Apprenticeship: Learning by doing
Nursing Process: Assessment, Nursing Diagnosis, Planning, Implementation, Evaluation
Nursing Art vs. Science : Initially, nursing was an art- it consisted of certain acts of care skillfully, with intuition and creativity. Over time, a scientific base was combined with the art of nursing. From this body of knowledge, the nurse can choose interventions that are most likely to produce desired outcomes for the patient
Founded the American Red Cross: Clara Burton
Invasive Procedure: Procedures that require entry into the body
Goals of Nursing: To promote wellness, to prevent illness, to facilitate coping, to restore health
Aseptically: Without introducing infectious material
Evidence Based Practice (Nursing): Nursing practice based on validated research
Nurse Practice Act : Designed to protect the public, and they define the legal scope of practice.
Nursing Process: Organized, deliberate, systematic way to deliver nursing care. Provides a way to implement caregiving, and it combines the art and science of nursing
Implementation: To put into action
NAPNES (National Association for Practical Nurse Education and Service: Was formed to standardize practical nurse education and to establish licensure criteria for graduates
Practical Nurses: Provide direct patient care under the supervision of a registered nurse, physician, or dentist
Practice Settings for LPN:
- Hospitals- Restorative care is provided to ill or injured patients
- Extended Care Facilities-Facilities for intermediate or long-term care where personal care and skilled care is provided for those requiring rehabilitation or custodial care
- Physician’s Office- Ambulatory patients receive preventative care or treatment of an illness or injury
- Ambulatory Clinics- Ambulatory patients come for preventative care or treatment of an illness or injury; often treatment by specialty groups is available on site
- Renal Dialysis Clinics- Patients with kidney failure receive renal dialysis treatments
- Hospices- Supportive treatment is provided for patients who are terminally ill
- Home Health Agencies- In-home care is provided to patients by nurses who visit the home
Diagnosis Related Groups: created by medicare in 1983 as an attempt to contain healthcare costs. system means that a hospital recieves a set amount of money for a patient who is hospitalized with a certain diagnosis
Integrated Delivery Network: set of providers and services organized to deliver coordinated care to promote wellness, care for illness, and promote rehabilitation
Capitated Cost: they are paid a set fee for every patient enrolled in the network each year
Health Maintenance Organizations: a type of group practice, enroll patients for a set fee per month. They provide a limited network of physicians, hospitals, and other health care providers from which to choose. One goal is to keep patients healthy and out of the hospital
Preferred Provider Organizations PPO’s: Offer a discount on fees in return for a large pool of potential patients. Allows insurance companies to keep their premium rates lower and in turn makes insurance coverage of employees less expensive for employers
Interventions: Actions taken to improve, maintain or restore health or prevent illness.
Privilege: premission to do something that is usually not permitted in other circumstances
Ethical Codes: Actions and veliefes approved by a particular group of people
Ethical Principles: Rules of right and wrong from an ethical point of view
Ethics Committee: A committee formed to consider ethical problems
Laws: Rules of conduct that are established by our government
Judicial Law: Results when a law or court decision is challenged in the courts and the judge affirms or reverses the decision: Administrative Law
Comes from agencies created by the legislature
Statutes: Laws that may be either civil or criminal.
Tort: Violation of Civil Law
Crime: A wrong against society, and imprisonment and/or fines may result if one is convicted.
Nurse Practice Act: A law that defines the scope of nursing practice, and provides for the regulation of the profession by a state board of nursing. Regulates the degree of dependence or independence of a licensed nurse with regard to other nurses, physicians, and health care providers
Scope of Practice: the definition of nursing for LPN’s and may include definitions for advanced practice . T
Reciprocity: Recognition of one state’s nursing license by another state.
Student Nurses: Held to the same standards as a licensed nurse. Legally responsible for her own actions or inaction, and may schools reqire carrying malpractice insurance. Need to know the nurse practice act and it’s definition of nursing in the state in which they are practicing and not exceed the scope of practice for their state. it is not legal to do something beyond the scope of practice for their state. It is not legal to do something beyond the scope of nursing practice just because someone told them they were to do so
Accountability: Taking responsibility for ones actions. Means asking for assistance when unsure, performing nursing tasks in the sage and prescribed manner, reporting and documenting assessments and interventions, and evaluating the care given and the patients response to that care. means all of the above plus a commitment to continuing education to stay current and knowledgeable.
Delegation: The assignment of duties to another licensed person
Assignment: The assignment of duties which can be done by an unlicensed person, such as a nursing assistant
Standards of Care: Legally, the LPN is responsible for their own actions under the nurse practice act and according to the standards of care that are approved by the profession
Negligence: Not reporting another professional’s misconduct
Continuing Education: It is necessary for nurses to continue their education about changes in health care practice, pharmacology, and technology in order to practice safely. Nurses may stay current by attending programs provided by their employer, through participation in their professional organization, by attending workshops, seminars, or presentations on health care topics, by readin professional nursing journals, by formal continuing education in colleges, or by corresponding courses
OSHA: Passed in 1970 to improve the work environment in areas that affected workers health or safety. it includes regulations for handling infectious or toxic materials, radiation safeguards, and the use of electrical equipment
Child Abuse Prevention and Treatment Act (CAPTA): A federal law that defines child abuse and neglect as “any recent act, or failure to act, that results in imminent risk of serious harm, death, serious physical or emotional harm, sexual abuse, or exploitation of a child by a parent or caretaker who’s responsible for the child’s welfare”. States that healthcare personnel are required to report child abuse
Discrimination: Making a decision or treating a person based on a class or group to which he belongs, such as race, religion, or sex, rather than on his or her individual qualities
Sexual Harrassment: Unwelcome sexual advances, requests for sexual favors, an other verbal or physical conduct of a sexual nature
Good Samaritan Law:Laws that protect a healthcare professional from liability if she stops to provide aid in an emergency
Patients Rights: A list of rights the patient could expect and responsibilities that the hospital may not violate. Under some legally specified conditions, certain rights may be temporarily suspended, such as in an emergency when the patient is unconscious or unable to communicate or is in danger of injury and cannot protect himself from harm, or to protect the public from harm
International Center for Safety of The Joint Commission: Have developed goals to promote specific improvements in patient safety. The goals attempt to provide evidence-based and expert-based solutions to areas that have been problematic in terms of patient safety
Sentinel Event: An unexpected patient care even that results in death or serious injury (or risk thereof) to the patient
SBAR: Situation, Background, Assessment, Recommendation. A strategy that reduces the likelihood of critical patient details being lost
Confidential: Kept private.
Chart or Medical Record: Confidential. Only people directly associated with the care of that patient have legal access. It is the property of the hospital or agency or physician, not the patient. Patient does have right to access and copies may be authorized by the patient to be provided to other agencies. Used to determine the truth of what happened and what was done or not done to a patient during a period of time. Therefore, it always needs to be accurate, pertinent, and timely.
HIPAA Health Insurance Portability and Accountability Act: Called for the creation of regulations regarding patient privacy and electronic medical records. Failure to comply may lead to civil penalties. Protect the way patient information is conveyed and stored. Also dictates to whom information may be revealed. Rule states that disclosing medical information to family members, close personal friends, or other individuals identified by the patient for involvement in the patient’s care is permittied if the patient DOES NOT object.
Consent: Permission given by the patient or his legal representative. Also known as releases and are legal documents that record the patients permission to perform a treatment or surgery, or to give information to insurance companies or other health care providers. If the patient has any questions, they should be satisfactorily answered before the patient signs. It is important to determine that proper consent has been obtained both legally and ethically. Failure to obtain a valid informed consent may lead to charges of assault and battery, or invasion of privacy.
Competent: Person who is legally fit mentally and emotionally
Emancipated Minor: One who has established independence by moving away from parents or through service in the armed forces, marriage, or pregnancy, is considered capable of signing a consent
Implied consent: assumed when in a life threatening emergency, consent cannot be obtained from the patient or the family.May be obtained by telephone it is witness by two persons who hear the consent of the family member
Release: Legal form used to excuse one party from liability
LAMA (Leave against Medical Advice): Form used by a hospital or facility when a patient does not accept the physicians recommendation for hospitalization, and leaves the agency. This form documents that the reasons for continuing hospitalization or treatment, and risks of leaving without treatment have been explained to the patient. If the patient refuses, that is noted and witnessed
Advance Directive: Sometimes called a living will. It’s a consent that has been constructed before the need arises. It spells out a patients wishes regarding surgery as well as diagnostic and therapeutic treatments.
DNR: Orders written by a physician when the patient is indicated to be allowed to die if he or she stops breathing or his or her heart stops. In this situation, no CPR would be started.
Battery: A nurse would be charged with this if they attempt to resuscitate a patient who has a physician’s DNR order
Patient Advocate: One who speaks for and protects the rights of the patient
Negligence: Failing to do something a reasonably prudent (sensible and careful) person would do, or doing something a reasonably prudent person would NOT do
Prudent: Sensible and Careful
Malpractice: Negligence by a professional person. Person doesn’t act according to professional standards of care as a reasonably prudent professional would. In nursing ___________________ a reasonably prudent person is a similarly educated, licensed, and experienced nurse. Example: a nurse did not check the patient’s vital signs and condition after surgery, and the patient was hemmorhaging, and the patient went into shock and died
4 Elements that must be present in Malpractice
Duty, breach of duty, causation, and injury. If one is not present, the nurse is not guilty
Assault: The threat to harm another or even to threaten to touch another person without the person’s permission. Example: Threating to hold down a patient to give them an injection they have refused.
Battery: The actual physical contat that has been refused or that is carried out against the person’s will. Example: Holding down a patient and giving them an injection they have refused
Nurses Responsibility: It is the nurses responsibilty to explain the reason why a particular drug or treatment is important. However, if the patient still refuses, the nurse should obtain a release from liability because the treatment is not done or the drug is not taken
Defamation: When one person makes remarks about another person that are untrue, and the remarks damage that other person’s reputation
Slander: Oral form of defamation. Example: Two nurses are overheard talking about a physician in a way that holds the physician up to ridicule or contempt
Libel: Written form of defamation. Example: A letter or newspaper article quotation that states that a person is incompetent or dishonest.
Invasion of Privacy: Occurs when there has been a violation of the confidential and priveleged nature of a professional relationship. Occurs when unauthorized persons learn of the patient’s history, condition, or treatment from the professional caregiver.The only exception is that nurse’s are required by law in most states to report information regarding child or elder abuse, sexual abuse, or violent acts that may be crimes (stabs or gunshot wounds)
False Imprisonment: Preventing a person from leaving, or restricting his movements in the facility. When a patient wants to leave the hospital against the advice of the physician , a release to leave “against medical advice” is used.
Protective Devices: May be mechanical, such as locks, rails, belts, or garments that prevent a person from getting out of a room, bet, or chair, or they may be chemical drugs such as sedatives or tranquilizers that sedate the patient that he is unable to move about. A PHYSICIAN ORDER IS NECESSARY FOR ANY PROTECTIVE DEVICE, MECHANICAL OR CHEMICAL. The inappropriate use of devices can lead to charges of false imprisonment.
Nursing competence: possessing the suitable skill, knowledge, and experience necessary to provide adequate nursing care. FIRST AND MOST IMPORTANT IS COMPETENT AND WELL-DOCUMENTED NURSING CARE. POTENTIAL LAWSUITS MAY BE AVOIDED BY EARLY IDENTIFICATION OF DISSATISFIED PATIENTS.
Incident (Occurrence) Reports: Often used to document what happened, the facts about the incident, and who was involved or witnessed. Tool used by the risk management department. Useful because it allows the facility to note dangerous patterns, or if a change in the appearance of a medication might have been a factor in several recent similar medication errors. Generally not filed as part of the patient’s chart. No reference to the report is made in the patient’s chart
Liability Insurance: Does not provide protection from being sued, but it protects the livelihood and assets of a nurse should the nurse get sued. If a nurse is sued, it pays for the expense of a lawyer to defend the nurse and pays any award won by the plaintiff up to the limits of the policy. May also pay for attorney costs and related costs if the nurse is subjected to a review by the state board of nursing
Ethics: Rules of conduct that have been agreed on by a particular group. Based on the consensus of the group that these rules are believed to be morally right or proper for that group
Values: The worth or importance of an action or belief to an individual
Dilemma: Problem or conflict
Codes of Ethics for Nursing; -A respect for human dignity, the individual, and provision of nursing care that is not affected by race, religion, lifestyle, or culture
-A commitment to continuing education, to maintaining competence, and to contributing to improved practice
-The confidential nature of the nurse-patient relationship, outlining behaviors that bring credit to the profession and protect the public
Euthanasia: Mercy killing. the act of ending another person’s life, with or without the person’s consent, to end actual or potential suffering. IT IS ILLEGAL IN ALL STATES
Assisted Suicide: Aiding a person (providing the means) to end his life.
Whistle-blowing: Reporting illegal or unethical actions
Ethical Dilemmas; Result when people hold different views on issues. Ethics committees can provide an interdisciplinary approach to solving these
Patient Care Partnership: Recognizes that patients do not lose their civil rights when they are hospitalized
Scientific Method: A step-by-step process with observable results used by scientists to solve problems
Five Components of Nursing Process
- Assessment (Data Collection)
- Nursing Diagnosis
Goals of the Nursing process: To explore patient’s health status, identify actual or potential healthcare problems, determine desired outcomes, deliver specific nursing interventions to solve the problems and promote health, and evaluate care given to determine whether outcomes have been achieved
Patient Input: During the planning state, this results in more success with the plan of care
Assessment: Collecting, organizing, documenting, and validating data about a patient’s health status. Assessment data are obtained from the patient, the family, the physician, diagnostic tests, and information about the patient from other health professionals
Nursing Diagnosis: The process by which the assessment data are sorted and analyzed so that specific actual and potential health problems are identified. The factors contributing to the problems are considered and specific nursing diagnoses are chosen for the patients care plan
Planning: A series of steps by which the nurse and the patient set priorities and goals to eliminate or diminish the identified problems. The goals are stated as specific expected outcomes. The nurse and the patient collaborate and choose specific interventions for each nursing diagnosis. The interventions assist the patient to meet the expected outcomes. The expected outcomes and nursing interventions are listed on the patients nursing care plan
Implementation: Carrying out the nursing interventions in a systematic way. The nurse carries out the interventions or delegates some of them to an appropriate person. The patient’s response to the care given is documented on the patient’s chart.
Evaluation: assessing the patient’s response to the nursing interventions. The responses are compared with the expected outcomes to see to what extent the outcomes have been achieved. The entire care plan is reassessed in this phase, and any changes needed are made.
Critical Thinking: Directed, purposeful, mental activity by which ideas are evaluated, plans are constructed, and desired outcomes are decided.
Steps in the Problem Solving Process
- a.Define the problem clearly
- b.Consider all possible alternatives as solutions to the problem
- c.Consider the possible outcomes for each alternative
- d.Predict the likelihood of the outcome occurring
- e.Choose the alternative with the best chance of success that has the fewest undesirable outcomes
Priority: More important than something else at the time
Priority Setting: Involves placing nursing diagnoses or nursing interventions in order of importance
Basic Principles for Priority Setting
- a.Consider what will happen if the task is not done on time
- b.Priorities constantly change because patient needs and conditions change frequently.
- c.Must be flexible and frequently reorder tasks.
- d.Reconsider work organization plan at least ever two hours during a shift, reprioritizing as needed
- e.Physiologic needs for basic survival take precedence. The airway ALWAYS comes first
- f.After physiologic needs, safety problems take priority
- g.After these two, psychosocial needs of love and belonging, self esteem, and self actualization are given attention
- h.Every nurse must attempt to look at each patient holistically, keeping psychosocial needs in mind while working on physical problems
Nursing Process: A way of thinking and acting based on the scientific method. It is a framework for planning, implementing, and evaluating nursing care
Formulating a Plan: A collaborative process among the nurse, the patient, and other health care members
Critical Thinking: Improves the outcomes of the problem-solving process
Critical Thinking: a directed, purposeful, mental activity by which ideas are created and evaluated, plans are constructed, and desired outcomes are decided
Critical Thinking: Necessary to make reliable observations regarding health status and to draw sound conclusions from the data obtained
Critical THinking: Involves a variety of skills. Effective reading, writing, attentive listening, and effected communicating are the foundation skills
Critical Thinking: With this, factors can be weighed, problems skillfully solved, and good decisions made a majority of the time
Assessment: Consists of gathering information about patients and their needs using a variety of methods. These are an ongoing process. You will continue to gather data about the patient each time there is an encounter
Data: Pieces of Information on a specific topic
Database: All the information gathered about a patient
LPN and Assessment Data Collection: often asked to assist with the task and participate in carrying out the plan by continuing to collect data
Interview: Conversation where facts are obtained
Subjective Data: Data obtained from the patient verbally. Example: I have a headache, i’m nauseated, The sharp pain is in my hip, i’ve been feeling really blue lately, i’ve been lonely since my husband died, i’m tired all the time, i’m afraid i have cancer
Objective data: Information obtained through the senses and hands-on physical examination. Example: Temperature 101.4F, bruise on right hip, eyes downcast flat effect, Only one visitor seen in room all day, Pathology report states tissue is adenosarcoma
3 basic Stages of patient interview:
- 1. The opening, when rapport is established with the patient
- 2. The body of the interview, when the necessary questions are presented
- 3. The closing segment of the interview
Cues: Pieces of data or information that influence decisions
Inferences: Conclusions made based on observed data
Nursing Diagnosis: Indicates the patient’s actual health status or the risk of a problem developing, the causitive or related factors, and specific defining characteristics(signs and symptoms)
Etiologic Factors: Causes of the problem
Signs: Abnormalities that can be verified by repeat examination and are objective data
Symptoms: Data the patient has said are occuring that can’t be verified by examination and are subjective data: Defining Characteristics
Characteristic : (signs and symptoms) that must be present for a particular nursing diagnosis to be appropriate for that patient
Nursing Diagnosis: Defines the patient’s response to an illness
Medical Diagnosis: Labels “the illness”
Physiologic needs: Number one priority. Circulation. Airway Always comes first!
Psychosocial needs: Take priority after safety problems. Every nurse must
Safety Problems: Take priority after physiologic needs
Goal: Broad idea of what is to be achieved through nursing interventions
Short term goal: goals that are achievable within 7 to 10 day or before discharge
Long Term Goal: Goals that take weeks or months to achieve. Often relate to rehabilitation
Expected Outcomes: A specific statement of the goal the patient is expected to achieve as a result of nursing intervention. Should be realistic and attainable and should have a defined time line
Chart Review: useful for gathering information for the nursing database and for obtaining information for a student assignment
Analysis: used to sort and group assessment data so that nursing diagnoses can be chosen and priorities can be set
Lesions: Tissue damage or abnormality
Palpation: Sench of touch performed with the hand and uses touch to feel various parts of the body. Can be used to detect the size, shape, and position of parts of the body and the texture. Used to ascertain the presence of muscle spasm or ridgity, pain, swelling, or presence of a growth, skin temperature, turgor, and presence of edema
Edema: Fluid in the tissues (swelling)
Tremors: Involuntary fine movement of the body or limbs
Percussion: Involves light, quick tapping on the body surface to produce sounds. Used primarily over the chest and abdomen to determine the size, location, and density of the organs that lie within.
Auscultation: Listening to the sounds produced in the body with the aid of a stethoscope. Used to take blood pressure readings, listen to the lungs, and assess heart sounds and bowel sounds
Olfaction: Sense of smell. used to identify characteristic smells associated with specific problems. A sweetish odor to the breat can indicate diabetic acidosis, alcohol on the breath can provide a clue to the patient’s lethargy or irrationality. mouth odor may indicate periodontal disease or poor oral hygiene
Where not to take a blood pressure: On the arm containing a dialysis shunt or on the side where a mastectomy and lymph node dissection have occured.
Lordosis: Exaggerated lumbar curve (lower back)
Kyphosis: Increased curve in the thoracic area (hunchback)
Scoliosis: Pronounced lateral curve of the spine
Bronchovesicular Sounds: Lung sounds heard over the central chest or back. Normally equal in length during inspiration and expiration and have no pause between them
Vesicular Sounds: Soft, rustling sounds heard in the periphery of the lung fields. Longer on inspiration than expiration and there is no pause between them
Adventitious Sounds: Abnormal lung sounds
Assessment of Basic Needs:
- Rest and Activity
- Nutrition, fluid and electrolytes
- Safety and security
- Hygiene and grooming
- Oxygenation and circulation needs
- Psychosocial and learning
Supine position: Laying on back
Prone position: Laying on Stomach
Dorsal Recumbent position: On back with knees bent
Lithotomy position: On back with feet in stirrups, knees relaxed
Sims Position: laying on side
Knee chest: Face down, knees bent up to chest
Otoscope: used to check the ears
Ophthalmoscope: Used to check the eyes
Nystagmus: jerky movements
Glasgow Coma Scale: used to score the neurologic check and to quantify the neurologic condition of the patient