Florence Nightingale
-Environment theory
-“Lady with the Lamp”
-first nurse epidemiologist
-created “notes on nursing” literature: first nursing philosophy
-need light, fresh air, warmth, clean area, quiet, good nutrition
Clara Barton
founded American Red Cross
Dorothea Dix
-A reformer and pioneer in the movement to treat the insane as mentally ill, beginning in the 1820’s
-responsible for improving conditions in jails, poorhouses and insane asylums throughout the U.S. and Canada.
Mary Mahoney
First professionally trained African American nurse
Isabel Robb
founded American Nurses Association (ANA)
Mary Nutting
first professor of nursing
Mary Breckinridge
-Established the Frontier Nursing Service
-rode horseback to delivery babies in West Virginia
Dorothea Orem
- Self care theory
-goal is to have patient manage his or her health problems
Virginia Henderson
-Need theory
-14 basic needs
basic nursing care involves 14 activities: physiological, spiritual and sociological. Pay attention and listen to person
Jean Watson
-Theory of Human Caring
-caring is a central focus of nursing
Patricia Benner
5 levels of proficiency
Hildegard Peplau
-Theory of Interpersonal Relations (between patient and nurse)
-creates a “maturing” force
Levels of Benner’s five stages of proficiency
-Novice
-Advanced beginner
-Competent
-Proficient
-Expert
novice
beginning nursing student or a nurse entering a situation in which there is no previous level of experience.
advanced beginner
a nurse that has some level of experience with the situation.
competent
a nurse that has been in the same clinical position for 2 to 3 years. The understands the organization and specific care required by the type of patients.
proficient
a nurse with more than 2 to 3 years of experience in the same clinical position.
expert
a nurse with diverse experience who has an intuitive grasp of an existing or potential clinical problem
Prescriptive Theory
detailed nursing interventions for a specific phenomenon and the expected outcome of the interventions
APRN
-Advanced Practice Registered Nurse
-Has a masters degree or Doctor of Nursing Practice (DNP) degree in nursing; advanced education in pathophysiology, pharmacology, and physical assessment; and certification and expertise in a specialized area of practice
-independently functioning nurse
CNS
-Clinical Nurse Specialist
-an APRN who is an expert clinician in a specialized area of practice
NP
-Nurse Practitioner
-An APRN who provides comprehensive health care to a group of patients in an inpatient, outpatient, ambulatory care, or community-based setting
CRNA
-Certified Registered Nurse Anesthetist
-An APRN with advanced education from a nurse anesthesia-accredited program. Must have at least 1 year of critical care or emergency experience
Nurse Administrator
Manages patient care and the delivery of specifical nursing services within a health care agency.
Nurse Researcher
Conducts evidence-based practice and research to improve nursing care and further define and expand the scope of nursing practice.
Doctor of Philosophy (PhD)
-this is a nurse researcher and the preferred degree is a doctorate in nursing with at least a masters in nursing.
-More research and theory development oriented
DNP
-Doctor of Nursing Practice
-Practice-focused doctorate; it provides skills in obtaining expanded knowledge through the formulation and interpretations of evidence-based practice
Standards of Practice
Contain authoritative statements of duties that all RN’s, regardless of role, population, or speciality, are expected to perform competently.
Nurse Practice Act
-Protects the patients, keeps the nurses accountable
-developed standards of practice
Code of Ethics
-Statement of philosophical ideals of right and wrong that define the principles you will use to provide care to your patient
-Important to also incorporate your own values and ethics into your practice.
Nurse Educator
Explain concepts and facts about health, describe the reason for routine care activities, demonstrate procedures such as self-care activities, reinforce learning or patient behavior, and evaluate the patients progress in learning
Nurse Communicator
-Central to the nurse-patient relationship
-Allows you to know your patient, including their preferences, strengths, and weaknesses, and needs
Patient Advocate
-You protect your patient’s human and legal rights and provide assistance in asserting these rights if the need arises
-As an advocate you act on behalf of your patient and secure your patient’s health care rights
Nurse Manager
-Establish an environment for collaborative patient-centered care to provide safe, quality care with positive patient outcomes
-Uses appropriate leadership styles to create a nursing environment for patients and staff that reflects the mission and values of the health care organization
Autonomy & Accountability
-Autonomy is an essential element of professional nursing that involves the initiation of independent nursing interventions without medical orders.
With increased autonomy comes greater responsibility and accountability
-Accountability means that you are responsible professionally and legally for the type of quality nursing care provided
Affordable Care Act
more than 32 million Americans are gaining access to health care services, including those provided by RNs and APRNs
Vulnerable Populations
-Immigrants
-Poverty/ Homeless
-Abused
-Mental Illness
-Substance Abuse Issues
-Older Adult
-Disabled
Healthy People 2020
-recognizes that health starts in our homes, schools, workplaces, and communities.
-one goal is to “create social and physical environments that promote good health for all”
DRG
-Diagnosis Related Group
-Prospective payment system, capitation, Resource Utilization Groups
-Designated amount the hospital receives
-DRG payment is still used but payers now demand that evidence-based standards of care be followed to further reduce the cost of healthcare
HMO
-Health Maintenance Organization
-A type of managed care health insurance plan
-Typically offer lower costs, but have a more restrictive provider network
-You will have to coordinate medical care through a primary care physician
PPO
-Preferred Provider Organization
-A type of managed care health insurance plan that provides maximum benefits if you visit an in-network physician or provider but still provides some coverage for out-of-network providers
-A group of doctors, hospitals and other health care professionals that an insurance company has a contractual agreement with to provide health care services at a reduced rate to policy holders
Three Levels of Prevention
-Primary
-Secondary
-Tertiary
Primary Level of Prevention
-educating people on healthy living (teaching), health promotion
-Preventative Care: Disease oriented and focus on reducing/ controlling risk factors.
Secondary Level of Prevention
Screen people for testing (screening/testing), provided by a specialist or agency upon referral from primary care physician.
Tertiary Level of Prevention
Preventing any type of deterioration, specialized consultative care
Restorative Care
-Home care: cheaper more comfortable
-Rehabilitation: care accident, stroke, fall
-Extended Care facilities:extensive care for a long duration of time
Preventative Care
disease; focused on reducing and controlling risk factors.
Magnet Recognition Programs
a hospitals recognition, not a certification
Globalization of Health Care
5 Components
-transformational leadership
-structural empowerment
-exemplary professional practice
-new knowledge, innovations, and improvements
-empirical quality outcomes
Transformational Leadership
A vision for the future and the systems and resources to achieve the vision are created by nursing leaders.
Structural Empowerment
Structure and processes provide an innovative environment in which staff are devoted and empowered and professional practice flourishes.
Exemplary Professional Practice
strong professional practices is established and accomplishments of the practice are demonstrated.
New Knowledge, Innovations, and Improvements
Contributions are made to the profession in the form of new models of care, use of existing knowledge, generations of new knowledge, and contributions to the science of nursing.
Empirical Quality Outcomes
focus is on structure and processes and demonstration of positive clinical, workforce, and patient and organizational outcomes.
Roles of Public Health Nursing
-Specialty and requires nurse to care for the needs of the population.
-Understands the factors that influence health promotion and maintenance.
Roles:
-Recording and analyzing aggregate medical data
-Evaluating the health of patients and creating treatment plans
-Monitoring patients for any changes in condition
-Delivering top-quality care alongside physicians
-Educating patients about available support services and helping them access care
-Emphasizing primary prevention in order to avoid disease or injury before it occurs
-Working with public health officials to help underserved communities gain access to care
-Developing a relationship with patients and following up to track progress
Referring patients to other providers as needed
-Assessing health trends in communities
HCAHPS
-Hospital Consumer Assessment of Healthcare Providers and Systems
-patient satisfaction
HEDIS
-Healthcare Effectiveness Data and Information Set
-designed to provide purchasers and consumers with the information they need for reliable comparison of health plan performance
Maslow Hierarchy of Needs
-Self-Actualization: Morality, Creativity, spontaneity, problem solving, lack of prejudice, acceptance of facts
-Esteem: Self-esteem, confidence, achievement, respect of others, respect by others
-Love/belonging: friendship, family, sexual intimacy.
-Safety: security of body, employment, resources, morality, the family, health, property
-Physiological: breathing, food, water, sex, sleep, homeostasis, excretion
Best way for nurses to stay up to date in their profession
-education and certifications
-continuing education
DRGs
-Diagnosis-Related Group
-Classifications based on a hospitalized patient’s primary and secondary medical diagnosis that are used as the basis for establishing Medicare reimbursement for patient care
Managed Care
Health care system in which there is administrative control over primary health care services. Redundant facilities and services are eliminated and costs are reduced Preventive case and health education are emphasized.
Nursing Shortage
-Aging of baby boomers
-Not having enough clinical locations to keep the numbers of cohorts high enough to keep up with the demand
Based on Atul Gawande’s video, “How do we heal medicine?”, what are the three steps to healing medicine
- identify the issues or problem (identify failure)
- plan a way to fix those identified problems
- Put the plan into action, get people on board with the plan.
Key points of the video
-He talked about the checklists and how it helped change the normal for when they went into surgery.
-Spoke about how the checklist lowered the complications by 35% and lowered infection issues post-surgery.
-The checklist made sure that even the smallest thing would not get passed by, implemented things like pause sections and check offs for the whole surgical staff.
AACN fact sheet
MISSION: As the collective voice for academic nursing, the American Association of Colleges of Nursing (AACN) serves as the catalyst for excellence and innovation in nursing education, research, and practice. AACN establishes quality standards for nursing education, influences the nursing profession to improve health care, and promotes public support of baccalaureate and graduate nursing education.
Essentials of Baccalaureate Education
-the theory of having the why
-you treat due to why
Caring
-Swanson’s Theory, developed in perinatal unit
-defined as a nursing way of relating to value others
-nurturing
5 categories Swanson’s theory outlines
-Knowing: striving to understand an event as it has meaning in the life of the other
-Being with: being emotionally present to the other
-Doing for: doing for the other as he or she would do for self if it were at all possible
-Enabling: facilitating the other’s passage through life transitions (ex. Birth, death) and unfamiliar events
-Maintaining belief: sustaining faith in the other’s capacity to get through an event or transition and face a future with meaning