Intro to Nursing/Nursing Process

• · Founder of modern nursing
• · Role of nurses: recover and remain free of disease
• · Sanitation and healing
• · ENVIRONMENT: believed in this influence
• · During 1860s Crimean War
• · Founded school of nursing
• · Had a list of nurse requirements (sober, honest, etc..)
• · Practicing epidemiologist
• · Kept and analyzed statistics, making recommendations based on data
• · HOLISTIC nursing
• · By 1950s, ideas totally accepted
• · Nursing field transitioned into a mostly female career

• * Nursing Shortage
• * Evidence Based Practice
• * Comunity Based Nursing
• * Decreased Length of Hospital Stay
• * Aging population
• * IncreaPed Chronic Health Issues
• * Independent Nursing Practice
• * Culturally Competent Care

• A: Assessment
• D: Diagnoses
• O: Outcomes identification
• P: Planning
• I: Implementation
• E: Evaluation

• P: Practice Quality
• P: Practive Evaluation
• E: Education
• E: Ethics
• C: Collegiality
• C: Collaboration
• R: Research
• R: Resource Utilization
• L: Leadership

• Each state has its own
• identifies scope of practice
• Protects patients of that state

• perspective of a profession
• provides practical/theoretical orientation for a discipline

• main concepts overlapping
• *Nursing
• *Evironment
• *Health/Illness
• *Individual

• Describes event
• Further identifies properties/components
• Circumstances of occurence

• addresses nursing interventions
• consequences of each
• control, promote, &change clinical nrsg practice

• Illness was supernatural
• Doctor: medicine man, priest
• Nurse: "slaves"
• males gave nrsg care and bury dead

• Religious warfare, exploration, expansion
• Nurse: criminal women serving sentence
• Social Reform in 18-19th century

• Socal Reform/Crimean War
• Challenged femal prejudice
• training school, wrote books
• Health/Illness different from medicine
• Nutrition, Therapies
• Continued Education, managing documentation

• Civil War: need for nurses
• School based on Nightingale
• WWII: women increased independent, increased education
• School objective: degrees
• Nrsg knowledge base for Nrsg practive

• 1. Promote Health: optimal fxn + wellbeing; desire to increase wellbeing
• 2. Prevent Illness: decrease risk, early detection, promote good habits
• 3. Restore Health: inidiv. focus from early detection to rehab
• 4. Facilitate Coping: cope w/altered fxn, maximize strengths

• varied settings
• usually 1 year
• 1/3 class, 2/3 clinical
• Test: NCLEX-LPN

• 1. Diploma: 3 yrs
• 2. ADN: 2 yrs, faster, comm/jr college, non-trad. students
• 3. BSN: 4 yrs, admin manager, community health, collaborative, research

• Master: national cert, manager, ARNP, clinical specialist
• Doctorate: carry out research necessary to advance nrsg theory + practice

• 1st intn'l org of prof women
• maintain standards
• promote ethics
• natn'l nrsg orgs work together

• late 1800s
• State level
• Standards of Practice
• Research to Advance Nrsg Practice
• Rep Nrsg for Legislative Axn

• 1953
• Voluntary accredication
• Develop nrsg services + educ
• Largest prof. testing service
• Primary research source for data (surveys)

• late 1800s
• Natn'l Voice for BSN or higher
• Estab. quality educ. standards
• Influence prof. + improve HC
• Promote public support of Bach/Grad educ.
• Natn'l accreditation based on CCNE

• Voluntary participation
• Students: self governance, advocate for student + patient's rights
• Collective responsible axn on social/political issues

examines general idea, then considers specific actions/ideas

builds from specific ideas/axns to conclusions about general ideas

• adjustment to other living things and evironmental conditions
• Internal (self)
• Social (others)
• Physical

• Process is orderly/predictable
• Each stage highly individualized
• Erikson: socialization, 8 stages in life
• Maslow: psychosocial, 5 Basic Needs

• Universal application
• One element affects all other aspects of the system

• Basic: (pure/lab) generate/refince theory, often not directly useful in practice
• Applied: (practical) directly influence/improve clinical practice
• TYPES: Descriptive, Correlational, Quasi-Experimental, Experimental

• Discovers meanings
• Reality if based on perceptions, thus always changes
• Focus on Words rather than #s
• TYPES: Phenomology, Grounded, Theory, Enthnography

• A: Assess need for change in practice
• L: Link problem intrvn + outcome
• S: Synthesize best evidenct
• D: Design practice change
• I: Implement + Evaluation change in practice
• I: Integrate + Maintain change in practice

• 1. Identify a specific area of concern
• 2. Review the published literature to determine if enough research has been done
• 3. Critically Analyze the published literature to be sure it is accurate/relevant

• non-profit
• funded by local/state/natn'l orgs

• for- or non-profit
• funded by communities, churches, corporations, charitable orgs

• kind of like walk-in clinic
• come for just procedure, then leave

• continuity of care
• critical pathway

• essential HC
• scientific, socially acceptable
• accessible to community

• Social Security Act
• Elderly, Disabled, their Dependents
• DRG paid for

any age w/ low income

• prepaid group managed plans
• only affiliated providers
• pay zero or small copay

• allows payer to contract w/group of HC provider
• provide low cost service in return for prompt payment/guaranteed business
• pay out of pocket if choose own provider

• large, nonprofit, tax exempt
• small, for profit, private
• monthly premiums
• 3rd part payer (insurance pays all/most of care)
• choose own provider

• 90% paid by Medicaid + out of pocket
• Medicare + private only pays minimally

• Daycare
• Mental Health
• rural
• Schools
• Industry
• Homeless Shelters
• Rehab

• 1. Right Task
• 2. Circumstances
• 3. Person
• 4. Direction/Communication
• 5. Supervision

• Directive
• Complete control

• Participative
• Sense of equality
• decisions/activities shared
• mutually set goals/outcomes
• used most often

• relinquish power to group
• encourages independent activity
• difficult to successfully achieve

• creates revolutionary change
• charismatic
• inspires/motivates
• vulnerable: care, express ideas/emotions/concerns, willing to take risks

• comprehensive approach to considering leadership style, work group's maturity, situation at hand
• often lacks in depth and responsiveness to challenges

• Old vs. New
• moves beyond traditional modea
• change is dynamic, everpresent, continually unfolding

• increased efficiency, but impersonal care
• assigned specific tasks
• like industrial "assembly line"

• focus on individual care (personal)
• team of RN + caregivers care for designated group on specific shift
• delegation

• patient-centered
• nurse as caregive (all aspects of care)
• lack of continuity between shifts
• expensive

• comprehensive, individualized, consistent care
• expensive
• nurse plans, evaluates, directs care of a pt 24 hrs/day thru entire stay

• one nurse oversees quality and financial outcomes of pt care
• works collaboratives along agreed-upon clinical pathway

ability to think critically and evaluate a situation systematically and accurately based on data

• practice to achieve confidence
• familiarize yourself w/procedure and equipment
• seek help if needed

• building a positive nurse-patient caring relationship by interacting with them, not viewing them as an object or job to be done
• rewarding to both counterparts

• develop accountability for your knowledge and implementation
• practice altruism
• always prioritizing needs of patient
• remain within legal rights and scope of practice
• advocating for your patient, self, peers, etc.

• Initial: shortly after admittance (baseline)
• Focused: gather data about specific problem identified
• Emergency: in phys/psych crisis (conditions are life-threatening)
• Time-Elapsed: present data compared to baseline data (reassess, make necessary revisions)
• Medical: target data pointing to pathological conditions
• Nursing: focus on pt's responses to health problems (Holistic)

• Actual: Label, Definition, Def. Charac, Related Factors
• Risk: potential for developing actual
• Possible: additional data needed
• Wellness: "readiness for.." higher level
• Syndrome: cluster of actual/risk data all defined by a particular event

• info perceived only by affected person
• cannot be perceived/verified by anyone else

• observable, measurable by someone other than pt
• can be measured on a diff pt as well, or on the same pt but by a diff person

• Preparatory: review info w/open mind
• Introduction: expectations
• Working: gather info for database
• Termination: key points, what to expect, any questions?

• Problem: describes health state/problem
• (related to)
• Etiology: factors/causes
• (evidenced by)
• Defining Characteristics: obj/subj data

• Goal: aim or end
• Outcome: expected conclusion to helath problem/expectation
• Expected Outcome: specific measurable criteria used to evaluate extent to which patient has met outcome

• Initial: admission
• Standardized Care Plan: common to specific problem
• Ongoing: develop new diagnoses as old outcomes are met
• Discharge: begin at admission, teaching/counseling, leaves w/knowledge

• 1. Physiologic
• 2. Saftey & Security
• 3. Love & Belonging
• 4. Self-Esteem
• 5. Self-Actulization

• Nursing: outcomes derived from problem statement in nrsg Dx
• Patient Goals: suggested by problem statement
• Nrsg Intrv: suggested by etiology/cause

• Cognitive: increase in patient knowledge/intellect
• Psychomotor: new skill
• Affective: change in pt value/belief/attitude
• Physiologic: physical change is targeted

• Patient Profile: hx bckgrnd info, strength/problems
• Patient's Preferred Name: many be diff
• Chief Complaint/Reason for Admission
• Patient's current health status: phys/emotional changes requiring modification
• Routine assitance pt needs to meet basic human needs
• Priorities for nursing care
• Special "Events": diagnostic studies, consultations, therapies
• Special teaching, counseling, advocacy needs
• Special needs of family

• 1. Life threatening
• 2. What's important to the patient
• 3. What you know needs to be done, regardless
• 4. Last: Long-term goals, patient teaching

• specially designed to promote excellence
• enable accountability of care to society
• Quality by Inspection: find/remove deficient workers
• Quality by Opportunity: find opportunities for improvement, thrives on tmwrk & fixing probs in the system

• STRUCTURE evaluation: describe physcial facility/equip, organization characterisitics/policies, resources avail
• PROCESS evaluation: nature/sequence of activities of nurses/nursing process
• OUTCOME evaluation: focus on measurable changes in patient health status; end results

• Concurrent: during pt care: observations, patient interviews, chart review
• Retrospective: post discharge: questionaire, pt interview, chart review