a threat to medical practice. Breckinridge lowered maternal mortality, provided primary care, prenatal care and postnatal care. Cadet Nurse Corps 1945 (Frances Payne Bolton). 180,000 nurses were trained as a result of this act. Great Depression and stock market crash 1929 leading to wide spread unemployment including private duty nurses and the closing of several nursing schools. As a result of the depression and WW ii programs were implemented to offset the burdens. With WW II many nurses volunteered for both the Army and Navy corps leading to a shortage of nurses at home. Social Security Act of 1935 passed by Congress to provide "old-age" benefits, rehabilitation services, unemployment compensation, aid to dependent and/or disabled children and money to state and local health services. This also included Title VI which provided use of federal funds for the training of public health personnel. This led to the placement of public health nurses in state health departments and the expansion of public health nursing as a viable career. Hollywood began featuring nurses in films during the depression These films highlighted nurses in a positive, professional image and as heroes. Young women began to see nurses in a positive light during a bleak time in history (the depression). Hollywood began changing the image of nursing. Post WW II saw dramatic changes in both science and technology leading to: New drugs; sulfa, new cardiac drugs, surgeries and treatment for vib fib. Hill Burton Act 1946 provided funds to increase construction of new hospitals. As a result of the expansion of private health insurance coverage and significant increase in births (baby boom) more hospital beds were needed. First ANA Code of Ethics adopted in 1950 and in 1953 the ICN adopted in international Code of Ethics for Nurses. First scholarly journal published in US 1952- Journal of Nursing Research ANA accepted African American nurses for membership and males entered nursing school most likely as a result of being medics in the war. Both breaking down the barriers of racial and gender inequity in nursing. As a result of the increasing number of hospital beds, increased financial resources for healthcare (expansion of health insurance) and post WW II economic resurgence, nursing was faced with an acute shortage and stressful working conditions (not enough nurses to care for the ill, sick, surgeries and births, etc). Discussions emerged about strikes and collective bargaining. Landmark publication To Err is Human published by the IOM in 1999 really spurs the healthcare industry to focus on quality and safety. This publication draws attention to the fact the errors are preventable and occur because of faulty systems, processes or conditions not because of people. This report highlights the concerns about safety and quality within healthcare. Systems should be designed or redesigned in an effort to make it difficult to make errors. This first report stated that there were about 100,000 errors/year that occurred that could have been prevented. This number was later revised to closer to 400,000. Elements of a profession - Professional work is knowledge work - learning occurs that is specific and unique to the profession, must advance to role and contribute to the profession and participate in continuing education - Profession Becomes Identified with the Person - profession becomes part of the person's identity - Professional Work as a Social Mandate - licensing and competency with penalties for nonperformance or professional wrongs - Knowledge work always changes - advance and change as new knowledge emerges - Evidence, Improvement Science and Translation of Knowledge and best practice - EBP has become the expectation of clinical practice. Shared governance - Despite elements that make nursing look like a trade (shift work, hourly pay, unions) nursing is knowledge work. Also, shared decision making peer review and accountability at the point of service make it different from a trade - Basic principles; majority of decisions are local and made where they are implemented. Quality is achieved by the owners of the work, competence is require and ownership and investment is made by the clinicians - Participation in shared governance is voluntary, however active participation should occur in an effort to participate in decisions that affect quality, education, competency, research Consumerism • Patient Bill of Rights 1973 now the Patient Care Partnerships: Understanding Expectations, Rights and Responsibilites • Consumers assumed more control of their health • Information technology provided huge resource for gaining knowledge allowing for better informed choices and decisions Autonomy "one's ability to self-rule and to generate personal decisions independently" Obtaining informed consent for treatment; explaining choices to a patient (risks vs. benefits); acceptance/refusal Ex: Accepting/obtaining a DNR Team Approach - many ethical dilemmas require nurses to participate interdependently with others in decision-making. - All ethical cases undergo an analysis: -Medical Indications -Patient Preferences -Quality of Life -Contextual Features Ethical Dilemmas - making a choice between two actions. Neither choice is good or bad. They can arise between anyone in healthcare, not just nurses. - Example- Staying an extra shift...staffing issues vs. lack of sleep Moral Suffering - feeling experienced in situations when emotions are needing sorted out. - Example- Can arise from disagreements with institutional policy. Also caused when acting courageously (morally right) despite anticipated, disturbing, consequences. Women in nursing • Socialized as the more passive gender. Primary role to raise a family. Acceptable career options; nurse or teacher (if needed to work) • Women's movement in '60's empowered women and opened doors to more career options. This led to decreased enrollment in nursing school. Men in nursing • 5.4% in 2000; 9% 2011. 41% nurse anesthetist. Men enrolled in BSN 11.7% 2014 • Men have been nurses throughout history. • Nightingale believed nursing was a female discipline • Negative stereotypes; homosexual, low achievers and feminine, pt refusal • Decreasing stereotypes. Gravitate towards high technology, ICU, ER, nurse anesthetist Changing Demographics and Cultural Competence • Minorities equal about 1/3 pop • Nurses; 91% female, 83.2% white. In 2014, 30% enrolled in BSN were minorities. We need to strive for a nursing population that mirrors the community we serve • IOM 2003 warns of unequal treatment of minorities. Cultural differences, lack of access to health care, high rates of poverty and unemployment contribute to the ethnic and racial disparities in health status and outcomes. Key strategy are to increase the number of minorities in health professions, improve cultural competence and reduce health disparities. • Cultural Competence is a priority for health care and nursing in an effort to improve quality and reduce racial ethnic and gender disparities. • Culturally competent healthcare providers increase access, quality and satisfaction with health care. Cultural competence begins with self-awareness • Examples; education in multiple languages, translation services Access to Health Care • Health insurance provides access to care • At greatest risk for healthcare disparities (difference in access to care); racial and ethnic minorities and low socioeconomic status. • Lack of health insurance key contributor. Patient Protection and Affordable Care Act helps remove this barrier. • Other barriers also affect access (see below) Continuity of Care • Individual with a PCP or facility more likely to receive routine care and have better outcomes and reduced disparities. • Nursing role is to educate on importance of continuity of care Economic Barriers • Poverty is the greatest risk to healthcare. • Low socioeconomic status associated with low quality healthcare Geographic Barriers • Access to care is challenging in rural areas • number of providers, transportation, lack of robust services Sociocultural Barriers • translators, written material in multiple languages, written at an appropriate reading level Global Aging • 2030 71 mil older adults (41 mil 14.7% in 2000). Baby Boomers after WWII along with increased life expectancy, better health, advances in infertility • Affordable Care Act 2010 provides preventative services for older adults • Healthy People 2020 include objectives for older adults-improved health outcomes function and quality of life • Nursing has addressed this change by adding and expanding geriatric focus in the schools of nursing Complementary and Alternative Approaches • Complimentary combines conventional medicine with less conventional medicine • Alternative is used instead of conventional medicine o Homeopathic, meditation, prayer, herbs, food, vitamin, massage, therapeutic touch Nurse Faculty Shortage • Average age of doctoral faculty 61.6 years! • Limits student capacity Nurse Shortage • This has been a topic for most of nursing's history • Based on trend that include increased population, increased number of older adults, advanced technology, advances in medical science. In addition, decreased nursing grads, aging RN workforce (46.8), declines in earnings and alternative job opportunities • Beginning in 2008, employers report a decrease demand for RNs and nursing students report difficult to secure employment. ??is there a shortage??? • Experts caution ending the shortage due to economic downturn and healthcare reform Closing the Education and Practice Gap • Evidence supports that better educated nurses are needed • 45% AND, 34% BSN • IOM report; nursing need to practice to the full extent of their education and training, nurses should achieve higher education, nurses should be full partners with the healthcare team Nursing Practice and Workplace Environment • Nursing shortage affects staff and patient ratios • Healthcare has changes; Increased health care costs, decreasing reimbursement, increased technology and knowledge explosion • Cost containment is a key priority and payment processes have changed leading to organizations working to decrease costs including the number of RN • Research shows decreased RN staff increases patient care errors, infection, readm and mortality • Low nurse-patient ratios likely to experience job burnout and dissatisfaction Nurse Retention • Predictor of nurse turnover and dissatisfaction is the practice environment • Causes include patient acuity, work schedules, poor physician relations, new technology, staff shortages, unpredictable workflow/load, and perception of unsafe care • Average yearly turnover 5-21%, first year grad 35-61%! Every 1% turnover costs the hospital about $300,000/year Complexity of Nursing Work • As pace and complexity of care increase nursing work is expanding at both ends; undertake take that less qualified staff could do while unable to use their high-level skills and expertise. This can lead to turnover Nursing Education • Nursing education needs to change in order to meet the demands of the complex, high acuity, ethically diverse ever changing environment. • IOM report 2003 states students are not prepared to care for the culturally diverse pop, interprofessional team access EBP. Identifies 5 core competencies: patient center care, work in interdisciplinary teams, use EBP, apply quality improvement and identify errors and hazards and utilize informatics • National Council of State Boards of Nursing 2005 released 5 recommendations regarding nursing education • Nursing education must be reformed: The Future of Nursing: Leading Change, Advancing Health (IOM 2011) - need new competencies and outcomes for students • New roles: CNL and doctor of nursing practice (DNP) - represents and effort to address nursing education and meet the healthcare needs of the future HITECH • Provided money to organizations and providers to encourage use of HER • Encouraged implementation over three phases with financial reimburse as each was met Informatics: What is it? • Both a field of study and an area of specialty. Use of information technology in nursing practice Three primary laws that have affected HIM o Health Insurance Portability and Accountability Act (HIPAA): privacy and security of health information o Health Information technology for Economic and Clinical Health (HITECH): provide money grants) to help advance the use of health information technology (hit) o Patient Protection and Affordable Care Act also provides funding for HIT HIPAA • Advances were slow due to the worry about privacy. In 1996 Congress passed HIPAA to encourage the development of HIS. Act addressed standardizing claims and privacy regulations (protect health info). Means to protect against unauthorized access: login with freq password change • Benefits: increase efficiency and improve care Healthcare agencies have policies and procedures regarding penalties of misuse • Consequences are severe; termination Nursing Informatics Competencies • All nurses demonstrate proficiency in use of information and patient care technology. • All nurses maintain privacy, security and confidentiality of PI as stated by HIPAA Technology Informatics Guiding Education reform Initiative (TIGER) 2004 • develop competencies for all practicing nurses and nursing students o basic computer competencies, information literacy, information management • ANA adopted the Principles for Social Networking o Do not place place pt info on line, observe ethically prescribe nurse-patient boundaries, bring harmful content to appropriate authorities (pg 309/306) • State Board of Nursing (NCSBN) also adopted these guidelines and include possible consequences; reprimand, fine, temporary or permanent loss of license. • Improper use of social media might violate state and federal laws resulting in civil or criminal penalties; fines or jai

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    Test Bank for Role Development in Professional Nursing Practice 5th Edition by Masters

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