metaparadigm
is a world view of discipline (human beings, environment, health & nursing).
philosophies
a statement encompassing onto-logical claims about the phenomena of central interest came to a discipline, epistemic claims about how those phenomena come to be known, and ethical claims about what the discipline value, and noted that the function of a philosophy is to communicate what the members of a discipline believe to be true in relation to the phenomena of interest to that discipline
conceptual models
a set of relatively abstract and general concepts that address the phenomena of central interest to a discipline, the propositions that broadly describe those concepts, and the propositions that state relatively abstract and general relations between two or more concepts.
theories
one or more relatively concrete and specific concepts that are derived from a conceptual model, the propositions that narrowly describe those concepts, and the propositions that state relatively concrete and specific relations between two or more concepts
grand theory
abstract, broad theory consists of propositions that are less broad and abstract than a conceptual model, but not as specific and concrete as middle range theory
Grand theories
- Leininger’s Cultural Care, Diversity and Universality Theory and Model
- Margaret Newman Theory of Health as Expanding Consciousness
middle range theory
less abstract, narrower in scope, and has fewer propositions and concepts than grand theory.
middle range theories
- Jean Watson: Theory of Human Caring
- Imogene King: Conceptual System & Theory of Goal Attainment
- Nola Pender: Health Promotion Theory
empirical indicators
provide a way for middle-range theories to be tested or generated, but there is no direct link between empirical indicators and conceptual models, philosophies, or the metaparadigm
proposition
a statement about one or more concepts
Theory of Human Caring
- Jean Watson –
Initially differentiated nursing and medicine, stating that curing is a domain for medicine, and caring is a domain of nursing. It indicated that transpersonal caring relationship depends on moral commitment to human dignity, wholeness, caring, and healing
Conceptual System and Theory of Goal Attainment
- Imogene King –
Conceptual system that is the notion that human beings are open systems interacting constantly with the environment
Theory of Health as Expanding Consciousness
- Margaret Newman –
Patterning of a person’s interaction with the environment. Consciousness is a manifestation of an evolving pattern of person-environment interaction.
Cultural Care Diversity and Universality Theory Model
- Madeleine Leininger –
Theory of transcultural nursing promotes understanding of both the universally held and common understanding of care among humans and the culture specific caring beliefs and behaviors that define any caring context or interaction
Health Promotion Model
- Nola Pender –
Health promotion revolves around raising consciousness related to health promoting behaviors, promoting self-efficacy, enhancing the benefits of change, and managing the barriers to change
Humanistic Learning Theory
emphasizes a person-centered approach and stresses the importance of feeling over thoughts. The subjective human experience of each individual is seen as being of value, and human relationships depend on being spontaneous, authentic, and empathetic. The goal is to help individuals express their inner creativity, reach their inner potential, and strive for personal growth. Maslow Hierarchy of Needs
Behaviorist Learning Theory
Learning is based on associations people make between stimuli and responses, and the belief that life is largely a matter of habit that requires little thinking. What is learned can be unlearned by modifying the stimulus conditions in the environment or changing the response to stimuli. B.F. Skinner operant conditioning & Pavlov classical conditioning
Cognitive Learning Theory
Focuses on perceptions, thinking, reasoning, memory, developmental changes, and processing of information that transpire with the learner. This theory is useful for appreciating the different ways that individuals approach and respond to any learning situation, recognizing the complexity of learning, and promoting instructors to take their cues from learners to be effective. Jean Piaget cognitive development
Picot Model for generating EBP clinical questions
P = patient population (identify the population of interest)
problem (identify primary problem)
I = intervention (identify the interventions to be considered)
C= comparison (identify what the intervention will be compared to)
O = outcomes (identify the goal of the intervention
T =time (time frame for measuring outcomes)
Behavioral systems model
- Dorothy Johnson –
is a model of nursing care that advocates the fostering of efficient and effective behavioral functioning in the patient to prevent illness
nurse educator
master or doctoral prepared registered nurses who practice as full time or adjunct faculty in college/universities, hospital based educational residency programs, and/or health care facilities. Responsibilities for both classroom and practical setting include mentoring and preparing future generations of nurses and current nurses in practice. They play a vital role in serving as role models, while strengthening the nursing workforce, by assuring quality educational opportunities, guiding employees and/or students through the learning process, as well as implementing evidenced based research into practice; they also play a role in evaluating and documenting educational learning experiences or outcomes.
Nurse Informaticist
relatively new, and involves the integration of the science of nursing, computer science, and management of information science to communicate data, knowledge, and information in nursing practice. generally have experience and training in both the practical setting and computer science, to better enhance the efficiency and effectiveness of the tools and strategies health care providers use as a means to improve the overall health care experience and communication between the patient and the nurses; work in a variety of settings, to include industrial, hospitals, and academic sectors that train current nurses in using technology more effectively. also take on administrative roles, where their responsibilities include overseeing technology for an entire medical institution or health care system. Such administrative roles, gives them the title and responsibilities of a Chief Information Officer.
Nurse administrator
typically are Master prepared nurses, whose positions requires a strong knowledge base of nursing practice as well as the overall general field of healthcare. work primarily in managerial positions, and although they do not work closely with the patients, their responsibilities consist of ensuring the safety, welfare, and satisfaction of the patients, supervising employees of health care, facilitating communication among members of the health care team/staff and other areas of the healthcare system/organization, budgeting and decision making, as well as formulation of policy
coach
a purposeful, complex, dynamic, collaborative, and holistic interpersonal process aimed at supporting and facilitating patients and families through health-related experiences and transitions to achieve health-related goals, mutually determined, whenever possible. These goals may include higher levels of wellness, risk reduction, reduced morbidity and suffering from chronic illness, and improved quality of life, including palliative care. This APN process can best be understood as an intervention.
leadership
a core competency of advanced practice nursing, but the concept has some unique characteristics in the APN context – involves three distinct defining characteristics—mentoring, innovation, and activism.
their activities may range from taking a stand on behalf of an individual patient to advocating for a change in national health policy.
classical organizational theory
the approach that assumes that there is a single best way to design organizations. this approach assumes that managers need to have close control over their subordinates and calls for designing organizations with tall hierarchies and a narrow span of control
neoclassical organizational theory
argues that not only economic effectiveness but also employee satisfaction should be goals of an industrial organization; this approach assumes that managers do not have to carefully monitor their subordinate and calls for designing organizations with flat
servant leadership
leaders who influence and motivate others by building relationships and developing the skills of individual team members. makes sure the needs of the individual team members are addressed. In this style of management, the entire team has input into decision making based on the organization’s values and ideals. these leaders create devoted followers in response to positive attention they give
transformational leadership
based on building relationships and motivating staff members through a shared vision and mission; typically have charisma to communicate vision, confidence to act in a way that inspires others, staff respect and loyalty from letting the team know they are important, and are masters at helping people do things they weren’t sure they could do by giving encouragement and praise
democratic leader
encourages open communication and staff participation in decisions. Workers are given responsibility, accountability, and feedback regarding their performance. Relationships are important to this leader who places a focus on quality improvement of systems and processes, rather than on mistakes of individual team members
authoritarian or autocratic leader
leader makes all decisions without considering input from staff. Negative reinforcement and punishment are often used to enforce rules. Because knowledge is seen as power, critical information may be withheld from the team. Mistakes are not tolerated and blame is placed on individuals rather than on faulty processes. The positive side of this style is that it works perfectly in emergencies or chaotic situations where there is little time for discussion. It is useful when enforcing policies and procedures that protect resident health and safety, but it does promote trust, communication, or teamwork when used for day to day operations; micromanagers
laissez-faire leader
leader provides little or no direction or supervision, and prefers to take a hands-off approach. Decisions are not made, changes rarely occur, and quality improvement is typically reactive, not proactive. It is most often used by new, inexperienced leaders or by those at the end of their career who choose not to address issues since things will soon be changed by their replacement leader.
change theory
created by Kurt Lewin; has three major concepts (driving forces, restraining forces, and equilibrium) and three stages (unfreezing, change, and refreezing)
driving forces
push in a direction that causes change to occur. They facilitate change because they push the patient in a desired direction. They cause a shift in the equilibrium towards change
restraining forces
They hinder change because they push the patient in the opposite direction. They cause a shift in the equilibrium that opposes change.
equilibrium
is a state of being where driving forces equal restraining forces, and no change occurs. It can be raised or lowered by changes that occur between the driving and restraining forces.
unfreezing
the process which involves finding a method of making it possible for people to let go of an old pattern that was somehow counterproductive. It is necessary to overcome the strains of individual resistance and group conformity.
change
also called “moving to a new level” or “movement,” involves a process of change in thoughts, feeling, behavior, or all three, that is in some way more liberating or more productive
refreezing
establishing the change as the new habit, so that it now becomes the “standard operating procedure.” Without this final stage, it can be easy for the patient to go back to old habits.
evidence based practice
the process of systematically finding, appraising, and using research findings as a basis for making decisions about patient care; used in an organization to design a standard of care for a population of patients.
clinical nurse specialist
role initially was carried out in hospital settings, in psychiatry and oncology nursing; was more focused on indirect care, such as consultation, leadership, staff education, and management of complex patients with specific diagnoses (e.g., cardiac or respiratory disease, cancer)
nurse practitioner
APNs trained and educated to provide health promotion, prevention, and maintenance through conducting physical exams, running diagnostic tests/procedures, and managing acute illnesses and chronic conditions; are one of the leading classes of APRNs in delivering primary care in the United States. are more than providers, they’re nurse educators, administrators, researchers, and leaders
certified nurse midwife
education= a basic competency within initial nurse education or as a postgraduate course; education is now provided in specialized courses or university programs. some were not even nurses, especially in low-resource countries
certification
A formal process (usually an examination, but may be a portfolio) used by a certifying agency to validate, based on predetermined standards, an individual’s knowledge, skills, and abilities; provides validation of the APRN’s knowledge in a particular specialty. It is used by most states as one component of second licensure for APRN practice.
accreditation
The voluntary process whereby schools of nursing are reviewed by external nursing educational agencies for the purpose of determining the quality of a nursing and/or APRN program.
credentialing
The requirements that a state uses to assess minimum standards of competency for APRNs to be authorized to practice in an APRN role. The purpose is to protect the health and safety of the public. These requirements include an unencumbered RN license, graduate education transcripts, national certification in one of six population foci.
privileging
an entitlement process whereby nurses in advanced practice roles are granted authority to provide specific healthcare services to patients at ROPH practice sites. APRNs requesting privileges must identify a physician, with active privileges for the same procedures requested by the APRN.
advance nsg practice
integration and application of a broad range of theoretical and evidence based knowledge that occurs as a part of graduate nsg education
advance practice nsg
the patient focused application of an expanded range of competencies to improve health outcomes for patients and populations in a specialized clinical area of the larger discipline of nsg
what are the 4 stages in the evolution of the APN?
stage 1: specialty begins
stage 2: specialty organizes
stage 3: pressure mount for standardization
stage 4: maturity and growing interdisciplinary
specialty begins
development in practice settings driven by increasing complexity and demands; innovative practice opportunities
specialty organizes
organized training begins and progresses to certificate training; specialties in transition (i.e. forensic nsg)
pressures mount for standardization
knowledge base grows, graduate education; scope of practice expands; emerging APN specialties
maturity and growing interdisciplinary
well articulated practice; recognized by others; established APN roles
what are the core competencies of APN practice?
direct clinical practice
guidance and coaching
consultation
evidence based practice
leadership
collaboration
ethical decision making
standards of practice
- Defined by the profession nationally
- Held to standard of practice by nsg profession and by APRN specialty
- Describes basic competency levels for safe and competent practice
- Closely match core competencies for APRNs
scope of practice
- Describes practice limits and sets parameters within which nurses in various APRN specialties may practice
- Differs from state to state; based on state statues promulgated by various state nurse practice acts and rules and regulations for APRN practice
standards of care
also called practice guidelines
- Provide a foundation for health care providers to administer safe and competent care to patients
- Cross cut health profession’s disciplines
- Derived from evidence based practice and continuously evolving
- APNs need to be part of interprofessional development
role supplementation
anticipatory socialization
role stress
a situation of increased role; performance demand
role strain
subjective feelings of frustration, tension, anxiety in response to role demands
role conflict
when role expectations are perceived to be mutually exclusive or contradictory
role transition
a dynamic process of change over time as new roles are acquired
role incongruity
incompatibility between skills and abilities, personal values, self concept, and obligations
role ambiguity
unclear expectations, diffuse responsibilities, uncertainties about sub-roles
role insufficiency
feeling inadequate to meet role demands
what does AACN stand for?
american association of colleges of nursing
- APN core has to have these 3 courses (advanced health and physical assessment, advanced physiology and pathophysiology, & advanced pharmacology
NONPF
national organization of nurse practitioner faculties
NACNS
national association of clicinal nurse specialists
AANA
american association of nurse anesthetists
Hamric’s Integrative Model
- Proposed an integrative understanding of the core of advanced practice nursing, based on literature from all APN specialties
- Hamric proposed a conceptual definition of advanced practice nursing and defining characteristics that included primary criteria (graduate education, certification in the specialty, and a focus on clinical practice with patients)
- and a set of core competencies (direct clinical practice, collaboration, guidance and coaching, evidence-based practice, ethical decision making, consultation, and leadership).
Fenton’s and Brykczynski’s Expert Practice Domains of the Clinical Nurse Specialist and Nurse Practitioner
Their findings further illuminate why Benner’s work has influenced descriptions of advanced practice. By examining the extent to which APNs demonstrate the seven domains found in experts by experience and uncovering differences, the findings offer a possible explanation of the differences between expert and advanced practice. In addition, they also describe ways in which two advanced practice nursing roles, CNSs and NPs, may be different with regard to practice domains and competencies
Calkin’s Model of Advanced Nursing Practice
developed the model to help nurse administrators differentiate advanced practice nursing from other levels of clinical practice in personnel policies, and proposed that this could be accomplished by matching patient responses to health problems with the skill and knowledge levels of nursing personnel; three curves were overlaid on a normal distribution chart. Calkin depicted the skills and knowledge of novices, experts by experience, and APNs in relation to knowledge required to care for patients whose responses to health care problems (i.e., health care needs) ranged from simple and common to complex and complicated
Brown’s Framework for Advanced Practice Nursing
developed a conceptual framework for the entire field of advanced practice nursing, including the environments that surround and impact upon practice; 4 main and 17 specific concepts (specific concepts are in parentheses): environments (society, health care economy, local conditions, nursing, advanced practice community); role legitimacy (graduate education, certification, licensure); advanced practice nursing (scope, clinical care, competencies, managing health care environments, professional involvement in health care discourse); and outcomes (patient, health care system, the nursing profession, individual APN outcomes)
Oberle and Allen: The Nature of Advanced Practice Nursing
They refer to practice by the term praxis, which captures the values-oriented, reflective, and creative nature of the work of nurses. They conceive of nursing as a dialectic (back and forth) process between the nurse’s knowledge and his or her experiences and relationships with patients; As nurses accumulate experience, this dialectic process that occurs in relationships with patients contributes to developing expertise
Shuler’s Model of Nurse Practitioner Practice
a complex systems model that is holistic and wellness-oriented. It is definitive and detailed in terms of how the NP-patient interaction, patient assessment, intervention, and evaluation should occur; It is complex and its value for understanding NP practice may not become clear until one is in practice; is intended to describe the NP’s combined functions (i.e., nursing and medicine), benefits for practitioner and patient, and a framework whereby NP services can be evaluated
Ball and Cox: A Theory of Legitimate Influence
Subjects (N = 36) from the United States, Canada, United Kingdom, and Australia participated; they were required to be master’s-prepared or graduate students preparing for an advanced practice role. The investigators conducted interviews and made observations of the participants over a 3-year period. The theory emerged from this study; work suggests that the activities of APNs, in this case NPs and CNSs, are strategic and focused and that some activities involve direct service to patients, whereas others are aimed at communication and system issues
Dunphy and Winland-Brown’s Circle of Caring
health care needs of individuals, families, and communities are not being met in a health care system that is dominated by medicine and one in which medical language (i.e., the International Classification of Disease Codes [ICD-10-CM]) is the basis for reimbursement; foster a more active and visible nursing presence in the health care system and to explain and promote medical-nursing collaboration; The conceptual elements are the processes of assessment, planning, intervention, and evaluation, with a feedback loop
anticipatory guidance
a particular type of guidance aimed at helping families know what to expect
primary prevention
health promotion and wellness activities; preventing disease/injury before it occurs
ex: seat belts, bike helmets, eating healthy, exercising, vaccines/immunizations
secondary prevention
Strategies seek to reduce barriers to early treatment or completion of therapy, improving treatment outcomes and reducing disease chronicity; reduce impact of disease that have already occurred
ex: regular exams and screening tests, daily, low-dose aspirins and/or diet and exercise programs to prevent further heart attacks or strokes
tertiary prevention
a. Minimizing disease complications and comorbidities. aims to soften the impact of an ongoing illness or injury that has lasting effects; aims to soften the impact of an ongoing illness or injury that has lasting effects
ex: cardiac or stroke rehabilitation programs, chronic disease management programs (e.g. for diabetes, arthritis, depression, etc.), support groups
cultural diversity
Ongoing process that involves accepting and respecting differences and not letting personal beliefs get in the way
vocational rehab
prepares and assists eligible South Carolinians with disabilities to achieve and maintain competitive employment
Acne Vulgaris
patho: Excessive production of sebum; related to androgenic hormones; Increase size and productivity of the sebaceous glands; hyperkeratinization
treatment for acne vulgaris
Topical retinoid, benzoyl peroxide, and antimicrobial agents: are the preferred treatment; surgery – Comedo extraction, intralesional steroids, and cryosurgery.
Atopic Dermatitis or Eczema
a. Cause is unknown, but 75% to 80% demonstrate a personal or family history of asthma, allergic rhinitis, food allergies, or elevated immunoglobulin E (IgE)
Atopic Dermatitis or Eczema
patho: “Inside-out” or immunologic dysregulation, leading to an epidermal barrier abnormality; “Outside-in” explanation with primary barrier dysfunction as the cause; Alterations in filaggrin protein: Defect of the epidermal barrier
Impetigo contagiosum
Transmission: Is by both direct and indirect contact;
Superficial infection is usually caused by Staphylococcus or group A streptococci; Incidence is high in hot, humid climates; small vesicles with a honey-colored serum; types: nonbullous and bullous
tinea capitis
Wood light examination, potassium hydroxide (KOH) examination, and fungal culture; tx: Oral griseofulvin, Terbinafine, itraconazole, and fluconazole; Adjunct therapy: 2% ketoconazole and 1% selenium sulfide shampoos
Consideration: Treatment of household contacts with a sporicidal shampoo
Molluscum contagiosum
Highly contagious pox viridae infection of the skin; Skin-to-skin and fomite transmission; Virus encourages epidermal cell proliferation and blocks the immune response; Clinical manifestations; Discrete, slightly umbilicated, dome-shaped papules
Rubella (German or 3-day measles)
RNA virus; Disease mild in most children; s/s: Enlarged cervical and postauricular lymph nodes, low-grade fever, headache, sore throat, runny nose, cough, faint pink-to-red maculopapular rash on face, spreading to the trunk and extremities, sparing the palms and soles of the feet.
Treatment- Rest, fluids, and use of a vaporizer
c. Rubeola (red measles)
Clinical manifestations: High fever, malaise, enlarged lymph nodes, runny nose, conjunctivitis, barking cough, erythematous maculopapular rash, developing over the head and spreading distally over the trunk, extremities, hands, and feet; Koplik spots: Mouth lesions
Treatment- Rest, fluids, and use of a vaporizer
what’s the medical name for “bed bugs”?
Cimex lectularius
Simple Febrile seizure
Are from a high temperature.
Afflict 2% to 5% of children.
Are benign and most common. Are brief and self-limited. Often occur between the ages of 9 months and
5 years. Temperatures higher than 102.2º F can cause simple febrile seizures.
Treatment: Phenobarbital use is recommended
EMG
abnormalities in nerve conduction helps differentiate muscle diseases from peripheral nerve and neuromuscular junction disorders; Records the summation of actin potentials of the muscle fibers in each motor unit
Oncotic Pressure (colloid osmotic pressure)
A pulling force solution has for water due to its protein content. Protein (Albumin) needed to maintain this pressure. Filtration is opposed by this pressure
oxyhemoglobin dissociation curve
When hemoglobin saturation and desaturation are plotted on a graph, the result is a distinctive S-shaped curve
Shift to the right
depicts the hemoglobin’s decreased affinity for oxygen or an increase in the ease with which oxyhemoglobin dissociates and oxygen moves into the cells.
- Acidosis (low pH) and hypercapnia and hyperthermia
Shift to the left
depicts the hemoglobin’s increased affinity for oxygen, which promotes association in the lungs and inhibits dissociation in the tissues.
- Alkalosis (high pH) and hypocapnia and hypothermia
Bohr effect
Shift in the oxyhemoglobin dissociation curve caused by changes in CO2 and H+ concentration in the blood
Acute Epiglottis
Severe, rapidly progressive, life-threatening infection of epiglottis and surrounding area. Cause: Haemophilus influenzae type B (Hib); Decreased incidence is due to the Hib vaccination. s/s: High fever, sore throat, inspiratory stridor, severe respiratory distress, tripod position with drooling and dysphagia
Do NOT examine the throat: may trigger laryngospasm and cause respiratory collapse
Tx: Emergency airway and antibiotic administration
Cystic Fibrosis
Exocrine or mucus-producing glands secrete abnormally thick mucus as a result of defective epithelial ion transport. In the lungs, thick secretions obstruct the bronchioles and predispose the lungs to chronic infections. Chronic inflammation leads to hyperplasia of goblet cells, bronchiectasis, pneumonia, hypoxia, and fibrosis, among other conditions
- Evaluation: Immunoreactive trypsinogen (IRT) blood test, Sweat test, Universal newborn screening in the United States
Asthma
Episodic attacks of bronchospasm, bronchial inflammation, mucosal edema, and increased mucous production.
patho: Immunoglobulin E (IgE) causes the mast cells to degranulate, releasing a large number of inflammatory mediators; Vasodilation; Increased capillary permeability; Mucosal edema; Bronchial smooth muscle contraction (bronchospasm); Tenacious mucous secretion; Coughing
Sarcoidosis
Inflammatory immune system disorder that can affect multiple organs. (heart, lungs, liver…etc.). Unknown etiology
Patient’s develop granulomatous masses that can invade nerves or tissues and cause dysfunction
- Symptoms may come on suddenly and be severe and disappear rapidly
how often and how long does a person stop breathing with OSA?
at least 10 seconds—20 to 30 times an hour
Glomerulonephritis
Cause: Untreated group A strep complications = Nephrotic sediment: contains massive amount of protein and lipids and either a microscopic amount of blood or no blood
Nephritic Sediment: Blood is present in the urine with red cell casts, white casts, and varying degrees of protein
Nephrotic syndrome
Excretion of 3.0 g or more of protein in urine from glomerular injury
s/s: hypoalbuminemia, peripheral edema, prone to infection, peritonitis (board like ridid abdomen
more dangerous
Duchenne Muscular Dystrophy
Most common muscular dystrophy; X-linked recessive inheritance (males only)
Deletion of a segment of deoxyribonucleic acid (DNA) or a single gene defect on the short arm of the X chromosome
Pseudohypertrophic
i. Progressive weakness with large calf muscles
ii. Consist of fat and connective tissue rather than muscle
Diabetes Insipidus
A condition caused by ↓ in ADH (Vasopressin); comes from posterior lobe of the pituitary gland.
- Blood: increased osmolality (thick)
- Urine: decreased osmolality (dilute)
SIADH
A condition caused by ↑ADH; Blood: decreased osmolality
Urine: Increased osmolality
Reed- Sternberg cells
a. cells in the lymph nodes
b. Are necessary for the diagnosis but not specific to Hodgkin lymphoma
c. Are derived from malignant B cells that usually become binucleate. Release cytokines.
Impaired Spermatogenesis: which cells are not functioning?
In the absence of adequate gonadotropin levels, the Leydig cells are not stimulated to secrete testosterone
sperm maturation is not promoted in the Sertoli cells.