Nursing: Unit 2 EXAM

• The practical nurse's role is to be an advocate, educator, caregiver, collaborator, and manager.
• Florence Nightingale studied in Germany with a Protestant order of women who cared for the sick. During the Crimean War, she was allowed to train women to care for the sick.
• Florence Nightingale's beliefs: 1. Nutrition is important to nursing care. 2. Fresh, clean air is beneficial to the sick. 3. Sick people need OT and recreational therapy. 4. Nurses should help identify and meet patients' personal needs, including providing emotional support. 5. Nursing should be directed towards two conditions: health and illness. 6. Nursing is distinct and seperate from the practice of medicine and should be taught by nurses. 7. Continuing education is needed for nurses.
• The Union government appointed Dorothea Dix, a social worker, to organize women volunteers to provide nursing care for the soldiers during the Civil War. Those women acted as nursing assistants today.
• Clara Barton took volunteers into the field hospitals to care for soldiers of both armies. She founded the American Red Cross.
• Lillian Ward took nursing out into the community. In 1893, she and Mary Brewster established the Henry Street Settlement Service in NYC. The service focused on the health needs of poor people.
• In the USA, students staffed hospitals and worked without pay. There were no formal classes; education was achieved through work. There was no set curriculum. Instruction was done at the bedside by the physician.
• In 1892, the New York Young Women's Christian Association (YWCA) started the first official school for practical nursing, the Ballard School offered a 3-month course.
• The National League of Nursing Education issued formal standards for practical nursing education
• All definitions of nursing share these 4 common goals, to promote wellness, to prevent illness, to facilitate coping, and to restore health.
• Caregiving skills are interventions aimed at restoring and maintaining a person's health
• Patient education and health counseling are functions of the practical nurse and are directed toward promoting wellness and preventing illness.
• Active listening is a therapeutic technique that helps the patient consider possible solutions when a problem occurs. Establishing a good nurse-patient relationship is necessary to gain the patient's trust so that patient education and other communications are well received.
• A nursing theory is a statement about relationships among concepts or facts based on existing information. Nursing theorists generally base their beliefs on the relationships among humans the environment, health, and nursing.
• Evidence-based nursing describes nursing care that uses the best research evidence coupled with the clinical expertise of the clinician.
• Evidence-based practice involves using the best scientific evidence from research to guide nursing care and improve patient outcomes.
• "Best practices" means the use of care concepts, interventions, and techniques that are grounded in research and known to promote higher quality of care and living. Clinical field experience and evidence-based research are used to establish the best practices for patient care.
• Clinical practice guidelines are the product of evidence-based research and they serve as a way for nurses to implement evidence-based practices.
• The National Association for Practical Nurse Education and Service ( (NAPNES) formulated a set of standards for practical nurses. Each state has a regulatory body that makes and enforces rules and regulations for the nursing profession. The practice acts generally define nursing activities, state the legal requirements and titles for nursing licensure, and establish what education is needed for nurses to become licensed.
• The practice acts are designed to protect the public, and they define the legal scope of practice. The National Council of State Boards of Nursing has recommended a transition to practice for all new nurses. The program is typically a 6 month preceptorship with ongoing support through the first year of practice.
• Practical Nursing was created to fill a gap left by nurses who enlisted in the military during WWll, LPNS cared for those who were well or mildly ill. So the RNs could concentrate on the acutely ill. NAPNES was formed to standardize practical nurse education and establish licensure criteria for graduates.
• Practical Nurses provide direct care under the supervision of a registered nurse, APRN, PA, MD/DO, dentist, or podiatrist.
• After completion of your LPN graduation, you can seek certification by NAPNES in pharmacology, LTC, and/or IV therapy. May also attain certifications in specialties like nephrology, urology, wound care, corrections, hospice, and breastfeeding support.
• The ADN nurse is considered a technical nurse and is not specifically prepared to work in a management position. BSN programs prepare nurses who have bedside nursing skills plus managerial skills. The push towards professionalism, unification, and higher educational standards and consistencies for nursing has caused ANA to propose that the BSN degree be necessary for entry into professional nursing practice.
• Nurses who pursue higher education are prepared as specialists in the various clinical branches of nursing, in research, or in administration. You can choose to pursue your graduate degree and become one of the following, NP, CRNA, CNM, or CNS (clinical nurse specialist)
• Functional nursing was the first care delivery system for the practical nurse. PN's performed a series of tasks such as administration of medication and treatments. Care was rather fragmented; cost-effectice.
• Team Nursing evolved in the 1950s and extended into the mid-1970s and RN was the team leader who coordinated care for a group of patients. Work tasks were assigned to the other members of the team.
• Total patient care in which the nurse carried out all the nursing functions for the patient and this was an effort to provide less fragmented care for the patient, this was more expensive.
• Primary Nursing appeared in the late 1960s and 1970s. One nurse plans and directs care for a patient over a 24-hour period. This method eliminated the fragmentation of care between shifts. When the primary nurse is off-duty, an associate nurse takes over the care and planning.
• There is research showing better patient outcomes with more care being delivered by nurses, there is a trend back to total patient care.
• Relationship-based care emphasizes 3 critical relationships. 1. the relationship between caregivers and the patients and families they serve. 2. the caregiver's relationship with him or himself. 3. the relationship among health team members. This was to promote cultural transformation by improving relationships to foster care for the patient
• Patient-centered care targets 6 areas for improvement in the US healthcare system, including safety, effectiveness, efficiency, equity, timeliness, and patient-centeredness. Patient-centered care has been fully embraced by the nursing community and it is identified as one of the seven QSEN competencies.
• Diagnosis-related groups were created by Medicare in 1983 as an attempt to contain rising healthcare costs. The DRg system means that a hospital receives a set amount of money for a patient who is hospitalized with a certain diagnosis. If a patient is admitted, only a certain number of days of hospitalization are allowed and will be paid for by Medicare.
• In 2008, Medicare stopped paying hospitals for care related to preventable hospital-acquired conditions and complications.
• To prove patient needs and proper care, nursing documentation of patient assessment and identified needs becomes very important. There are 6 levels of care within the health care system, these shoshowws the scope of services and setting where patients receive care.

  1. Preventative Care- education
  2. Primary Care-early detection and routine care
  3. Secondary Care- Emergency treatment and critical care
  4. Tertiary Care- special care
  5. Restorative Care-intermediate follow-up from post-op, routine care or medical care, rehab, or home care.
  6. Continuing care- LTC, chronic care, hospice care.
• Health Maintenance Organizations, a type of group practice, enroll patients for a set fee per month. They provide a limited network of physicians, hospitals, and other healthcare providers from which to choose. The patient or employer pays a monthly fee for the insurance and a small copayment may be required from the patient each visit. Patients must be referred by their PCP for diagnostic tests, hospitalizations, ER visits, and consultation with specialists. Two national HMOS are Kaiser Permanente and US family health plan. HMO is to keep patients healthy and out of the hospital.
• The Affordable Care Act was signed into law in 2010 and was meant to be phased in over several years. It created health insurance exchanges, expanded eligibility for Medicaid, and provided subsidies for low-income people to purchase health insurance.
• The World Health Organization has defined health as "a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity."
• Disease is a pathologic process with a definite set of signs and symptoms. Disease causes illness.
• Chronic illness is persisting for a long time. It often develops slowly, can be controlled but not cured. Example: hypertension