Details of NR 222 Final Exam Outline all Chapters Chamberlain College of Nursing
Chapter 1
Nursing as a Profession
Patient centered
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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
➢ Insightfu l and compassionate approach
➢ Critical thinking
Benner’s stages o
f nursing proficiency:
➢ Novice
➢ Advanced beginner
➢ Competent
➢ Proficient
➢ Expert
Scope and Standards of Practice
Nursing definitions
➢ American Nurses Association (ANA)
➢ International Council of Nurses (ICN)
N
ursing: Scope and Standards of Practice
➢ 1960: Documen tation began
➢ Standards of Professional Nursing Practice
➢ Standards of Professional Performance
➢ Code of Ethics
Profe
ssional 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
➢ N ursing Shortage
• Correlation between direct care pro vided 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 profession ally.
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 discipl ine.
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 nur sing 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 BrewsterLillian Wald and Mary Brewster
Twentieth CenturyTwentieth Century
• Movement toward scientific, researchMovement toward scientific, research--basebased practice and defined body of knowledged practice and defined body of knowledge
• Nurses assumed expanded and advanced practice rolesNurses assumed expanded and advanced practice roles
➢ 1906: Mary Adelaide Nutting, first nursing professor at Columbia Teacher’s College 1906: Mary Adelaide Nutting, first nursing professor at Columbia Teacher’s College
➢ Army and Navy Nurse Corps estaArmy and Navy Nurse Corps establishedblished
➢ 1920s: Nursing specialization began1920s: Nursing specialization began
➢ 1990:1990: ANA established Center for Ethics and Human RightsANA established Center for Ethics and Human Rights TwentyTwenty--First CenturyFirst Century
• Changes in curriculum to meet changing societal needsChanges in curriculum to meet changing societal needs
• Advances in technology and informatics requires nurses to have a strong and current Advances in technology and informatics requires nurses to have a strong and current knowledge baseknowledge base
• Last Acts CampaignLast Acts Campaign
• EndEnd--ofof--lifelife care and practices added to nursing curriculacare and practices added to nursing curricula
Contemporary InfluencesContemporary Influences
• Importance of nurses’ selfImportance of nurses’ self--carecare
• Health care reform and costsHealth care reform and costs
• Demographic changesDemographic changes
• Medically underservedMedically underserved
Trends in NursingTrends in Nursing
• EvidenceEvidence--based practicebased practice
• Quality and Safety Education for NurseQuality and Safety Education for Nurses (QSEN)s (QSEN)
• Impact of emerging technologiesImpact of emerging technologies
• GenomicsGenomics
• Public perception of nursingPublic perception of nursing
• Impact of Impact of nursing on politics and health policynursing on politics and health policy
PProfessional Registered Nurse Educationrofessional Registered Nurse Education
• PrelicensurePrelicensure
➢ 22--year associate’s degreeyear associate’s degree
➢ 44--year baccalaureate degreeyear baccalaureate degree
• Graduate educationGraduate education
➢ MaMaster’s degree, advanced practice RNster’s degree, advanced practice RN
➢ Doctoral degreesDoctoral degrees
• Continuing and inContinuing and in--service educationservice education Nursing PracticeNursing Practice
• Nurse Practice Acts (NPAs)Nurse Practice Acts (NPAs)
➢ Overseen by State Boards of Nursing Overseen by State Boards of Nursing
➢ Regulate scope of nursing practice Regulate scope of nursing practice
➢ Protect public health, safety, and welfareProtect public health, safety, and welfare
• LicensuLicensure and certificationre and certification
➢ Licensure: NCLEXLicensure: NCLEX--RN® examinationRN® examination
➢ Certification: requirements varyCertification: requirements vary
Professional Nursing OrganizationsProfessional Nursing Organizations
• Address member concernsAddress member concerns
• Present educational programsPresent educational programs
• Publish journalsPublish journals
• Student organizationsStudent organizations
➢ National Student Nurses Association (NSNNational Student Nurses Association (NSNA) A)
➢ Canadian Student Nurses Association (CSNA)Canadian Student Nurses Association (CSNA)
Chapter 2
Chapter 2
The Health Care Delivery System
Challenges to Health CareChallenges to Health Care
• US health care system is complex and constantly changing US health care system is complex and constantly changing
➢ UninsuredUninsured
• Nurses should be prepared and work toward:Nurses should be prepared and work toward:
➢ Improving accessImproving access
➢ MaintaininMaintaining quality and safetyg quality and safety
➢ Lessening health care costsLessening health care costs Traditional Level of Health CareTraditional Level of Health Care
• PreventativePreventative
• PrimaryPrimary-- is true prevention. Its goal is to reduce the incidence of disease.is true prevention. Its goal is to reduce the incidence of disease.
• SecondarySecondary-- focuses on preventing the spread of disease, illness, or infection once ifocuses on preventing the spread of disease, illness, or infection once it t occurs.occurs.
• TertiaryTertiary-- occurs when a defect or disability is permanent and irreversible. It involves occurs when a defect or disability is permanent and irreversible. It involves minimizing the effects of longminimizing the effects of long--term disease or disability by interventions directedterm disease or disability by interventions directed at at preventing complications and preventing complications and deterioration.deterioration.
• RestorativeRestorative
• Continuing healContinuing health careth care
Primary and Preventative Health CarePrimary and Preventative Health Care
• Preventive CarePreventive Care
➢ Improved health outcomes for an entire populationImproved health outcomes for an entire population
➢ Reduces and controls risk factors for diseaseReduces and controls risk factors for disease
• Primary carePrimary care
➢ Focuses on improved health outcomes Focuses on improved health outcomes
➢ Requires collaborationRequires collaboration
• Health promotion programHealth promotion programs lower overall costss lower overall costs
➢ Reduces incidence of diseaseReduces incidence of disease
➢ Minimizes complicationsMinimizes complications
➢ Reduces the need for more expensive resourcesReduces the need for more expensive resources
Secondary and Tertiary Care (1 of 3)Secondary and Tertiary Care (1 of 3)
• Focus: Diagnosis and treatment of illnessFocus: Diagnosis and treatment of illness
• Used when the natureUsed when the nature or severity of a condition makes por severity of a condition makes primary care insufficient.rimary care insufficient.
• Secondary: Provided by a specialist upon referral from PCPSecondary: Provided by a specialist upon referral from PCP
• Tertiary: Specialized consultative care, usually provided on referral from secondary Tertiary: Specialized consultative care, usually provided on referral from secondary medical personnelmedical personnel
Secondary and Tertiary Care Secondary and Tertiary Care (2 of 3)(2 of 3)
• HospitalsHospitals
➢ Provide comprehensivProvide comprehensive secondary and tertiary care to acutely ill.e secondary and tertiary care to acutely ill.
• Intensive careIntensive care
➢ Advanced technologyAdvanced technology
• Mental health facilitiesMental health facilities
• Rural hospitalsRural hospitals
➢ Critical Access HospitalsCritical Access Hospitals Secondary and Tertiary Care (3 of 3)Secondary and Tertiary Care (3 of 3)
• Discharge planningDischarge planning
➢ Develops plan for continuing careDevelops plan for continuing care
➢ Determines postDetermines post--hohospital destinationspital destination
➢ Identifies patient needsIdentifies patient needs
➢ Begins process while still hospitalizedBegins process while still hospitalized
Restorative ServicesRestorative Services
• Serves patients recovering from an acute or chronic illness/disability Serves patients recovering from an acute or chronic illness/disability
• Helps individuals regain maximal function and enhance quality of lifeHelps individuals regain maximal function and enhance quality of life
• Home carHome caree
• RehabilitationRehabilitation
• Extended care facilitiesExtended care facilities
Restorative Services: Home CareRestorative Services: Home Care
• Home services for heaHome services for health maintenance, education, illness, prevention, diagnosis and lth maintenance, education, illness, prevention, diagnosis and treatment of disease, palliation, and rehabilitation.treatment of disease, palliation, and rehabilitation.
• Durable medical equipmentDurable medical equipment
• Highly individualHighly individualiized carezed care
Restorative Services: RehabilitationRestorative Services: Rehabilitation
• Process aimed at enabling people with disaProcess aimed at enabling people with disabilities to reach and maintain their optimal bilities to reach and maintain their optimal physical, sensory, intellectual, psychological, and social functional levels.physical, sensory, intellectual, psychological, and social functional levels.
• Rehabilitation services after acute care inRehabilitation services after acute care incclude physical, occupational, and speech therapy lude physical, occupational, and speech therapy and social services.and social services.
• Rehabilitation sRehabilitation settings include rehabilitation institutions within acute care centers, ettings include rehabilitation institutions within acute care centers, freefree--standing outpatient settings, and the home.standing outpatient settings, and the home.
Restorative Care: Extended CareRestorative Care: Extended Care
• Extended care facExtended care facililityity
➢ Provides intermediate medical, Provides intermediate medical, nursing, or custodial care for patients recovering nursing, or custodial care for patients recovering from acute illness or disabilitiesfrom acute illness or disabilities
• Intermediate care/skilled nursing facility Intermediate care/skilled nursing facility
➢ Provides care for patients until thProvides care for patients until they can return to their community or residential care ey can return to their community or residential care llococationation
Continuing CareContinuing Care
• For people who are disabled, functionally dependent, or suffering a terminal diseaseFor people who are disabled, functionally dependent, or suffering a terminal disease
• Available within institutional settings or in the homeAvailable within institutional settings or in the home::
➢ Nursing centers or facilitiesNursing centers or facilities
➢ Assisted livingAssisted living
➢ Respite careRespite care
➢ Adult day care centersAdult day care centers
➢ PalliatiPalliativeve and Hospice Careand Hospice Care
Continuing Care: Nursing Centers or FacilitiesContinuing Care: Nursing Centers or Facilities
• Provide 24Provide 24--hour intermediate and custodial carehour intermediate and custodial care
➢ Nursing, rehabilitation, diet, social, recreational, and religNursing, rehabilitation, diet, social, recreational, and religious servicesious services
➢ Residents of any age with chronic or debilitating illnessResidents of any age with chronic or debilitating illness
• RegulaRegulateted by standards: Omnibus Budget Reconciliation Act of 1987d by standards: Omnibus Budget Reconciliation Act of 1987
• RAIsRAIs
➢ Minimum Data SetMinimum Data Set
➢ Care Area AssessmentCare Area Assessment
➢ RAI Utilization GuidelinesRAI Utilization Guidelines
Continuing Care: Assisted LivingContinuing Care: Assisted Living
• LongLong--term care setting term care setting
• Home environment Home environment
• Greater resident autonomyGreater resident autonomy
• No fee capsNo fee caps
Continuing Continuing CarCare: Respite Caree: Respite Care
• Respite care provides shortRespite care provides short--term relief or “time off” for people providing home care to an term relief or “time off” for people providing home care to an individual individual who is ill, disabled, or frail.who is ill, disabled, or frail.
• Settings include home, day care, or health care institution with overnight care.Settings include home, day care, or health care institution with overnight care.
• Trained volunteers enaTrained volunteers enableble family caregivers to leave the home for errands or social time.family caregivers to leave the home for errands or social time.
Continuing Care: Adult Day Care CentersContinuing Care: Adult Day Care Centers
• ProvidProvide a variety of health and social services to specific patient populations who live e a variety of health and social services to specific patient populations who live alone or with family in the communityalone or with family in the community
• May be associated wiMay be associated with th a hospital or nursing home or may operate independentlya hospital or nursing home or may operate independently
Continuing Care: Palliative and Hospice CareContinuing Care: Palliative and Hospice Care
• PalliatPalliative care: Patientive care: Patient-- and familyand family--centered care approach with a goal of improving the centered care approach with a goal of improving the quality of life of patients and families who are experiencing quality of life of patients and families who are experiencing probproblems related to lems related to lifelife--threatening illnesses.threatening illnesses.
• Hospice care: Focuses on palliative (not curative) careHospice care: Focuses on palliative (not curative) care
• ManyMany hospice programs provide respite care, which is important in maintaining the health hospice programs provide respite care, which is important in maintaining the health of the primary caregiver and family.of the primary caregiver and family.
Issues in Health Care Issues in Health Care DeDeliverlivery for Nursesy for Nurses
• Health care agencies tHealth care agencies today are working hard to improve patient experience and oday are working hard to improve patient experience and engagement while delivering high quality care, improving outcomes and controlling cost.engagement while delivering high quality care, improving outcomes and controlling cost.
• As you face issues of how to maintain health care quality while reducingAs you face issues of how to maintain health care quality while reducing costcosts, you need to s, you need to acquire the knowleacquire the knowledge, skills, and values necessary to practice competently and effectively.dge, skills, and values necessary to practice competently and effectively.
Health Care Costs and QualityHealth Care Costs and Quality
• Social Security ActSocial Security Act
• CMS Innovation CenterCMS Innovation Center
• The Affordable Care ActThe Affordable Care Act
• Reforms that incent:Reforms that incent:
➢ Hospital valueHospital value--based purcbased purchasinghasing
➢ Hospital readmissions reduction programHospital readmissions reduction program
➢ Bundled payments for care improvementsBundled payments for care improvements
➢ Hospital acquired condition reduction programHospital acquired condition reduction program
• Patient satisfactionPatient satisfaction
Nursing ShortageNursing Shortage
• Will intensify as baby boomers age and an increWill intensify as baby boomers age and an increased need for health care growsased need for health care grows
• NursinNursing schog schools struggle to increase capacityols struggle to increase capacity
• IndicatorsIndicators
➢ Bureau of Labor Statistics Employment ProjectionsBureau of Labor Statistics Employment Projections
➢ Institute of Medicine’s report, Institute of Medicine’s report, The Future of Nursing: Leading Change, Advancing The Future of Nursing: Leading Change, Advancing HealthHealth
➢ Passage of Patient Protection and Affordable Care ActPassage of Patient Protection and Affordable Care Act
CompetencyCompetency
• QQSEN anSEN and The Massachusetts Nurse of the Future Nursing Core Competencies© d The Massachusetts Nurse [Show Less]