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NC 7 for Excelsior College


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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.
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.
This 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.
Balanced Budget Act (BBA) Public Law 105-33 of 1997:
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 tende
Clara Barton 1821-1912
): A contract is a promise or set of promises between two parties. The RN may be asked to witness a one-party document.
Breach of Contract (Liability Theory):
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.
Elements of a valid contract
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 n
Breach of Warranty (Liability Theory):
Worked with Lillian Wald and Lavinia Dock to establish the Henry Street Settlement. Pioneer in community health nursing.
Mary Brewster
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 ar
Case Management
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 bu
Case Method (Delivery of Care):
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.
: 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.
Luther Christman
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, Col
Clinical Pathways (aka Outcomes):
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
Community College Education for nursing (a study published in 1959):
a tool used to measure efficiency, satisfaction and quality
Continuous Quality Improvement (CQI
): 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.
Corporate Negligence (Liability Theory
Two elements have to be proven. Corporate Negligence
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.
Who 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
Florence Nightingale
Crimean War 1854
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.
Critical Path
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
Critical Thinking:
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.
The publication of anything injurious to the good name or reputation of another
Defamation of Character
is when it’s spoken or oral
. Slander
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.
Delegation: 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 5 step process
: 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.
: This 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 t
Differentiated Practice
Direct Liability: Three theories.
. Corporate Negligence, Breach of Contract/Breach of Warranty and Intentional Misrepresentation or Fraud.
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
Dorothea Dix 1802-1887
She worked with Lillian Wald and Mary Brewster to establish the Henry Street Settlement in New York City. A pioneer in community health nursing.
Lavinia Dock:
Eight Ethical Principles:
Fidelity Beneficence Ethics Nonmaleficence . Fidelity
Veracity . Autonomy
Confidentiality : Justice
is the right to be treated equally.
: Justice
is owed to the patient.
is the obligation that the nurses’ personal beliefs not interfere with patient care.
is the obligation to be honest and not deceptive
the obligation to not create or inflict harm on others.
is the obligation to be faithful to the commitment.
is the obligation to do good and avoid harm.
is the right to self determination, freedom and independence
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.
Emergency Medical Treatment and Active Labor Act (EMTALA
: This is designed to provide consistent application for employee benefits which would include health care benefits.
ERISA Act of 1974
: 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.
This act was passed into law in 1966 followed by the Privacy Act of 1974. The FOIA gives people the right to obtain information from public and governmental entities by requesting it in writing.
Freedom Of Information Act (FOIA):
Four Elements That Comprise Malpractice (or Negligence):
Duty. Breach of Duty. Proximate Cause (causation). Damages.
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 pa
Functional Nursing
This religious order was founded by St. Vincent de Paul. Louise de Gras was the first superintendent. She established the first nursing education program.
Louise de Gras - Sisters of Charity 1633
seeks to involve everyone and conveys responsibility and accountability on all group members.
Group Process:
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”.
This agency determines the reimbursement for service to Medicare beneficiaries. It administers the Medicare and Medicaid programs.
Health Care Financing Administration (HCFA):
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 Care Quality Improvement Act of 1986 (HCQIA):
This act addresses electronic patient information. It developed standards for health information systems for the electronic transmission of health care information
Health Insurance Portability and Accountability Act of 1996 (HIPPA):
Several types. Most popular are the Staff model, the Network model, and the Independent Practice Association model. are the most common type of managed care plan with the highest number of people enrolled. provide services for enrollees with a fixed fee
Health Maintenance Organization (HMO):
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. Th
Health Professions Education For the Future: Schools in Service to the Nation 1993:
This study augments the Healthy People 2000 study. developed surveillance and monitoring patterns in health and living. provides more emphasis to individual communities to strengthen their own capabilities to promote and protect health and assure access
Healthy People 2010:
Was the National Organization for Women (NOW) first president. Now was formed in 1966. She was a nurse and a feminist.
Wilma Scott Heide 1966
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
Virginia Henderson 1961
This act sets forth the requirements for federally qualified health maintenance organizations
HMO Act of 1973
A worldwide project calling upon scientific teams to collaborate to map the entire human genome.
Human Genome Project:
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
International Council of Nurses (ICN):
Informed Consent Three rights
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.
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.
Joint Commission on Accreditation of Healthcare Organizations JCAHO):
She introduced the concepts of Transcultural Nursing and Caring Nursing.
Madeline Leininger (1970’s-1980’s
: 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 a
In 1879, she became the first trained Black American nurse. She trained at the New England Hospital for women and Children.
Mary Mahoney 1845-1923
She formed this religious order in Dublin Ireland. The nuns were trained to help the sick and spread their order to the entire world.
Catherine McAuley - Sisters of Mercy 1832
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 guid
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 pa
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 est
Mens Rea
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
Middle Ages (500 to 1500 A.D.):
: In 1951, her doctoral research changed nursing education more dramatically than ever before. In 1959, she published the results of “Community College Education for Nursing”, a five year project that resulted in the establishment of the Associate De
Mildred Montag 1959
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
National Commission on Nursing Study 1983:
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 Natio
National Council of State Boards of Nursing (NCSBN):
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 (â
Betty Neuman 1972
She 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 o
Florence Nightingale 1820-1910:
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. Publish
National League of Nursing (NLN):
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”.
National Student Nurses Association
: 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 recommen
Nursing for the Future; the Brown Report 1948
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 pro
Dorothea Orem 1959
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 r
Ostensible (apparent) Agency
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.
Outcomes Management:
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 eff
Partners in Practice Model⬝ developed in 1989 by Marie Manthey:
Patient Classification Systems
(1) North American Nursing Diagnosis (2) Nursing Intervention Classification (3) Nursing Outcomes Classification (4) Home Health Care Classification nomenclatures.
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 Medi
Peer Review Organizations (PRO):
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 directio
Hildegard Peplau 1952:
: 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 pro
Pew Health Professions Commission; 21 Competencies 1995
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
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 ca
Primary Nursing:
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
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.
Productive Conflict
An organized group of people educated with a unique body of knowledge and all engaged in a specialized expertise.
10 criteria: for profession
(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.
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 establishe
The Reformation (1500 A.D.):
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 o
Res Ipsa Loquitur “The thing speaks for itself” (Corporate Negligence/Liability Theory):
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)
Respondeat Superior “Master-Servant Doctrine”:
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.
Responsibility (in the context of delegation):
She is considered America’s first trained nurse. She developed new nursing programs and improved on existing ones. She was very active in founding national nursing organizations and was the first president of ASSTSN.
Melinda Ann (Linda) Richards:
She made radical changes to nursing education. She cut down the student’s workday to ten hours and eliminated the free private duty services.
Isabel Hampton Robb:
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
Martha Rogers (1970):
She developed the 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
Sister Callista Roy 1970
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
Margaret Sanger
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.
Shared Governance
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 e
State Boards of Nursing (SBON):
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 o
Standards of Clinical Nursing Practice:
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 deter
Standards of Professional Performance
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
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,
Study of Credentialing in Nursing: A New Approach⬝ 1979:
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.
Team Nursing:
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 w
300-500 A.D.
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 abl
Time Management
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/Violat
Torts (Corporate Negligence):
): A tool that is used in business to measure efficiency, satisfaction and quality. Sometimes called CQI.
Total Quality Management (TQM
Worked with Clara Barton to tend to wounded soldiers during the Civil War.
Harriet Tubman
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 th
Unproductive Conflict:
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 reimburseme
Utilization Review:
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 Sch
Lillian Wald 1867-1940:
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 emphasiz
Jean Watson 1979

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