Week 9 Objectives

Question 1

Development of professional nursing roles

Question 2

Benner’s Stages of Nursing Proficiency

Answer 2

1)Novice
2)Advanced Beginner
3)Competent
4)Proficient
5)Expert

Question 3

Nurse Careers

Answer 3

• Provider of care
• Advanced practice registered
  nurses
• Clinical nurse specialist
• Certified nurse practitioner
• Certified nurse midwife
• Certified registered nurse
  anesthetist
• Nurse educator
• Nurse administrator
• Nurse researcher

Question 4

Educational Programs for Nursing Knowledge + Career opportunities

Answer 4

PN/RN Education: pn certificate, rn adn (2 year), rn bsn (4 year)

Graduate education: Masters degree, advanced practice rn; Doctoral apply research to clinical; PHD research and theory development, DNP, EBP

Continuing and In-sevice education: CEU (latest reaser: COVID, meds, stroke)’ In-service (new tech: balloon pumps, equipment change in iv catheter or chest tubes)

Question 5

Nurse Practice Acts (NPAs)

Answer 5

• Overseen by State Boards of Nursing
• Regulate scope of nursing practice
• Protect public health, safety, and welfare

Question 6

American Nurses Association

Answer 6

• Supports nursing profession
• Develops the standards of nursing practice
• Present nursing issues to legislation
• Provide professional resources for advanced practice

Question 7

Six standards of practice

Answer 7

Assessment
Diagnosis
Outcome’s identification
Planning
Implementation
Evaluation

Question 8

Healthcare Disparities

Answer 8

Result from poverty, environmental threats,
inadequate access to health care, individual and
behavioral factors, and educational inequalities

Negatively affect groups of people who have
systematically experienced social or economic
obstacles to health
 Preventable differences in the burden of disease,
injury, violence, or opportunities to achieve
optimal health that are experienced by socially
disadvantaged populations

Question 9

Community Health Nursing

Answer 9

Collaborative, patient-centered approach to provide culturally appropriate health care within
a community. Focuses on primary rather than institutional acute care;
includes health promotion

Occurs outside of traditional health care facilities
 Schools
 Workplace
 Churches

Question 10

Public Health Nursing

Answer 10

Nursing specialty that requires understanding the needs
of a population or a collection of individuals who have
one or more personal or environmental characteristics in
common. Relationships with legislative body for policy changes
may require bsn
ex: Increase child injury on playground, lobby for all
playgrounds to have shock-absorbing material instead
of concrete

Question 11

Components of a theory

Answer 11

Phenomenon: idea, situation, group of events or process
Concepts: describes or explains phenomenon
Definitions: theoretical/conceptual (define the concept); operational (how concepts are measured
Assumptions: identify relationships or structure of a theory based on values and beliefs

Question 12

The Domain of Nursing

Answer 12

Domain
* Perspective of profession or discipline (knowledge, history, theory,
education, research)
Paradigm- links concepts, theories, beliefs, values, and assumptions
* Conceptual framework: view or organize the relationship of the
phenomenon
Nursing metaparadigm: explains the who, what, and why of
nursing profession
* Person (receiving care, pt, family, community)
* Health (the individuals view, healthcare professional view)
* Environment/Situation (setting: acute, long-term, home)
* Nursing (promotion of health, prevention, and caring for the ill)

Question 13

Types of theories

Answer 13

Grand: Broad in scope, complex
Ideas related to nursing that could apply at any level

Middle-range: Limited in scope and less abstract
Specific field of nursing: administration, education, clinical, teaching

Practice: Narrow in scope and focus
Bring theory to the bedside; pain management, infection prevention

Descriptive: Describe phenomena and identify circumstances in which
phenomena occur; help understand patient assessment (development)

Prescriptive: Address nursing interventions for a phenomenon, guide practice change, and predict the consequences. Motivate patient, overcome obstacles, develop nursing action based on situation
40

Question 14

Nightingale

Answer 14

• Environment as the focus of nursing care
• Grand theory (can be applied to all aspects of nursing)

Question 15

Peplau

Answer 15

• Focus on interpersonal relations between nurse,
  patient, and patient’s family (relationships decrease
  anxiety)
• Phases: preorientation (data gathering), orientation
  (defining issue), working (therapeutic activity),
  resolution (end of relationship)
• Middle-range theory (specific to communication with
  psych nursing)

Question 16

Orem

Answer 16

• Focuses on patient’s self-care needs
• Goal is for patient to manage his or her health problems.
• Grand theory

Question 17

Leininger

Answer 17

• Theory of cultural care diversity and universality
• Integrates patients’ cultural traditions, values and
  beliefs into care plans
• Middle-range theory

Question 18

EBP

Answer 18

The best scientific evidence comes from well-designed, systematically conducted research studies found in scientific, peer-reviewed journals.

Question 19

Steps of Evidence-Based Practice

Answer 19

0. Cultivate a spirit of inquiry.
1. Ask a clinical question in PICOT format.
2. Search for the best evidence.
3. Critically appraise the evidence.
4. Integrate the evidence.
5. Evaluate the outcomes of practice decision or
   changes.
6. Communicate the outcomes of the evidence-
   based practice decision.

Question 20

Cultivate a Spirit of Inquiry

Question 21

PICOT

Question 22

Search for Best Evidence

Answer 22

stystemic review

Question 23

Critically Appraise the Evidence

Answer 23

 After critiquing all articles for a PICOT question:
 Synthesize or combine the findings
 Consider the scientific rigor of the evidence and
whether it has application in practice
 Requires systematic approach.
 Determine the value, feasibility, and usefulness of
evidence.

Question 24

Integrate the Evidence

Answer 24

 Apply the research in your plan of care for a
patient; use evidence as rationale.
 Education about the change must occur.
 Large-scale change requires planning.
 Pilot study can show if change can be
implemented easily.
 Incorporate into policies and procedures.
 Integration: teaching tools, clinical practice
guidelines, P&Ps, new assessment tools

Question 25

Evaluate the Outcomes of the Practice Decision or Change

Answer 25

When evaluating an EBP change determine:  Was the change effective?  Are modifications needed?  Should the change be discontinued?

Question 26

Communicate the Outcomes of the Evidence-Based Practice Decision

Answer 26

 Clinical staff on the unit  Nursing practice council or the research council  Clinicians  Professional conferences and meeting

Question 27

Quantitative Research

Answer 27

Measurable (surveys, evaluation, experimental/nonexperimental)

Question 28

Qualitative Research

Answer 28

understand patients’ experiences with health problems and the contexts in which the experiences occur

Question 29

The Relationship between EBP, Research, and Performance Improvement

Answer 29

EBP: Use of information from research and other sources to determine safe and effective nursing care with the goal of improving patient care and outcomes  Research: Systematic inquiry answers questions, solves problems, and contributes to the generalizable knowledge base of nursing; may or may not improve patient care  PI/QI: Improves local work processes to improve patient outcomes and health system efficiency; results usually not generalizable

Question 30

WHAT IS A FAMILY?

Answer 30

Defined as a set of relationships or network of individuals that influence one another’s lives

Question 31

Family Roles

Answer 31

Nuclear Family * 2 adults and/or children Extended Family * Nuclear Family + aunts, uncles, grandparents, and cousins Single-Parent Family * One parent leaves the nuclear form due to death, divorce, or desertion * Single person has or adopts a child Blended Family * Parents bring children from previous marriages or parenting relationships into a new joint-living situation Alternative Family * Multi-adult households * Grand families (grandparents caring for grandchildren) * Communal groups with children * Adults living alone * Cohabiting Partners

Question 32

Family function/structure

Answer 32

Structure: rigid (difficult if member becomes ill), flexible (lack stability if too flexible) Function: Interacts to socialize younger family members, meet economic needs, and relate to society Processes used to achieve family goals * Communication * Conflict resolution * Caregiving/Nurturing * Internal and external resources

Question 33

Family as a ...

Answer 33

Family as a Context: * Primary focus on one individual in a family * Does family meet basic physiological and psychological needs? Family as a Context: * Primary focus on one individual in a family * Does family meet basic physiological and psychological needs? Family as a System: Combination of Patient and Context * Focus on each individual family member using all community resources * Environmental, social, financial, physical, and psychological

Question 34

Erikson

Answer 34

Trust vs. Mistrust (Birth to 12 to 18 months)  Parents need to meet the needs of infant to develop trust (self, parents, caregiver)  Attachment develops at birth in a healthy environment with adequate rest and nutrition  Separation and separation anxiety (4-8 months)  Stranger fear 6-8months Autonomy vs Shame and Doubt ( Toddler 1-3)  Independent- explore and separate themselves from the parents  Toilet training, dressing, feeding self  Regression- bedwetting/thumb sucking in response to stress or anxiety  Parallel play- play next to a child but not together  Moral Development-only see their point of view  Obedience introduced in this stage  Temper tantrums (ask questions with given choices not “yes/no” responses) Initiative vs. guilt (preschool 3-6)  Feeling of guilt when unable to complete a task or done something wrong  No perceptions of realistic tasks for their age Industry vs. inferiority (School age (6-12)  Increase stress from parents and peer expectations Identity vs. Role Confusion (adolescent 12-20)  Peer group influences behavior more than parents  Feeling of invincible and may participate in risky behaviors  Plan for college/career  Sexuality explored  Body image Intimacy vs. Isolation (young adult (20-35)  Affiliation vs. Love  Take on more responsibilities and commitments  Develop their own values, beliefs, and response to ethical dilemmas  Adults might: leave home and establish independent living situations; establish close friendships; transition from being single to being a member of a new family; question their ability to parent; experience increased anxiety and/or depression, especially after the birth of a child Generativity vs. Self-absorption and Stagnation (middle adult 35-65)  Moral:Religion and spiritual preferences Integrity vs. Despair (review of life) (older adult 65+)

Question 35

Piaget