Unit 1 study guide:



Unit 1: The Nature of NursingChapter 1: The Origins of NursingChapter 2: Beginning Yours Nursing CareerChapter 3: The Healthcare Delivery SystemChapter 4: Legal and Ethical Aspects of Nursing[This is a compilation of PowerPoints, notes and straight from the book. THIS IS NOT ALL INCLUSIVE!)(References: Rosdahl, C. B, Kowalksi, M. T. ( 2017). Textbook of Basic Nursing ( 11th ed.). Wolters Kluwer / Jessica Barham)Chapter 1: The Origins of NursingIntro:The word nurse comes from the Latin word meaning “to nourish”.Nursing is a practical and noble profession.Individual attributes required to be a nurse include a strong sense of responsibility and the highest standards of integrity.Nursing is an art and a science.Individual receiving care is usually called a client, patient, or consumer.Historical Influences: History shows us that care has been provided for the sick even before the time of Christ. Based on mythical figures, the caduceus and the staff of Aesculapius are the modern symbols of medicine.Hippocrates: the “Father of Medicine”Emphasized the importance of caring for the whole person (holistic healthcare), and thus helped lay the groundwork for modern nursing and medicine. First person to propose concepts such as:Physical AssessmentMedical EthicsClient-Centered CareSystematic ObservationReportingHis holistic approach translates into the nurse’s attentiveness to clients’ needs—their emotions, lifestyles, physical changes, spiritual needs, and individual challenges. (The patient as a WHOLE)The Florence Nightingale pledge and Practical Nurses’ pledge are based on the Hippocratic oath:Hippocratic Oath: A pledge based on the principles of Hippocrates repeated by healthcare providers when they enter the field of medicine.The Roman Matrons:Phoebe: Known as the first deaconess and visiting nurse.Fabiola: (Roman woman) Credited for influencing and paying for the construction of the first free hospital in Rome in 390 AD.Saint Marcella: (Roman woman) Converted her home into a monastery, taught nursing skills, considered the first nursing educator.Saint Paula: Established inns and hospitals for pilgrims traveling to Jerusalem, first to teach philosophy that nursing is an art rather than a service.Saint Helena: (Mother of Roman Emperor Constantine) Est. the first gerontological facility or home for the aged.Monostatic and Military Nursing Orders:Crusades (1096–1291): Male military personnel conducted most nursing care. The symbol for this order was the Maltese Cross, which was the forerunner of nursing school pins worn today.Male military personnel, such as the Knights Hospitallers of St. John in Jerusalem, conducted most nursing care. They would wear armor under their religious garments, and this symbol was the Maltese Cross, which later became the symbol of the Nightingale School.The Reformation:Dark Ages of Nursing: Until the 1800s, nursing was considered the most menial of all tasks. In the 1500’s and during the European religious movement.Many monasteries closed and work of women in religious orders nearly ended.Fliedner in Kaiserswerth:Pastor Theodor Fliedner: 1836 established the Kaiserswerth School for Nursing in his parish in Germany. By the late 1800s, with the increase in the number of schools for trained nurses, the status of nursing began to improve.One of the most formally est. schools in the world.Out of the KSN, grew the Lutheran Order of Deaconesses. (Florence Nightingale was the most famous student).Florence Nightingale:Most nurses before her time, received almost no training.Born in Italy in 1820 to wealthy English parents.1851: Nightingale entered the Deaconess School in K-Worth.1853: Graduated and became the superintendent of a charity hospital for governesses.1854: Crimean War began. She entered battlefield near Scutari, Turkey with 38 other nurses and cared for sick & injured.Nightingale insisted on est. sanitary conditions and providing quality nursing care. (Helped reduce mortality rate).When she was nursing, she carried an oil lamp and created an image of “the lady with the lamp”.Nightingale Lamp “Lamp of Learning” became a symbol of nursing and nursing education.Nightingale’s Definition of Nursing:1859: Published a book, “Notes on Nursing: What It is and What It is Not”.Nightingale’s 5 essential points that are necessary for the maintenance of health and the support of recuperation:Clean airClean waterEfficient drainageCleanlinessLightInnovations Established by Florence Nightingale School of Nursing:Establishment of a nurses’ residenceEntrance examinations and academic and personal requirements, including a character referenceRecords of each student’s progress—later known as the “Nightingale plan,” a model for current nursing programsRecords of employment of students after graduation, or a formal register—the beginnings of nursing practice standardsThe Nightingale School:1860: Nightingale opened the first nursing school outside a hospital.Florence Nightingale’s Nursing Principles:Cleanliness is vital to recovery.Nursing is an art and a science.Nurses should spend time caring for others, not cleaning.Prevention is better than cure.The nurse must work as a member of a team.The nurse must use discretion but must follow the healthcare provider’s orders.Self-discipline and self-evaluation are important. A good nursing program encourages a nurse’s individual development.The nurse should be healthy in mind and body.Teaching is part of nursing.Nursing is a specialty.A nurse does not graduate but continues to learn throughout his or her career.Nursing curricula should include both theoretical knowledge and practical experience. Other innovations included in the Nightingale School:Est. of nurse’s residence.Entrance exams and academic and personal requirements, including a character reference.Records of each student’s progress, later known as the “Nightingale Plan”, a model for current nursing programs.Records of employment of students after graduation, or a formal register, the beginnings of nursing practice standards.Nursing in the United States:The First Nursing Schools:1849: Pittsburgh Infirmary was the first real school of nursing in the US, although limited training existed in other hospitals in NY and Pennsylvania before 1849.1873: 3 nursing programs based on the Nightingale plan were formally established:Bellevue Hospital School of Nursing in NYConnecticut Training School in New HavenBoston Training School in Massachusetts General Hospital.Notable American Nurses & Collegiate Nursing Education:Dorothea Lynde Dix (1802–1887) campaigned against the inhumane treatment of the mentally ill.Clara Barton (1821–1912) founded the organization now known as the American Red Cross.Melinda Ann (Linda) Richards (1841–1930) was the first trained nurse in the United States.Isabel Hampton Robb (1860–1910) founded the school of nursing at Johns Hopkins University and two national nursing organizations. She wrote one of the earliest nursing textbooks, Materia Medica for Nurses.Lavinia Lloyd Dock (1858–1956) assisted Robb in founding the American Society of Superintendents of Training Schools of Nursing. Mary Adelaide Nutting (1858–1947) established the first college-based nursing program at Teachers College of Columbia with Robb.Lillian Wald (1867–1940) is considered the founder of American public health nursing. Mary E. Mahoney (1845–1926) was the first African American graduate nurse and promoted fair treatment of African Americans in healthcare.Mary Breckinridge (1881–1965) started one of the first midwifery schools in the United States.Pioneering Nursing Schools in the United States:University of Minnesota: Beginning of nursing as a professionBallard School: YWCA opened first this first practical nursing school in the United States in Brooklyn, New YorkThompson Practical Nursing School: Founded in Brattleboro, Vermont/still exists todayHousehold Nursing School: Founded by women who wanted to provide nursing care in the homeImportant Milestones in the History of Nursing Education:In 1908, the American Red Cross began offering home nursing education to teach women how to care for illnesses within their families.In 1914, Mississippi became the first state to designate licensed practical nurses (LPNs).In 1917, the U.S. Congress passed the Smith-Hughes Act, to promote vocational-technical and public education.In 1919, the first vocational school-based nursing program opened in Minneapolis.In 1941, The Association of Practical Nurse Schools was founded.In 1942, the U.S. Office of Education planned and advocated the first practical nursing curriculum for the entire country.In 1966, the Chicago Public School system’s program was the first practical nursing program to be accredited by the National League for Nursing (NLN).War-Related Developments in Nursing:World War I marked the first emergency training of nurses. During this time, the Army School of Nursing was established.The U.S. Cadet Nurse Corps was established during World War II, and more than 14,000 volunteer nurses graduated in about 2 years. It also marked the first time that men as well as women were actively recruited into nursing. By the end of the war, emphasis was placed on improved graduate education for nurses. Nurses also began to assume a broader, more responsible role—a trend that continues today.Current Influential Trends in Nursing:The nurses’ responsibilities have increased as a direct result of the following trends:Higher client acuity in hospital and long-term settings Shift to community-based care Developments in technology Lifestyle factors and greater life expectancyChanges in nursing education Increased autonomyNursing Insignia, Uniforms, and the Nursing School PinThe Nursing InsigniaThe “Nightingale lamp” remains a standard of nursing insignia. The Nursing Uniform Clients usually feel more comfortable when nurses are easily identifiable and distinguishable from other staff. A nametag is important.The Nursing School Pin The Nightingale lamp is also a common component of the nursing pin.Chapter 2: Beginning Your Nursing Career:Healthcare Practice:Types of Nursing Programs:(Certified) Nurses Aide (CNA) Unlicensed Assistive Personnel (UAP) Licensed Vocational/Licensed Practical Nurse (LV/LPN)Registered Nurse (RN)Advanced Practice Nurse or Nurse Practitioner (NP)Basic Education:Registered Nurses (RNs):2-year program leading to associate degree (AD-RN)/Technical Nurse 3-year program affiliated with community and state colleges that grant college credits 4-year program in a college or university that leads to a baccalaureate or bachelor’s degree in nursing Practical Nurses (LPNs/LVNs): 12 to 18 months of full-time studyResponsibilities:Registered Nurses:care for the acutely ill and assist in surgeryteach professional and practical nursing students manage personnel and take charge in various healthcare settings Practical Nurses: provide nursing carework under the supervision of an RN or MDLicensure of Nurses:Licensing laws or Nurse Practice Acts: Protect the public from unqualified workersEstablish standards for the profession Differentiate between a qualified and an unqualified workerNurses must know and understand the licensing laws and the state’s Nurse Practice Act specific to their level of licensing.NCLEXNational Council’s Licensure Examination for graduates from an approved nursing programMandatory LicensureDesignates the functions, duties, and responsibilities of the nurse and use of the title “nurse” in the particular state.Permissive LicensurePracticing nursing without a licenseEndorsementIt is a form of agreement between states, particularly state licensing agencies. ReciprocityIt is a type of recognition of previous education and experience from state to state.Nurse’s Pledge:Serves as a guide for nursing practiceRNs recite the Florence Nightingale pledgeLPNs recite the practical nurse’s pledgeTheories of Nursing:A theoretical framework provides a reason and a purpose for nursing actions.Natural-Healing theory by Florence NightingaleIndependent-Functioning theory by Virginia HendersonSelf-Care theory by Dorothea OremAdaptation theory by Sister Callista RoySystems theory by Betty NeumanContemporary Nursing Roles:The Nurse’s Image:Nurses must: project a professional imageshow respect for allfollow general practices of good grooming wear washable uniforms with their nametagmaintain maximum levels of safety, hygiene, and protection for clients and self-maintain optimal healthRole of Nursing Organizations:To provide professional forumsTo offer continuing education opportunitiesTo enable network with peersTo influence healthcare, nursing, and public policy legislation Nursing Organizations:National Association for Practical Nurse Education and Service (NAPNES): First national nursing organization to delineate goals for the development and improvement of practical nursing education. National Federation of Licensed Practical Nurses (NFLPN): Professional organization providing standards of nursing care and promoting competence through post-licensure education and certification.National League for Nursing (NLN): Major focus is providing accreditation to RN and LV/LPN schools. Health Occupations Students of America (HOSA): specifically designed for students in secondary and postsecondary/collegiate health occupational programs, including nursing. The American Nurses Association (ANA): an organization whose membership is composed of RNs; considers itself the official voice of professional nursing in the United States. The national nursing associations usually have state affiliates and sometimes local chapters. Chapter 3: The Healthcare Delivery SystemKey Concept: The principles of excellent nursing care are universal.Healthcare Trends in the 21st Century:There is an emphasis on wellness and individuals assuming more responsibility for their own health.Technology continues to influence healthcare.The rising costs of healthcare are to be met by preventive care.Health education is an important aspect of healthcare.Health maintenance organizations (HMOs) provide managed care emphasizing disease prevention and health promotion. The Impact of Healthcare Changes on Clients and Healthcare Providers:Healthcare may involve discussion among the healthcare practitioner, an insurance provider, and the client.With the increasing challenges, it is not uncommon for unlicensed assistive personnel (UAPs) to be hired to administer nursing care. As a result of financial constraints and the influence of managed care plans, clients may even be forced to have treatment outside a hospital.Acute Care and Extended Care Facilities:Acute Care Facilities Extended Care Facilities Clients with serious conditions or high level of acuity are admitted for a short period.Clients discharged from acute care facilities may be admitted for a longer period.Include:Acute care hospitalsIntensive care unitsSubacute care facilitiesInclude:Skilled nursing facilitiesIntermediate care facilities Inpatient rehabilitation centersHealthcare Settings and Services:Specialized HospitalsThese facilities admit only one type of client for specific conditions. Home Healthcare Service provided by an acute care facility or an agency that specializes in home healthcare. HospiceSpecializes in the care of the terminally ill.Respite Care Part-time supervision of clients who have chronic conditionsTelehealth Ability to access a nurse or healthcare provider via telephone or computer audio/video linkCommunity Health Services:Public health serviceImmunizations, well-baby checks, and treatment for specific diseases Community health clinicsLow-cost healthcare services to the public Independent living facilitiesStable, home-like environment for mentally challenged individuals School Nurse:Cares for ill childrenProvides intensive nursing care for the physically challengedPromotes preventive care by regular assessments, teaching, and screening for common disordersSupervises administration of immunizations and medicationsProvides teaching and health counselingIndustrial Nurse:Promotes health Teaches prevention of accidentsServes as a liaison between the industry and the Occupational Safety and Health Administration (OSHA)Functions of The Joint Commission:The Joint Commission accredits a hospital or other healthcare facility.It has established rigid standards for an ongoing quality assurance program in acute care and extended care facilities.It requires objective and systematic monitoring and evaluation of the quality and appropriateness of client care.Relation of The Joint Commission’s Functions to Nursing:The Joint Commission stresses the importance of quality assurance. As a result, facilities and agencies have contiguous quality improvement (CQI) committees that monitor the quality of ongoing care.The process of care relates to how care is given. The outcome, which is equally important, relates to the result, which is also known as outcome-based care. Thus, nurse accountability, which involves the delivery and accurate documentation of quality care, is vital. Quality Assurance in Healthcare Facilities:Quality assurance focus is on delivery of care. The standards of quality include:Standards of nursing practiceStandards of client/patient careStandards of performanceThe nursing audit committee or CQI committee evaluates care given to clients. Peer review allows nurses to constructively critique each other.Roles of the Client Representative and Advocate or Ombudsperson:To act as a consumer advocate and assist the client and family by resolving concerns or problemsTo focus on client care, needs, and concerns, and listen and answer questionsTo help clients and their families find needed services like housing, child-care, etc.To uphold the Patient Bill of RightsHospital Organization and Ownership:Numerous trained individuals work together in organized units Government ownershipPrivate ownershipProprietary, investor-owned, or for-profitNot-for-profitMethods of Payment:Individual Private Insurance Group Insurance Fee for Service PlansHealth Maintenance OrganizationsPreferred Provider Organizations (PPOs)Point of Service Plans (POS) MedicareMedicaidProspective Payment Diagnosis-Related Groups (DRGs) Complementary Healthcare:Chiropractic, Physical, and Occupational Therapy Holistic HealthcareHerbalists and Vibrational Remedies Acupuncture and Acupressure Relaxation and Imagery Meditation Therapeutic Touch Consumer Fraud:As a result of misleading the public with “sure cures,” ill people run the risk of delaying vital treatment for diseases such as cancer and obesity until it is too late. The general public often cannot tell the difference between true and false claims. As a nurse, you may encourage clients to find out all the facts before starting any untested healthcare measure.Chapter 4: Legal & Ethical Aspects of Nursing:Types of Law and Examples:Constitutional: Right to free speechStatutory: Nurse Practice ActsAdministrative: State Boards of NursingCriminal: Prosecution of malpracticeCivil: HIPAA violations of privacyLegal Terminology:CrimeDeliberate commission of a forbidden act or omission of an act required by law FelonySerious crime MisdemeanorCrime that is considered not as serious as a felony but is still serious and may be cause for revocation of a nursing licenseLiabilityLegal responsibility for one’s actions or failure to act appropriately TortInjury that occurred because of another person’s intentional or unintentional actions or failure to actNegligenceHarm done to a client as a result of neglecting duties, procedures, or ordinary precautions MalpracticeProfessional negligenceAssaultThreat or an attempt to do bodily harm including physical or verbal intimidationBatteryPhysical contact with another person without that person’s consentInformed consentTests, treatments, and medications are to be explained, documented, and signed by clientLibelWritten statement or photograph that is false or damagingSlanderMalicious verbal statements that are false or injuriousLegal Issues of Nursing Practice:False imprisonmentAbandonment of careInvasion of privacy and confidentiality Trespassing Illegal search and seizureReleasing private informationNurse Practice Act:The law that defines and regulates the practice of nursing in the United States is called the Nurse Practice Act.These laws define the title of “nursing” and regulate the many aspects of the field of nursing. The law or Nurse Practice Act in each state, province, or territory defines regulations for practical and registered ponents of a Nurse Practice Act:Definition of practical and registered nursingNursing functions protected by the lawRequirements for an approved school of nursing Establishment of requirements for licensure Process and procedures for becoming licensed Procedures for maintaining licensure and continuing educationIssue and renewal of nursing licensesSuspension, revocation, and reinstatement of license Interstate endorsementFunctions of the State Board of Nursing:The legislative power to initiate, regulate, and enforce the provisions of the Nurse Practice Act is delegated to a specific state agency often known as the State Board of Nursing.Boards are subject to legal parameters, but usually they have some leeway in interpreting aspects of the Nurse Practice Act.In the recent past, the State Boards of Nursing were responsible for the creation of the licensing examination, however, now they are written by the National Council of State Boards of Nursing.Precautions Against Lawsuits:Follow accepted procedures.Be competent in your practice. Ask for assistance.Document well.Do not give legal advice to clients. Do not accept gifts.Do not help a client prepare a will.Consider a malpractice insurance policy.The Good Samaritan Act:In effect in most statesProtects a person from liability: if they give emergency care within the limits of first aid if they act in a “reasonable and prudent manner”Professional Boundaries:Power versus vulnerabilityDo not exploit the power to access private client informationBoundary crossingsQuestionable behavior Boundary violationsExcessive personal disclosures Professional sexual misconduct Seductive, sexually demeaning, or harassing behavior Advance Directives:Definition: a legal document in which a person either states choices for medical treatment or names someone to make treatment choices if he or she loses decision-making abilityExamplesLiving willDirective to healthcare providersDurable power of attorney for healthcareMental health advance declarationDeficient or Harmful Care:People who are vulnerable to deficient or harmful care include:Children and some adults Mentally incompetent or confused persons Elderly people People living in isolationThe law protects vulnerable persons from injury, abuse, or neglect while receiving care in a healthcare facility, nursing home, school, or their own home. Brain Death:Cessation of breathing after artificial ventilation is discontinuedCessation of heartbeat without external stimuliUnresponsiveness to external stimuliComplete absence of cephalic reflexes Pupils fixed and dilated Irreversible cessation of all functions of the brain Biologic Death or Clinical Death:Absence of respirations Absence of a heartbeat Ethical Issues in Treatment:Organ transplantationCriteria and questionsRefusal of treatmentWithholding treatmentTermination of treatmentEuthanasiaRights and Responsibilities of Healthcare Clients:Clients’ Rights A Patient’s Bill of Rights Clients’ ResponsibilitiesClients are active participants in formulating their care plan and making healthcare decisions, and have a responsibility to participate in and cooperate with care given. Provisions and Goals of the HIPAA Legislation:In 1996, the Health Insurance Portability and Accountability Act (HIPAA), Title II, was passed and serves as federal privacy regulation. The HIPAA, Title II act:Regulates who can have access to client informationSets standards for storage and transmission of client informationRequires that healthcare facilities write policies allowing clients access to their own personal health information. (The client has the right to request correction of any errors.)Impact of HIPPA on Nursing Care:Nursing students or staff nurses will most likely be asked to sign a HIPAA confidentiality statement each year which certifies that they are familiar with HIPAA regulations and will follow their guidelines. Violation of HIPAA privacy practices is cause for termination of employment or of student status in most facilities.BARHAM Unit 1 Study Guide (Need to Knows)*This is not an all-inclusive list. Please read the chapters assigned to you. Lecture: Monday, November 16, 2020 at 08:00Exam: Friday, November 30 ,2020 at 08:00Chapter 1: The Origins of NursingBe able to answer all learning objectives listed at the beginning of the chapter, and be familiar with all bolded terms Hippocrates and his influences of modern medicineFlorence Nightingale and her influences of modern medicineFive Essential Points necessary for maintenance of health and support of recuperationPrinciples of Nightingale School for Nurses Dorothea DixClara BartonLillian WardMary E. Mahoney Ballard School (YWCA) Impacts of World War I on nursingImpacts of World War II on nursingThe trends that directly influence nursing responsibilities today Chapter 2: Beginning Your Nursing CareerBe able to answer all learning objectives listed at the beginning of the chapter, and be familiar with all bolded terms Table 2-1, page 11Importance of licensure of nurses (page 13) Mandatory licensure vs Permissive licensure Theoretical framework Roles of the Nurse Box 2-3, page 15Purpose of nursing organizations Chapter 3: The Healthcare Delivery SystemBe able to answer all learning objectives listed at the beginning of the chapter, and be familiar with all bolded terms Preventative care How acuity affects admissions to different levels of care Healthcare Settings and Services, pages 21- 23Acute Care Facilities Specialized HospitalsHome HealthcareHospice Respite CareTelehealthExtended Care Facilities Community Health Services Healthcare in School and Industry Quality Assurance The Joint CommissionOutcome-based care Standards for Quality Assurance Chain-of-command MedicareMedicaidHolistic HealthcareChapter 4: Legal and Ethical Aspects of NursingBe able to answer all learning objectives listed at the beginning of the chapter, and be familiar with all bolded terms Ethics Liability Negligence and examples of suchConsent for careInferredInformed Right to PrivacyHIPAA and Client Privacy “Need to know/Right to know” “No Information” statusJohn Doe Nurse Practice Acts Major concepts of legislation of Nurse Practice Acts (p 37) NCLEX-PNNCSBNWritten by practicing nurses and educators Most significant content areas: NURSING PROCESS and CLIENT NEEDS Common Sense Precautions: p38-39Box 4-1, page 39Good Samaritan ActAdvance Directives Living WillDirectives to physiciansDurable Power of Attorney for healthcare (POA) Definitions of DeathLegal Death = Clinical DeathBrain DeathEthical Standards of HealthcareEthics is defined as conduct appropriate for all members of a group Quality of lifeEthical Issues in TreatmentOrgan TransplantationRefusal of treatmentWithholding treatmentTermination of treatmentEuthanasiaClient Responsibilities (p44) Tips for Studying:Read the chapters Know the learning objectives and bolded termsLook at the Key Points at the end of each chapter Use your Workbook for Textbook of Basic Nursing, Eleventh Edition for practice questions Answer practice questions at the end of each chapter ................
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