Nurs310 Final Exam

• To I.D. the purposes and functions of nursing
• To differentiate nursing from other health occupations (this is important because health care facilities are concerned with cost. They try to replace nurses with unqualified people-unlicensed)
• Needed in legislation (our government writes laws. The law that governs the practice of nursing-Nurse Practice Act)

phenomenon

• the building blocks of theory
• abstract ideas or mental images of phenomena
• expressed in words or phrases

• 1. readily observed or concrete (thermometer, rash, lesion)
• 2. indirectly observable (pain, anxiety)
• 3. nonoservable (powerless, stress, adaptation)

• often used to describe the interrelationship between concepts that represent and are common to a profession
• a phenomenon of interest
• really BIG concepts, or words, with many different meanings or ways in which to use the word

• 1. person or client-recipient of care (ind., families, groups, or communities)
• 2. environment (both external and internal that affects the client)
• 3. health (degree of wellness or well-being)
• 4. nursing (attributes, ch., and actions of the nurse providing care on behalf or in conjunction with the client)

• study of truths and priniciples of being, knowledge, or conduct
• this looks at the nature of things and beings when someone starts to wonder about something

• a group of related concepts
• abstract in nature
• often the foundation from which theories are derived
• provide guidelines for data collection but cannot be used to predict events or outcomes

a picture or diagram of a conceptial framework

• a statement or set of statements that aims to describe, explain, predict, or control a phenomenon
• defines concepts and specifically outlines relationships between those concepts
• less abstract than conceptual frameworks and are more prescriptive-they propose an explicit outcome that is testable in practice and research

• 1. construct
• 2. proposition statement
• 3. hypothesis

construct

proposition statement

hypothesis

the process by which people learn to become members of groups and society, learn the social rules and define relationships into which they will enter

• behavior
• feeling
• seeing the world
• it is a lifelong process

• is a learned process
• social control is intrinsic-capacity of a social group to regulate itself through conformity and adherence to group norms, norms become internalized standards

• formal-taught in school
• informal-observed

• roles
• we all have numerous roles

socially prescribed and agreed upon rights and responsibilities associated with the role

norms specific to the position

how a person believes they should behave in a role

what the person actually does

• concepts: person, environment, health, nursing
• nursing process
• standards of nursing practice
• nurse practice act & licensure laws
• national and international code of ethics

• direct hands-on care in a variety of settings
• assist clients-preserve client dignity
• physical, psychological, developmental and spiritual realms
• influenced by holistic approach
• essential attribute of the expert nurse

• teaches patients, families, the community, other health care members, students
• determine learning needs, motivation and readiness of learner

• help client recognize and cope with stressful situations
• one on one
• groups (self-help)

management of resources

• officially appointed, offical power
• carry out predetermines policies, procedures, and rules
• attempt to maintain an orderly environment
• relate to people according to rules
• perform role as long as the appointment is held
• rewarded by achieving the organizations mission and goals
• may or may not be good leaders

• may or may not have an official position
• have power if followers allow it
• influence followers to set goals
• risktakers
• intuitively and empathetically relate to people
• feel rewarded by personal accomplishments
• may or may not be successful managers

• traditional: focus on hierarchy and division of roles
• behavorist: interested in group dynamics
• systems: focuses on the organization as a series of units or departments
• continguency: blends all 3 styles

• charismatic: "people person"
• autocratic: authoritarian
• democratic: involves followers in decision making
• laissez-faire: passive and uninvolved

• promotes what is best for the client
• sees that the clients needs are met
• protects client's rights

• works to initiate and facilitate change
• requisite skills: tact, energy, creativity, interpersonal skills

• gives advice and expertise to others
• may own business

• investigates whether current nursing actions achieve their expected outcomes
• investigates what options of care are available and how to best provide nursing care

• works with other health care professional to ensure that everyone agrres on the same patient outcome
• collaborates with patients and their families

• critical pathways and variance analysis
• came about d/t: change in reimbursement programs, the need to manage clinical outcomes to limit costs

• stress-occurs when obligations are unrealistic or conflicting
• strain-emotional reaction

unclear role expectations

competing role expectations

values incompatible with role expectations

• overload-too much expected
• underload-minimal expectations

• quality improvement
• research
• education
• management

• quality of care
• performance appraisal
• education
• collegiality
• ethics
• collaboration
• research
• resource utilization

• learn necessary cognitive and motor skills
• adopt values of the profession
• gain identity with the profession
• balance the professional role with other roles

• Davis Model: student socialization
• Hinshaw's Model: 3-phrase general model of socialization
• Benner's stage of proficiency: novices, advanced beginner, competent practitioner, proficient practitioner, expert practitioner

• stage I: apprentice, subordinate
• stage II: colleague
• stage III: informal mentor, role model
• stage IV: sponser

• stage 1: skill and routine mastery
• stage 2: social integration
• stage 3: moral outrage
• stage 4: conflict resolution

• strong commitment to the service that nursing provides for the public
• belief in dignity & worth of each person
• a commitment to education
• autonomy

4 stages: unilateral dependence, negativity/independence, dependence/mutuality, interdependece

6 stages: innocence, recognition of incongruity, "psyching out", increasing role stimulation, provisional internalization, stable internalization

• novice: little background, relies on rules
• advanced beginner: marginally competent skills, difficulty establishing priorities
• competent practitioner: feels competent, organized, sets goals, several tasks
• proficient practitioner: holistics, sets priorities, long term goals
• expert practitioner: autonomatic

a set of expectations associated with a position in society

• the process by which a person assumes or develops a new role
• move to a new set of: responsibilites, norms, values

• 1. help the ill regain health
• 2. help the healthy maintain their health
• 3. help those who cannot be cured to realize their potential
• 4. help the dying live as fully as possible until their deaths

• priority setting and time management
• rewriting job descriptions for clarity

• health care reform
• societal changes
• managed care
• demongraphical population changes

the functional roles of nurse administrators and educators

1954-Rutgers University developed to prepare APN in psyc/mental health

in the 1940s and 50s

1952-NLN agreed baccalaureate education program to prepare nurse generalists

• improve client care
• function as expert in practice setting
• specalized area of nursing
• resource to novice nurses
• education and development
• consultant for physicians
• active participant in research

• health care personnel shortage as a result of Vietnam War
• developed in 1965 by Dr. Loretta Fod and Dr. Henry Silver
• University of Colorado
• focused on the care of children
• w/in 9 years-65 NP programs in pediatrics, additional developed in women health and family health

• according to AACN-requires preparation at graduate level
• CNS
• nurse-anestetist
• nurse-midewife
• NP
• specialized roles: management, education, administration and informatics

• research
• education
• practice
• PhD
• DNS
• ND
• emergining DNP program

• wide scope of practice
• more autonomous role
• acute-care NP, adult NP, family NP, gerontoloical NP, pediatric NP

• one of the earliest APN roles in the US
• American Association of Nurse Anesthetics

• economically-driven change
• health care organizations must change to survive

• integrative thinking
• skill in applying change theory
• problem-solving aptitude

change

reactive or unplanned change because it is not fully anticipated, it cannot be avoided, and there is little or no time to plan response stratgies

physio-psychologic changes that occur during an individual's life cycle or to the growth of an organization as it become more complex

an intended, purposeful attempt by an individual, group, organization, or larger social system to influence the status quo of itself, another organism, or a situation

• power-coercive
• empirical-rational
• normative-reductive

• power is with 1 or more persons of influence
• command and control approach in which positions of authority enforce the change
• can cause resistance

• people are rational and they will change if it is in their self-interest
• most effective when there is little resistance to the change and is perceived as reasonable

• human motivations depends on the sociocultural norms and individuals commitment to these norms
• change occurs if the people invovled develop new attitudes and values by acquiring new information

one who works to bring about change

• develop a rational for change
• write objectives in measurable terms that xan be accurately evaluated
• develop a projected timetable for each stage-remember to be flexible
• develop a system of information flow
• monitor progress
• plan for long-range evaluation

behavior intended to maintain the status quo; prevent change

• fear something of personal value will be lost
• misunderstanding of change and implications
• low tolerance for change r/t intellectual or emotional insecurity
• perception that change will not achieve goals
• failure to see big picture
• lack of time/energy

• perception that change is challenging
• economic gain
• perception that change will improve the situation
• visualization of the future impact of change
• potential for self-growth, recognition, acheivement, improved relationships

• 1948
• believed in I.D. driving forced which faclitate change and restraining forces with impede change
• 3 step process: unfreezing, moving, refreezing stages