Foundations of Professional Practice Flashcards

Terms Definitions
Clara Barton
nurse in civil war
organized the American Red Cross
Frances Payne Bolton
Ohio congresswoman
Bolton Act of 1943
US Cadet Nurses Corps
Bolton Act of 1943
addressed nsg shortage during WWII by providing funding for nsg students & schools
created US Cadet Nurses Corps
Mary Breckenridge
Nurse midwife
started Frontier Nursing Service in Ky because region had no MD's.
American Assoc of Nurse Midwives 1929
American School of Midwifery in NY 1932
introduced model rural health care system in USA 1925
Dorthea Dix
Crusaded against inhumane tx of pts in mental hospitals
her careful documentation resulted in construction of state psychiatric hospitals
during Civil War served as Superintendent of Army Nurses
Lavina Dock
Political activist -1920 passage of 19th amendment
believed advancement of nursing could not be achieved until women tx equally
pioneer in community health nursing
worked with Lillian Wald, Mary Brewster est Henry Street Settlement
compiled Materia Medica for nurses (drug manual)
Loretta Ford
founder of nurse practitioner model
Annie Goodrich
recommended nurse training schools be set up in each military hospital thus beginning the Army School of Nursing
Virginia Henderson
nursing is assisting individuals sick or well to regain INDEPENDENCE
13 components of nsg care
nurse's role as an advocate to move pt toward goal of independence
1961 - DEVELOPMENTAL MODEL nursing theory
Imogene King
Her model is based on systems theory but has been classified as an INTERACTION MODEL
model of 3 interacting systems: personal, interpersonal, & social
The end point of this interaction between nurse & pt is transaction at which the person's goal is met
Dorothy Johnson
BEHAVIORAL SYSTEMS MODEL- regulate external forces to stabilize client's behavioral system & restore, maintain or attain balance
Madeline Leininger
TRANSCULTURAL NURSING MODEL - humanistic scientific mode of helping pt thru specific cultural CARING processes (cultural beliefs, values, practices) to improve or maintain health
Myra Levine
CONSERVATION THEORY MODEL- conserving an pt wholeness.
4 conservation principals: energy, structural integrity, personal integrity & social integrity
3 environments that effect pt: perceptual, operational & conceptual
coined by Myra Levine
describes the nurse's judgement about the patient's condition
Mary Mahoney
1st trained black nurse
New England Hospital for Women & Children 1879
Mildred Montag
Community College Education for Nursing Report

suggested ADN because of a shortage of nurses during WWII

nursing a technical program
Betty Neuman
HEALTH SYSTEM NURSING MODEL- assist pt to reduce stress or adverse factors that affect optimal functioning
Florence Nightingale
Crimean War 1854: Florence Nightingale became involved and helped the English Secretary of War clean up terribly unsanitary conditions in the hospitals. She started programs of social welfare and helped radically improve the sanitary levels which dropped the mortality rates to 1%. In 1860, she established a nursing school in London’s St. Thomas Hospital

founder of modern nursing; 1st nurse theorist; focused on environement; raised status of nursing theory education & influenced reform in nsg educ.
Dorthea Orem
SELF CARE MODEL- selected & performed actions to assist pts to maintain self care with structural integrity, functioning & development

nursing system to be supportive & provide educ as needed by pt
Heldegard Peplau

"psychodynamic nursing" - relationship between nurse & pt
4 phases of relationship:
1) orientation - pt & ns id the pt's problem
2) identification - pt id's with ns accepting help
3) exploitation - pt makes use of ns help
4) resolution - pt accepts new goals & frees themselves from the relationship
6 nursing roles:
1) Counseling role - working with pt on current problems
2) Leadership role - working with pt democratically
3) Surrogate role - figuratively standing in for a person in pt's life
4) Stranger - accepting the pt objectively
5) Resource person - interpreting the medical plan to the pt
6) Teaching role - offering info & help pt learn
Melinda Ann Linda Richards
USA 1st trained nurse
development of nsg education
Isabel Hampton Robb
Founded John Hopkins School of Nursing
Founding committee for the American Journal of Nsg
educ changes: reduced student's work day to 10 hrs & eliminated free private duty services & implemented grading policy for nsg students
president of NLN & ANA
one of the founders of modern USA nursing theory
Martha Rogers
SCIENCE OF UNITARY MAN MODEL- man as unified whole in constant interaction with the environment
systems & electromagnetic theory

Developed “the science of unitary man” model. The person is a unified field which is continually interacting and exchanging matter and energy with the environment. She concluded that well being is reflected in patterns and organization of this energy field. She saw the nursing role as one to act to promote and facilitate symphonic interaction between man and environment.
Sister Callista Roy
ADAPTATION MODEL- The model is influenced by system, stress and adaptation theories. This model assumes that the patient adapts their behavior to cope with stimuli from environmental stressors. Stressors disrupt the patients’ state of equilibrium and illness results. The nurses’ role is to assess the adequacy of the patients’ coping and maybe change the patients response potential by bringing the stimuli to the point where a positive response is possible.
Margaret Sanger
With her sister, she opened the first birth control clinic in the United States in Brooklyn NY. She battled for decades over the distribution of birth control information.
Imprisoned for opening birth control clinic
Ada M Stewart
health counseling to factory workers
hired by Vermont Marble Company to take care of its employees thru home visiting, most of pts were obstetrical but also cared for medical & surgical pts
services to employees & townspeople who could not afford any other care was free
Sojourner Truth
real name: Isabella Baumfree
Underground Railroad
civil war nurse
Freedman's Relief Association after Civil war
Betty Neuman
She developed the Systems Model based on line of defense. This says that each patient has a usual range of responses to stress that maintain equilibrium. (“Normal Line of Defense”). In unusual situations, the patient uses flexible lines of defense (“Lines of Resistance”) to stabilize the situation. The nurses’ role is to decrease the stress factors and adverse conditions that threaten optimal functioning. The nurse identifies stress factors and helps the patient respond by strengthening their normal and flexible lines of defense.
Harriet Tubman
runaway slave from Md
Civil war nurse - cared for blacks
underground railroad
Jean Watson
1979: She developed the Theory of Caring. This is based on three assumptions: (1) caring is a universal social behavior (2) care for self is necessary before care for others (3) care and love are the cornerstones of humanness. The nurses’ role is to emphasize the humanistic dimension of nursing that can only be practiced interpersonally.
(In the context of delegation). To accept ownership for the results or lack of results associated with a task. Accountability is shared and you can only delegate the tasks for which you are responsible.
The process by which an agency or organization evaluates and recognizes an institution or program of study as meeting certain predetermined criteria or standards.
The act of standing in for the rights of the patient. The RN, as an advocate and because she has the specific training, has specific responsibilities to and for the patient.
American Academy of Nursing (AAN)
An organization for professional nurses in the USA. Focus is on standards of healthcare, nurse professional development, economic and general welfare of nurses. The goal is to transform healthcare so as to optimize the well being of the American people and the world.
American Civil War 1861-1865
At the beginning, there was no organized system for caring for the wounded or sick. Doctors began developing a short training course for female volunteers. Members of existing religious orders began to volunteer and were assigned to larger hospitals. Dorothea Dix was appointed “Secretary of War” to oversee the trained nursing volunteers.
American Nurses Association (ANA)
Established in 1897. It’s a federation of state associations. Voluntary professional nursing organization. Serves as a spokesperson/agent for nurses and nursing. Publications: American Journal of Nursing (AJN), Nursing Research, International Nursing Index. The American member of the International Council of Nurses (ICN). Membership in the ANA is open to professional nurses with currently valid license.
Balanced Budget Act (BBA) Public Law 105-33 of 1997
his removed the restrictions on Nurse-Practitioner billing. It means that NP’s can be independent Medicare providers and can bill Medicare separately. This law requires a collaborative rather than supervisory relationship between NP’s and doctors.
Clara Barton 1821-1912
she was a schoolteacher with no formal nurse training. She served with the German Red Cross during the Franco-Prussian Was and founded the American Red Cross. She founded the “Missing Soldier Office” during the Civil War. She and Harriet Tubman tended wounded soldiers. Clara directed relief operations during the war, mobilizing 6000 women for the North and 1000 women for the South. She convinced Congress to ratify the Geneva Treaty which allowed the American Red Cross to act in peacetime.
Breach of Contract (Liability Theory)
A contract is a promise or set of promises between two parties. The RN may be asked to witness a one-party document.
Elements of a valid contract
1. Parties are competent to contract. 2. The contract must concern a legal subject matter. 3. There must be a consideration (without it, the agreement is for a gift). 4. There is a mutuality of agreement.
Breach of Warranty (Liability Theory)
These claims are a specific type of contractual claim and are prompted by representations from the HMO that its providers will provide “high quality care”. Although the HMO may advertise high quality care, the HMO is not simultaneously guaranteeing non-negligent medical care.
Mary Brewster
Worked with Lillian Wald and Lavinia Dock to establish the Henry Street Settlement. Pioneer in community health nursing.
Case Management
A process that is implemented in an integrated health care delivery system. The RN is assigned as the Case Manager and is responsible for moving the patient through the continuum of care in the integrated system. The Case Manager secures services that are desired and available. Social Workers used to be Case Managers but RN’s are better suited for the task.
Case Method (Delivery of Care)
The total care of one patient is assigned to one RN. Case nursing delegates and assigns total responsibility of one patient to one nurse for the duration of the patients’ stay. The main nurse assigns associate nurses duties to help with patient care but the main nurse is totally responsible and accountable. Case nurses are salaried but are definitely a staff position.
Used as a tool to measure competence (a measure of TQM or CQI). It’s voluntary and signifies competence or specialization. There are 3 criticisms: 1. denial of certification may be based on a lack of educational background or failure to pass the exam. 2. The nurse could be grandfathered into certification. 3. A conflict of interest could exist. The agency that confers the certification may also be the agency that accredits the educational program that the candidate must graduate from to qualify.
Luther Christman
A nursing pioneer. The nurse who founded the American Assembly for Men in Nursing. He is the founder and Dean Emeritus of the Rush University School of Nursing in Chicago.
Clinical Pathways (aka Outcomes)
Used to make nursing knowledge manageable, define standards and maintain quality. Standardized tools used for measuring outcomes are also known as Critical Paths, Care Maps, Care Protocols, Practice Guidelines, Clinical Guidelines, Clinical Outcomes, Collaborative Paths or Anticipated Recovery Paths. They define and describe the optimum progression of the patient through the system and are specific to health problems or issues.
Community College Education for nursing (a study published in 1959)
Conducted by Montag and others. A two part report sponsored by the Institute of Research and Service in Nursing Education at the Columbia University Teachers College in NY. “Action Research” was the evaluation of effectiveness that was built into the planning and design of the research. The study showed that Associate Degree (AD) nurses could carry on intended nursing functions and programs could be set up in community colleges. It recommended that more AD programs be developed.
Continuous Quality Improvement (CQI)
a tool used to measure efficiency, satisfaction and quality.
Corporate Negligence (Liability Theory)
Says that the hospital may be held liable if it fails to uphold the proper standard of care owed to the patient. It’s a non delegatable duty owed directly to the patient. Two elements have to be proven. 1. The patient must prove that the hospital knew of the defect in its procedures. 2. The defect was a substantial factor in bringing about the injury to the patient. It is the duty of the HMO to monitor the doctors’ performance for competence.
Corporate Negligence (Liability Theory) Failure to allocate resources properly
This is caused by a failure of the HMO to properly allocate its resources. Did the HMO arbitrarily deny coverage for a given procedure or did it delay approving a procedure that resulted in personal injury to the patient? This application of liability is unique to managed care.
Crimean War 1854
Florence Nightingale became involved and helped the English Secretary of War clean up terribly unsanitary conditions in the hospitals. She started programs of social welfare and helped radically improve the sanitary levels which dropped the mortality rates to 1%. In 1860, she established a nursing school in London’s St. Thomas Hospital.
Critical Path
This defines standards and outcomes. It creates a multidisciplinary approach and reduces the burden of documentation. The analytical component provides multiple opportunities such as variance analysis, trending and modification of paths. It is used to progress patients and evaluate care as effective or to determine whether other measures are required.
Critical Thinking
The process of identifying underlying assumptions, interpreting and evaluating arguments, imagining and exploring alternatives and develop a reflective criticism to attain a logical and justifiable conclusion
Decision Making
There are three levels. 1. Immediate – there is no time for reflection. Action is automatic or immediately responsive. 2. Intermediate – There is time for reflection before acting. 3. Deliberate - Information acquisition precedes thinking, consulting and reflection with the objective of making a rational decision. Deliberate decision making is the most common.
Defamation of Character
he publication of anything injurious to the good name or reputation of another. Slander is when it’s spoken or oral. Libel is when it’s written. The best defense against defamation is the TRUTH
Defined as transferring authority to a competent individual to perform a selected nursing task in a selected situation. It depends on a balance of responsibility, accountability and authority. Six factors. 1. Know yourself. 2. Know your world and organization, 3. Know your practice. 4. Know your delegates’ strengths and weaknesses. 5. Know what needs to be done. 6. Know how to communicate, resolve conflict and give feedback.
Delegation Process
Five Steps: 1. define the task. You can only delegate a task that you have authority over. You must define the task in terms of performance requirements and must determine which of the five levels of delegation to use. 2. Determine to whom to delegate – give the task to the lowest appropriate person. 3. Provide clear communication about expectations regarding the task. 4. Reach a mutual agreement about the task. 5. You must monitor and evaluate the results and provide feedback to the individual regarding the performance of the task.
Differentiated Practice
his builds on primary nursing but decentralizes all management functions such as staffing and scheduling. It is the structuring of roles and functions of nurses according to their expertise, education and competence. It is believed that education is the best basis for practice. Clinical Ladder: competence demonstrated and categorized in levels.
Direct Liability:
three theories. Corporate Negligence, Breach of Contract/Breach of Warranty and Intentional Misrepresentation or Fraud.
Dorothea Dix 1802-1887
She was the Superintendent of Nursing during the Civil War. Also called the “Secretary of War”. She insisted that nurses be “plain looking women over the age of 35, moral with common sense”. She fought with chauvinistic military surgeons who did not want women there. The nurses were employed as civilian employees of the Army and were paid 40 cents and one meal ration per day. After the war, she was credited with helping to develop state psychiatric institutions.
Lavinia Dock
She worked with Lillian Wald and Mary Brewster to establish the Henry Street Settlement in New York City. A pioneer in community health nursing.
Eight Ethical Principles
Justice is the right to be treated equally. Beneficence is the obligation to do good and avoid harm. Autonomy is the right to self determination, freedom and independence. Nonmaleficence is the obligation to not create or inflict harm on others. Veracity is the obligation to be honest and not deceptive. Fidelity is the obligation to be faithful to the commitment. Confidentiality is owed to the patient. It’s an obligation as well as a right. Ethics is the obligation that the nurses’ personal beliefs not interfere with patient care.
Emergency Medical Treatment and Active Labor Act (EMTALA)
This act prevents patient “dumping” (primarily from for-profit hospitals) and denial of emergency care when a patient does not have the ability to pay.
ERISA Act of 1974
This is designed to provide consistent application for employee benefits which would include health care benefits.
A wealthy first century Christian convert who founded the first free hospital for the poor. She was in a group of other notable women – Empress Helena, Olympias, Paula and Marcella. Most of them built churches, hospitals and orphanages.
Four Elements That Comprise Malpractice (or Negligence)
Duty. Breach of Duty. Proximate Cause (causation). Damages.
Functional Nursing
This bundles patient care tasks and assigns them. Tasks are grouped to save time and to comply with legal requirements. The obvious disadvantage is that there is minimal, if any, continuity of care and the care is fragmented. This isn’t good for the patient. The object is to get the work finished without regard to the nurse’s or the patient’s satisfaction.
Louise de Gras - Sisters of Charity 1633
this religious order was founded by St. Vincent de Paul. Louise de Gras was the first superintendent. She established the first nursing education program.
Group Process
this is collaborative decision making. The group process seeks to involve everyone and conveys responsibility and accountability on all group members. There are seven ways of group decision making. 1.. Majority rule. 2. Minority rule. 3. Autocracy. 4. Autocracy with polling. 5. Consensus. 6. Unanimity. 7. Decision by non-decision (“motion tabled after discussion”.
Health Care Financing Administration (HCFA)
This agency determines the reimbursement for service to Medicare beneficiaries. It administers the Medicare and Medicaid programs.
Health Care Quality Improvement Act of 1986 (HCQIA):
An effort to control various components of the health care delivery arena. It gave rise to efforts that provided and managed information on health care providers who had been a party in litigation.
Health Insurance Portability and Accountability Act of 1996 (HIPPA)
This act addresses electronic patient information. It developed standards for health information systems for the electronic transmission of health care information.
Health Maintenance Organization (HMO)
Several types. Most popular are the Staff model, the Network model, and the Independent Practice Association model. HMO’s are the most common type of managed care plan with the highest number of people enrolled. HMO’s provide services for enrollees with a fixed fee mostly through affiliated providers.
Health Professions Education For the Future: Schools in Service to the Nation 1993
A study sponsored by Pew Health Professions Commission. It was funded by Pew Charitable Trusts. It followed up on the 1991 report. It found that education and training of health professionals were not adequate to meet the health care needs in America. The professional education was out of synch with the changing health care system. It proposed seven competencies and six strategies.
Healthy People 2010
This study augments the Healthy People 2000 study. HP 2000 developed surveillance and monitoring patterns in health and living. HP 2010 provides more emphasis to individual communities to strengthen their own capabilities to promote and protect health and assure access to health services.
Virginia Henderson 1961
She created the Developmental Model. She was influenced by Orem and Maslow. She based her theory on the assumption that the patient is a person who needs help moving toward the goal of independence. She saw a nurses’ role as an advocate where the nurse would act on the behalf of the patient for those things that the patient would be able to do for themselves if they had the strength, knowledge and willingness to do so.
Human Genome Project
A worldwide project calling upon scientific teams to collaborate to map the entire human genome.
International Council of Nurses (ICN)
Established in 1900. It’s a confederation of national associations of professional nurses. One per country. It provides for the sharing of knowledge so that nursing practice throughout the world is strengthened and improved. Publishes the International Nursing Review.
Informed Consent
1. The patient must be informed regarding the treatment or procedure which means that risks, benefits or alternatives are provided. 2. The patient must be provided an opportunity to review the consent and ask questions. 3. A patient must have the capacity to sign the consent. (a) The patient must be the age of majority in the state and (b) the patient must not be impaired mentally or chemically.
Joint Commission on Accreditation of Healthcare Organizations JCAHO)
Inspection teams that visit healthcare institutions to insure that government mandated standards are met. Noncompliance with the standards results in loss of federal funds to that institution.
Knights Hospitallers of the Middle Ages
Military religious orders founded by monks in the 11th to 13th centuries. Most prominent was the Order of St. Benedict. Their most important duty was to care for the sick. They considered bathing a priority and established infirmaries within the monasteries. These orders sent monks throughout Europe to provide care for the sick and the poor.
The process by which an agency or arm of the government grants permission to a nurse to practice. The state board of nursing certifies that the licensee has attainede the minimal degree of competency necessary to insure that the public health, safety and welfare will be protected.
Catherine McAuley - Sisters of Mercy 1832
She formed this religious order in Dublin Ireland. The nuns were trained to help the sick and spread their order to the entire world.
State medical assistance based on Title XIX of the Social Security Act. States receive 50% in matching federal funds to provide medical care and services to people categorical and income requirements. It covers home health services based on Medicare guidelines.
Federal government insurance coverage for persons over 65 or disabled and under 65 who have paid into the Social Security or Railroad Retirement Systems. Part A provides for hospitalization, home care and hospice care. Part B is voluntary and provides partial coverage of doctors services to Part A eligible persons for a monthly fee.
Mens Rea
The mental state required to fulfill elements of criminal charges. The state of mind must accompany the conduct. “The person charged must have intent with the conduct, making the action deliberate rather than accidental”. Documentation is used to establish the state of mind/intent.
Middle Ages (500 to 1500 A.D.)
The first half is called the “Dark Ages”. The number of Deaconesses who cared for the sick decreased and were replaced with religious (monastic) orders that controlled the hospitals. These focused on the religious rather than physical problems. Since religious orders concentrated on religion, lay people formed secular orders to tend to the sick. Nursing was their main work.
National Commission on Nursing Study 1983
A three year chartered commission sponsored by the American Hospital Association, Hospital Research and Education Trust and The American Hospital Supply Corporation. The purpose was to develop and implement action plans to provide practical solutions to confront nursing problems. The recommendations to improve the nursing environment were shot down by the AHA. The commission recommended that the desirable goal for entry level nursing be the BSN.
National Council of State Boards of Nursing (NCSBN)
Created in 1978. Its members are State and Territorial Boards of Nursing. It collaborates on common interest matters, issues affecting the public health, safety and welfare which includes the development of licensing exams. Develops and refines the National Council Licensure Exams (NCLEX) for Registered and Practical nurses.
Betty Neuman 1972
She developed the Systems Model based on line of defense. This says that each patient has a usual range of responses to stress that maintain equilibrium. (“Normal Line of Defense”). In unusual situations, the patient uses flexible lines of defense (“Lines of Resistance”) to stabilize the situation. The nurses’ role is to decrease the stress factors and adverse conditions that threaten optimal functioning. The nurse identifies stress factors and helps the patient respond by strengthening their normal and flexible lines of defense.
Florence Nightingale 1820-1910
he is regarded as the founder of modern nursing. She was born in Italy to a wealthy family. In 1853, she was named the superintendent of a charity hospital for sick governesses. During the Crimean War, English Secretary of War Sid Herbert asked her to organize nurses and clean up the terrible sanitary conditions. In 1860, she founded a training school for nurses. She was a planner, administrator, researcher, reformer and politician. She believed that nurses were not there to do the heavy cleaning, laundry or to be doctors slaves.
National League of Nursing (NLN)
Grew out of and absorbed several professional nursing groups. Officially existed in 1952. Membership is open to nurses, consumers and friends. The mission is to advance quality nursing education that prepares for future changes in the profession. Publishes Nursing and Health Care. It is the official accrediting agency for nursing schools.
National Student Nurses Association
An autonomous student financed and run organization established in 1952. Publishes “Imprint, the NSNA Newsletter, The Dean’s Notes, Business book and Getting the Pieces to Fit”.
Nursing for the Future; the Brown Report 1948
Funded by the Carnegie Foundation for the Advancement of Teaching and the Sage Foundation. The study was conducted by the National Nursing Council. The purpose of the study was to analyze the changing needs of the nursing profession. The study recommended that schools of nursing be located in universities and colleges. It also recommended that nursing education should be mainstream education and could be divided into professional as well as practical.
Dorothea Orem 1959
She developed the Self Care Model. There are three related theories: Self Care, Self Care deficit and Nursing systems. Orem believed that nursing should focus on the self care deficit because the nursing system is designed as supportive and it should provide education as needed by the patient.
Ostensible (apparent) Agency
This doctrine says that the HMO or other managed care system can be held vicariously liable for the medical malpractice of a contract doctor when: (1) The patient looked to the institution (HMO) rather than the doctor for care and (2) the HMO created a reasonable presumption to the patient that the doctor was its’ agent. Ostensible agency is applied almost exclusively to group and IPA model HMO’s.
Outcomes Management
A tool using new technology that combines costs and quality to measure and evaluate current and past practices with the goal of improving clinical practice.
“Partners in Practice Model” developed in 1989 by Marie Manthey
This model intends to provide an efficient way of using the skills of a mix o professional and nonprofessional staff with differing levels of expertise. The nurse and the assistant agree to be partners with the nurse taking the lead and directing the efforts of the junior partner. The partners work together with the same patients and on the same schedule. This model offers more continuity and accountability, less expense and is more professionally rewarding for the partners.
Patient Classification Systems:
(1) North American Nursing Diagnosis (2) Nursing Intervention Classification (3) Nursing Outcomes Classification (4) Home Health Care Classification nomenclatures.
Peer Review Organizations (PRO)
The government instituted PRO’s as a mandate from the 1983 Medicare legislation. It established mechanisms for quality assurance by private entities in a competitive market. Consumers are members on government mandated PRO’s. PRO’s review only Medicare services and payment is tied to the outcomes of the Peer Reviews. The Peer Review is used for multiple purposes, TQM/CQI, internal and external employee evaluation and as a legal tool but peer review results are generally not admissible in court.
Hildegard Peplau 1952
She is known as the “Pioneer of Psychiatric Nursing”. She developed the Interpersonal Relations Model (process-organized). She said that a person is an organism that lives in an unstable equilibrium and life is the process of striving in the direction of stable equilibrium which is never reached except in death.
Pew Health Professions Commission; 21 Competencies 1995
this was a continuation of an earlier 1990’s report. Tries to assist policymakers and educational institutions to produce health care workers who meet the changing needs of the US health care system. It made specific recommendations to all health professionals in general and specifically to disciplines including nursing.
She was the first deaconess identified in the Bible. Paul identified her as providing nursing care. The Deaconesses were the first public health nursing organization. It’s the earliest record of Christian nursing.
Primary Nursing:
Organized in the 1970’s. One nurse does most of the work unless they are off duty. It assigns the total care of one patient to one nurse. The nurse is responsible for the entire care of the patient during the entire stay. The primary nurse plans the care and is responsible for the management of the patient. The associate nurses report to the primary nurse and the primary nurse makes the changes to the care plan. The goal is for the primary nurse to collaborate with the patient, the patient’s family and other members of the health care team. The primary nurse is not usually used for administrative roles like charge nurse.
Problem Solving (seven steps)
(1) Define the problem (2) Gather relative information (3) Analyze the information (4) Develop solutions (5) Make a decision (6) Implement the decision (7) Evaluate the solution.
Productive Conflict
Produces stress or tension and can often lead to results that are “out of the box”. The basic goal of conflict management is to prevent escalation of a conflict.
An organized group of people educated with a unique body of knowledge and all engaged in a specialized expertise. 10 criteria: (1) has well defined, well organized body of knowledge (2) enlarges its body of knowledge (3) practitioners must be educated in higher learning institutions (4) applies its knowledge in practical services (5) functions autonomously (6) is guided by a code of ethics (7) is distinguished by common culture and norms (8) it has a clear standard of educational preparation for entry (9) it attracts people who put work above self (10) it strives to compensate practitioners by providing freedom of action, growth opportunity and economic security.
The Reformation (1500 A.D.)
Protestant churches formed and monasteries closed. Male nurses disappeared and women became the primary nursing providers from then on. The Sisters of Charity, a non cloistered order including Protestants formed in Paris. The Church of England established the Sisters of Mercy in Dublin Ireland in 1832.
Res Ipsa Loquitur “The thing speaks for itself” (Corporate Negligence/Liability Theory)
This permits the jury to conclude negligence without proving the facts. For example: The patient dies of peritonitis and the surgeon left an instrument inside during surgery. The jury can rule against the surgeon because it seems obvious that the error of forgetting to remove the instrument caused the complication which caused the death of the patient.
Respondeat Superior “Master-Servant Doctrine”
An employer may be held vicariously liable for the negligent acts of an employee when those acts are conducted in the course and scope of employment. Based on three factors: (1) the level of control exerted by the employer over the employees’ work (2) the method of payment (3) the parties’ understanding regarding the relationship. HMO’s use the defense of “corporate practice of medicine. They say they aren’t liable because the HMO doesn’t actually provide the care, the employees do.
Responsibility (in the context of delegation)
This means that there is an obligation to accomplish a task. Along with responsibility, you must transfer authority. It makes the delegate empowered to accomplish the task.
Shared Governance
Sometimes referred to as “shared ownership in an organization”. It’s a management style in which staff nurses are given responsibility and expected to participate in decision making. It requires free flow of information and that management and staff agree upon the basic principles. It gives increased job responsibility to staff nurses.
Standards of Care
These are primarily dictated by the profession but may also include standards defined by specific institutions or professional literature.
State Boards of Nursing (SBON)
these are created by the legislature and members are appointed by the Governor to oversee the practice of nursing. They are entrusted with many responsibilities. The major one is to insure that the Nurse Practice Act is carried out. It is involved with education, licensure and discipline.
Standards of Clinical Nursing Practice
Formed by the ANA in 1991 and revised in 1998. These make a distinction between patient-focused and provider-focused standards. They distinguish between a competent level of care as demonstrated by the nursing process for patients and a competent level of behavior in the professional role.
Standards of Professional Performance
These define a competent level of behavior in the professional role. They include activities related to quality of care, performance appraisal, education, ethics, collaboration, research and resource utilization. Along with Standards of Care, these determine both the standard utilized for competence and the standard from which negligence is established.
An act by the state legislature what becomes law. Statutes are enacted to prescribe conduct, define crimes, create government bodies, appropriate public monies and, in general, to promote the public good and welfare. At the local level, government adopts “ordinances”. At the state or federal level, they are called “regulations”.
Study of Credentialing in Nursing: A New Approach” 1979
this study was sponsored by the ANA and conducted by the Center for Health Research at the Wayne State College of Nursing. It recommended establishment of a national nursing credentialing center. Also, there should be principles applied to credentialing, it also produced position statements that addressed the definition of nursing; entry levels into practice; accountability and competence.
Team Nursing
This involves RN’s, LPN’s and unlicensed assistive personnel (UAP’s) caring for the needs of multiple patients. It became popular after WWII because of the nursing shortage. The main disadvantage is that it doesn’t provide for continuity of care. The team leader (the RN) has Managerial and Staff duties. The team leader assigns patients to tam members according to their skills and experience.. It is the team leaders’ job to communicate between the doctors and the staff.
300-500 A.D.
In 335 A.D. Christianity became the official religion of Rome. The Bishops became responsible for care of the sick, poor, widows and children. The Bishops designated special groups called Deacons and Deaconesses to assume this responsibility.. The Deaconesses were widows, virgins and matrons.
Time Management:
Goal is effectiveness, not efficiency. It is essentially about planning (a left brain activity) and requires linear thinking and the ability to dissect or analyze tasks that make up an activity. It requires clarity of thought and purpose. You must be able to “FOCUS” (Follow One Course Until Successful).
Torts (Corporate Negligence)
A tort is a legal wrong. Several kinds relate to nursing. Assault: menacing a patient. Battery: physically contacting a patient who does not give permission for the contact. False imprisonment: unlawfully restraining a patient. Invasion of Privacy/Violation of Confidentiality: making information about the patient public knowledge. Abandonment: unilateral severance of care. Fraud: intentional deception that results in injury to the patient. Also remember Slander and Libel.
Total Quality Management (TQI)
A tool that is used in business to measure efficiency, satisfaction and quality. Sometimes called CQI.
Unproductive Conflict
The type of conflict that usually benefits from intervention, either from a facilitator (or if that person is engaged in conflict) someone educated in conflict management. The facilitator may look to raise the conflicted persons’ consciousness about the issue causing conflict. There are three general techniques:
(1) Controlled Discussion (2) Role Reversal (3) Hidden Agenda Counseling - in this type, the person says what they want to say to an empty chair.
Utilization Review
The Gatekeeper, also known as the Utilization Review Coordinator, controls the allocation of capitol and human resources. The external utilization review determines what is customary and reasonable as it relates to health care and the cost of reimbursement. Traditional utilization reviews did not provide an opportunity for health care consumers to appeal an internal decision.
Lillian Wald 1867-1940
She was a key figure in Community Health Nursing. She introduced school nursing for children. She worked with Mary Brewster and Lavinia dock to establish the Henry Street Settlement (a clinic for the poor) in New York City. She trained at the NY Hospital School of Nursing. She participated in Rural Nursing Service meetings, correlated demographics with mortality and morbidity statistics. This resulted in the founding of the National Organization of Public Health Nursing and she became the first president of this group.
Jean Watson 1979
She developed the Theory of Caring. This is based on three assumptions: (1) caring is a universal social behavior (2) care for self is necessary before care for others (3) care and love are the cornerstones of humanness. The nurses’ role is to emphasize the humanistic dimension of nursing that can only be practiced interpersonally.
Autocratic Leadership style
obtain power with a group by maintaining control over it

decreases desire of nurses to work autonomously
Democratic Leadership
share power, allows consensus decision making & distribution of power. AKA Participative

respects nurse professionlism & knowledge.

increases accountability & autonomy
Bureaucratic Leadership
decreases nurses creative problem solving
Laissez Faire
leaders maintain no control over group, decision making is unstructured & commonly performed by an unofficial leader of the group

increases autonomy & decreases collaboration
ANA's journal?
American Journal of Nursing
NLN's journal?
Nursing Education Perspectives
primary purpose of continuing education
to maintain competency
Nursing theories
has an impact on educational curricular pattern

necessary for continued development of the discipline

borrows from many fields & uses various concepts

independent from medical model

advances the discipline of nursing
Sunset laws
state laws enacted to ensure that legislation is current & reflects the needs of the public

therefore nurses can initiate change in the nurse practice act to ensure correlation with current practice
Cadet Nurse Corps
financed & legislated during WWII to provide additional nurses to meet needs

proved qualified nurse could be educated in < 3 yrs

influenced development of ADN
the network of science, philosophy and theory accepted by a discipline or person. The prevailing paradigm directs the activities of a discipline.
the most global perspective of a discipline, singles out the phenomena with with a discipline deals in a unique manner, i.e. person, environment, health, illness, etc.
metaparadigm concept of health
actualization of human potential
metaparadigm concept of nursing
ADN - provider of care, manager of care, member of profession

BSN - coordinates & provides care for clients with multiple, complex & variable health care problems to promote, protect & restore health & support end of life care

Masters - apply specialty knowledge to engage in clinical reasoning & decision making
metaparadigm concept of environment
both internal & external where nurse - pt interaction & health occur
metaparadigm concept of client to the ADN
individual within the context of family
metaparadigm concept of client to the BSN
client includes individuals, families, aggregates & COMMUNITIES
metaparadigm concept of client to the Master
individuals, families, aggregates, communities & SYSTEMS
Who publishes "Imprint"?

Imprint, the official membership magazine, is printed five times a year, and includes an in-depth news section informing members of association news; a number of columns and departments, an editorial by the Imprint student editor, and 4-5 features per issue on a given topic decided by the Imprint student editor.
Who publishes "Nursing Outlook"?
Elsevier, Inc.

The journal serves nursing educators, policy makers, administrators, and practitioners with practical advice, new teaching methods and recruiting techniques, curriculum and heath policy developments, and information on proposals that will affect the profession.
Who publishes "Getting the Piece to Fit"?
Getting the Pieces to Fit is NSNA's official handbook. Updated annually, it contains the NSNA constituency form, NSNA elected officers information, vital information about forming a state and school chapter, and much more.
Who publishes "American Nurse Today"?

American Nurse Today reaches 175,000 nurses including 160,000 members of the American Nurses Association (ANA). In addition to keeping nurses abreast of ANA’s advocacy for the profession, American Nurse Today provides valuable, peer-reviewed, evidence based clinical, practical and career information that nurses can assimilate into their busy practices immediately.

HealthCom Media is a specialty publishing company located in Doylestown, PA. The company also publishes other specialty journals including Menopause Management, Assisted Living Consult, and Medicare Patient Management.
Who publishes "American Journal of Nursing"?
The American Journal of Nursing (AJN), the official journal of the American Nurses Association
Who publishes "Nursing Education Perspectives"?
Nursing Education Perspectives (NEP) is the NLN's scholarly journal.

the NLN publishes the quarterly NLN Report, two biweekly e-newsletters, the NLN Member Update and Faculty Development Bulletin, Nursing Education Policy, special news bulletins from the CEO, and reports from task groups and advisory councils.
Community Health Accreditation Program (CHAP)
accredits home care & community based providors
Dept of Health & Human Services (DHHS)
federal agenc responsible for human development services, public health services, SS, medicare, medicaid
National Committee for Quality Assurence (NCQA)
reviews & evaluates HMO's
only nurses are members

nursing practice & certification

high standards
improvement of health care systems via political action
International Council of Nurses- ICN
international federation of nurses associations

focuses on providing quality & ethical nursing care

only nurses are members
National Council of State Boards of Nursing - NCSBN
promotes effective & safe nursing practices
National League for Nursing - NLN
ensures quality of nursing education & preparation for the nursing workforce

non nurses & nurse members
American Hospital Association - AHA
monitors quality of hospital care to public
National League for Nursing Accrediting Commission - NLNAC
national accrediting body for all types of nursing educational programs

recognized by the US Dept of Ed as the accrediting agency for postsecondary & higher degree nursing programs

publishes "Bridges"
Case Mangement
Structure for providing CONTINUITY of care

Managed Care
Business of health care

care of many persons

health care reimbursement
Omnibus Budget Reconciliation Act - OBRA
mandates national standards of care in skilled nursing facilities
Health Professions Education for Future:Schools in Service to the Nation (1993)
emphasised the need for increased numbers of advanced practice nurses

expand the number of master's level nurse practioners programs
Brown Report 1948
Ester Lucile Brown
studied changing needs of nursing profession

Findings: Nsg ed should take place in universities
Men & minorities s/b recruited
Lysaught Report 1970
identified need for increased research into practice & ed & enhanced ed systems & curricula

Recommended 2 separate licenses:
1. acute
2. distributive care
PEW Health Commission 1995
recommends that role of ADN is different than that of BSN

emphasizes role interdependence

Recommends interdisplinary collaboration

recommended need for nurses in specialized roles (there is too great a shortage of nurses especially in rural areas to meet the need)
Goldmark Report 1923
focused on educational prep of students

pointed out faults in hospital training schools including length of workday for nursing students
ANA Code of Ethics for Nurses (2001)
functions as a tool for professional self regulation

a statement of ethical obligations & duties for practice

makes explicit the primary goals, values & obligations of the profession
Position Paper on Education for Nursing (ANA 1965)
1st position paper paper MINIMUM EDUCATION for beginning nurse s/b BS

none of ANA suggestions were adopted by NLN d/t proposal to make BSN entry level; because NLN represents all levels of nsg: AD, BS, masters etc
ANA position paper (1985)
dealt with ethical issues
Patient Self Determination Act
allows pt to be involved in health care decisions including decisions about tx intended to preserve life
ANA Standards of Clinical Nursing Practice
describes responsibilities for which nurses are accountable

standards provide direction for professional nursing practice & a framework for the evaluation of practice

ie: referring a patient reflects the standard of planning
Primary care
preventive routine health maintenance & care for illness
Secondary care
emergency & acute care (ie: mantoux)
Tertiary care
long term care & rehab
1st state to allow its own ADN to take NCLEX
North Dakota
1st state to enact whistle blower protection for health care workers
New Jersey
criminal law, serious crime such as arson, burglary, murder
written defamation
negligence by a professional in performing their duty
criminal law
failure to report observed substance abuse
4 elements:
1. duty
2. breach of duty
3. proximate cause
is the name given to a body of law that addresses, and provides remedies for, civil wrongs that do not arise out of contractual duties.[1] A person who is legally injured may be able to use tort law to recover damages from someone who is legally responsible, or "liable," for those injuries.
At common law, simple battery is a misdemeanor and the elements of the offense are:

An unlawful application of force;
To the person of another;
Resulting in either bodily injury or an offensive touching.
State nurse practice act
Primary purpose: to define the parameters of professional nursing including education & scope of practice .

also sets requirements for licensure & for license revocation
state board of nursing
implements states' nurse practice act
Excelsior's definition of ADN
Role of provider of care:
1) uses skills to apply nsg process to care for clients in a variety of settings to restore & maintain health or provide end of life care
2) uses holistic approach to priortize & evaluate care to clients across the continuium of the complex health care environment using established nsg standards & protocols
Excelsior's definition of manager of care
identifies scope of practice for members of health care team, delegates, manages people to deliver care
Excelsior's definition of role of member of profession
practices within ethical, legal, regulatory frameworks of nsg & standards of professional nsg practice

articulates the contributions of professional nursing to health care

advocates for rights of clients & members of nursing
Excelsior's definition of client
individual within the context of family
Excelsior's definition of Supporting concept of critical thinking
conceptualizing, applying, analyzing, synthesizing, & evaluating info gathered from varied sources to informed decision making
Excelsior's definition of Supporting concept of communication

to receive, process & send info, thoughts, ideas & feelings
Excelsior's definition of Supporting concept of research
scientific inquiry leading to state of the discipline knowledge that can be used as evidence to confirm nursing practice
Excelsior's definition of Supporting concept of role development
professional socialization into:
a) provider of care
b) manager of care
c) member of profession
Excelsior's definition of Supporting concept of caring & cultural competence
patterns of nurse client interaction that are characterized by sensitivity to & respect for human/person values, experiences & cultures
management & supervision of nsg unit

leading team of RNs, LPNs

community nsg
technical bedside care
Group Development
1) Forming - 1st stage - members of group first meet
2) Storming - 2nd stage - resistance to group influence occurs & objectives of the group aren't yet clearly established
3) Norming - consensus begins to evolve, cohesion & norms develop, & conflict & resistance are resolved
4) Performing - stage where the group focuses on the task at hand & constructive group efforts improve task performance
team nursing
NA bathes, RN does tx, LPN meds, etc
functional nsg
does same task for group of pts

fragmented care
primary nsg
RN responsible for numbers of pts from admission to discharge

one nurse responsible for complete care 24 hrs X 7 days
managed care
designed to promote & deliver care @ the pts bedside in an acute care setting
case management
nsg care delivery method that is designed to promote & provide care across the health care continunum (home->hospital->clinic->home)

focuses on outcomes

RN manager of team
modular nursing
nurses rec pt assignments according to a particular unit or geographical location
differentiated practice model
nurses receive pt assignments accordingly to their education & experience
attempt or threat to touch another person
willful touching of a person that may or may not cause harm
failure to act as a reasonably prudent nurse would act
negligence by a specially educated professional person in the performance of his duties
differentiated practice pattern of nsg care delivery
allows nurses to assume roles & responsibilities commensurate with their level of educational preparation & experience

practice competencies in the workplace are consistent with expected competencies of nsg programs
nursing certification
validation that a nurse has met minimum standards of competency in a specialty area
mandatory licensure
an attempt to ensure safe nsg
legal permits that allow persons to practice a profession

determines the minimum standards to practice a profession
public relations
address issues & convey info to public
nursing audits
compare nursing care to established clinical standards
quality assurance
focus on clinical aspects of the providers care & is frequently used in response to an identified problem
record audit
uses documentation by reviewing a record & comparing it to established standards
nursing intervention classification (NIC)
established a standarized language for nursing interventions (treatments)
nursing outcomes classification (NOC)
labels patient outcomes & indicators of the patients condition
honesty, tell the truth
communicating openly to the pt's family
the duty to do no intentional harm

ie: nurse pulls pt up in bed & tears skin but she didn't INTEND to do it
may prohibit, oppose or discourage autopsy
Jehovah's witnesses
orthodox jews
Eastern orthodox christians
ethical theory of caring
general ns theory used as framework to guide ns practice
ethical theory of deontology
moral standards are independent of consequences
ethical theory of natural law
morality is part of natural order
ethical theory of utilitarism
"the end justifies the mean's"; focuses on consequences of an action rather than the nature of the action
ethical theory of autonomy
right of self determination
ethical theory of distributive justice
fair distribution of burden & benefits
ethical theory of fidelity
obligation to be faithful to agreements, commitents, responsibilities

ie: reporting chronic understaffing to state nurses association
peer review
compare nursing performance to established standards & benchmarks

evaluates patient outcomes
nursing care plans
plan nursing care of pt & evaluate efficency of the care
utilization review
evaluates cost effectiveness
critical pathway
outlines outcomes, care activities for each day
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