NR 351 Week 1 exam with answers / NR351 Exam 1 exam with answers- Wagner College (A grade) - 100% Correct and Reliable

NR 351 Week 1 exam with answers - Wagner College (A grade) NR 351 EXAM 1 Chapter 8 IOM (Institute of Medicine) six outcomes for new healthcare - Safe - Effective - Efficient - Patient-centered - Timely - Equitable 1999- To ERR is Human – states that too many mistakes were made that could have been prevented; focused on human safety Health Care should be: - Affordable - Accessible - Quality and safety Continuously Learning -through science, public reports and patient-clinician partnerships IOM’s 4-tiered strategy to prevent medical errors: 1. Establish a national focus to create research and protocols to enhance our knowledge on safety 2. Identify and learn from errors by developing a nationwide public reporting system 3. Raising performance standards and have them be overlooked by higher authorities in health care professionals 4. Implement safety systems to ensure safe practice Pay Per Performance -DSRIP (delivery system reform incentive payment program) Goal: to reduce hospital readmissions by 25% Gives incentive to hospitals by giving them a monetary rewards Fined if they can’t do it PPACA (patient protection and affordable care act) Goal: to decrease number of uninsured, control healthcare costs and improve healthcare delivery system Provide a new way to get health insurance: The Health Insurance Marketplace AHRQ- Agency for Health Care Research and Quality Levels of Health Care 1. Preventive- focuses on educating to prevent future health problems 2. Primary- treatment of common health problems a. Physicals once a year 3. Secondary- treatment of problems requiring more specialized clinical experience a. More than routine ex/diabetes 4. Tertiary- management of rare and complex disorders a. Chronic illnesses/no cure U.S. is a multipayer system: -Government funded (Medicaid = poor / Medicare = old) -Military = champus/tricare -Private plans 1. Traditional insurances 2. MCOs- Managed care organizations- quality care designed to control costs 3. PPOs- Preferred provider organizations- clients choose from a list of providers 4. EPOs- Exclusive provider organizations- clients choose from a list of providers within a contracted organization 5. Long term insurance DRGs – diagnosis related grouping -When you go into the hospital it refers to the length of stay they believe you should have according to what it wrong with you or what procedure you are getting done. Discharge planning- starts as soon as you are admitted Health Care Settings 1. Primary Care Centers a. APRN’s, NP’s, midwives and clinical nurse specialists work with physicians to help patients 2. Home Health Care a. Rapidly growing- based out of hospitals or private home care agency b. Helps support patient and their families 3. Extended Care Facilities a. Assisted living/ transitional sub acute care/ intermediate and long term care b. “Aging in place” 4. Specialized Care Centers and Settings a. Daycare/ mental health/ schools/ rehab centers/ homeless centers b. Focus on restorative health for follow-up care 5. Health care Services for the Seriously Ill and Dying a. Respite care- family care that needs a break/ beds in hospital for patient b. Hospice care- dignity and comfort for those dying c. Palliative care- focuses on emotional, physical and spiritual distress To be part of the healthcare team you NEED to be a team player! Trends in healthcare/nursing: -Increased diversity and technology -Educated and engaged consumers -Costs of healthcare -Shortages of healthcare professionals -EBP -Culturally competent for diverse populations -Decreased length of hospital stay -Aging population Strategies to reduce healthcare costs - DRGs - Bundled payments and better rates - Eliminating fraud/abuse - Improving population health - More efficient and less costly Currently, healthcare is a privilege and we are trying to make it a moral right. But, risk takers aren’t wanted. (ex/ drugatics who we save and diabetics who wont eat right) Chapter 1 History of Nursing -Early civilization- nurse was mother/ temples were the place for care -Early Christian period- socialites and nuns were nurses -16th century- expansion of knowledge occurred/nurses were needed more -18th-19th century- male dominance of healthcare/nursing more respected Florence Nightingale - First nurse researcher - “Notes on nursing: what it is and what it is not” -Defined nursing as both a science (knowledge base for care that is given) and an art (skilled application of that knowledge) -Recognized not only health but illness -Stressed the need for nursing education Mary Eliza Mahoney- 1st African American nurse to graduate from New England hospital for woman and children Clara Barton- established the Red Cross Margaret Sanger- founder of Planned Parenthood WW2 -Men were at war so women filled their job spots/became more assertive -Explosion of knowledge in medicine and technology 1950’s to present- nursing broadened/became more seriously taken -Nursing research was conducted and published ex/restraints reduction -BSN becoming greater than associates Nursing Roles 1. Caregiver a. Combines the art and science of nursing in meeting physical, emotional, intellectual, sociocultural and spiritual needs. Integrates all other roles into this one. 2. Communicator a. Use of effective interpersonal and therapeutic skills 3. Teacher/educator a. Use of communication skills to make individualized learning plans to patient and their families 4. Counselor a. Use of therapeutic communication skills to help with problem solving and decision making 5. Leader a. Assertive, self-confident practice of nursing when providing care or working in groups 6. Researcher a. Participating in research to increase knowledge to improve patient care 7. Advocate a. Protection of human or legal rights to give the patient the right to make informed decisions for themselves 8. Collaborator a. Use of skills to help all of the functions in the health care team Nursing- nutrix- to nourish Patient/individual/community is central focus IOM- institute of medicine- constantly putting out detailed reports on nursing ICN: international council of nursing- promotes health, prevention of illness and collaborative care ANA: American nurses association- gives social policy statements that may influence regulations NCSBN: national council of state boards of nursing -Website that tells us what NCLEX will look like -Works hand in hand with Offices of Professions (gives requirements for NCLEX) Aims of Nursing: 1. To promote health (state of optimal functioning or well-being) 2. To prevent illness- vaccinations 3. To restore health- rehab/PT 4. To facilitate with disability or death- ex/terminal illnesses FOCUS ON: “dealing” Birth, health, illness, death and prenatal---- important because doctors help cure Nurses use knowledge, skills and critical thinking. Nurses use four essential competencies: 1. Cognitive skills 2. Technical skills 3. Interpersonal skills 4. Ethical/legal skills QSEN: quality and safety education for nurses: -Further specifies the duties of a nurse, including: Provide patient-centered care Be team players/collaborators Improve quality of care Demonstrate evidence-based practice Collect and analyze information Nursing as a professional discipline -Well-defined body of nursing knowledge -Service focused/code of ethics (ANA MAKES THEM) -Recognized authority- regardless of rank -Professional organizations set standards -Ongoing research -autonomy- need to know to question order Professional Organizations ICN: international council of nurses NSNA: national student nurses association NLN: national league for nursing AACN: association of colleges in nursing Sigma Theta Tau- national honor society at wagner ANA: American nurses association Standards of practice: ADOPIE Standards of professional performance: EEEQCLCPREC Each state has established set of laws- “office of professions” website They define legal scope of nursing practice Excludes untrained/unlicensed from practicing nursing (UAP- Unlicensed Assisted Personnel) ex/patient care tech Nurse Licensure Compact: 24 states that say if youre licensed in NY and maintain it, you can work in their state as well after you take a few more tests Nurse Practice Acts: regulate practices of nursing Create a state board of nursing to: Make and enforce rules and regulations Define terms and activites Establish a criteria for education and licensure THE NURSING PROCESS- one of the major guidelines on how to act as a nurse -helps nurses implement their roles -integrates art and science of nursing -defines the areas of care that are within the domain of nursing Chapter 2 Sources of Knowledge 1. Traditional- passed down from generation to generation 2. Authoritative- comes from an expert, accepted as truth based on person’s expertise 3. Scientific- arrived at through the scientific method (research) -informatics- how we collect information Types of Knowledge- influenced by history and society 1. Science- observing, identifying, describing, investigating, explaining surroundings 2. Philosophy- the study of wisdom and fundamental knowledge 3. Process (The Nursing process)- series of actions/changes/functions to achieve a result ex/frameworks and theories Theory- group of concepts that describe a pattern of reality - can be tested, changed and used to guide research Concepts- abstract impressions organized into symbols of reality Conceptual framework or model- group of concepts that follow a pattern Deductive Reasoning- examines general ideas and considers specific ideas DOWN Inductive Reasoning- builds from specific ideas to conclusions of general ideas UP Nursing Theories 1. General systems theory a. Universal application; break a whole into parts to see how they work together b. All about how a system works together and the boundaries and reforms they use to maintain balance 2. Adaptation theory a. Adjustments of living matter: internal, social and physical 3. Developmental theory a. Orderly and predictable growth and development from conception to death Goal of Theories: To provide holistic patient care Individualized care to meet needs of patients -does patient allow you to perform care you know you need Promotion of health Prevention or treatment of illness Maslow- developed a theory of human needs in terms of physical and psychosocial needs considered essential to human life in order to achieve self-actualization Benefits of Nursing Theory -directs nurses toward a common goal -leads to improved patient care -helps resolve current nursing issues -prepares nurses to question assumptions and values -Descriptive vs. Prescriptive D: Qualitative- describes phenomenon ex/interviews/themes P: Quantitative- address/”prescribing” interventions and consequences that is being taught ex/high blood pressure Common concepts in nursing theories 1. Health 2. Patient in general 3. Nursing 4. Environment Orem: -self care is a human need/requires nursing action -nurses manage self care actions for each patient ex/ stroke victims- environment? Family? It all changes the type of care they receive “Nursing Research”- first research journal -uses data, collected in a systemic manner, to describe, explain or predict events -conducted to validate current knowledge or develop new knowledge -Goals: improve care of people in clinical setting Study people and the nursing process (education, policy development, ethics and nursing history) develop explanations/ find solutions to problems -Problems: restricted access to resources Limited time to participate in research Lack of educational preparation Quantitative- involves concepts of basic and applied research (usually with #’s and facts) Types: 1. Descriptive- ex/whoever had healthcare stands up 2. Correlational- ex/sample of populations with different blood pressures vs. strokes (uses statistics) 3. Quasi-experimental- conducted in clinical settings to examine effects between nurse and patient 4. Experimental- highly controlled settings Terms for quantitative: -Variable- independent influences dependent (ex/blood pressure levels depends on blood pressure medicine being given) -hypothesis/data/instruments Qualitative- conducted to gain insight by discovering meanings (personal perception) Types: 1. Phenomenology- describes experiences as they are lived by the subject 2. Grounded Theory- how people describe their own reality and how their beliefs coincide with their actions in social settings 3. Ethnography- used to examine issues of a culture that are of interest to nursing; discipline of anthropology 4. Historical- examines past events to increase understanding of nursing today Scientific Method 1. State the problem 2. Define the purpose 3. Review literature 4. Formulate hypothesis 5. Select research design 6. Select population and sample 7. Collect data 8. Analyze data 9. Communicate conclusions EBP- Evidence Based Practice -problem solving approach to making clinical decisions using the best evidence available -blends art and science for best outcome -culture counts- setting in which nurses work must support changes based on EBP -differences ex/sloan vs. rural hospital Steps to Implement EBP: 1. Ask a question about a clinical area of interest or an intervention a. Patient/population/problem of interest- need for description b. Intervention of interest- the more defined the more focused the search of the literature will be c. Comparison of interest- to another treatment or usual standard of care d. Outcome of interest- finding evidence of other outcomes dealing with same interest 2. Collect most relevant and best evidence 3. Critically appraise the evidence 4. Integrate the evidence with clinical expertise, patient preferences and values in making a decision 5. Evaluate the practice decision or change Cochran Database- panel that approaches research and studies to make findings Protecting Rights of Patients -informed consent- patients need to give this if they are going to partake in research -federal regulations- laws- legal and ethical -IRBs- institutional review boards HERBs (human experimental research board) at Wagner AACN- American association of critical care nurses -will post protocols so that maybe other organizations will pick up the same practices Chapter 5 Cultural diversity- varying cultures; racial and ethnic origins; religion; size, age and gender; sexual orientation; disability Culture- shared system of beliefs, values and behavioral expectations that provide social structure for daily living -patients decisions may be altered due to their culture -patients cultures effect how they feel towards certain things ex/ pain, mental health, promptness, family support, communication Subculture- large group of people who are members of a larger cultural group -have certain characteristics not common to the larger culture ex/nursing (largest), Italian Dominant group- largest group; has most authority to control values and sanctions of society Minority group- smaller group- physical or cultural characteristic identifies the people as different than dominant group Ethnicity- sense of identification with a collective cultural group; based on common heritage ex/Italian, American Race- typically based on specific physical characteristics ex/white 5 major categories: American Indian; Asian; black; white; native Hawaiian Stereotyping- the assumption that all members of a culture or ethnic group act alike -may be positive (makes it easier to generalize) or negative (racism, prejudice) Cultural assimilation (acculturation= without culture)- minorities living within a dominant group lose the characteristics that made them different Culture shock- the feelings a person experiences when placed in a different culture Cultural imposition- belief that everyone should conform to the majority belief system Cultural blindness- ignores differences and proceeds as if they did not exist Culture conflict- people become aware of differences and feel threatened and in response they ridicule beliefs and traditions of others Ethnocentrism- belief that one’s ideas, beliefs and practices are the best Nurses must accommodate and respect others belief systems and continue giving the best care that they can regardless of how their patient feels. White: youth and attractiveness valued; assess dietary habits; assess use of OTC medications African: may use folk healing; frequently religious; value extended family/matriarchal Asian: seldom complain about pain; family and ancestors valued; YinYang; consider polite to give expected responses Hispanic: hot/cold theory of treating illness; elders and males are respected; normal diet may be high in starch Chapter 7 Law- standard or rule of conduct established and enforced by government Litigation- process of bringing and trying a lawsuit Plaintiff- person bringing suit Defendant- person being accused of a crime (presumed innocent until proven guilty) Types of Law 1. Public law- government is directly involved 2. Private law- civil law between people 3. Criminal Law- concerns state and federal criminal statutes; criminal actions Four Sources of Law 1. Constitutions- serve as guides to legislative bodies 2. statutory law- enacted by a legislative body a. ex/ nurse practice acts- specific to state- MOST important 3. administrative law- empowered by executive officers 4. common law- judiciary system reconciles controversies; creates body of common law a. ex/malpractice; right to refuse treatment Legal Regulation in Nursing -Nurse practice acts- MOST IMPORTANT -Standards- guidelines developed by our peers; not mandatory -Credentialing- “maintaining license” through accreditation, licensure and certification Reasons for Suspension or Revoking of a License -drug or alcohol abuse- MOST FREQUENT -fraud -negligence and malpractice -Due Cause for Revoking: Notice of Investigation Fair and impartial hearing Proper decision based on substantial evidence Best Defense for Nurse: Accurate documentation; early legal counseling; character witnesses Criminal Law 1. Crime- wrong against a person or the person’s property as well as the public a. Misdemeanor- punishable by fines or less than 1 yr imprisonment b. Felony- punishable by imprisonment for more than 1 yr 2. Tort- a wrong committed by a person against another person or that person’s property; tried in civil court a. Intentional- assault and battery; defamation of character (oral-slander written- libel); invasion of privacy (social media use); false imprisonment; fraud (lying) b. Unintentional- negligence; malpractice Liability (4 elements) 1. Duty- obligation to use due/standard care 2. breach of duty- failure to reach standard of care 3. causation 4. damages- harm to patient Malpractice Types: Failure to… Follow standards of care Use equipment in responsible manner Assess and monitor Communicate/document Outcomes of Mal. Litigation: All parties work towards fair settlement Case is presented to panel and brought to trial court Legal Safeguards for Nurses -competent practice/adequate staffing -informed consent or refusal- this is a process- need signature -Documentation- key to a competent practice -Whistle-blowing- nurses who speak up -Professional liability insurance- how much it could cover you in case of an incident -Risk management programs -Incident reports- used for quality improvement -Sentinel events- unexpected occurrences such as death or serious injury -Never events- list of 29 events- VERY serious ex/wrong patient, wrong part -Patient’s rights/good Samaritan laws Elements of Informed Consent 1. Disclosure- patient has to be aware 2. Comprehension- understand that it is not a guaranteed outcome 3. Competence-make sure they understand 4. Voluntariness- make sure they are willing Risk Management Programs-designed to identify/analyze issues and treat risks -safety program- environment safety -products safety program- safe-adequate equipment -quality assurance programs- quality healthcare to patients; ongoing evaluation of patient care Incident Reports -complete name, characteristics, date and time of incident -factual evidence -documentation by physician OSHA- Occupational Safety and Health Regulations: -use of electrical equipment -use of isolation techniques -use of radiation/chemicals HIPAA-Ensured Patients Rights -to see, copy and update their health record -to get a list of disclosures and request correction of any mistakes -to choose how to receive health information Chapter 6 Value Transmission -modeling, moralizing, laissez-faire, rewarding and punishing, responsible choice 1. Choosing- choosing freely from alternatives after careful consideration of the consequences of other alternatives 2. Prizing (treasuring)- involves pride, happiness and public affirmation 3. Acting-combining choice into one’s behavior with consistency and regularity on the value Altruism- concern for welfare and well-being of others Autonomy- right to self-determination Human dignity- respect for inherent worth and uniqueness of individuals and populations Integrity- acting according to code of ethics and standards of practice Social justice- upholding moral, legal and humanistic rights Types of Ethics 1. Bioethics- encompasses a number of fields of “life sciences” 2. Nursing ethics- formal study of ethical issues that arise in nursing 3. Feminist ethics- critiques existing patterns of oppression and domination in society effecting women Utilitarian- the rightness or wrongness of an action depends on the consequences of the action Deontologic- an action is right or wrong independent of its consequences Beauchamp and Childress’s -Autonomy- respect rights of patients to make healthcare decisions -Nonmaleficence- avoid causing harm -Beneficence- benefit the patient -Justice- give each his or her due and act fairly -Fidelity- keep promises TRUST Functions of Ethics Committees 1. Education 2. Policy making 3. Case review 4. Consultation -occasionally research