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Nursing Fundamentals 1


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Identify ways in which society has influenced the history of nursing
Roles of women, Role of religion, Wars
What is meant by the phrase “the scope of nursing”?
Promotes health and wellness (lifestyle changes and community programs)
Prevents illness by preventing disease
Restores health (direct care, diagnostic activities, health care provider consultations, teaching and rehabilitation)
Care of the dying (home, hospice)

What is the purpose of the Nurse Practice Act?
Regulates the practice of the nurse in the United States and Canada
Each state has their own and it varies state to state

Be able to identify roles/functions of the nurse
Client advocate
Change agent
Case manager
Research consumer

What are some factors that influence nursing?
Economics – Diagnostic-related groups (DRGs)
Consumer demands – In US, health is a right, not a privilege, & demand is for health maintenance and disease prevention
Family Structure – Decrease in extended family, more single parents or adolescent parents, and poverty in families.
Science/Technology – Must be familiar with a variety of equipment
Information/Telecommunications - Telenursing
Legislation – Influence nursing practice
Nurse Practice Act
Patient Self-Determination Act
Demography – Increasing elderly population, move from rural to urban settings, & mortality/morbidity rates
Nursing Shortage: reasons for shortages have varied over years
Collective Bargaining
Nursing Associations

What is the purpose of the nursing code of ethics?
Formal statement of nursing profession’s ideals and values
Serve as a Nursing Standard of Care
Usually have higher requirements than legal standards

Define values clarification.
No one set of values is right for everyone
Must be able to identify values; then can retain or change based on free choice
Promotes personal growth by increasing personal awareness, insight, empathy
What are your values about life, death, health, illness?
What can you accept? Why does a certain situation bother you? What would you do in this situation?
Need to reflect on viewpoints and previous experiences, new knowledge, new experiences
Patients may be unclear about their values

How can the nurse clarify his/her own values?
Consider attitudes about specific issues.
How can the nurse assist the client in values clarification?
List alternatives, examine possible consequences of choices, choose freely, feeling about the choice, affirm the choice, act with a pattern.
Theory of values clarification
Choosing-cognitive, Prizing-affective, acting-behavioral.
What are the essential nursing values and behaviors?
Human dignity
Social justice

A concern for the welfare and well being of others.
Right to self-determination.
Human Dignity
Respect for the inherent worth and uniqueness of individuals
Acting in accordance with an appropriate code of ethics and accepted standards of practice.
Social justice
Acting in accordance with fair treatment regardless of economic status, race, ethnicity, age, citizenship, disability or sexual orientation.
Wha are the moral principles associated with nursing and the code of nursing ethics?
Nonmaleficence Beneficence – Justice - Fidelity – Veracity – Accountability –
Responsibility –

“Do no Harm”

Beneficence –
“Doing Good”


Fidelity –
Faithful to promises

Veracity –
Truth telling

Accountability –
Answerable to self & others

Specific accountability or liability related to duties of a particular role

What is an advocate?
expresses or defends the cause of another
What is the advocacy role of a nurse?
Being assertive for the client’s benefit.
Recognizing the rights/values of the client/family must take precedence when they conflict with those of the healthcare provider.
Being aware that conflicts arise over issues that require consultation, confrontation, or negotiation between the nurse and administrative personnel, or between the nurse and physician.
May be needed when working with community agencies and lay practitioners.
Knowing that advocacy may require political action with government and other officials

Why do nurses need to practice critical thinking skills?
DO NO HARM , essential for safe, competent, skillful nursing practice.
Need to apply knowledge from other subjects, fields.
Constantly manage change, deal with stressful situations

Essential for data collection, data interpretation, problem solving, decision making

What are the critical thinking skills?
Socratic, inductive, deductive, critical analysis
Socratic questioning
A technique one can use to look beneath the surfaces, recognize and examine assumptions search for inconsistencies, examine multiple points of view, and differentiate what one knows from what one merely believes
Inductive reasoning
generalizations formed from a set of facts or observations. moves for specific to generalized
Deductive reasoning.
Reasoning from general premise to specific conclusion.
Critical analysis
Application of a set of questions to a particular situation or idea to determine essential information and ideas and discard superfluous information and ideas.
Different types of statements
Facts, Inferences, Judgements, Opinions
Can be verified through investigation
Conclustions drawn from the facts going beyond facts to make a statement about something not currently known
Beliefs formed over time, inclde jugements that may fit facts or be in error
Ex. Blood pressure is affected by blood volume is a
EX. If blood volume is decrease the blood pressure will drop is
Example It is harmful to the clients health if the blood pressure drops to low is
Example Nursing intervention can assist in maintaining the clients blood pressure within normal limits is
identify critical thinking attitudes
Accepts HOLISTIC approach
Independence of thought
Self aware
Fair and open minded
Understand egocentricity and sociocentricity
Intellectual humility (careful and prudent)
Intellectual courage to challenge status quo and rituals
Curious and inquisitive
Confident and resilient
Sensitive to diversity
Courageous, flexible, improvement oriented

Think for themselves
Assessing all viewpoints with the same standards and not basing their judgements on personal or group bias or prejudice
Insight into egocentricity
Open to the possibility that their personal biases or social pressures and customs could unduly affect their thinking.
Intellectual Humility
Having an awareness of the limits of one's own knowledge.
Intellectual courage to challenge status quo and rituals

Willing to consider and examine fairly his or her own ideas or views, especially those to which the nurse may have a stronly negative reacation.
Great deal of thought and research to arrive at an answer. Address the problem until it is solved.
Belief that well reasoned thinking will lead to trustworthy conclusions.
What are the ways a nurse problem solves?
Trial and error
Intuition: need lots of experience
Research process/scientific method

Identify attitudes that foster critical thinking in the professional nurse.
Self assessment
Tolerance of ambiguity, dissonance
Seeking situations where good thinking is practiced
Creating environments that support CT

What is “s” (subjective) data?
Symptoms/covert data apparent to client
Described/verified only by client
Includes sensations, feelings, perception of personal health

Examples: pain, nausea, dizziness is a type of what kind of data

What is “o” (objective)data?
Signs or overt data
Detectable by the observer
Can correlate to subjective data Can be measured, tested against standard (seen, heard, felt, smelled)

Examples: BP reading, heart beat, swelling
is what kind of data?
Objective data

What is a primary source of data?
What is secondary data?
Family members (support people,) lab, Dx reports, other health care providers
Client records

Interviews are influenced by
Time, Place, Seating Arrangement Distance, Language
What is the best time for an interview?
Client is physically comfortable and free of pain, no interruptions.
What is the best place for an interview?
Well lit, well ventilated room that is free of noise, movements and distractions encorages communication and where others cannot overhear or see the client.
What is the best seating arrangement for an interview if client is in bed?
Sit at a 45 degree angle to bed.
What is the best seating arrangment for a client sitting.
Both parties sit on two chairs placed at right angles to a desk or table or a few feet apart with no table between.
What is the primary reason for interviewing?
The systematic and continuous collection, organization, validation and documentation of data (creation of database)
What types of interview techniques can be used to collect data?
Initial assessment
Problem-focused assessment
Emergency assessment
Time-lapsed reassessment

What type of data is collected?
Subjective/Objective Data
What type of interview helps develop rapport between the nurse and client?
nondirective interview
What is a fact?
Has been validated or double checked to confirm accuracy.
What is an inference?
Nurses interpretation or conclusion made based on cues.
What is a cue?
Subjective or objective data that can be directly observed by the nurse.
Example: What the client says or the nurse can see, hear feel smell or measure is a
Example: Nurse observes the incision is red, hot and swollen and the nurse thinks the incisio is infected is
Why does the nurse validate the client’s assessment data?
Ensures assessment is complete
Objective/subjective data agree
Obtain additional data
Differentiate between cues/ inferences
Avoid jumping to conclusions, making assumptions, doing something unsafe

What is the order of the phases in the nursing process?
Assessment, Diagnose, Plan, Implement, Evaluate.
How does each phase influence the other phases?
Phases are not discreet, but continually overlap
Are closely interrelated , each affects others
Data from each phase provides input into next phase
Process is constantly in motion

What are characteristics of the nursing process?
Client centered
Focused on client’s response to health practices, diseases, alterations in body structure
Decision making involved in every phase
Is interpersonal, collaborative
Requires direct communication (verbal, non-verbal, languages)
Client, health care providers, insurance and funding persons
Joint effort to provide quality care
Used across the life span
Used for nursing care provided in all health care settings

What is the difference between nursing process and the medical process?
Nursing Diagnosis: Statement of nursing judgment
Refers to condition the nurse is licensed to treat
Describes client’s physical, socio-cultural, psychological, spiritual responses to health/illness problem
Relates to nurse’s independent functions

Medical Diagnosis
Made by a physician
Refers to condition only physician can treat
Disease processes,
Prescribes therapies and treatments; nurse obligated to carry out (dependent nursing function)

What are the sources for data collection?


Physical Exam/ Assesment

What are the types of nursing diagnoses?
Actual Nursing Diagnosis : At Risk Nursing Diagnosis:
What is Actual Nursing Diagnosis?
Client problem present at time of assessment.
What is At Risk Nursing Diagnosis:
Clinical judgment that problem does not exist, but presence of risk factors indicates that a problem is likely to develop unless the nurse intervenes.
What is a goal?
The opposite healthy response to a nursing diagnosis.
How are goals prioritized?
High - Life threatening.
Medium -Health threatening.
Low- arises from normal development needs or requirs minimal nursing support.

Compare and contrast the similarities and differences of a goal and an outcome.
Are interchangable except when discussing and using standarized language. Goals may be groad statement and outcomes more specific.
Know how to write a measurable outcome.
subject, verb, condition/modifier, criterion of desired performance
When does the evaluation phase occur?
planned, ongoing, purposeful activity.
What is the purpose of evaluation?
Desired outcome met
Actual problem resolved or still exists
Potential problem prevented
Risk factors present or not
Care plan needs revision, or not

Basic definition of a conceptual model or conceptual framework.
Structured assessment format.
Uses the word pattern to signify a sequence of recurring behaviors.Ex Health perception health management pattern
Self care Model universal self care requisites ex the maintenance of sufficeint intake of air.
Adaptive modes
ex. physiologial needs, self concept, role function, interdependence.
Roy Adaption Model
What is a qualifier?

words that have been added to some NANDA labels to give additional meaning to the diagnostic statement. ex. deficient.
What is meant by “Nurses focus on the client’s response to health practices, disease, alterations in body structure”?
Nurses treat and prevent reponses to disease process or health problem. Doctors treat the disease.
What are the four sources of law?
Constitution, Legistration, Administrative, Common
How do the 4 sources of law relate to the Nurse Practice Act?
Originates from Legislation.
Governed by the Administrative Branch (the Administrative Branch is comprised of boards that govern statutes (laws) passed through legislation)

What are the Standards of Care?
Legal guidelines for nursing practice.

How are Standards of Care used?
Protect the consumer, evaluate quality of nursing care.
What is an informed consent?
Informed consent can be either expressed consent or implied consent.

Expressed Consent – oral/written agreement

Implied Consent – nonverbal behavior indicates agreement

What are the 3 major elements that must be satisfied before an informed consent can be considered legal?
The person must be giving consent of their own free will.
They must have the mental capacity and be competent to do so and to understand.
Person must be given enough information to make the decision

What is the nurse’s role of the informed consent?
To listen to the explanation, make sure the client has enough information, questions have been answered, have form signed.
Make sure elements are all there.
Are they legally able to sign consent?
Is consent voluntary?
Is signature authentic?
Is the client competent?

What are the nurses responsibility regarding delegation of tasks?
Know the scope of practice of themselves and employers policies and procedures for delegation.
What are the nurses responsibility regarding abuse/neglect, and unprofessional conduct?
Nurses are mandated reporters
Nurses are legally required to report the situation to the appropriate authorities.

Committed when the nurse conducts their practice below the standards of acceptable professional performance than an ordinary, reasonable, and prudent individual would perform in this role.
Places the client in an unsafe position.

Gross Negligence:

Gross Negligence:
Extreme lack of knowledge, skill or decision-making that the nurse should have, but did not display.


Professional negligence that occurs when while the person is performing as a professional.

What are the 6 six elements of malpractice?
duty, breach of duty, foreseeability, causation, harm or injury, and damages.
relationship exists between nurse and client.

Breach of Duty -
Nurse did not follow accepted professional standards when providing care.
links the nurse’s act and the injury the client suffered.
Proves that harm to the client was the direct result of the nurses failure to follow the standard of care.
Harm or Injury –
Physical, emotional, or financial harm must have occurred to the client as a result of the breach of duty.
Nurse is held liable for damages that compensates the client or family.
What are the legal issues regarding a physician order whether it is verbal or written when carried out by the RN.
If unclear, seek clarification.
Record verbal or telephone orders to avoid miscommunication.
Question any order the client questions.
Question any order if the client’s condition has changed (update physician on changes).
Any order that is illegible, unclear, or incomplete .

Do-Not-Resuscitate Orders
No Code or DNR
For terminal, irreversible illness or expected death, or as stated in Living Will.
Goal of treatment is a dignified, comfortable death.
Nurses need to be familiar with state laws and agency policies.

The Americans with Disabilities Act
Prohibits discrimination on the basis of disability
Provide national mandate
Provide enforceable standards
Ensures government role in enforcing

The Impaired Nurse

Functions diminished due to
Chemical dependency on drugs
Mental illness

Health Insurance Portability & Accountability Act of 1996 (HIPAA)

Includes four specific areas
Electronic transfer of information among organizations
Standardized numbers for identifying providers, employers, and health plans
Security rule
Privacy rule

Incident Reports

Agency record of an incident or unusual occurrence (also called unusual occurrence report)
Make all the facts available to agency personnel
Contribute to statistical data about incidents
Help health personnel prevent future incidents
Filed according to agency policy


What do you do if you have direct knowledge of a nurse endangering the health and safety of a client?
Document a clear, complete, factual description, be sure YOU are credible, obtain support from one other person who is credible, follow chain of command, sign your name, follow up.

How can a nurse reduce her/his chance of liability?
Function within scope of education, job description and nurse practice act
Follow procedures and policies
Build and maintain good rapport
Always check the clients identity
Observe and monitor
Accurately communicate and record significant changes
Promptly and accurately document all assessments and care
Be alert when implementing nursing interventions
Perform procedures correctly and appropriately
Administer the right medication, in the right dose, via the right routes, at the right time, to the right client
Delegate appropriately
Protect clients from injury
Report all incidents
Always check any order that is questioned
Know own strengths and weaknesses
Maintain clinical competence
Clear and accurate documentation is the nurses best defense against potential liability.

Good Samaritan Act
Protects health care providers providing assistance at an emergency scene against claims of malpractice

Good Samaritan Act

Protects health care providers providing assistance at an emergency scene against claims of malpractice

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