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Why is is important to define nursing?
- 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)
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observable circumstance or event
phenomenon
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What is a concept?
- the building blocks of theory
- abstract ideas or mental images of phenomena
- expressed in words or phrases
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Concepts can be...?
- 1. readily observed or concrete (thermometer, rash, lesion)
- 2. indirectly observable (pain, anxiety)
- 3. nonoservable (powerless, stress, adaptation)
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What is a metaparadigm?
- 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
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What are the 4 concepts of nursing theory (metaparadigm)?
- 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)
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What is a philosophy?
- 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
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What is a conceptual framework?
- 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
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What is a conceptual framework?
a picture or diagram of a conceptial framework
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What is a theory?
- 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
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What are the 3 elements of a theory?
- 1. construct
- 2. proposition statement
- 3. hypothesis
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a concept invented for a special purpose
construct
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specifies the relationship between the constructs (concepts)
proposition statement
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a statement that tries to predict whether there is or is not a relationship between the constructs and the proposition statement
hypothesis
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What is role socialization?
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
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Socialization involves...?
- behavior
- feeling
- seeing the world
- it is a lifelong process
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Professional Socialization
- 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
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Formal vs. Informal Professional Socilization
- formal-taught in school
- informal-observed
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behaviors oriented to the expectations of others
- roles
- we all have numerous roles
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Ideal role
socially prescribed and agreed upon rights and responsibilities associated with the role
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Role expectations
norms specific to the position
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Perceived role
how a person believes they should behave in a role
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Performed role
what the person actually does
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What are boundaries for nursing roles?
- concepts: person, environment, health, nursing
- nursing process
- standards of nursing practice
- nurse practice act & licensure laws
- national and international code of ethics
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Caregiver Role
- 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
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Teacher/Educator Role
- teaches patients, families, the community, other health care members, students
- determine learning needs, motivation and readiness of learner
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Counselor role
- help client recognize and cope with stressful situations
- one on one
- groups (self-help)
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Manager/Leader role
management of resources
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Characteristics of a Manager
- 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
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Characteristics of a Leader
- 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
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Management Styles
- 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
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Leadership Styles
- charismatic: "people person"
- autocratic: authoritarian
- democratic: involves followers in decision making
- laissez-faire: passive and uninvolved
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Advocate role
- promotes what is best for the client
- sees that the clients needs are met
- protects client's rights
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Change agent role
- works to initiate and facilitate change
- requisite skills: tact, energy, creativity, interpersonal skills
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entrepreneur/consultant role
- gives advice and expertise to others
- may own business
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researcher role
- investigates whether current nursing actions achieve their expected outcomes
- investigates what options of care are available and how to best provide nursing care
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collaborator role
- works with other health care professional to ensure that everyone agrres on the same patient outcome
- collaborates with patients and their families
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case manager role
- critical pathways and variance analysis
- came about d/t: change in reimbursement programs, the need to manage clinical outcomes to limit costs
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What is the difference between role stress and strain?
- stress-occurs when obligations are unrealistic or conflicting
- strain-emotional reaction
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Role ambiguity
unclear role expectations
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Role conflict
competing role expectations
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role incongruity
values incompatible with role expectations
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Overload vs. Underload
- overload-too much expected
- underload-minimal expectations
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Professional Accountabilities include...?
- quality improvement
- research
- education
- management
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ANA standards of professional performance
- quality of care
- performance appraisal
- education
- collegiality
- ethics
- collaboration
- research
- resource utilization
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Role Socialization
- learn necessary cognitive and motor skills
- adopt values of the profession
- gain identity with the profession
- balance the professional role with other roles
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Models that define the process of role socialization
- 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
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Dalton, Thompson & Price Career Stages
- stage I: apprentice, subordinate
- stage II: colleague
- stage III: informal mentor, role model
- stage IV: sponser
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Kramer Resocilization Model
- stage 1: skill and routine mastery
- stage 2: social integration
- stage 3: moral outrage
- stage 4: conflict resolution
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Critical values of professional nursing
- strong commitment to the service that nursing provides for the public
- belief in dignity & worth of each person
- a commitment to education
- autonomy
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Cohen Model
4 stages: unilateral dependence, negativity/independence, dependence/mutuality, interdependece
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Davis Model
6 stages: innocence, recognition of incongruity, "psyching out", increasing role stimulation, provisional internalization, stable internalization
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Benner's Stage of Nursing Proficiency
- 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
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What is a role?
a set of expectations associated with a position in society
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Role transition
- the process by which a person assumes or develops a new role
- move to a new set of: responsibilites, norms, values
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Nurses' 4 responsibilities
- 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
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Stratgies for relieving role stress
- priority setting and time management
- rewriting job descriptions for clarity
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Advanced practice nursing
- health care reform
- societal changes
- managed care
- demongraphical population changes
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What did early advanced practice nursing degrees focus on?
the functional roles of nurse administrators and educators
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Hildegard Peplau
1954-Rutgers University developed to prepare APN in psyc/mental health
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When was the master's degree level proiferated?
in the 1940s and 50s
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When was the master's degree to prepare nurse specialists established?
1952-NLN agreed baccalaureate education program to prepare nurse generalists
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Clinical Nurse Specialist (CNS)
- 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
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First NP Program
- 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
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Master's Degree in Nursing
- according to AACN-requires preparation at graduate level
- CNS
- nurse-anestetist
- nurse-midewife
- NP
- specialized roles: management, education, administration and informatics
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Doctoral Programs
- research
- education
- practice
- PhD
- DNS
- ND
- emergining DNP program
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Nurse Practitioner
- wide scope of practice
- more autonomous role
- acute-care NP, adult NP, family NP, gerontoloical NP, pediatric NP
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CRNA
- one of the earliest APN roles in the US
- American Association of Nurse Anesthetics
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The health care system is in the midst of what kind of change?
- economically-driven change
- health care organizations must change to survive
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Skills needed by a nurse to initiate change?
- integrative thinking
- skill in applying change theory
- problem-solving aptitude
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the process of making something different from what it was, leads to alteration in individual or institutional patterns of behavior
change
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Spontaneous 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
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Developmental Change
physio-psychologic changes that occur during an individual's life cycle or to the growth of an organization as it become more complex
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Planned change
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
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What are the 3 change approaches?
- power-coercive
- empirical-rational
- normative-reductive
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Power-coercive change approach
- power is with 1 or more persons of influence
- command and control approach in which positions of authority enforce the change
- can cause resistance
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Empirical-rational Change approach
- 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
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Normative-reductive change approach
- 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
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Change Agent
one who works to bring about change
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Responsibilities of change agents
- 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
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Resistance to change
behavior intended to maintain the status quo; prevent change
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Restraining forces to 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
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motivating forces to change
- 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
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Kurt Lewin's Change Theory
- 1948
- believed in I.D. driving forced which faclitate change and restraining forces with impede change
- 3 step process: unfreezing, moving, refreezing stages
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