advanced practice registered nurse (APRN)
the most independently functioning nurse. Has a master's degree in nursing; advanced education in pathophysiology, pharmacology, and physical assessment; and certification and expertise in a specialized area of practice.
American Nurses Association (ANA)
The only full service professional organization representing the 2.2 million registered nurses in the US. It comprises 52 State Nurses Associations. The organization fosters high standards of nursing practice , promotes the economic and general welfare of
caregiver
helps patients maintain and regain health, manage disease and symptoms, and attain a maximal level function and independence through the healing process.
certified nurse-midwife (CNM)
an APRN who is also educated in midwifery and is certified by the American College of Nurse-Midwives. Involves providing independent care for women during normal pregnancy, labor and delivery, and care for the newborn.
certified registered nurse anesthetist (CRNA)
an APRN with advanced education in a nurse anesthesia accredited program. Provide surgical anesthesia under the guidance and supervision of an anesthesiologist, who is a physician with advanced knowledge of surgical anesthesia.
clinical nurse specialist (CNS)
an APRN who is an expert clinician in a specialized area of practice.
code of ethics
the philosophical ideals of right and wrong that define the principles you will use to provide care to your patients.
continuing education
involved formal, organized educational programs offered by universities, hospitals, state nurses associations, professional nursing organizations, and educational and health care institutions.
genomics
describes the study of all the genes in a person and interactions of these genes with one another and with that person's environment.
in-service education
instructional or training programs by a health care agency or institution. Is held in the institution and is designed to increase the knowledge, skills, and competencies of nurses and other health care professionals employed by the institution. Often are
International Council of Nurses (ICN)
objectives include promoting national associations of nurses, improving standards of nursing practice, seeking a higher status for nurses, and providing an international power base for nurses.
National League for Nursing (NLN)
advances excellence in nursing education to prepare nurses to meet the needs of a diverse population in a changing health care environment. Sets standards for excellence and innovation in nursing education.
nurse administrator
manages patient care and the delivery of specific nursing services within a health care agency. Begins with positions such as the assistant nurse manager. Experience and additional education sometimes leads to a middle-management position such as nurse ma
nurse educator
works primarily in schools of nursing, staff development departments of health care agencies, and patient education departments. Need experience in clinical practice to provide them with practical skills and theoretical knowledge.
nurse practitioner (NP)
an APRN who provides health care to a group of patients, usually in an out-patient, ambulatory care, or community-based setting. Provide care for patients with complex problems and a more holistic approach than physicians.
nurse researcher
investigates problems to improve nursing care and further define and expand the scope of nursing practice. Often works in an academic setting, hospital, or independent professional or community service agency. The preferred educational requirement is a do
nursing
the protection, promotion, and optimization, of health and abilities; prevention of illness and injury; alleviation of suffering through the diagnosis and treatment of human response; and advocacy in the care of individuals, families, communities, and pop
patient advocate
protects patient's human and level rights and provides assistance in asserting these rights if the need arises.
professional organization
deals with issues of concern to those practicing in the profession.
Quality and Safety Education for Nurses (QSEN)
initiative created to respond to reports about safety and quality patient care by the IOM. Addresses the challenge to prepare nurses with the competencies needed to continuously improve the quality of care in their work environments. Encompasses the compe
registered nurse (RN)
the most frequent way to become this is either through a completion of an associate or baccalaureate degree program.
Graduates of both programs are eligible to take the National Council Licensure Examination for Registered Nurses (NCLEX-RN).
clinical decision making
is a problem solving activity that focuses on defining a problem and selecting an appropriate action. Requires careful reasoning (i.e. choosing the options for the best patient outcomes on the basis of the patient's condition and the priority of the probl
concept map
a visual representation of patient problems and interventions that shows their relationships to one another. It offers a nonlinear picture of a patient that can then be used for comprehensive care planning.
critical thinking
a continuous process characterized by open-mindedness, continual inquiry, and perseverance, combined with a willingness to look at each unique patient situation and determine which identified assumptions are true and relevant.
Involves recognizing that an
decision making
a product of critical thinking that focuses on problem resolution. Following a set of criteria helps to make a thorough and thoughtful decision.
diagnostic reasoning
the analytical process for determining a patient's health problems. Begins once you receive information about a patient in a clinical situation. Accurate recognition of a patient's health problems is necessary before you decide on solutions and implement
evidence-based knowledge
knowledge based on research or clinical expertise; makes you an informed thinker.
inference
the process of drawing conclusions from related pieces of evidence and previous experience with evidence. Involves forming patterns of information from data before making a diagnosis.
nursing process
a five-step clinical decision-making approach: assessment, diagnosis, planning, implementation, and evaluation. Purpose is to diagnose and treat human responses to actual or potential health problems.
problem solving
involves evaluating the solution over time to make sure that it is effective. It becomes necessary to try different options if a problem recurs.
reflection
the process of purposefully thinking back or recalling a situation to discover its purpose or meaning. It is like rewinding a videotape. Involves playing back a situation in your head and taking time to honestly review everything you remember about it.
scientific method
a way to solve problems using reasoning. It is a systematic, ordered approach to gathering data and solving problems used by nurses, physicians, and a variety of other health care professionals.
1. Identifying the problem
2. Collecting data
3. Formulating
active listening
means being attentive to what a patient is saying both verbally and nonverbally. Facilitates patient communication.
assertiveness
allows you to express feelings and ideas without judging or hurting others. Behavior includes intermittent eye contact; nonverbal communication that reflects interest, honesty, and active listening; spontaneous verbal responses with a confident voice; and
autonomy
being self-directed and independent in accomplishing goals and advocating for others.
channels
means of conveying and receiving message through visual, auditory, and tactile senses.
communication
a lifelong learning process. Helps collect meaningful assessment data, provide education, and interact using therapeutic communication to promote personal growth and attainment of health-related goals. It is an essential part of patient-centered nursing c
empathy
the ability to understand and accept another person's reality, accurately perceive feelings, and communicate this understanding to the other.
To convey this, accurately perceive the patient's situation, communicate that understanding to the patient, and a
environment
the setting for sender-receiver interaction. Needs to meet participant needs for physical and emotional comfort and safety.
feedback
the message the receiver returns. It indicates whether the receiver understood the meaning of the sender's message.
interpersonal communication
one-on-one interaction between a nurse and another person that often occurs face to face. It is the level most frequently used in nursing situations and lies at the heart of nursing practice.
interpersonal variables
factors within both the sender and receiver that influence communication.
Ex: perception, educational and developmental levels, sociocultural backgrounds, values and beliefs, emotions, gender, physical health status, and roles and relationships.
intrapersonal communication
communication that occurs within an individual. Also called self-talk, self-verbalization, or inner thought. Provides a mental rehearsal for difficult tasks or situations so individuals deal with them more effectively and with increased confidence.
message
the content of the communication. It contains verbal, nonverbal, and symbolic language.
metacommunication
a broad term that refers to all factors that influence communication. Awareness of influencing factors helps people better understand what is communicated.
nonverbal communication
includes the five senses and everything that does not involve the spoken or written word. Is unconsciously motivated and more accurately indicates a person's intended meaning than the spoken words.
Aspects of this include:
- personal appearance
- posture
perceptual biases
human tendencies that interfere with accurately perceiving and interpreting messages from others.
People often assume that others think, feel, act, react, and behave as they would in similar circumstances. They tend to distort or ignore information that g
public communication
interaction with an audience. Requires special adaptations in eye contact, gestures, voice inflection, and use of media materials to communicate messages effectively.
receiver
the person who receives and decodes the message.
referent
motivates one person to communicate with another.
sender
the person who encodes and delivers the message.
small-group communication
interaction that occurs when a small number of persons meet. This type of communication is usually goal directed and requires an understanding of group dynamics. Most effective when they are cohesive and committed and have an appropriate meeting place wit
symbolic communication
the verbal and nonverbal symbolism used by others to convey meaning. Art and music are forms of this.
sympathy
concern, sorrow, or pity felt for a patient. The nurse takes on a patient's problems as if they were his or her own.
Subjective look at a person's world that prevents a clear perspective of the issues confronting that person. It is not as therapeutic as e
therapeutic communication
specific responses that encourage the expression of feelings and ideas and convey acceptance and respect. Learning these techniques helps you develop awareness of the variety of nursing responses available for use in different situations.
Occurs within a
transpersonal communication
interaction that occurs within a person's spiritual domain. Many people use prayer, meditation, guided reflection, religious rituals, or other means to communicate with their "higher power.
verbal communication
uses spoken or written words. This is a code that conveys specific meaning through a combination of words.
Aspects of this include:
- Vocabulary
- Denotative and connotative meaning
- Pacing
- Intonation
- Clarity and Brevity
- Timing and Relevance
affective learning
deals with expression of feelings and acceptance of attitudes, opinions, or values. Getting feelings out; discussion; role play. Includes all of the following:
- receiving
- responding
- valuing
- organizing
- characterizing
analogies
supplement verbal instruction with familiar images that make complex information more real and understandable.
cognitive learning
includes all intellectual behaviors and requires thinking. Includes all of the following:
- knowledge
- comprehension
- application
- analysis
- synthesis
- evaluation
functional illiteracy
the inability to read above a fifth-grade level
health literacy
the cognitive and social skills that determine the motivation and ability of individuals to gain access to, understand, and use information in ways that promote and maintain good health. Includes patients' reading and mathematics skills, comprehension, ab
learning
the purposeful acquisition of new knowledge, attitudes, behaviors, and skills. This is a lifelong process.
learning objective
describes what the learner will be able to do after successful instruction
motivation
a force that acts on or within a person (e.g. an idea, emotion, or a physical need) to cause the person to behave in a particularly way.
psychomotor learning
involves acquiring skills that require the integration of mental and muscular activity such as the ability to walk or use and eating utensil; things you do. Includes the following:
- perception
- set
- guided response
- mechanism
- complex overt response
reinforcement
requires using a stimulus that increases the probability for a response. Are positive or negative.
return demonstration
when learners first observe the teacher and then have the chance to practice the skill.
self-efficacy
a concept included in social learning theory, refers to a person's perceived ability to successfully complete a task.
teaching
an interactive process that promotes learning. It consists of a conscious, deliberate set of actions that help individuals gain new knowledge, change attitudes, adopt new behaviors, or perform new skills.
aura
a bright light, smell, or taste. Patients usually report this before a convulsive episode, which serves as a warning or sense that a seizure is about to occur.
Food and Drug Administration (FDA)
a federal agency responsible for the enforcement of federal regulations regarding the manufacture, processing, and distribution of foods, drugs, and cosmetics to protect consumers against the sale of impure or dangerous substances.
immunization
reduces (and in some cases, prevents) the transmission of disease from person to person. Individuals acquire active immunity by an injection of a small amount of attenuated (weakened) or dead organisms or modified toxins from the organism (toxoids) into t
pathogen
any microorganism capable of producing an illness. The most common means of transmission is by the hands.
poison
any substance that impairs health or destroys life when ingested, inhaled, or absorbed by the body. Often impair the function of every major organ system.
pollutant
a harmful chemical or waste material discharged into the water, soil, or air.
restraint
any manual method, physical or mechanical device, material, or equipment that immobilizes or reduces the ability of a patient to move his or her arms, legs, body, or head freely. This does not include devices such as orthopedically prescribed devices, sur
seizure
hyperexcitation and disorderly discharge of neurons in the brain leading to a sudden, violent, involuntary series of muscle contractions that is paroxysmal and episodic, causing loss of consciousness, falling, tonicity (rigidity of muscles), and clonicity
seizure precaution
encompasses all nursing interventions to protect the patient from traumatic injury, position for adequate ventilation and drainage of oral secretions, and provide privacy and support following the seizure.
status epilepticus
prolonged or repeated seizures. This condition is a medical emergency and requires intensive monitoring and treatment.
adventitious crises
often created by a major natural disaster, man-made disaster, or crime of violence.
alarm reaction
during this, rising hormone levels result in increased blood volume, blood glucose levels, epinephrine and norepinephrine amounts, heart rate, blood flow to muscles, oxygen intake, and mental alertness.
In addition, the pupils of the eyes dilate to produc
allostatic load
chronic arousal with the presence of powerful hormones causes excessive wear and tear on the person. If this increases, this causes chronic illness. If this is persistent, this can cause long term physiological problems such as chronic hypertension, depre
appraisal
how people interpret the impact of the stressor on themselves or on what is happening and what they are able to do about it.
burnout
occurs as a result of chronic stress. In nursing, this frequently results from intense caregiving and manifests as emotional exhaustion, loss of a sense of personal identity, and feelings of failure.
coping
the person's effort to manage psychological stress. Effectiveness of these type of strategies depends on the individual's needs. The person's age and cultural background influence these needs. For this reason, no single strategy works for everyone or for
crisis
this results when stress overwhelms existing coping mechanisms and patients lose emotional balance.
crisis intervention
a specific type of brief psychotherapy with prescribed steps. It is more directive than traditional psychotherapy or counseling, and any member of the health care team who has been trained in its techniques can use it.
When using this approach, you help t
developmental crises
occur as a person moves through the stages of life.
ego-defense mechanisms
regulate emotional distress and thus give a person protection from anxiety and stress. These help a person cope with stress indirectly and offer psychological protection from a stressful event. Everyone uses them unconsciously to protect against feelings
exhaustion stage
occurs when the body is no longer able to resist the effects of the stressor and has depleted the energy necessary to maintain adaption. The physiological response has intensified; but with a compromised energy level, the person's adaptation to the stress
fight-or-flight response
the arousal of the sympathetic nervous system; prepares a person for action.
flashback
recurrent and intrusive recollections of the event. Responses may include self-destructive behaviors such as suicide attempts and substance abuse.
general adaptation syndrome (GAS)
a three-stage reaction to stress, describes how the body responds to stressors through the alarm reaction, the resistance stage, and the exhaustion stage. This is triggered either directly by a physical event or indirectly by a psychological event. This i
posttraumatic stress disorder (PTSD)
begins when a person experiences, witnesses, or is confronted with a traumatic event and responds with intense fear or helplessness. Anxiety associated with this is sometimes manifested by nightmares and emotional detachment.
Example of traumatic events t
primary appraisal
evaluating an event for its personal meaning.
resistance stage
the body stabilizes and responds in a manner opposite to that of the alarm reaction. Hormone levels, heart rate, blood pressure, and cardiac output return to normal; and the body repairs any damage that has occurred. However, if the stress response is chr
secondary appraisal
focuses on the possible coping strategies. Balancing factors contribute to restoring equilibrium.
situational crises
provoked by external sources such as a job change, a motor vehicle crash, a death, or severe illness provoke situational crises.
stress
an experience to which a person is exposed through a stimulus or stressor. It is a physical, emotional, or psychological demand that often leads to growth or overwhelms a person and leads to illness.
Refers to the consequences of the stressor and the pers
stressors
tension-producing stimuli operating within or on any system.
trauma
occurs if symptoms of stress persist beyond the duration of the stressor
Florence Nightingale
first practicing epidemiologist; organized first school of nursing (at St. Thomas' Hospital in London); improved sanitation in battlefield hospitals (during the Crimean War). Was known as the "lady with the lamp."
Her practices remain a basic part of nurs
Clara Barton
founder of the American Red Cross. Tended soldiers on the battlefields, cleansing their wounds, meeting their basic needs, and comforting them in death.
Dorothea Lynde Dix
was superintendent of the female nurses of the Union Army. Organized hospitals, appointed nurses, and oversaw and regulated supplies to the troops.
Mother Bickerdyke/Mary Ann Ball
organized ambulance services and walked abandoned battlefields at night, looking for wounded soldiers.
Harriet Tubman
was active in the Underground Railroad movement and assisted in leading over 300 slaves to freedom.
Mary Mahoney
the first professionally trained African American nurse. She was concerned with relationships between cultures and races; and as a noted nursing leader she brought forth an awareness of cultural diversity and respect for the individual, regardless of back
Isabel Hampton Robb
helped found the Nurses' Associated Alumnae of the United States and Canada in 1896. This organization became the ANA in 1911.
Lillian Wald and Mary Brewster
opened up the Henry Street Settlement, which focused on the health needs of poor people who lived in tenements in NYC. Nurses working in this settlement were some of the first to demonstrate autonomy in practice because they frequently encountered situati
The Twentieth Century
Movement toward scientific, research-based practice and defined body of knowledge.
- 1901: Army Nurse Corps established
- 1906: Mary Adelaide Nutting, first professor of nursing at Columbia University
- 1908: Navy Nurse Corps established
- 1920-1923: Stud
Health Care Reform
affects how health care is paid for and how it is delivered. There will be greater emphasis on health promotion, disease prevention, and illness management in the future. More services will be in community-based care settings. As a result, more nurses wil
demographic changes
there will be a steady rise in the population. This requires expanded health care resources. There will also be a steady increase in the population of people age 65 years and older. The population is still shifting from rural areas to urban centers, and m
medically underserved
the rising rates of unemployment, underemployment and low-paying jobs, mental illness, and homelessness and rising health care costs all contribute to increases in this.
Examples are the poor, those on Medicaid, the working poor, etc.
threat of bioterrorism
many health care agencies, schools, and communities have educational programs to prepare for nuclear, chemical, or biological attack. Nurses are active in disaster preparedness.
Nurse Practice Acts (NPAs)
State Boards of Nursing oversee these. They regulate the scope of nursing practice and protect public health, safety, and welfare. This includes shielding the public from unqualified and unsafe nurses.
novice
beginning nursing student or any nurse entering a situation in which there is no previous level of experience (e.g. an experienced operating room nurse chooses to now practice in home health). The learner learns via a specific set of rules or procedures,
advanced beginner
a nurse who has had some level of experience with the situation. This experience may only be observational in nature, but the nurse is able to identify meaningful aspects or principles of nursing care.
competent
a nurse who has been in the same clinical position for 2 to 3 years. This nurse understands the organization and specific care required by the type of patients (e.g. surgical, oncology, or orthopedic patients). This nurse is a competent practitioner who i
proficient
a nurse with more than 2-3 years of experience in the same clinical position. This nurse perceives a patient's clinical situation as a whole, is able to assess an entire situation, and can readily transfer knowledge gained from multiple previous experienc
expert
a nurse with diverse experience who has an intuitive grasp of an existing or potential clinical problem. This nurse is able to zero in on the problem and focus on multiple dimensions of the situation. He or she is skilled at identifying both patient-cente
concepts of a critical thinker
- truth seeking
- open-mindedness
- analytic approach
- systematic approach
- self-confidence
- inquisitiveness
- maturity
critical thinking skills
- interpretation
- analysis
- inference
- evaluation
- explanation
- self-regulation
commitment
At this level of critical thinking, a person anticipates when to make choices without assistance from others and accepts accountability for decisions made.
At this level, you choose an action until a later time. You choose to delay as a result of your exp
complex critical thinking
At this level of critical thinking, a person analyzes and examines choices more independently. Each solution has benefits and risks that you weigh before making a final decision. There are options. Thinking becomes more creative and innovative. The person
basic critical thinking
At this level of critical thinking, a learned trusts that experts have the right answers for every problem. Thinking is concrete and based on a set of rules or principles.
At this level answers to complex problems problems are either right or wrong, and o
five components of critical thinking
- specific knowledge base
- experience
- nursing process competencies
- attitudes
- standards
attitudes a nurse needs
- confidence
- independence
- fairness
- responsibility
- risk taking
- discipline
- perseverance
- creativity
- curiosity
- integrity
- humility
Requirements for Communication Skills
- critical thinking
- perseverance and creativity
- self-confidence
- fairness and integrity
- humility
professional nursing relationships
these relationships include:
- nurse-patient relationships
- nurse-family relationships
- nurse-health care team relationships
- nurse-community relationships
nurse-patient helping relationships
in this relationship, the nurse assumes the role of professional helper and come to know a patient as an individual who has unique health needs, human responses, and patterns of living. Include:
- preinteraction phase
- orientation phase
- working phase
-
preinteraction phase
this phase of the nurse-patient relationship occurs before meeting the patient. The nurse reviews available data, including the Hx; talks to other caregivers for information; anticipate health concerns or issues that arise; find a comfortable setting; and
orientation phase
this phase of the nurse-patient relationship occurs when the nurse and patient meet and get to know one another (rapport). The nurse sets the tone for the relationship by adopting a warm, empathetic, caring manner; expect the patient to test your competen
working phase
this phase of the nurse-patient relationship occurs when the nurse and patient work together to solve problems and accomplish goals. The nurse encourages and helps the patient express feelings about his or her health; set goals; and use therapeutic commun
termination phase
this phase of the nurse-patient relationship occurs when the relationship is ending. The nurse reminds the patient that termination is near; evaluates goal achievement; relinquish responsibility; achieve a smooth transition for the patient to other caregi
elements of professional communication
- courtesy
- use of names (it is inappropriate to call the patient by anything other than their names)
- trustworthiness
- autonomy and responsibility
- assertiveness (not aggressiveness)
therapeutic communication techniques
- active listening
- sharing observations
- sharing empathy
- sharing hope
- sharing humor
- sharing feelings
- using touch
- using silence
- providing information
- clarifying
- focusing
- paraphrasing
- asking relevant questions
- summarizing
- self-dis
non-therapeutic communication techniques
- asking personal questions
- giving personal opinions
- changing the subject
- automatic responses
- false reassurance
- sympathy
- asking for explanations
- approval or disapproval
- defensive responses
- passive or aggressive responses
- arguing
SOLER (active listening)
S- sit facing the patient. This posture conveys the message that you are there to listen and are interested in what the patient is saying.
O- observe an open posture. This posture suggests that you are "open" to what the patient says.
L- Lean toward the p
adapting communication techniques
for patients who:
- cannot speak clearly
- are cognitively impaired
- are hearing impaired
- are visually impaired
- are unresponsive
- do not speak English
SPEAK UP
S- Speak up if you have questions or concerns.
P- Pay attention to the care you get.
E- Educate yourself about your illness.
A- Ask a trusted family member or friend to be your advocate (advisor or supporter).
K- Know which medicines you take and why you
basic human needs
physiological needs, including the need for sufficient oxygen, nutrition, and optimum temperature, influence a person's safety.
list of serious reportable events (SREs)
- surgical events
- product or device events
- patient-protection events
- care-management events
- environmental events
- criminal events
patient-inherent accidents
accidents (other than falls) in which the patient is the primary reason for the accident.
procedure-related accidents
cause by health care providers and include medication and fluid administration errors, improper application of external devices, and accidents related to improper performance of procedures such as dressing changes or urinary catheter insertion.
equipment-related accidents
results from the malfunction, disrepair, or misuse of equipment or from an electrical hazard.
RACE
R- rescue patients
A- activate alarm
C- confine fire
E- extinguish
PASS
P- pull the pin
A- aim at the base of the fire
S- squeeze the handle
S- sweep
Done when extinguishing a fire.
chronic stress
this type of stress occurs in stable conditions and results from stressful roles.
acute stress
this type of stress is caused by time-limited events that threaten a person for a relatively brief period