Exam (elaborations) Nr 222 Final Exam Outline all chapters

Chapter 1 Nursing as a Profession Patient-centered care Professionalism Requires critical thinking Administer patient-centered quality care Be responsible and accountable Health care advocacy groups Robert Wood Johnson Foundation (RWJF) Future of Nursing: Campaign for Action Institute of Medicine (IOM) publication on The Future of Nursing Science and Art of Nursing Practice Nursing requires: Current knowledge and practice standards Insightful and compassionate approach Critical thinking Benner’s stages of nursing proficiency: Novice Advanced beginner Competent Proficient Expert Scope and Standards of Practice Nursing definitions American Nurses Association (ANA) International Council of Nurses (ICN) Nursing: Scope and Standards of Practice 1960: Documentation began Standards of Professional Nursing Practice Standards of Professional Performance Code of Ethics Professional Responsibilities and Roles Autonomy and accountability Caregiver Advocate Educator Communicator Manager Career Development Provider of care Advanced Practice Registered Nurses Clinical Nurse Specialist Nurse Practitioner Certified Nurse-Midwife Certified Registered Nurse Anesthetist Nurse Educator Nurse Administrator Nurse Researcher Nursing Shortage • Correlation between direct care provided by an RN and: Positive patient outcomes Reduced complication rates More rapid return of the patient to optimal functional status • With fewer available nurses, it is important for you to learn to use your patient contact time efficiently and professionally. Historical Influences • Nurses: Respond to needs of patients Actively participate in determining best practices • Knowledge of the history of the nursing profession increases your ability to understand the social and intellectual origins of the discipline. Florence Nightingale • Established first nursing philosophy based on health maintenance and restoration • Organized first school of nursing • First practicing epidemiologist • Improved sanitation in battlefield hospitals • Practices remain a basic part of nursing today Civil War to the Beginning of the Twentieth Century • Clara Barton • Dorthea Lynde Dix and Mother Bickerdyke • Harriet Tubman • Mary Mahoney • Isabel Hampton Robb • Lillian Wald and Mary Brewster Twentieth Century • Movement toward scientific, research-based practice and defined body of knowledge • Nurses assumed expanded and advanced practice roles 1906: Mary Adelaide Nutting, first nursing professor at Columbia Teacher’s College Army and Navy Nurse Corps established 1920s: Nursing specialization began 1990: ANA established Center for Ethics and Human Rights Twenty-First Century • Changes in curriculum to meet changing societal needs • Advances in technology and informatics requires nurses to have a strong and current knowledge base • Last Acts Campaign • End-of-life care and practices added to nursing curricula Contemporary Influences • Importance of nurses’ self-care • Health care reform and costs • Demographic changes • Medically underserved Trends in Nursing • Evidence-based practice • Quality and Safety Education for Nurses (QSEN) • Impact of emerging technologies • Genomics • Public perception of nursing • Impact of nursing on politics and health policy Professional Registered Nurse Education • Prelicensure 2-year associate’s degree 4-year baccalaureate degree • Graduate education Master’s degree, advanced practice RN Doctoral degrees • Continuing and in-service education Nursing Practice • Nurse Practice Acts (NPAs) Overseen by State Boards of Nursing Regulate scope of nursing practice Protect public health, safety, and welfare • Licensure and certification Licensure: NCLEX-RN® examination Certification: requirements vary Professional Nursing Organizations • Address member concerns • Present educational programs • Publish journals • Student organizations National Student Nurses Association (NSNA) Canadian Student Nurses Association (CSNA) Chapter 2 The Health Care Delivery System Challenges to Health Care • US health care system is complex and constantly changing Uninsured • Nurses should be prepared and work toward: Improving access Maintaining quality and safety Lessening health care costs Traditional Level of Health Care • Preventative • Primary- is true prevention. Its goal is to reduce the incidence of disease. • Secondary- focuses on preventing the spread of disease, illness, or infection once it occurs. • Tertiary- occurs when a defect or disability is permanent and irreversible. It involves minimizing the effects of long-term disease or disability by interventions directed at preventing complications and deterioration. • Restorative • Continuing health care Primary and Preventative Health Care • Preventive Care Improved health outcomes for an entire population Reduces and controls risk factors for disease • Primary care Focuses on improved health outcomes Requires collaboration • Health promotion programs lower overall costs Reduces incidence of disease Minimizes complications Reduces the need for more expensive resources Secondary and Tertiary Care (1 of 3) • Focus: Diagnosis and treatment of illness • Used when the nature or severity of a condition makes primary care insufficient. • Secondary: Provided by a specialist upon referral from PCP • Tertiary: Specialized consultative care, usually provided on referral from secondary medical personnel Secondary and Tertiary Care (2 of 3) • Hospitals Provide comprehensive secondary and tertiary care to acutely ill. • Intensive care Advanced technology • Mental health facilities • Rural hospitals Critical Access Hospitals Secondary and Tertiary Care (3 of 3) • Discharge planning Develops plan for continuing care Determines post-hospital destination Identifies patient needs Begins process while still hospitalized Restorative Services • Serves patients recovering from an acute or chronic illness/disability • Helps individuals regain maximal function and enhance quality of life • Home care • Rehabilitation • Extended care facilities Restorative Services: Home Care • Home services for health maintenance, education, illness, prevention, diagnosis and treatment of disease, palliation, and rehabilitation. • Durable medical equipment • Highly individualized care Restorative Services: Rehabilitation • Process aimed at enabling people with disabilities to reach and maintain their optimal physical, sensory, intellectual, psychological, and social functional levels. • Rehabilitation services after acute care include physical, occupational, and speech therapy and social services. • Rehabilitation settings include rehabilitation institutions within acute care centers, free-standing outpatient settings, and the home. Restorative Care: Extended Care • Extended care facility Provides intermediate medical, nursing, or custodial care for patients recovering from acute illness or disabilities • Intermediate care/skilled nursing facility Provides care for patients until they can return to their community or residential care location Continuing Care • For people who are disabled, functionally dependent, or suffering a terminal disease • Available within institutional settings or in the home: Nursing centers or facilities Assisted living Respite care Adult day care centers Palliative and Hospice Care Continuing Care: Nursing Centers or Facilities • Provide 24-hour intermediate and custodial care Nursing, rehabilitation, diet, social, recreational, and religious services Residents of any age with chronic or debilitating illness • Regulated by standards: Omnibus Budget Reconciliation Act of 1987 • RAIs Minimum Data Set Care Area Assessment RAI Utilization Guidelines Continuing Care: Assisted Living • Long-term care setting • Home environment • Greater resident autonomy • No fee caps Continuing Care: Respite Care • Respite care provides short-term relief or “time off” for people providing home care to an individual who is ill, disabled, or frail. • Settings include home, day care, or health care institution with overnight care. • Trained volunteers enable family caregivers to leave the home for errands or social time. Continuing Care: Adult Day Care Centers • Provide a variety of health and social services to specific patient populations who live alone or with family in the community • May be associated with a hospital or nursing home or may operate independently Continuing Care: Palliative and Hospice Care • Palliative care: Patient- and family-centered care approach with a goal of improving the quality of life of patients and families who are experiencing problems related to life-threatening illnesses. • Hospice care: Focuses on palliative (not curative) care • Many hospice programs provide respite care, which is important in maintaining the health of the primary caregiver and family. Issues in Health Care Delivery for Nurses • Health care agencies today are working hard to improve patient experience and engagement while delivering high quality care, improving outcomes and controlling cost. • As you face issues of how to maintain health care quality while reducing costs, you need to acquire the knowledge, skills, and values necessary to practice competently and effectively. Health Care Costs and Quality • Social Security Act • CMS Innovation Center • The Affordable Care Act • Reforms that incent: Hospital value-based purchasing Hospital readmissions reduction program Bundled payments for care improvements Hospital acquired condition reduction program • Patient satisfaction Nursing Shortage • Will intensify as baby boomers age and an increased need for health care grows • Nursing schools struggle to increase capacity • Indicators Bureau of Labor Statistics Employment Projections Institute of Medicine’s report, The Future of Nursing: Leading Change, Advancing Health Passage of Patient Protection and Affordable Care Act Competency • QSEN and The Massachusetts Nurse of the Future Nursing Core Competencies© Nurses would have knowledge, skills, and attitudes for 10 competencies to meet today’s challenges in health care • Ongoing competency is your responsibility Need to know most current practice standards Patient-Centered Care • Respect for patients’ values, preferences, and expressed needs • Coordination and integration of care • Information and education • Physical comfort • Emotional support and alleviation of fear and anxiety • Involvement of family and friends • Continuity and transition • Access to care Magnet Recognition Program • Recognizes health care organizations that achieve excellence in nursing practice. • Components Transformational leadership Structural empowerment Exemplary professional practice New knowledge, innovation, and improvements Empirical quality results. • Nursing-sensitive outcomes Technology in Health Care • Genetics/genomics • Less invasive, more accurate tools • 3-D printing • Robotics • Biometrics • Electronic health records • Telemedicine Health Care Disparities • Differences in health care outcomes and dimensions of health care Access Quality Equity Health People 2020 Chapter 6: Health and Wellness Healthy People • Provides evidence-based, 10-year national objectives for promoting health and preventing disease • Healthy People 2020 identifies leading health indicators (LHIs), which are high-priority health issues. • Healthy People 2030 will promote a holistic approach to health promotion and disease prevention. Definition of Health • A state of complete physical, mental, and social well-being, not merely the absence of disease or infirmity (WHO, 1947, 2018) • A state of being that people define in relation to their own values, personality, and lifestyle Models of Health and Illness (1 of 2) • Models help explain complex concepts or ideas, such as health and illness • Health beliefs • Health behaviors Positive Negative Health Belief Model Health Promotion