TEST BANK FOR NURSING RESEARCH METHODS AND CRITICAL APPRAISAL FOR EVIDENCE-BASED PRACTICE 9TH EDITION BY GERI LOBIONDO-WOOD, AND JUDITH HABER

TEST BANK FOR NURSING RESEARCH METHODS AND CRITICAL APPRAISAL FOREVIDENCE-BASED PRACTICE 9TH EDITIONBY GERI LOBIONDO-WOOD, AND JUDITH HABER Ch. 1 Evolution of Nursing Thought and Action Nursing Images throughout history The Angel of Mercy- is serene and content, is usually shown with a halo or other religious symbol. Until 100 years ago, nurses cared for patients at great risks to themselves. Even as recently as the 1950’s, antibiotics were not readily available, and the chief cause of mortality was infectious disease. -History demonstrates a strong link between nursing and religious orders. - The values of service and devotion to the patient faded along with the influence of Christianity during the 14th to the 16th centuries (renaissance) The Handmaiden- This stereotype portrays the male physician as the dominant role, this perception of nursing has changed with nurses doing more collaboration, planning and providing care not only the direction of the physicians but also along with them. - Although the handmaiden image was more widespread in the past, even then not all nurses considered themselves to be subservient to physicians The Battle-Ax- the nurse at the “torturer”, treating her patients with cruelty and disdain. Care giving activities contribute to the persistence of the battle-ax image- drawing blood, giving injections…. The naughty nurse- the sexy nurse image arose in the 20th burlesque shows. century with The Military Image – nurses are portrayed in uniform providing support at the battlefield Hospitalers- specialized soldiers during the crusade who at the end of battle returned to the outposts to care for the sick and injured Describe the role of religion in the development of nursing. In Eygpt, ancient Greece and Rome, temples were health centers as well as places of worship. Nurses started off in monasteries but moved to hospitals due to persecution. Ancient writings describe nursing responsibilities/attributes to include: knowledge of the preparation, compounding, and administration of drugs, wisdom, purity and devotion to the patient. The association of nursing with religion has not always been positive During the 15th and 19th centuries, the influence of Christianity began to wane and many nurses with religious orders fled to avoid imprisonment and death. There was a shift in medicine that moved practitioners from monasteries to universities. -Many nursing programs are still affiliated with religious groups. 1 | P a g eIdentify the factors that led to the change of nursing from a vocation of men and women to a predominantly female profession WAR Define nursing in your own words. Nurses assist the individual sick or well in activities that contribute to health or it’s recovery, or a peaceful death. The international council of nurses definition: pg 11. “ Nursing encompasses autonomous and collaborative care of individuals of all ages, families, groups and communities, sick and well and in all settings. Nursing includes the promotion of health, prevention of illness and the care of ill, disabled and dying people. Advocacy, promoting of a safe environment, research, participation in shaping health policy and in patient and health systems management, and education are also key nursing roles.” Florence Nightingales contributions to nursing: The establishment of nursing as a distinct profession Introduction of a broad-based liberal education for nurses Major reform in the delivery of care in hospitals The introduction of standards to control the spread of disease of hospitals ( epidemiology), decrease of nosocomial infections Major reforms in healthcare for the military Lilian Wald and Mary Brewster- Founded the Henry Street Settlement in New York to improve the health and social conditions of poor immigrants, this is considered the start of public health nursing in the U.S. White Women- About 82% of RN’s are white, 6% are male. Major nursing organizations agree that we need a more diversified nursing force. Examples of nursing activities Dependent activities -Administering prescribed medication -Assisting with a diagnostic test - Administering IV fluids -Ensuring that the patient received the prescribed diet Independent Activities -Evaluating the patient’s response to medication and withholding the next dose 2 | P a g eif the patient has a negative reaction -Teaching the patient what to expect from the diagnostic test , preparing the patient for the test. -Evaluating the patient’s response to treatment, monitoring the flow rate -Teaching a pregnant woman about additional nutrients needed in her diet. Full- spectrum nurse: Nurses use clinical judgement, critical thinking, and problem solving as they care for patients. Clinical Judgment- involved observing, comparing, contrasting and evaluating the client’s condition to determine where change has occurred. Critical thinking- is a reflective thinking process that involved collecting information, analyzing the adequacy and accuracy of the information. Problem solving- is a process by which nurses consider an issue and attempt to find a satisfactory solution to achieve the best outcomes. Learning outcomes… Pgs 12-24 Differentiate among the various forms of education Practical and Vocational Nursing Education • Known as LVNs or LPNs • May attend one of approximately 1200 approved programs given at technical or community college • Usually lasts a year in both classroom and clinical teaching • After completing education program must pass NCLEX-PN exam Registered Nursing entry education • 5 educational pathways lead to an RN • All must complete NCLEX-RN o Diploma programs ▪ Last 3 years focuses in clinical experiences o Associate degree programs ▪ Offered in community college ▪ Account for 53% of RN programs in the U.S. o Baccalaureate degree programs ▪ Lasts at least 8 semesters ▪ About 42% of nursing programs o Master’s entry programs ▪ Usually has another baccalaureate degree in another field 3 | P a g e▪ Programs are usually 3 years of full time study ▪ After education completion you are eligible to take licensing exam and receive master’s degree in nursing o Doctoral entry ▪ Very limited enrollment Graduate Nursing Education ▪ Master’s degree program o Prepares RNs to function in a more independent role o Program usually lasts 2 or years or longer at the university level ▪ Doctoral programs o Typically student has Baccalaureate and a Masters degree o Prepares for advanced clinical practice How Is Nursing Practice Regulated? ▪ Each state enacts its own nurse practice act ▪ Must be licensed as a nurse ▪ States require graduation from an approved nursing program ▪ Nursing is also guided by a standards of practice o Provide a means by which a profession clearly describes the focus of its activities, the receipts of service, and the responsibilities for which its practioner are accountable Give four examples of influential nursing organizations ▪ American and Canadian Nurses Associations o Originally focused on establishing standards or nursing o They track health-care legislation, serve as liaisons with national government representatives ▪ National League for Nursing o First to establish and maintain a universal standard of education o Sets standards for all types of nursing education programs and evaluate the programs ▪ International Council of Nursing o Represents nursing on a global level o More than 120 nations ▪ Sigma Theta Tau International o National honor society for nursing Name and recognize the four purposes of nursing care ▪ Health promotion o Activities foster the highest state of well-being of the recipient of the activities ▪ Illness prevention o Focuses on avoidance of disease, infection, and 4 | P a g eother comorbidities o Activities are targeted to decrease the risk of developing an illness or minimize the risk of exposure to disease Health Restoration ▪ Activities foster a return to health for those already ill ▪ Recall health has physical, mental, and social dimesions End-of-Life Care ▪ Promoting the respectful care of those who are terminally ill or dying Delineate the forces and trends affecting contemporary nursing practice ▪ Trends in Society o Trends in the economy o The growing number of older adults o Women’s movement ▪ Increased Use of Complementary and Alternative Medicine o Homeopathy o Traditional Chinese medicine ▪ Expanded Variety of Settings for Care o Working outside hospital ▪ Interest in Interprofessional Collaboration o Involving joint ownership of decisions and collective responsibility for outcomes ▪ Increased Use of Advanced Practice Nurses ▪ Increased Use of Nursing Assistive Personnel ▪ Influence of Nurses on Healthcare policy ▪ Divergence Between High-Tech and High-Touch Aida Pg. 21-24 ▪ Factors Influencing Contemporary Nursing Practice ? ▪ -Main two factors influence contemporary nursing practice: ▪ Professions in society at large ▪ Those within the nursing and healthcare ▪ -Trends in Society ▪ Historical Roots influenced current nursing practice. ▪ -Trends in economy ▪ In US, health insurance coverage is linked to full-time job. Unemployment means more people without insurance. Uninsured people delay seeking treatment and by the time they enter the healthcare system it raises the the level of nursing care required. ▪ -Growing number of older adults ▪ The growth rate for adults 65yrs and older has greatly outpaced the growth of the population of the country as a whole. In 2030 is estimated that 1 in 5 people will be age 65 or older. As people 5 | P a g eage, they tend to need more assistance with activities of daily living, and thy experience more acute and chronic illnesses. ▪ -Increases consumer knowledge ▪ Patients have access to more health and medical information, particularly through the internet. ▪ Direct-to-consumer marketing – is health information and medications direct at the potential user. Nurses should be prepared to address the truthfulness of the advertisements and present balanced information to clients. ▪ -Legislation ▪ There is Legislation directed at the care that nurses provide to the patients. ▪ Ex: confidentiality of patient records, the patient’s right to know and the patient’s right to a dignified death. ▪ -Women’s movement ▪ Opened up career choices for women and nursing has become just one of many options as opposed to a preferred career pathway. ▪ -Collective bargaining ▪ Is a form of negotiating that allows nurses to seek better wages and working conditions as a group rather than individually. ▪ The Trends in Nursing and Healthcare? ▪ There is an increased Use of Complementary and Alternative Medicine (CAM). CAM is defined by the National Institutes of Health as treatments and services outside the traditional healthcare system. ▪ -Examples of CAM: homeopathy, naturopathy, chiropractic, and traditional Chinese medicine, herbal medications, dietary changes, massage therapy, yoga, aromatherapy, prayer and hypnotism. ▪ - Reasons to seek CAM: ▪ Rising cost of traditional care ▪ Treatment errors ▪ Distrust of the role of insurance and managed care organizations in determining treatment options ▪ Constantly changing healthcare recommendation over the last 20yrs ▪ Creation of National Center for Complementary and Alternative Medicine at the National Institute of Health gave CAM a legitimacy it formally lacked. ▪ -Expanded Variety of Settings for Care ▪ The site of employment shifts away from hospitals and nurses must be prepared to function in these alternative settings. ▪ -Interest in Interprofessional Collaboration ▪ Collaboration is defined as the process of joint decision- making among independent parties. ▪ Leaders in healthcare are finding interprofessional teamwork to be essential to providing safe, high-quality patient outcomes. 6 | P a g e▪-Increased Use of Advanced Practice Nurses: Positive exposure and high patient satisfaction with APNs has increased acceptance and support for all nurses as well as greater cost effectiveness when compared with physician providers. ▪ Increase Use of Nursing Assistive Personnel ▪ Nursing Assistive Personnel (NAP) are healthcare provider who help nurses and physicians provide patient care. ▪ Nursing Assistive Personnel are getting assigned more tasks that pertain to Licensed Nurses. This delegation of activities distances nurses from direct patient care. They have to base important patient care decision on information obtained by by the NAP. ▪ Influence of Nurses on Healthcare Policy ▪ Professional nursing organizations have been actively involved in politics at the local, state, and national levels. Nursing organizations sponsor legislation that promote the interest of the profession and supports changes that positively influence health outcome Legislation ▪ Divergence between High-Tech and High-Touch ▪ Advances in clinical knowledge and technology have contributed to improved care for many patients who are critically ill. Chapter 8 1 Define nursing theory- describe and explain what is and what is not nursing pg 136 vol List four components of a theory- pg 136 vol1 • Assumptions • Phenomena • Concepts • definitions Describe how a nursing theory is developed pg 138 vol 1 • Logical reasoning- developed an argument or statement based on evidence that will result in a logical conclusion • Inductive reasoning- specific to general, • Deductive reasoning-general to specific List four essential concepts in the nursing theory pg 139 vol1 • Person • Environment • Health • nursing List three ways nurses can use nursing theory pg 140 vol1 7 | P a g e• in practice • in education • in research Discuss the relevance of Florence nightingales nursing theory to contemporary nursing practice • the idea of a clean environment would help improve the health of patients. Name 3 predominant thinkers who proposed theories of caring pg 142 vol 1 • Dr. Jean Watson • Dr. Patrica Benner- primary caring model, the nurses care helps the client cope • Dr. Madeleine Leininger- cultural competence Describe 3 nonnursing theories and their contributions to nursing pg 144 vol 1 • Maslows hierarchy of needs- o Physiological needs- basic needs food air water, temp regulation, elimination, rest, sex, and physical activity o Safety and security- protection, emotional and physical safety and security, order, law, stability, shelter o Love and belonging- giving and receiving affection, meaningful relationships, belonging to groups o Self esteem- pride sense of accomplishment, recognition by others o Cognitive- knowledge understanding, exploration o Aesthetic- symmetry, order, beauty o Self actualization- personal growth reaching potential o Transcendence- of self helping others self actualize • Validation Theory- o Go where the demented person is in his own mind • Stress and adaptation Theory- Hans Selye o Some stress is good but too much stress is bad called distress Define nursing research- systematic objective process of analyzing phenomena of importance to nursing. Purpose is to develop knowledge about issues that are important to nursing Pg 148 Vol 1 Describe the significance of evidence based nursing practice pg148 vol 1 • To integrate the best available current evidence with clinical expertise and patient/family preferences and values for delivery of optimal healthcare. • To guide practice decisions • Application to practice Describe the history of nursing research in the united states pg 149 8 | P a g e• As baccalaureate , masters and doctoral programs grew so did the number of and quality of research projects nurses preformed. • Supported by federal funds and private grants and results are reported in a growing number of nursing journals Compare and contrast quantitative and qualitative nursing research pg 150 vol1 • Quantitative -Is to gather data from enough subjects to be able to generalize the results to a similar population. Means what you think • Qualitative – focuses on the lived experience of people List 3 components of the research process and explain their importance pg 151 Vol1 • Select and define the problem • Select a research design • Collect data • Analyze data • Use research findings FIND MORE INFO ON THIS PROCESS ON CH 8 IN YOUR DAVIS CD Name 3 priorities in the process of protecting research participants and explain the significance of these to the nursing research process. Pg 152 vol1 • The right not to be harmed- safety protocols • Right to full disclosure- people have the right to have questions answered • Right to self determination- the right to say no, participant can stop the study at any time Describe the PICO method of formulating a question to guide a literature search pg 153 vol 1 chart 8-4 • P - Patient, Population or problem • I – Intervention, treatment, cause , contribution factor • C – Comparison intervention • O - Outcome List at least four steps in the process of analytic reading of research reports and explain their significance to the appraisal of research pg 155 vol1 chart 8-5 • What is the book, journal or article about as a whole? • What is being said in detail and how? • Is the book, journal or article true in whole or part? • What of it? Ask these questions to see if the research is good research this is appraisal research. Describe how to use nursing research in the nursing practice pg 156 vol 1 • Implement the clinical practice guidelines in their unit or hospital 9 | P a g e• Consider cost barriers to change facilitators for change and staff education. • Seeing if interventions are compatible with patient preferences Aida Pg. 159-164: Chapter 9 - Development across the Life Span Throughout the life span, humans are in a constant process of change, not always visible to the eye. Part I. Concepts of Development Principles and theories of growth and development serve as the foundation for planning and delivering effective personal care. Growth: Refers to physical changes that occur over time. Development: refers to the process of adapting to one’s environment. For centuries, scientists have debated the effects of nature (genetic) vs nurture (environment) on the individual. The joining of the ovum and the sperm forms chromosomes that determine appearance. The environment factors will affect how the child develops and thrives throughout the life span. Principles of Growth and Development: -Growth and Development usually Follow and orderly predictable Pattern: The timing, rate of change, and response to change are unique for each individual -Growth follows a Cephalocaudal Pattern: When an infant is born, the head is the largest position of the body. In the first year, the head, chest and trunk gain in size, yet the legs remain short. Growth of the legs is readily apparent in the second year. -Development Proceeds in Prosimodistal Pattern: The infant fist begins to focus his yes; then lifts the head, later pushing up and rolling over. As infant grows and gains strength and coordination from head to feet, he will crawl and later walk. -Simple Skills Develop Separately and Independently. Many complex skills represent a compilation of simple skills. The ability to feed yourself is an example. This act requires the ability to find your mouth, grasp an object, control movement of that object, coordinate movement of the hand from the plat to the mouth, and swallow solid food. -Each Body System grows at its own pace: This principle is apparent in fetal development; however, it applies throughout life. Puberty – is a series of changes that lead to full development of the reproductive system. -Body system Functions Become Increasingly Differentiated over time: Ex. Newborn’s startle response involves the whole body. As and adult you are able to identify the location of the sound and distinguish the origin of the sound. Theories of Development Theories of development attempt to explain and describe patterns of development common to all people. Such theories provide an organizing framework to help you understand and plan for the needs of the patients you will encounter, and they provide a basis for nursing interventions and clinical decision-making. Developmental Task Theory – Robert Havighurst was an educator who theorized that learning is a lifelong process. He believed a person moves through six life stages, each associated with a number of tasks that must be learned. He characterized developmental task as “midway between an individual need and societal demand. It assumes an active learner interacting with an active social 10 | P a g eenvironment”. Failure to master a task leads to imbalance within the individual, unhappiness, and difficulty mastering future tasks and interacting with others. Psychoanalytic Theory – Sigmund Freud was a pioneer in the science of human development. Freud believed human development is maintained by instinctual drives, sush as libido (sexual instinct), aggression, and survival. Psychoanalytic Theory became the dominant theoretical foundation of early 20th century psychotherapy. Freud identified several forces that influence the development of our personality: ID represents instinctual urges, pleasure, and gratification such as hunger, procreation, pleasure, and aggression Ego begins to develop around 4 to 6 months old. It strives to balance what is waned (id) and what is possible to obtain. According to psychologist Anna Freud, there is a number of defense mechanism, which are described as thought patters of behaviors that the ego employs in the face of threat. Superego sometimes referred to as our conscience. This force develops at 5 to 6yrs. Unconscious mind is composed of thoughts and memories that are not readily recalled but unconsciously influence behaviors. Cognitive Development Theory – According to Piaget, cognitive development requires three core competencies: Adaptation - The ability to adjust to and interact with one’s environment. Assimilation - The process of taking in new information into our previously existing schemas is known as assimilation. The process is somewhat subjective, because we tend to modify experiences and information somewhat to fit in with our preexisting beliefs. In the example above, seeing a dog and labeling it "dog" is an example of assimilating the animal into the child's dog schema. Accommodation - Another part of adaptation involves changing or altering our existing schemas in light of new information, a process known as accommodation. Accommodation involves altering existing schemas, or ideas, as a result of new information or new experiences. New schemas may also be developed during this process. According to Piaget, cognitive development occurs from birth through adolescence in a sequence of four stages: • • The Sensorimotor Stage: During this stage, infants and toddlers acquire knowledge through sensory experiences and manipulating objects. The Preoperational Stage: At this stage, kids learn through pretend play but still struggle with logic and taking the point of view of other people. • 11 | P a g e The Concrete Operational Stage: Kids at this point of development begin to think more logically, but their thinking canalso be very rigid. They tend to struggle with abstract and hypothetical concepts. • The Formal Operational Stage: The final stage of Piaget's theory involves an increase in logic, the ability to use deductive reasoning, and an understanding of abstract ideas. Psychosocial Development Theory: Erik Erikson's theory of psychosocial development is one of the best-known theories of personality in psychology. Much like Sigmund Freud, Erikson believed that personality develops in a series of stages. Unlike Freud's theory of psychosexual stages, Erikson's theory describes the impact of social experience across the whole lifespan. Erikson’s Theory (8 stages) is widely used in nursing and health care: Stage Infancy (birth to 18 months) Early Childhood (2 to 3 years) Basic Conflict Trust vs. Mistrust Autonom y vs. Shame and Doubt control over physical skills and a sense of independence. Success leads to feelings of Import ant Events Outcome Feeding Children develop a sense of trust when caregivers provide reliabilty, care, and affection. A lack of this will lead to mistrust. Toilet Training Children need to develop a sense of personal Preschool (3 to 5 years) Initiative vs. Exploration Guilt autonomy, failure results in feelings of shame and doubt. Children need to begin asserting control and power over the environment. Success in this stage leads to a sense of purpose. Children who try to exert too much power experience disapproval, resulting in a sense of guilt. School Age (6 to 11 years) 12 | P a g eAdolescence Industry vs. Inferiority Identity vs. School Social Children need to cope with new social and academic demands. Success leads to a sense of competence, while failure results in feelings of inferiority. Teens need to develop a sense of self and (12 to 18 years) Role Confusion Relationships personal identity. Success leads to an ability to stay true to yourself, while failure leads to role confusion and a weak sense of self. Young Adulthood (19 to 40 years) Intimacy vs. Isolation Relationships Young adults need to form intimate, loving relationships with other people. Success leads to strong relationships, while failure results in loneliness and isolation. Middle Generativity Work and Adults need to create or nurture things that will Adulthood (40 to 65 years) vs. Stagnation Parenthood outlast them, often by having children or creating a positive change that benefits other people. Success leads to feelings of usefulness and accomplishment, while failure 13 | P a g eresults in shallow involvement in the world. Maturity(65 to Ego Integrity Reflection on Older adults need to look back on life and feel a death) vs. Despair Life sense of fulfillment. Success at this stage leads to feelings of wisdom, while failure results in regret, bitterness, and despair. Moral Development Theory – Lawrence Kholberg developed his theory of moral development by studying the responses to moral dilemmas of 84 boys whose development he followed for a period of 20 years. In this theory, moral reasoning appears to be somewhat age related. Theory was questioned because study only included males. Carol Gilligan proposed an alternative theory that incorporates the concepts of caring, interpersonal relationships, and responsibility. She proposed 3 stages: Caring for onself Caring for others Caring for onself and others Spiritual Development Theory – was based on the works of Piaget, Erikson, and Kohlberg. James Fowler defined faith as a universal human concern and as a process of growing in trust. Part II: Infancy Though Middle Age- normal development depends on nurture and nature. Part III: Older Adults: Overview Interventions depend on the diagnosis and its etiology but Interventions have to be individualized. Chapter 12 The Family Pages 207-215 Family: 2 or more individuals who provide physical, emotional, economic, or spiritual support while maintaining involvement in each other’s lives. Family Structures: (Learning Objective #1) Traditional Family: Married couple with at least one child, the husband, in the labor force, and the wife employed in the home. Adults Married No Children: Self explanatory Dual Earner Family: Both Parents in the