State of Michigan Nursing Home Administrator Exam

PATIENT TRUST FUNDS

1) Policy:
Must have a policy.
May state that the facility will not handle monies in excess of $5,000.00.
The facility may charge a reasonable fee not to exceed the ACTUAL COST of providing service.

2) Required Printed Information:
This must be given resident upon admission.
A statement that the facility will handle personnal funds if no other person is available.
Periodic statement of accounts (Minimum: Quarterly)

3) Procedure: American Institute of CPA
Quarterly statements including all activity, (A-H) in easily readable form.

Written account of all personal funds held in trust must be sent to the executor, administrator, rep payee or next of kin within 10 DAYS OF THE DEATH OF A PATIENT.

Account must be closed and balance sent to resident within 3 DAYS OF DISCHARGE.

Access to Funds

4) Financial records:
not less than two (2) hours during normal business hours.

5) Petty Cash:
during all normal business hours.

Accounts

6) Funds:
Cannot be CO-MINGLED with any other facility funds (Can with Residents’)

7) Interest Bearing Accounts:
May keep up to $200.00 in a non-interest bearing account of petty cash fund.

Money in excess of $200.00 shall be deposited in an interest bearing account within 15 days of the date the $200.00 minimum is exceeded.

8) Designation For Patient Unable To Handle Own Funds:
Facility notifies the Family Independence Agency, Adult Protective Services in writing when a mentally incompetent patient has no one to act on his behalf.

9) Sale Or Transfer of Ownership
Written receipt from new owner acknowledge receipt of the funds for safeguarding.

10) Surety Bond:
Not LESS than $2,000.00 or 125% of the previous year’s patient trust funds average balance held, whichever is greater.

Michigan State Plan For Long Term Care

11) Department of Community Health (MDCH or DCH)
DCH is responsible for the Medicaid Program under contract to the federal agency named Centers for Medicare and Medicaid Services (CMS).

MDCH also contracts with other departments and agencies to provide specific services.

12) Medical Services Administration (MSA)
This agency, under authority of MDCH writes policy, acts as fiscal intermediary, designs categorical reimbursement programs, audits and authorizes facility-specific reimbursement rates.

13) Bureau of Health Systems: DCH
has this bureau under its department for oversight of the quality of care within nursing homes through the certification process.

The actual certifying agency is CMS. This is accomplished through the surveys and inspections.

14) Department of Community Health, Bureau of Construction Codes, Office of Fire Safety.
DCH contracts with Office of Fire Safety to conduct the Life Safety Code portion of the survey.

15) Michigan Department of Human Services (DHS):
DCH contacts with DHS who determine an individuals Medicaid eligibility and “co-payment” responsibility. DHS utilized the local offices for direct contract with applicants.

16) Bureau of Health Professions: DCH
Has this bureau under its department for oversight and licensing of Nursing Home Administrator (NHA)

17) Michigan Department Community Health
This Department contracts directly with the federal agency CMS and as such is designated responsibility for Title XIX of the Social Security Act.

Currently this program is 56% federally funded and 44% state funded.

18) Medical Service Administration (MSA)
itself handles two primary aspects of the program POLICY AND REIMBURSEMENT.

Medicaid Policy

19) Providers must adhere to
ALL POLICIES TO PARTICIPATE

20) Facility must be licensed
MANDATORY

21) Certification of Facility
VOLUNTARY

22) MDCH uses the
Bureau of Health Systems to perform surveys for this certification.

23) Delivery of Services (Fairness/Non-Discrimination Doctrine)
Services Reimbursed by MSA are listed in the Medicaid manual.

Facilities MUST render covered services to ALL ELIGIBLE recipients in the same scope, quality, and manner as provided to the general public.

24) Compliance:
Facility must render services in accordance with all federal and state statutory and regulatory requirements.

25) Medicaid is Payor of :
LAST RESORT

26) Medicaid Payment is:
PAYMENT IN FULL (critical issue)

For covered services the facility must except the Medicaide reimbursement rate as payment in full for each and every Medicaid recipient.

The facility may not seek additional payment from residents or families for covered services.

27) For NON-COVERED SERVICES
The facility may seek payment from the recipient IF the resident chooses the service AND is informed of the charge PRIOR to receiving the service.

Record Keeping

28) Retention:
Facility services – 6 years
Orders of Contracted Services (Not records) – 6 years

Attending Physician

29) Attending Physicians’ responsibility
Federal and State regulations require the attending physician (MD or DO licensed in Michigan) to provide specific services to recipients.

30) Physician Compliance
It is the facilities responsibility

31) Physician Visits
Every 30 days for first 90 days, then every 60 days thereafter (more frequently if medically necessary)

32) Physicians’ must have
Written Plan of Care, signed

Annual Requirements for Inspection of Care

33) Under State Plan, DCH utilizes its
Bureau of Health Services to complete this during the annual survey.

Process assures that residents are receiving the appropriate care at the APPROPRIATE level of care.

Grounds for Termination of Enrollment or Refusal to Renew

34) Facility actions that:
Threaten the health, safety, or welfare of Medicaid recipients (determined through the survey process)

35) Facility actions that:
Threaten the fiscal integrity of the Medicaid program.

Abuse of Resident Trust Fund

36) Enforcement actions:
Failure to meet the federal conditions of enrollment or participation

Failure to meet the Certification Standards

Termination or suspension of Medicare automatically does the same to Medicaid

37) Patient Pay Amount
recipient must pay to the nursing home each month the amount of income determined to be in excess.

Facility is responsible for collecting

May NOT bill Medicaid for uncollected portion.

38) Co-insurance:
Must be applied to the FIRST DAYS OF STAY.

Remember facility MAY NEVER CHARGE A MEDICAID RECIPIENT MORE than the MEDICAID RATE.

39) Medicaid resident is discharged on the 11th of the month. How much do you charge whom if:

Private Pay Rate: $100.00 per day
Medicaide Rate: $80.00 per day
Patient Payed: $1000.00 per day

Amount due = Medicaid Rate X Days of Stay (80.00 X 10 = 800.)

Facility may charge for day of Admission, but not day of Discharge.
So stay = 10 days.

You must notify the local DSS office of all discharges.

Amount due from (to) resident = Amount Due – Patient Pay Amount for month
(800 – 1000 = -200)
You owe resident $200.00
Bill Medicaid 0.00

39). Under NO circumstances may a facility change the payment status of the resident to private pay and charge the full $100.00.
The DHS determines whether or not the recipient is Medicaid eligible. If the resident had stayed more days, you would have billed Medicaid.

40) Prior authorization for Services is Mandatory for
all recipients BEFORE receiving care.

41) Prior authorization for Routine Services is accomplished
Through the PreAdmissions Screening of PASAAR. Conducted by MDCH by contract to local Community Mental Health (CMH).

Pre-payment review for nursing need.

42) Prior Authorization for Ancillary Services
is Mandatory for all ancillary services (Therapies and Durable medical equipment).

43) Invoice (DSS-1073) is submitted to DCH AFTER
SERVICES RENDERED. You may bill both ROUTINE and ANCILLARY services on the same bill.

44) Therapeutic Leave Days:
Each recipient is entitled to 10 hospital leave days providing:

Hospitalization is unexpected
Return Anticipated within 10 days
Resident returns before day 10

REIMBURSEMENT

45) DCH
is the fiscal intermediary for Medicaid program.

46) Reimbursement Structure:
limits are established by legislature.

47) Cost Reporting:
to determine the facility-specific rates, DCH utilizes the MICHIGAN STATISTICAL and OPERATING COST REORT which must be filed within 90 days of the facility’s fiscal year end.

Relationship Between Medicare and Medicaid

48) Many recipients are eligible for both types of benefits.
If so, then facility MUST first bill Medicare, receive initial payment and then bill Medicaid

49) Medicare Part A:
Routine Services plus Ancillaries

Medicare pays in full for days 1 – 20

On Day 21, you begin to bill co-insurance (Medicaid) for day 21 – 100.

50) A recipient must enroll in Medicare Part A to be eligible for Medicaid.
If a recipient refuses to enroll, he is automatically denied Medicaid.

51) Medicare Part B:
Ancillary Services provided

Outpatient or Medical Services

Therapies (Non Medicare A)

Billable Medical Supplies D.M.E.

Diagnostic Services

Payment: Bill deductible to Medicaid

Workers Compensation

52) Purpose:
Alternative to employer “tort” liability in the legal system.

53) Sole:
Workers Compensation is the sole remedy for workers injured or disabled in the corse of employment.

54) Employees accepting workers compensation
cannot sue the employer

55) Workers Compensation Benefits
are statutory

56) Workers Compensation Rates
are set by rating agency on behalf of insurers

57) Workers Compensation Claims
appeals process is handled by state bureau

58) “Rate Making”
Process used in determining rates to be charged by insurance companies. Rates are set by the bureau

59) “Loss Experience”
Actual Payments and reserves for anticipated payments added together.

60) “Manual (or Book) Rate”
Assume parity with the averages within a given employer group, such as clerical, nursing, maintenance.

61) “Reserves”
Estimates of medical cost and lost time payment (including fringe benefits) that are set aside by the carrier for each anticipated injury AT THE TIME THE CLAIM IS FILED.

62) Michigan is a Total Disability State:
any injury is considered total disability. Either you can work or you can not.

63) Compensable injuries:
any injury arising out of and in the course of employment.

death due to or rising out of the course of employment

any injury received going to or from the workplace on the premises
where work is to be performed and within a reasonable time before and after working hours.

Coverage Liabilities

64) Employers Mandatory Participation:
Every private employer who employs one or more employees 35 hours per week or more for 13 weeks or longer.

65) Compensation Payments:
No loss time compensation shall be paid unless the employee is incapacitated from earning wages for more than one week.

66) Benefits Level:
Maximum weekly benefit is 90% of State average weekly wages as set by the Department of Consumer and Industry Services

67) Statue of Limitations:
Two years from date of injury, or two years from the time that employee knows that injury is work related.

Employers’ Responsibility To Bureau

68) Form 100
“Employers’ Basic Report of Injury” Filed immediately with
The “Bureau of Workers’ Compensation” and copies distributed to
The insurance carrier
The employer and
The employee

69) Form 104
“Petition for Hearing” –

70) Form 107
“Notice of Dispute” aq

Union Process of Recognition and Certification

71) Petition NLRB (National Labor Relations Board
potential union members for interest with signature cards.

show interest must be equal to or greater than 30% of potential bargaining unit interested.

the election (NLRB Conducts; 50% plus 1 of potential bargaining unit members voting wins)

The Nursing Home shall provide a written copy of facility rules and regulations:
to the patient or the patient’s representative upon admission and when the rules and regulations are changed.

The Policy shall be developed by a:
Patient Care Policy Committee

The Patient Care Policy Committee must consist of:
At least 1 Physician, the Director of Nursing, and the Administrator, with such additional memebers as the committee dems appropriate.

Oxygen Administration:
Only personnel who have been trained to administer oxygen shall do so and that Oxygen shall only be administered on the Order of a Physician or as authorized in Emergency Situations.

Infection Control Committee
The Director of Nursing and Representative of Administration, dietary, housekeeping, and maintenace services.

Medical Examination of Patients
1) Except in the case of a Friday Admission, in which case the patient shall be exaimed by a licensed physician within 72 hours.

2) A patient admiitted to a home shall be examained by a licensed physician within 48hours after admission

Medical Examination of Patient currently in the facility:
Shall be seen and, to the extent appropriate, shall be examined by a licensed physician at least once every 60 days, unless justified otherwise and documented by the attending

Standing Orders Must be:
Reproduced in the patients Clinical record and shall be signed by attending physician within 48 hours.

Telephone or Verbal Orders Recorded by the licensed nurse in charge
Shall be countersigned by the physician withhin 48 hours.

The Director of Nursing
Shall be a Registered with specialized training or relevant experience in the area of gerontology and shall be employed FULL TIME BY ONLY 1 NURSING HOME

The Charge Nure
A licensed nurse shall be the charge nurse on each shift or tour of duty and shall be responsible for the immediate direction and supervision of nursing care provided to patients.

In Homes less than 30 beds the Director of Nursing
May serve as Charge Nurse on a shift when present for full shift.

Reporting and enforcement of nurse staff requirements:
A home Shall maintain for a priod of Not Less than 2 years , employee time records, including time cards or their equivalent and payroll record

An Ambulatory Resident/Patient shall have a complete Tub or Shower
under staff supervision at least once a week, unless the physician writes an order to the contrary.

A Bedfast Resident/Patient shall be assisted with bathing or bathed completelt
at least twice a week and shall be partially bath daily and as required due to secretions, excretions, or odoors.

A patient’s Clothing or Bedding shall be changed Promptly
when they become wet or soiled

A patient shall be Weighed and have his or her vital signs tanken and recorded
On Admission and at least Monthly thereaftter or more frequently if ordered by a physician.

Begining Patient Care Planning
An assessment of a patient shall be initiated by licensed nursing personnel within 24 hours of admission and the results of the assessment shall be documented in the patients clinical record.

A Patient Care Confrence
shall be held periodically, but not less than Once Every 90 Days to evaluate a patient’s needs and evaluate care plan

Equipment and Supplies Bed
An individual bed not less than 36 inches wide and 72 inches long, or longer when necessary, with springs in good condition, and a mattress not less than 5 inches thick in good condition, with a nonobsorbent cover.

The home Shall provide a written copy of facility rules and regulations
To the patient or the patients representative upon admission and when the rules and regulations are changed

Diversional Activities
A Home shall provide an on going diversional activities program that stimulates and promotes social interaction, communication, and constructuctive living.

Patient Counsel
shal permit the formation of a patient/resident counsel by interested patients, and at time of admission to home shall inform all of the counsel and the rules if any

When the Dietary or Food service supervisor is other than a registered dietitian
The supevisor shall receive routine consultation and tecnical assisstance from a registered dietitian (R.D) not less than 4 hours every 60 days.

Food and Nutritional Needs of a patient
Shall be met in accordance with the physicians orders in keeping with acceptable standards of practice of most recent recommended daily dietary allowences

Not less than 3 meals or their equivalent
shall be served daily, at regular times, with not more than a 14 – hour span between a substantial evening meal and breakfast.

Menus, postings, filing
as actually served to patients must be kept for preceding 3 montns on file in the home

Food acceptance record
shall be retained in the facility

Self Administration of Medication by a Patient
shall not be permitted, except when special circumstances exist and when supported by a physician’s written order and justification

Diagnostic Services
An arrangement shall be made by the administrator for obtaining promptly and conveniently a clinical laboratoy, x-ray, or other diagnostic services ordered by the physician

A written report of each diagnostic test and service
shall be included in the patients clinical record within 1 week

Clinical Records of DISCHARGED patients
shall be completed within 30 days following discharge.
Clinical records shall be under the supervision of a full time employee of the home

Clinical Records are Retained for a Minimum of
6 years from date of discharge or, in the case of a minor, 3 years after the individual comes of age under state law, which ever is longer.

Accident Records and Incident Reports
shall be prepared for each accident or incident involving a patient, personnel, or visitor and shall include all of the following information.

Employee Records and work Schedules
a daily work schedule shall be prepared in writting and be maintaned to show the number and type of personnel on duty in the home for the previous 3 months

A Time Record for each employee
shall be maintained for not less than 2 years

“Medical Audit”
means the retrospective examination, review, and evaluation of the clinical application of medical knowledge utilized in the diagnosis and treatment of poatients as revealed n the patient’s clinical record and carried out for purpose of education, accountability, and quality control.

“Quality Control”
means the planned and systematic medical management actions which assures the consistent acceptabe quality of health care and services rendered to patients including the use of variousmonitoring techniques.

“Utilization Review”
means retrospective, concurrent, and prospective review of the provision and utilzation of health care services by providers and recipients in terms of cost, effectiveness, efficiiency, and quality

Home Entrance for Physically Hanicapped
IN A NEW CONSTRUCTION, addition, major change, or conversion after AUGUST 22, 1969, at least 1 entrance Shall provide easy access for the Physically handicapped

A minimum od 20 square feet of floor space per patient bed
Shall be provided for dayroom, dining room, recreation, and activity purposes.

A new contruction after August 22, 1969 Shall provide
A sleep, day, dining room, recreation, or activity room with a minimum ceiling height of 8 feet

20 feet of unobstructed vision space outside of any
window in a room requiring windows. One additional foot shall be added to the minimum distance of 20 feet for each 2 foot rise above the first story up to a max of 40 feet of required unobstructed space

A multi bed patient room (not more than 4 beds)
shall have a 3 foot clearance btw beds and not less than 70 square feet of usable floor space per bed

The temerature of HOT WATER at plumbing fixtures used by patients
shall be regulated to provided tempered water NOT LESS than 120 degrees fahrenheit.

A room used for patients shall maintain a regular daytime temperature
of NOT LESS than 72 dehrees fahrenheit

Kitchen and Dietary
A Reliable Thermometer
shall be provided for each refrigerator and freezer

In new construction (August 22, 199) general storage space of
10 square feet shall be provided in the home

In a 100 bed Nursing Home Day Staff
8:1 ration RN?LPN/ CNA

In a 100 bed Nursing Home Evening Staff
12:1 ratio RN/LPN/CNA

In a 100 bed Nursing Home Night Saff
15:1 ration RN/LPN/CNA

Class Outlines and Lesson Plans
shall be retained in the facility for not less than 2 years

MIOSHA
General recording criteria
You must consider an injury or illness to meet the criteria, if it results in
a) DEATH
b) Days away from work
c) Restricted work or transfer to another job
d) Medical treatment beyond first aid
e) LOSS of consciousness

MIOSHA
Retention and Updating
Must save MIOSHA 300 Log during the 5 year storage period

MIOSHA
Hospitilization
Within 8 hours after death of any employee from a work-related incident or the inpatient hospitialization of 3 ormore employees as a result of a work-related incident

MIOSHA incident reporting
You must orally report the fatality/multiple hospitilization by telephone or in person to the Michigan Department of Consumer and Industrial Services, Bureau of Safety and Regulation, State Secondary complex

MIOSHA
If the Building Office is Closed, May I report the incident by leaving a message on MIOSHA’s answering machine, faxing the bureau office, or sending an e-mail?
NO! If you can’t talk to a person at the bureau office you must report the fatality or multiple hospitilization incident using the 800 number

800-858-0397

“Licensed bed capacity”
means the autorized and licensed bed complement of a nursing home

Rule #107 Type Documentation
When the statue or these rules required a document or parts of a document to be printed in 12 point type the distance btw the top

Rule # 111 Governing Body
The governing body of the nursing home shall assume full responsibility for the overall conduct and operation of the home

The Governing Body Shall Appoint a
Licensed Nursing Home Administrator and shall deligate to the administrator the responsibility of operating the facility according to the policy and perceedures they established

Rule #112 Posting Resident Rights
Shall develop, adopt, post in a public place, distribute, and implement a Policy on the rights and responsibilities of patients in accordance with the requirements

All patient complaints shall be investigated with in
15 days of the complaint and home within 30 days following the complaint the home shall provide complintee a written status report or results of investigation

Patient Trust
Policy that home will not handle funds freater than $5,000.00

Patient has the right to have a representative from_____________ to handle his/her funds
Social Security Administration

Disaster Plan
Shall have a written Plan or procedure to be followed in case of fire, explosion, or other emergency

A regular Simulated Drill
shall be held for each shift NOT LESS than 3 times per year

Building Construction
If the building has a common wall with a nonconforming building, the common wall is a fire barrier having at least two hour fire resistance rating

Interior Walls and Partitions in building of Type I or Type II
construction shall be noncombustible or limited-combustible material.

Interior Walls and Partitions in building of Type I or Type II
shall be noncombustible or limited-combustible materials

Interior Finish 2000 EXISTING
Interior finish for corridors and exitways, includeing exposed interior surface of building has flame spread rating of Class A or Class B

Interior Finish 2000 NEW
Must have Flame Spread Rating of Class A or Class B. LOWER PORTION OF CORRIDOR WALLS CAN BE CLASS C

Corridor Walls and Doors 2000 EXISTING
are separated from use areas by walls constructed with at least 1/2 hour fire resistance rating.

Corridor Walls 2000 NEW
NO fire resistance rating is required for corridor walls.

Doors 2000 EXISTING
doors protecting corridor opening in other than required enclosures of verticle openings, exits, or hazardous areas shall be constructed of 1 3/4 inch sold-bond wood

Doors in Sprinkler buildings
are only required to resist smoke.

Exit Components 2000 Exists
such as stairways are enclosed with construction having a fire resistance rating of at least one hour,

Smoke Barriers New 2000
shall be provided to form at least two smoke compartments on every sleeping room floor for more than 30 patients

The smoke compartment
shall not exceed 22,500 square feet and smoke barrier shall not exceed 200 feet

Exit and Exit Access
Not less than Two exits, REMOTE from each other, are provided for each floor or fire section of the building

Exit and Exit access shall be arranged such that no
cooridor, aisle or passageway has a pocket or dead-end exceeding 30 feet

Width of Aisle or Corridors 2000 EXISTING
clear and unobstructed, serving as exits shall be at least 4 feet

Width of Aisles or Corridors 2000 NEW
clear and unobstructed serving as exit access in hospitals and nursing homes shall be at least 8 feet

Illumination of Means and Egress including exit discharge
is arranged so that failor of any single lighting fixture (bulb) will not leave the area in darkness

Emergency Lighting of at least
1 1/2 hour duraton is provided in accordance

Fire Alarm System 2000 Existing
There shall be ANNUNCIATION of the fire alarm system to an approved central station.

Fire Alarm System 2000 NEW
There shall be remote annunciation of the fire alarm system to an approved central station

Automatic Smoke Detection 2000 New
An automatic dectection system is installed in all cooridors with detector spacing not further apart than 30 ft on center, nor more than 15 ft from any wall.

Windor and Door 2000 Existing
Every patient sleeping room shall have an outside window or outside door.

The allowable height shall not exceed 36 inches (91 cm) above the floor.

Soiled linen or trash collection receptacles
shall not exceed 3 gal (121) in capacity

Oxygen storage locations of greater than
3,000 cu ft are enclosed by a one-hour separation.

Generators are inspected
weekly and exercised under LOAD for 30 minutes per month and shall be in accordance

National Fire Protection Association
Private, nonprofit organizaton – NOT A GOVERNMET AGENCY.

Author of Life Safety Code

Nursing Homes are required by OBRA to meet LSC

Proceedure in Event of Fire
1) Removing all residents involved
2) Transmitting alarm
3) Isolating the fire by closing doors
4) Evacuating by plan

Stairs: Clearance
44″; riser height – 7″ max

Smoke Towers
stair enclosure designed to limit penetration of heat and smoke. No more than 1% of the volume of air in stairwell will emanate from fire area

Handrails at bottom of stairs
Must extend parallel to floor for 12″

Windows must have
opening force requirement of no more 5lbs.

Preventive Maintenance
1) Save expense of requirs
2) Save labor
3) Assure safety

Facility Temperature
71F – 81F

Bed Space for each Patient
80 sq ft per resident in multi-bed rooms,
100 sq ft in private room

Obra Requirement for Housekeeping
Services necessary to maintain a sanitary, orderly, and clean interior.

Chapter 9 The Nurse as Leader and Manager

Challenges and Opportunities
• Limited access to healthcare services for many
• Limited resources for providing care
• Need to provide care for uninsured and underinsured
• Need to recruit and retain high-quality nurses
• Develop innovative approaches to nursing caredelivery and redefine the roles of professional nurses

Nursing Leadership

• Advocate for improvements in
– Client care quality
– Working environment
– Social well-being

Leadership occurs when influencing others to act
– Managers are assigned their roles
– Leaders attain their roles

Leadership characteristics
– Integrity
– Courage
– Positive attitude
– Initiative
– Energy
– Optimism
– Perseverance
– Balance
– Ability to handle stress
– Self-awareness
– Vision

American Nurses Association charges nurses with
leadership expectations
– Participate in professional organizations
– Communicate effectively
– Seek ways to advance nursing autonomy and accountability
– Participate in effort to influence healthcare policy
– Oversee nursing care by others while retaining accountability for quality of care
– Abide by vision, goals, and plan to implement and measure progress of clients
– Mentor colleagues
– Develop communication and conflict resolution skills

• Authoritarian leadership
– Makes the decisions for the group
– Directive, autocratic, or bureaucratic
– Negative connotations
-makes minimal openess and trust
-procedures well defined, predictbale, security
-supreses creativity
-can be effective when project must be completed quickly and efficiently

• Democratic leadership
– Participative leadership
Acts as a catalyst or facilitator
Seeks participation or consultation of subordinates
Actively guides the group toward achieving the group goals
Provides constructive criticism, offers information, makes
suggestions, asks questions

• Laissez-faire leadership
– Nondirectional leadership
– Minimal participation
– Group’s members act independently of each other
-inactive, inpassive, permissive

• Situational leadership
– Levels of direction and support vary depending on the maturity of the group
– Value placed on accomplishment of tasks and on interpersonal relationships
– Leadership style changes based on task, urgency, and individual needs

leader assumes one of four styles
-*directive*: clear direction and instruction to immature employees
– *coaching*: 2 way communicative, helps mature employee build confidence
– *supporting*: support mature emplyee use talents
– *delegating*: hands off, employees given responsibilities for carrying out plans

• Transactional leadership
– Traditional manager focused on the day-to-day tasks of
achieving organizational goals
– Relationship is based on exchange for some resource
valued by the follower

• Transformational leadership
– Emphasizes the importance of interpersonal relationships
– Leader serves as a role model who encourages and empowers team members to achieve team and personal goals
– Vital in creation of healthcare system that embodies community well-being, basic care for all, costeffectiveness, and holistic nursing care

4 factors of tranformational leader
-charisma: highly rescpected, inspires others
– inspirational motivation: shares visions with staff to go appeal to emotions and ideals
– intellectual stimulation: encourgae staff to question status quo
– contingent reward- recognizes mutual goals and rewards achievemnts

• Caring leadership
– An extension of transformational leadership
– Good management is a matter of love
– Proper management involves caring for people, not manipulation

• Quantum leadership
Humanistic interaction involving leader and followers
– Additional focus on problem to be solved or goal to be achieved
– Interaction and outcomes are affected by the leader, the followers, and the task to be accomplished
– Leader is creative, flexible, and encouraging
– Each team member adds value

Effective leadership
– a learned process requiring
an understanding of the needs and goals that motivate, knowledge to apply skills, and interpersonal skills to influence others
• Success is more than goal attained, also opportunity for growth

Nursing Management

Nurses as managers responsible for
– Planning
– Organizing
– Directing/delegating
– Controlling resources used in delivery of client care

• Resources used in delivery of client care
– Equipment and materials
– Technology
– Finances
– Environment
– Personnel

Management Roles

• Authority
– Official power given by organization to direct work of
others
– Conveyed through leadership action

• Accountability
– Ability and willingness to assume responsibility and consequences

• Planning
– First and most basic management function
– Four stages
Establishing goals and objectives
Evaluating current situation and predicting future trends and
events
Formulating a planning statement
Converting plan into an action statement

• Organizing
– Process of coordinating work to be done

• Leading
– Power is essential component of leading
– Power is the ability and authority to influence others
– Based on honor, respect, loyalty, and commitment

• Delegating
– Determine what is required, then identify help
– Development of the potential of nursing and support personnel
– Delegated individuals must be supervised and evaluated
– Provide ongoing feedback about performanc
– Getting work done through others
– Major tool in making most efficient use of time

– Five “rights” of delegation
Right task
Rights circumstances
Right person
Right direction and communication
Right supervision and evaluation

– Effective delegation requires nurses to be aware of
Needs and goals of the client and family
Nursing activities that can help the client meet the goals
Skills and knowledge of various nursing and support personnel

• Controlling
– Method to ensure that behaviors and performances are
consistent with expectations developed in planning
process
– Should be done with employees, not to employees
– Shared governance and team building help make
control easier

• Three levels of management
– First level
– Middle level
– Upper level
• Dependent on the type of organization

Management competencies described by American Organization of Nurse Executives
– Communication and relationship building
– Knowledge of healthcare environment
– Leadership skills
– Professionalism
– Business skills

• Magnet recognition
Program of American Nurses Credentialing Center
– Recognizes healthcare organizations for quality patient
care, nursing excellence, and innovations
– Identifies characteristics of hospitals that are successful
in recruiting and retaining nurses

• Pathway to Excellence Program
– Program of *American Nurses Credentialing Center*, launched in 2009
– Recognizes healthcare organizations and long-termcare
facilities for having positive practice environments
– Standards unique to long-term-care environment have been developed

Nursing Delivery Models

• Total patient care
– Case method
– Earliest model of nursing care
– Private-duty nurses
– Client-centered
– Client has consistent contact with one nurse during shift

• Functional method
– Evolved from concepts of scientific management
– Focuses on jobs to be completed
– Task-oriented approach
– Disadvantage is fragmentation of care
-ex. nurse and nursing assistant

• Team nursing
– Individualized nursing care given to clients by a nursing team led by a professional nurse
– Members include RNs, LPNs, nursing assistants
– Responsible for coordinated nursing during a shift
– Emphasizes humanistic values and individualized client care at a personal level
– Nurse leader motivates employees

• Primary nursing
– A system in which one nurse is responsible for total care of a number of clients 24 hours a day, seven days a week
– Provides comprehensive, individualized, and consistent
care
– Associates provide care, but the primary nurse plans and coordinates care

• Interdisciplinary team model
– Team consists of all disciplines required to provide quality care to client
– Each team member brings expertise to help client achieve quality outcome
– All members focus on client’s needs and collaborate to meet those needs

Case Management
pg 176
• Pioneered at the New England Medical Center
• Used in
– Insurance-based programs
– Employer-based health programs
– Workers’ compensation
– Maternal-child health
– Mental health
– Hospital-based practice

Case Management Defined as
– A collaborative process of assessment, planning,
facilitation, care coordination, evaluation, and advocacy to meet individual’s and family’s comprehensive health needs to promote quality, cost-effective outcome
– assist clients through complex
healthcare system

Differentiated Practice
178
• Differentiates nurses by level of education, expected clinical skills or competencies, job descriptions, pay scales, and participation in
decision making
• Can improve client care and contribute to client safety
• Allows for the effective and efficient use of resources

Shared Governance
• Nurses participate in decision making at all levels of the organization
• Employees will be more committed to an organization’s goals if they have input
• Promotes involvement, investment, participation,
sharing of power, interdependence, cooperation, horizontal relationships, autonomy, and
accountability

• Mentor
– Wise and trusted adviser who guides others on particular journey
– Provides support, challenge, and vision
-• Process can promote professional growth of both mentor and mentee

• Three phases
– Invitational
– Questioning
– Transitional

• Preceptor
– An experienced nurse who orients a nurse who is new
to the nursing unit and organization
– Assigned to assist in improving clinical nursing skill and
judgment necessary for effective practice in her or his environment
– Assists new nurses in learning routines, policies, and procedures of the unit

Networking
• Professional network consists of people that nurses may call on for assistance, support of ideas, and guidance
• Networking builds linkages with people
• Long-term process for building relationships
• Requires time, commitment, and follow-through

Networking
• Opportunities include
– Active membership in professional organizations
– Continuing education and university classes
– Socializing with professional colleagues
– Keeping in touch with former professors and nursing
associates

Chapman Maternal-Newborn Nursing Ch 2

Duties and obligations of obstetric and neonatal nurses outlined by…
American Nurses Association ANA Code of Ethics and
specialty practice standards from AWHONN Association of Womens Health, Obstetrics and Neonatal Nurses

ANA Code of Ethics for Nurses
describes the most fundamental values and commitments of the nurse; boundaries of duty and loyalty; and aspects of duties beyond individual patient encounters

Autonomy
right to self determination

Respect for Others
principle that all persona are equally valued

Beneficence
obligation to do good

Nonmaleficence
obligation to do no harm

Justice
principle of equal treatment or that others be treated fairly

Fidelity
faithfulness or obligation to keep promises

Veracity
obligation to tell the truth

Utility
the greatest good for the individual or an action that is valued

Rights Approach
The focus is on the individual’s right to choose, and the rights include the right to privacy, to know the truth, and to be free from injury or harm.

Utilitarian Approach
This approach posits that ethical actions are those that provide the greatest balance of good over evil and provides for the greatest good for the greatest number.

Ethical Dilemma
is a choice that has the potential to violate ethical principles

Advocacy
action taken in response to our ethical responsibility to intervene on behalf of patients in our care

Ethics
determining what is good, right, and fair.

Paternalism
system under which an authority makes decision for others

Four Topics Method
Three ethicists Jonsen, Siegler and Winslade developed method with which to work through difficult clinical situations with ethical dilemmas.

Four Topics Method include
1. Medical Indications
2. Patient Preferences
3. Quality of Life
4. Contextual Features

Medical Indications
A review of diagnosis and treatment options

Patient Preferences
Clinical patients values preferences are integral to all clinical situations

Quality of Life
Objective is to improve, or at least address, quality of life for the patient

Contextual Features
In the wider societal context beyond care providers and patient, to include family, the law, hospital policy, insurance companies and so forth

Most litigious of all nursing fields
Maternity nursing

Risk Management
identify systems, analysis and treatment risks before a suit is brought

The organization that publishes standards and guidelines for maternity nursing is
Association of Women’s Health, Obstetrics and Neonatal Nursing

Autonomy is defined as the right to
self determination

Ethics involves determining what is
correct

Evidence based decision making should include consideration of
patients clinical state, clinical setting, clinical circumstances

Risk management is an approach to the prevention of
morbidity and mortality

Nursing Interventions/Tx GI

Oral Cancer
1.Airway management
2•Cough Enhancement
3•Aspiration Precautions
Medical:
1. Oral examination for lesions &Palpation of cervical nodes
2•Biopsy of oral lesions which do not heal in two weeks
3•Surgical resection
4•Radiation Therapy
5•Chemotherapy
6•Combination of above 3

GERD Diagnosis (3)
-Rule out cardiac pain
-Diagnosis demonstrated reflux
1. 24-hour ambulatory pH monitoring (most accurate method of dx) (small catheter placed into distal esophagus that continuously monitors and records pH while client keeps a diary of activities and symptoms
2. Endoscopy/esophagogastroduodenoscopy (EGD) (requires conscious sedation)
3. Esophageal manometry: water filled catheter inserted through nose or mouth and slowly withdrawn while LES pressure and peristalsis measurements are recorded
-Labs

GERD Teaching (9)
1•Avoid foods & medication that reduce LES tone
2•Avoid eating within 3 hours of bedtime or lie flat after eating
3•Avoid restrictive clothing
4•Avoid large meals
5•Elevate HOB 6-12 inches for sleeping
6•Smoking cessation
7•Caffeine in moderation
8•Consult with dietician for weight loss
9•Avoid heavy lifting & straining or working bent-over

GERD Surgery tx

done if medical doesn’t work

1. Laparoscopic NissenFundoplication- done by laproscopy-A portion of the gastric fundus is wrapped around the sphincter area of the esophagus.
2. Nissen Fundoplication
3. Hill Repair
4. Belsy Repair (Mark IV)
5. Angelchic Prosthesis

Hiatal Hernia tx
1.Lifestyle Modification
Weight loss, small frequent meal, Avoid eating 2-3 hours before bedtime or lying down after meals, Avoid straining and vigorous exercise, Smoking cessation, Elevate HOB
2. Medications: Antacids, Histamine H 2-receptor antagonist, & Proton Pump Inhibitors

Hiatal Hernia surgery

done if severe, non-responsive, & if ulceration/necrosis is suspected

Surgery similar to that done for GERD-
-NissenFundoplication most common: fundus of stomach is brought up and wrapped around esophagus; stitched into place providing a one-way valve to control reflux; may be done laparascopically
-Complications include hemorrhage, infection, dysphagia, obstruction, perforation, fistula, pulmonary embolus

Achalasia tx
Aimed at relief of symptoms
•Elevate HOB
•Pain relief-Antacids, H2 receptor antagonists, and Proton pump inhibitors
•Calcium channel blockers and nitrates reduce LES pressure
•Botox injections to esophagus -Inhibits contraction of smooth muscle (90% improve, but requires repeated dosing; long-term effects are unknown)

Achalasia dx
-Barium Swallow: visualizes the esophagus and will show dilation with a narrowing at the terminal esophagus (hallmark)
-CXR: shows a distorted and dilated tubular esophagus, the absence of a gastric bubble, and occasionally a tubular mediastinalmass next to the aorta.
-Endoscopy: to evaluate the appearance of esophageal mucosa
-Manometry: usually reveals increased LES pressure and incomplete sphincter relaxation when swallowing

Achalasia Surgery
1. Esophageal dilation of LES- Usually done on outpatient basis, Local anesthesia used, 75% success rate
2. Esophagomyotomy -enlarging the LE sphincter by incising the circular muscle fibers down to the mucosa

Esophageal Tumors dx
-Esophagogastroduodenoscopy (EGD) with biopsy
-Bronchoscopy to determine metastasis to trachea

Esophageal tumor tx
1.Nutrition consult due to malnourishment or risk for malnourishment.
2.Speech pathologist consult to assist with oral exercise for improved swallowing.
3.Radiation therapy is used for inoperable tumors to manage symptoms or to provide palliation of symptoms by shrinking tumor.
4.Chemotherapy either alone or in combination with radiation and/or surgery.

Esophageal tumor surgery
1-Esophagectomy-removal of all or part of the esophagus and replacement with a Dacron graft or a portion of colon or small intestine
2-Esophagogastrostomy-resection of a portion of the esophagus and anastomosis of remaining portion to stomach
3-Palliative gastrostomy done for purpose of feeding client

Zenker Diverticulum tx/dx
Diagnosis: Esophagogastroduodenoscopy (EGD)

•Collaborate with Dietician for best food options
•Semisoft meals, small, frequent meals
•Sleep with HOB elevated
•Avoid being supine for at least 2 hours after eating
•Avoid excessive exercise after meals
•Avoid tight clothing
•Limit stooping and bending
•Surgical removal of diverticulum
-NPO for several days to promote healing
-IV fluids and possible tube feedings
-NG tube placement

Gastritis Acute tx (7) & Chronic (4)
Directed toward identification of and removing the cause and treating the symptoms
1.NPO until N/V abate
2.Bland diet progressing to regular diet as tolerated
3.Administer medications as ordered
4.Antiemetic for n/v
5.Antacids, H2 receptor antagonists, Proton Pump Inhibitor for gastric pain
6.Anti-diarrheal if a problem with diarrhea
7.Replacement IV fluids if dehydration is a problem

Chronic same as acute but add
1.R/O Gastric Cancer
2•Vitamin B12
3•Treat H. pylori
4•Stress reduction techniques

PUD tx
Treatment similar regardless of location
1. Medications
-Antimicrobials: Clarithromycin(Biaxin), Metronidazole(Flagyl), Amoxicillin(Amoxil), Tetracycline(Sumycin)
-PPI or H2 blocker
-Antacids or Bismuth
-Coating agents
-Gastrointestinal Prostaglandin-misoprostol(Cytotec)
2. Dietary modification
-Small frequent meals
-Avoid irritants/foods that promote gastric secretion, such as caffeine, milk, coffee, alcohol
3.Lifestyle modification
-Smoking cessation
-Stress reduction
-Exercise

PUD Complication: Hemorrhage tx (11)
Goal: Stop acute bleeding & prevent re-bleeding
1.Maintain airway, breathing, & circulation.
2.Cool saline lavage via NG tube
3.Endoscopic therapy via EGD for:
4.Thermal contact using a heater probe or multielectrocoagulation
5.Injection of bleeding site with diluted epinephrine
6.Laser therapy
7.Clipping vessel with mechanical clip
8.Suppression of gastric acid (H2-receptor antagonists, PPI, antacids)
9. Replace volume/fluids to maintain vascular, cellular, and intracellular perfusion (NS, LR)
10•Promote rest-Bedrest with limited visitors
11•Monitor VS, UOP, & kidney function, and neurological status
-Foley/hourly urine
-BUN/Creatinine
-Frequent neuro checks

PUD Complications: Perforation tx (5)
1•Keep NPO
2•Fluid/electrolyte replacement
3•Antimicrobial
4•Nasogastric suction
5•Emergency Surgery
-Hemigastrectomy
-Pyloroplasty
-Peritoneal Cavity flushing with antimicrobial and Normal Saline

PUD complications: Obstruction tx ()
1•Nasogastric suctioning
2•IV maintenance of fluid & electrolyte balance
3•Surgical Treatment
-Gastric resection-removal of portion of stomach involved
-Vagotomy-cutting of Vagus nerve to eliminate PSN stimulation of gastric secretion
-Pyloroplasty-pylorus in incised and re-sutured to relax muscle and enlarge opening from stomach to duodenum to increase rate of gastric emptying

Stress Ulcer tx (5)
1.Prevention is best! Monitor patients at high risk & prophylactic measures
2. Remember its painless
3. Admin Meds: Antacids, H2 Blockers, PPI, Coating Agents
4-Hemorrhage care
•Gastric lavage
•Vasoconstrictive meds-Vasopressin(Pitressin) drip
•Electrocoagulation
•Vagotomy
•Gastrectomy

ZES tx
1.Therapy aimed @ suppression of acid secretion (PPI or/and H2 receptor antagonists)
2.Tumor Removal
3.Aggressive disease may be treated with chemotherapy

Gastric Cancer tx (4)
Treatment depends on stage of disease
1•Little effective medical treatment available
2•Primary treatment is surgical resection (usually palative)-Gastrectomy (Partial/Total), Vagotomy, Pyloroplasty
3•Combination of radiation and chemotherapy after surgery may be used
4•TPN for nutrition

Dumping Syndrome tx (6)
1.Decrease amount of food eaten at one time
2.Eat high protein, high fat, low carbohydrate, dry diet
3.Eat 5-6 small meals per day
4.Minimize roughage (Fiber)
5.Eat in semi-recumbent position or lie down after meals
6.Avoid fluids 1 hour before meals and for 2 hours after meals

IBS tx (5)
No specific test to diagnose
1.Diet modification
•Restrict foods which irritate condition
•Dairy
•Grains
•Sorbitol/Fructose/Lactose (1st 2 are irritants, 3rd can have intolerance)
2.Stress relief
3.Manage psychosocial impact
4.Monitor analgesic use
5. Meds
-Constipation dominate: Bulk forming laxatives (Metamucil-psyllium) at mealtime w/8 oz H20
-Diarrhea dominate: antidiarrheals (Lomotil-difenoxin/atropine, Imodium-loperamide)
-Pain dominate: Anticholinergics or antispasmodics (Bentyl-dicyclomine, Pro-Banthine-propantheline)
-Tricyclic Antidepresants
-Postprandial discomfort: take meds 30-45 minutes prior to eating

Abd Hernia tx
1.Strengthening exercises
2•Weight control
3•Mechanical reduction by a truss which is a pad made with firm material, held in place by a belt.
4. Surgery

Intestinal Obstruction tx (11)
1•NPO-bowel rest
2•NG suction
-Low continuous decompression
-Replacement of NG output with IVF
3•Treatment of primary disease
-Barium enema to dislodge intussusception
4•Disempaction if mechanical empaction
5•Fluid & Electrolyte replacement (K)
6•TPN
7•Mouth care
8•Pain management (not opiods until dx)
9•Broad spectrum antibiotics
10•Insertion of an intestinal tube to decompress and/or break up obstruction
-Miller-Abbott
-Cantor Tube
11.Sugery: Exploratory Laparoscopy/Laparotomy•Bowel resection•Primary resection and anastomosis•Temporary colostomy/ileostomy•Lysis of Adhesions

Hemorrhoids tx
1•Prevent constipation:
-Diet high in fiber to avoid constipation, Avoid prolonged sitting, Ample fluids (water), Stool softeners, Mineral oil,Exercise
2•Relieve pain
-Sitz baths 3-4x day, Witch hazel compresses, OTC preparations- locally – temporary pain relief
•Ice pack
•Bulk laxatives
•Topical anesthetics

hemorrhoids surgery

Complications: Infection, Stricture formation, Hemorrhage, Urinary retention d/t rectal spasms

•Sclerotherapy- Injecting a sclerosing agent between and around tissue and veins to cause formation of scar tissue
•Ligation-used for internal hemorrhoids-hemorrhoids are tied off with rubber bands and in 8-10 days area sloughs.
•Cryosurgery- (freezing) not common now leads to necrosis and sloughing of hemorrhoids
•Laser-hemorrhoids are burned off with laser
•Hemorrhoidectomy-Vein is excised and is left open to heal by granulation or is closed with sutures

Appendicitis tx
No medical treatment for appendicitis
Surgical intervention, removal of appendix, within 24-48 hrs. of onset of symptoms
Delay usually results in rupture of appendix and subsequent peritonitis
Surgery may be small incision or by laparoscope

Peritonitis tx (11)
1.Maintain fluid and electrolyte balance
IV fluids
Replacement electrolytes
NG tube or long intestinal tube to reduce pressure within the bowel
2.Infection control
IV antibiotic therapy with potent broad-spectrum agents
3.surgery may have to be delayed until stable:
-Surgery will Repair perforated organ as soon as possible
-Irrigate abdominal cavity with antibiotic solution to reduce bacterial count
-Wound may be packed open or drain in place so that infection can be treated
4. Bedrest in Semi-fowlers position
5. TC & DB
6. Assess respiratory status, VS
7.Strict I & O, wt, hydration
8.Assess pain, IV, NG Tube
9.Assess GI function
10.Wound Care
11.Post-Op Care

Gastroenteritis tx (8)
1. IV fluids
2.Monitor I&O, Daily wts
3.NPO, advance as tolerated
4.Water only does not replace electrolytes
5.HOLD Anticholinergics and antiemetics
6.Antibiotics (Cipro, Septra, Bactrim)
7.Rectal Care
8.Health Teaching

Ulcerative Colitis dx (5)
1.Stool Samples
2.CBC/Electrolytes: Hgb & Hct Decrease, Increased WBC
Increased ESR, Hyponatremia and hypokalemia, Hypoalbuminemia
3.CT Scan of Abdomen
4.Lower GI Series
With or without contrast (Barium) and air
5.Colonoscopy (most definitive test)

Ulcerative Colitis tx(8)
1.Maintain Remission
2.Diarrhea Management (atropine sulfate (Lomotil), loperamide (Imodium)
3.Diet Therapy
4.No Smoking
5.Rest
6.Meds- Aminosalicylates, Corticosteroids, Immunomodulatory Agents
7.Prevent Complications
8.Surgical Management
-Total protocolecotmy with permanent ileosstomy
-Total colectomy with ileoanal anastomosis; ileoanal reservoir

Crohns tx (3)
1.Drug Therapy
-Antibiotics: Metronidazole (Flagyl), Rifaximin (Xifaxan)
-Immunosupressive (Immuron)
-Biological Agents: Infliximab (Remicaide), Adalimumab (Humira), Etanercept (Embrel)

2.Manage Complication of Fistula (abnormal tract from intestine to skin or intestine to intestine)
3. Surgical Management: bowel resection, total colectomy and ileostomy

IBD: Crohns & CUC Nursing management (12)
1.Maintaining Normal Elimination patterns
2.Relieving pain
3.Maintaining Fluid Intake, Measures to promote fluid an electrolyte balance,TPN or Parenteral Nutrition
4.Promoting rest
5.Reducing Anxiety, Incorporate Stress reduction into lifestyle, Enhancing Coping Measures
6.Preventing Skin Breakdown
7.Understanding of Disease
8.Post surgical care – ileostomy, colostomy or colectomy
9.Nutritional management-Bland, low-residue(during flares), high protein, high vitamin diet, Foods to avoid
10.Medication Regimen
11.Measures to treat exacerbation of symptoms
12.Management, complications and interventions

Diverculitis tx (6)
1.Rest
2. Diet : Clear liquid until inflammation subsides, low fiber diet during acute episodes then High-fiber, low fat diet (Avoid seeds and nuts)
3.Monitor I&O: Adequate fluid intake 10 glasses/d
4.Drug Therapy:
-Antibiotics broad spectrum (Flagyl)
-IV’s
-Anticholenergics (Pro-Banthine)
-Opiod analgeisics
-Antispasmodics
5. NG Tube
6.Surgical Management: One Stage resection, Two stage resection

Cholecytis tx (8)
1.Diet:
-Avoid high-fat or high volume meals
-NGT – decompression of stomach
-Chronic: Low-fat diet to decrease stimulation to gallbladder
2.Drug therapy:
-Opioid analgesics (Demerol) relieve abd pain and spasm, morphine
-Antispasmotic agents: (Bentyl) to relax smooth muscle
-Antiemetics: (Tigan) to relieve n/v
-IV antibiotics: Ampicillin, cephalosporins, aminoglycosides
-anticholinergic medications
3. Fluid and electrolyte balance; rehydrate with IV fluids
Withhold food/fluids for N/V
4.Monitor for complications
5.Endoscopy
6.Dissolution: UDCA: ursodiol, Dissolves cholesterol
7.ESWL (extracorporeal shock wave lithotripsy)
Can have no pancreatic or liver involvement, Conscious sedation, general anesthesia or epidural
Recurrence is High
8.Surgery

choleliathisis
(Gall stones)
1.Diet therapy:Low fat,Obst bile flow decreases fat soluble vitamins (A, D, E, & K), Avoidance of large meal after fasting
2. Drug therapy:
-Opioid analgesics
-Antispasmotic or anticholinergics (Bentyl)
-Antiemetics
-Bile acid therapy – dissolve gallstones: Chenodeoxycholic acid (Chenix), Ursodeoxycholic acid (ursodiol) Reduce cholesterol stones by unsaturating bile
3.Fluid and electrolyte balance: NPO, IV fluid hydration
Careful progression of diet
4.Extracorporeal Shock wave lithotripsy-Noninvasive, outpatient, Lithotriptor generates powerful shock waves to shatter the stones, Approximately one hour; 1500 shocks, Stones are then secreted via intestines, RUQ pain is common, resolving in 2 days
5.Surgical:Cholecystotomy, Choledocholithotomy, Cholecystectomy

CH 5 – Nursing Process & Critical Thinking

ACTUAL NURSING DIAGNOSIS
Human responses to health conditions / life processes that exist in an individual, family, or community. It is supported by defining characteristics that cluster in patterns or related cues or inferences.

ASSESSMENT
A systemic, dynamic process by which the nurse, through interaction with the client, significant others, & health care providers, collects & analyzes data about the client.

BIOGRAPHIC DATA
Relating to the facts and events of a person’s life.

CASE MANAGEMENT
(Now a certified nursing specialty) Refers to the assignment of a health care provider to a pt so that the care of that pt is overseen by one individual.

CLINICAL PATHWAY
A multidisciplinary plan that schedules clinical interventions over an anticipated time frame for high-risk, high-volume, high-cost cases. (Synonyms: critical paths, multdisciplinary action plans, action plans, care maps.)

COLLABORATIVE PROBLEM
Certain physiologic complications that nurses monitor to detect onset or changes in status. Use of physician-prescribed & nursing-prescribed interventions. EX: Potential Complication: hypoglycemia.

CUE
Synonym for subjective & objective data.

DATABASE
A large store or bank of information. (From which the nursing diagnosis can be identified).

DEFINING CHARACTERISTICS
Cues that tell how the diagnosis is manifested — The clinical cues, signs, & symptoms that furnish evidence that the problem exists.

DIAGNOSE
To identify the type & cause of a health condition. (ANA def. – a clinical judgment about the client’s response to actual or potential health conditions or needs, The diagnosis provides the basis for determination of a plan of care to achieve expected outcomes.)

EVALUATION
A determination made about the extent to which the established outcomes have been achieved. — Review pt-centered goals, Reassess pt to gather data about pts actual response to nursing interventions, Compare the actual outcome with desired outcome, Make critical judgment as to whether outcome was achieved.

GOAL (STATEMENT)
A statement about the purpose to which an effort is directed.

IMPLEMENTATION
Established plan is put into action to promote outcome achievement. — 5th phase of nursing process — Includes: ongoing activities of data collection, prioritization, performance of nursing interventions, & documentation.

MANAGED CARE
A health care system whose aim is to enhance specific clinical and financial outcomes within a specific time frame.

MEDICAL DIAGNOSIS
The identification of a disease or condition by a scientific evaluation of physical signs, symptoms, history, laboratory test, & procedures.

NANDA
North American Nursing Diagnosis Association – approved official definitions of a nursing diagnosis that are still in current use.

NURSING DIAGNOSIS
Clinical judgment about individual, family, or community responses to actual or potential health problems/life processes. — Provide the basis for selection of nursing interventions to achieve outcomes for which the nurse is accountable.

NURSING INTERVENTION
Those activities that should promote the achievement of the desired pt outcome — May include activities that the nurse selects to resolve a nursing diagnosis, to monitor for the development of a risk problem, or to carry out physician orders.

NURSING PROCESS
Serves as the organizational framework for the practice of nursing. — A systematic method by which nurses plan & provide care for pts. — Consists of 6 dynamic & interrelated phases: assessment, diagnosis, outcome identification, planning, implementation, & evaluation.

NURSING-SENSITIVE OUTCOMES
The results or outcomes of nursing interventions. These outcomes or indicators are influenced by nursing & can be used to judge effectiveness of care & determine best practices.

OBJECTIVE DATA (SIGNS)
Observable & measurable data that can be recorded. EX: rash, lesions, puffy eyes, crying, slurred speech, temperature elevation.

OUTCOME (Desired Pt Outcome)
States the behaviors that the pt will be able to perform rather than the nurse will do. — 2 functions: 1.) Guide the selection of interventions — 2.) Establishes the measuring standard that is used to evaluate the effectiveness of the nursing interventions.

PLANNING
Nurse establishes priorities of care, selects & converts nursing interventions into nursing orders, and communicates the plan of care using standardized languages or recognized terminology to document the plan.

PROBLEM
Any health care condition that requires diagnostic, therapeutic, or educational action. —

RISK NURSING DIAGNOSIS
Human responses to health conditions / life processes that may develop in a vulnerable individual, family, or community. It is supported by risk factors that are present that are known to contribute to the development of a problem.

STANDARDIZED LANGUAGE
A structured vocabulary that provides nurses with a common means of communication.

SUBJECTIVE DATA (SYMPTOMS)
Verbal statements provided by the pt. EX: nausea, fatigue, anxiety.

SYNDROME NURSING DIAGNOSIS
Used when a cluster of actual or risk nursing diagnoses are predicted to be present in certain circumstances. CURRENT: Post-trauma, Rape-trauma, Risk for disuse, Impaired environmental interpretation, Relocation stress.

VARIANCE
When a pt does not achieve the projected outcome. — Exit — Are examined by members of the interdisciplinary team to determine whether the failure to achieve the outcome was a system, provider, or pt problem. — Analysis is used to promote continuous quality improvement.

WELLNESS NURSING DIAGNOSIS
Human responses to levels of wellness in an individual, family, or community that have a readiness for enhancement.

NURSING
The protection, promotion, and optimization of health & abilities, prevention of illness and injury, alleviation of suffering through the diagnosis & treatment of human response, & advocacy in the care of individuals, families, communities, & populations.

FOCUS ASSESSMENT
Is advisable when a pt is critically ill, disoriented, or unable to respond — Gathers info about a specific health problem —

PRIMARY SOURCES OF DATA
The patient.

SECONDARY SOURCES OF DATA
Include family members, significant others, medical records, diagnostic procedures, nursing literature, & other health care team members.

2 BASIC METHODS OF COLLECTING DATA
Pt Interview. & physical examination.

PT INTERVIEW DATA
Health history, biographic data, information about the reason the pt is seeking health care, history of present illness, family history, environmental history, psychosocial history, followed by review of systems.

DATA CLUSTERING
Occurs when related cues are grouped together, attention being focused on health concerns. (Also assists in identification of the nursing diagnosis).

GUIDELINES FOR SIGNIFICANT CUES
1.) Deviations from population norms — 2.) Any change in the pts usual health status — 3.) Developmental delays — 4.) Dysfunctional behavior — 5.) Changes in usual behavior

NURSING DIAGNOSIS COMPONENTS
1.) Nursing diagnosis title/label — 2.) definition of the title/label — 3.) Contributing /etiologic /related factors — 4.) defining characteristics.

RISK FACTORS
Those circumstances that increase the susceptibility of a pt to a problem.

4 TYPES OF NURSING DIAGNOSIS
1.) Actual nursing diagnosis — 2.) Risk — 3.) Syndrome — 4.) Wellness

PT OUTCOME STATEMENT
Provides a description of the specific, measurable behavior (outcome criteria) that the pt will be able to exhibit in a given time frame following the interventions.

Role of Nurse: Change Agent

Change
-process of making something different from what it was
-Everyone affected by change
-Option 1: gaining new knowledge and skills
-Option 2: adapting what is currently known in light of new information

change agents
-Individuals who initiate, motivate and implement change
-Have excellent communication and interpersonal skills
-Have knowledge of available resources and how to use them
-Skilled in problem-solving
-Skilled in teaching
-Respected
-Ability to encourage and nurture
-Self-confident, able to take risks
-Able to make decisions
-Broad base of knowledge
-Good sense of timing

Types of change
-planned
-covert
-overt
-unplanned

planned change
Intended , purposeful attempt to influence

covert change
-Hidden, without awareness
-Example: gradual, subtle increase in severity of illness

overt change
-Aware, create anxiety
-Example: new medication

unplanned change
-Alteration (reaction) imposed by external events or persons:
Usually haphazard
Results might be unpredictable or positive
Situational (death)
Natural (flood)
-Drift..change occurs without effort on anyone’s part

Levin’s Model of Change
1. unfreezing
2. moving
3. refreezing

Levin’s Model of Change: Unfreezing
-Need for change recognized
-Driving and restraining forces identified –> Likelihood of acceptance of change –> If involved, more accepting; Small scale/pilot
-Deal with resistance
-Alternate solutions are identified
-Participants are motivated to change

Levin’s Model of Change: Moving
-Participants agree the status quo is undesirable
-Actual change is planned in detail
-Implemented

Levin’s Model of Change: Refreezing
Change is integrated and stabilized

Chapter 5: Perioperative Patient Care: Anesthesia & Nursing Implications

General Anesthesia
-Emergency Assessments
-Post Op Assessments
Unconsciousness with amnesia, analgesia, reflex suppression, and muscle relaxation.
– Cricoid Pressure may need to be used
– Apply warm blankets pre and post op for shivering
– Emergency assessments include airway patency, return of the reflexes, muscle strength, ability to follow commands.
– Post Op Assessment: LOC, airway patency, CV status, temp, fluid balance, return of neuro function. Assess for Nausea and vomiting, post-operative analgesia, operative site condition.

Cricoid Pressure
During induction of general anesthesia – may need to apply CRICOID pressure to displace the cricoid cartilage and close the esophagus when passing the ET tube to decrease the risk of aspiration – Assess for bilateral breath sounds after passing the ET tube.

Regional Anesthesia
2 types
Signs and Symptoms of Toxicity
Management of Toxicity
Local anesthetic acts on cell membrane, interrupting sensory pathways between surgical site & brain.
Lidocaine Hcl (Xylocaine) acts for 1-3 hours.
Bupivacaine (Marcaine) – 3-10 hours
Signs and Symptoms of toxicity: CNS first affected, THEN CV affected —> drowsiness, numbness tongue, blurred vision, tinnitus, dizziness, restlessness, slurred speech, muscular twitching, followed by convulsions. Also Hypotension, bradycardia, heart block, cardiac arrest can occur.

Management of the above includes: STOP administation of local anesthetic, resuscitation with epi, 02, IVF, aminophylline & hydrocortisone.

Lidocaine Hydrochloride (Xylocaine)
Regional anesthesia – Acts 1-3 hours – commonly used for infiltration, regional IV anesthesia, peripheral nerve block, epidurals, and spinal.

Bupivacaine (Marcaine)
Regional anesthesia – Acts for 3-10 hours – commonly used for infiltration, regional IV anesthesia, peripheral nerve block, epidurals, and spinal.

Infiltration Techniques: Local infiltration
Local: subcutaneous injection at the operative site. Provides sensory blockade of skin & subcutaneous tissue.

Infiltration Techniques: Intravascular Techniques & Nursing considerations.
aka Bier Block – Used for surgeries below elbow or knee. Double bladder tourniquet applied to operative extremity & inflated. Local anesthetic is injected into the distal peripheral vein which provides blockade to the level of the tourniquet.
Tourniquet Time is Crucial – Cannot be less than 30 minutes and greater than 90 minutes in UE and 2 hours in LE (can cause ischemia). Must deflate the tourniquet slowly to prevent systemic bolus.
Must assess for return of normal senstation, color, cap refill.

Peripheral Nerve Blockade
Name the block used for each type:
Upper Extremity
Knee
Foot & Toes
Sensory and motor nerve blockade due to local anesthetic injected around major nerve trunk that supplies the surgical site.
Upper Extremity: Brachial Plexus Block
Knee: Femoral Block
Foot and Toes: Ankle Block

Nursing Considerations: Postop: assess for return of sensory and motor function. If able to ambulate, support the LE until recovery is complete – use resistive device for ambulation.

Central Nerve Blockade
Local anesthesia injected into the spinal canal (subarachanoid space) with resultant sensory, motor, and autonomic blockade.

Central Nerve Blockade – Nursing Assessments IntraOp

– What are dermatomal landmarks?

Intraop- use dermatomal landmarks to assess level of sensory & motor blockade:
L1-2 = groin
T10 – umbillicus
T4 = nipple line

Assess for a high spinal by auscultating breathsounds – anesthetic may travel as high as C4.

Central Nerve Blockade – Nursing Assessments PostOp

-how to assess return of function
-what to monitor for/check for
-rare complications

Monitor for return of sensory and motor function. May Vary – One Leg may regain sensation before the other. Assess motor by having patient: wiggle toes, dorsiflex, raise/flex legs

Return of sensation to both extremities & rectal area = good indication recovery is complete

Check for HYPOTENSION (due to residual autonomic blockade). URINARY RETENTION (nerves supplying bladder are affected). SPINAL HEADACHE

other possible/rare complications: meningeal irritation, cord compromise (fever, pain, tenderness, weakness, paralysis)

Spinal Headache
– Cause
– When do you check for this?
-Prevention
-Symptoms
-Treatment
Can be caused from central nerve blockade (Epidural)
Cause: Dural Puncture with CSF leak
Check for this on the second post op day
Prevention: 25 gauge needle, adequate hydration, — early ambulation doesnt have effect on incidence.

Symptoms: severe frontal/occipital pain that worsens in upright position, nausea, vomiting double vision, tinnitus, dizziness

Treatment: 1st line (conservative) – BR, hydration, analgesics. If ineffective, must have a Blood Patch – 10ml of own venous bloos injected sterile into spinal puncture site to seal the leak. Relief is usually instantaneous.

IV Conscious Sedation

-Use
-Goals
-Monitoring
-Reversal Agent
-Side Effects

Used to promote a depressed level of consciousness but allows patients to maintain patent airway and respond appropriately to verbals instruction & physical stimuli.

GOALS: relaxation, sedation, amnesia, analgesia

Monitoring: Pulse ox, frequent VS checks,
If RN performs, must be his/her only task

Use supplemental 02 for nausea and vomiting control and decrease post op infections (02 helps the alveoi release immune defenses).

Reversal agent: Flumazenil (Romazicon) Also Narcan
Side Effects: N/V, Urinary Retention

IV Conscious Sedation:

Name the Two Classes of Drugs used and the specific meds per each class

BENZODIAZEPINES
Diazepam (Valium)
Midazolam (Versed)

NARCOTICS
Merperidine (Demerol)
Morphine
Fentanyl (Sublimaze)

Induction Agents
List TYPES
Thiopental Sodium ( Pentothal)
Methohexital Sodium (Brevital)
Propofol (Diprivan)
Midazolam (Versed) — reversed by Flumazenil (Romazicon), FYI
Atomidate

Induction Agents
– What is used for maintenance of anesthesia?
– Which drug should you use cautiously with egg white allergy?
– Which 2 can cause burning on injection
Hypnotic agents, used to render the patient unconscious
Propofol and Versed may be used for maintenance of anesthesia
Use propofol cautiously in patients with egg white allergy because it is dissolved in lecithin.
Propofol and etomidate can cause burning sensation on injection.
Some studies show that patients emerge more quickly with propofol rather than with inhalation anesthesia.

Inhalation Agents
List TYPES
Halothane (Fluothane)
Isoflurane (Forane)
Enflurane (Ethrane)
Desflurane (Suprane)
Sevoflurane
Nitrous Oxide (N20)

Inhalation Agents
-What organ absorbs and eliminates?
-What disease process can it trigger?

Which drug does the following:
_______ – Do not use for patients with hx of Seizure
_______- non irritating to respiratory tract, does not predispose to arrhythmia, kidney or liver function
________- shivering is common
________- Higher chance for bronchospasm/laryngospasm

Potent Respiratory depressant agents absorbed and eliminated primarily through the lungs.
MAY TRIGGER MH – malignant hypothermia (except N20)
– Usually given in combo with 02, narcotics, muscle relaxants for balanced anesthesia.
– All potent inhalation agents can cause transient elevation in liver enzymes.

Ethrane – Do not use for patients with hx of Seizure
Sevoflurane – non irritating to respiratory tract, does not predispose to arrhythmia, kidney or liver function
Halothane – shivering is common
Forane – Higher chance for bronchospasm/laryngospasm

Neuromuscular Blockers (Paralyzing Agents)
List TYPES
DEPOLARIZING AGENT
Succinylcholine chloride (Anectine)

NONDEPOLARIZING AGENT
Mivacurium (Micacron)
Atracurium (Tracrium)
Vercuronium (Norcuron)
Tubocurarine chloride (Curare)
Pancuronium bromide (Pavulon)
Pipercuronium bromide (Arduan)
Doxacurium chloride (Nuromax)

Neuromuscular Blockers (Paralyzing Agents)
– Who may give these meds and why
– Mechanism of Action
– Which one can cause malignany hypothermia
– Reversal Agent for the non-depolarizing NM Blockers
All of these render the patient APNEIC. Only for use by anesthesia providers
-All of these meds interfere with action of acetylcholine at the neuromuscular junction, they do NOT affect CNS. – Therefore, these drugs should be used only with other sedatives and narcotics to prevent patient awareness/distress.
-Succinylcholine has been identified as the primary triggering agent for Malignant Hypothermia – So if a patient has history of MH, use any other agent in this class.

Reversal agent for the non depolarizing NM Blockers: anticholinesterase inhibitors.

Anticholinesterase Inhibitors
— Use
— Name the 2 types
–Side effects
Neostigmine methylsulfate (Prostigmin)
Pyridostimine Bromide (Mestinon, Regonal)

Reversal agent for nondepolarizing neuromuscular blocking agents (NOT Succinylcholine since that type is depolarizing)
Act by allowing more acetylcholine to be available to compete with the NM blockers for receptor sites.

Side effects: parasympathetic nervous system effects such as : increased secretions, bronchospasm, bradycardia – Should be given with atropine or glycopyrrolate (Robinul).

Narcan
– Use
– What to observe for when administering
Effective to reverse narcotics only.
-Patient must be observed carefully for renarcotization, as the action of the narcotic may last longer than the action of the narcan. Use careful titration because abolishing all analgesia may produce tachycardia, sweating, nausea, vomiting.

Flumazenil (Romazicon)
– What does this reverse
– Caution to take
Benzodiazepine Inhibitor – Reverses Benzos only.
Effect of the flumazenil may be shorter than the effect of the midazolam – Dose may make patient awake for 15-30 minutes and then they are back to being sedated again.
— Patients who routinely take benzodiazepines have increased risk for seizure activity when they are reversed with flumazenil.

Anticholinergics
List two
– Why given?
-Sife Effect
-What disease is one contraindication?
Atropine Sulfate
Glycopyrrolate (Robinul)

– Given to dry oral secretions, decrease gastric acidity, possibly to prevent preinduction vagally mediated bradycardia
-May cause tachycardia
– Do NOT use in patients with narrow angle glaucoma.

Narcotics
List – There are 6

Which one is short acting, which one is intermediate acting

Fentanyl citrate (Sublimaze) -intermediate acting
Sufentanil citrate (Sufenta)
Alfentanil hydrochloride (alfenta) -very short acting
Morphine sulfate -long acting
Merperidine chloride (Demerol)
Hydromorphone (Dilaudid)

Narcotic Agonist-Antagonists
Pentazocine (Talwin)
Butorphanol (Stadal)
Nalbuphine (Nubain)
Dezocine (Dalgan)

Opiod Agonist-Antagonist
Actions range from potent analgesia to sedative effects, varying respiratory and cardiac depressive effects.

Antiemetics
LIST – (7)
Prochlorperazepine (Compazine)
Trimethobenzamine (Tigan)
Metoclopramide (Reglan)
Promethazine (Phenergan)
Odansetron (Zofran)
Droperidol (Inapsine)

Zofran is “quite expensive” !
Reglan in combination with narcotics will decrease effectiveness
Droperidol should be used with care, may increase BP and cause respiratory depression.

Miscellaneous Adjuncts

Ketamine hydrochloride (Ketalar, Ketaject)

Ketamine: useful nonopiod IV anesthetic related chemically to LSD and PCP – has been associated with vivid dreams, hallucinations, accompanying wild behavior in early postoperative period.
-benzos decrease incidence of hallucinations for patients on ketamine.

Stimulates the sympathetic nervous system, good for a patient experiencing bronchospasm or hypotension.

Can be used alone for short procedure because respiratory function remains intact — Patients receiving Ketamine in this fashion become dissociated with pain and amnesic for the event.

Miscellaneous Adjuncts

Ketorolac tromethamine (Toradol)

Nonsteroidal antiinflammatory drug – Injection can help with post op pain.
Can be used on regular schedule for short term post operative pain control.
No side effect of Respiratory Depression

Theory of Nursing – MidTerm Exam

What is important about 1750
1st hospital established
Penn Hospital

What happened in 1790s?
US Marine Hospital Service
Act of Congress for Public Health

Who is Clara Barton
Angel of the battlefield
Established the Red Cross

What are the four metaparadigms in nursing theories?
person
health
environment
nursing

PHEN (Paradigm = Phen)

What are the six criteria for theory acceptance?
simplicity
consistency
accuracy
relevance
fruitfulness
inclusiveness

SCARFI (need a scarf-I in order to be accepted)

Who is Florence Nightingale?
Cannons of Nursing
1860
“Lady with the lamp”
Investigates the effect of environment on healing
Ventilation, warming, noise, variety, diet, light, cleanliness

Florence Nightingale’s Contributions
Hygeine/cleanliness

Documentation of everything!
– use of statistics to improve health
– early research
– Founded 1st training school for nurses at St. Thomas’s hospital in London

Influential in training some nurses that helped in Civil War

Jean Watson: Theory of Human Caring 1971
Holistic outlook addresses the impact and importance of altruism, sensitivity, and trust (& interpersonal skills)
** Living Legend

Dorthea Orem: Self-Care Deficit Model 1979
Nurse implements appropriate measures to assist the client in meeting self-care needs

Hildegard E. Peplau: Interpersonal Relations as a Nursing Process 1952
Identified the client’s feelings as a predictor of positive outcomes related to health
“Peplau Predicts Positive outcomes”

Sister Callista Roy: Adaptation Model 1974
Adaptation will occur by assisting the “biopsychosocial” client in modifying external stimuli
6 physiological needs…
(nurse is the change agent that modifies whatever is going wrong so that it is more conducive to the patient)

Martha E. Rogers: Science of Unitary Human Beings 1970
Nurse promotes synchronicity between human beings and their universe/environment
“Energy Fields/Openess”

Ida Orlando 1960
Developed Nursing Process
ANOPIE (ADOPIE)
(assess, nursing diagnosis, outcome identification, planning, implementation, evaluation)

Virginia Henderson
Definition of Nursing! Modern day Flo Nightingale
14 essential functions towards independence –
(don’t overhelp patient, let them work towards ADLs)

Myra Levine: Conservation Model
Four principles of conservation of inpatient client resources:
Energy & Personal/Structural/Social Integrity
(PESSi =)
** Lamonica’s favorite

Betty Neuman: Systems Model
Wellness-illness continuum = supports the notion of prevention through appropriate intervention

Primary – prevention

Secondary – Early detection of illness and effort it prevent for escalating

Tertiary – Treating illness

(“Neuman”salad dressing where primary is fat free dressing, secondary light dressing, teriary is full fat dressing)

Imogene King
Goal Attainment Theory: Collaboration for goal
Nurse-client transactions to set and obtain goals

(nurse & patient have to have the same “IMAGE”to attain goal and be the KING of recovery)

Madeline Leininger
Theory of Cultural Care Diversity & Universality
Values & beliefs within a culture impact health practices
Ethnohistory are essential to four concepts: care, caring, health & nursing

Rosemarie Parse
Theory of Human Becoming
Quality of Life – nurse works with patient’s perceived quality of life in order to set goals
– Not fixing what is wrong, just working with patient on their goals.

Patricia Benner
Primacy of caring; the practice of nurses depends on the experience absorbed by engaging in five areas/levels (novice, advnced beginner, competent, proficient, expert) within the seven domains of nursing practice.

(Patricia = Practice skills
Benner = Better nurse)

Faye Abdellah
Better Nursing Care thru Research
Better patient-centered care through nursing research making the nurse the “problem-solver”

(abDELLah =RESEARCH on dell computer)

Ernestine Wiedenbach
Best known for Theory Development:
Family-centered maternity care

– got expelled from John’s Hopkins but later put back in program by Adelaide Nutting

Fruitful Nursing
Generates new direction for future research

Phenomena
Observable fact or event

complex and dynamic conceptual building blocks, are the basis of our nursing language

Theory
Group of related concepts (at least 2) that explains the phenomena that predicts future events
– abstract generalization
– Presents a systematic explanation

Concept Models
aka= framework

Common theme
Conceptual framework/model
More loosely structured than theories

Nursing Science related to Nursing Theory
Collection of Data
Related to nursing
Applied to nursing practice
Guides nursing practice
Goal is better client outcomes
Guides nursing research

Which events led to the first recognition of African Americans in nursing?
Mary Seacoyle efforts in the Crimean War

– She improved health conditions for British soldiers

Health Contributions – Early Civilizations
PREHISTORIC
• Evil spirits make illness
• Thought that you got sick because there was curse on the body/person
• Guided magic
• Religion
• Superstition
• Tribal rituals
• Evil spirits dispelled

Health Contributions – Early Civilizations
EGYPT
Preventive measures – created laws to promote cleanliness in order to prevent disease
Documentation (calendar & writing)
Pharmacopeia: 700 drugs
First to use sutures
Early midwives (saved baby Moses)

Health Contributions – Early Civilizations
PALESTINE
Created by Moses = Mosaic Law
Cause and Effect:
– laws to prohibit eating animals more than 3 days old
– Isolate those with communicable disease

Health Contributions – Early Civilizations
GREECE
Created the wisdom & immortality symbol

Gods controlled the illnesses

Paved way for scientific method

Hippocrates: Father of Medicine

Health Contributions – Early Civilizations
INDIA
Male staffed nurses

Importance of prenatal care

Surgery

Health Contributions – Early Civilizations
CHINA
Confucius

Moral Obligation to Society was basis for education & gov’t
– family unit, community

Yin & Yang
– balance = good health

Ancient Chinese Medicine
– Acupuncture
– hydrotherapy
– herbs
– massage
– exercise

Health Contributions – Early Civilizations
ROME
1st Military Hospital

Adapted medical practices from those they enslaved
– Galen (Greek) made important medical contributions as a slave

Both male & female took care of sick

Health Contributions – Early Civilizations
MIDDLE AGES
Women of nobility took care of sick
Use of purging (leeches and mercury to cause bleeding done by barbers)
Female nurses had limits in how they could care for male patients (even male babies)
Use of Christian concepts in charity and sanctity in Nursing

Health Contributions – Early Civilizations
RENAISSANCE
Major advances in medicine
– medical education, not nursing education
– use of cadavers
– pharmacy/chemistry/surgery/A&P

Health Contributions – Early Civilizations
COLONIAL PERIOD (Americas)
First Hospital in the Americas – Medical School of Mexico

Plagues – yellow fever, typhoid, small pox

Still used purging (bleeding)

Impact of war on nursing:
More women became nurses when their economic opportunities were scarce.

Dr. Jonathan Letterman
Father of modern military medicine

Created field hospitals to improve response time

Antietam Battle of Civil War
Bloodiest battle

Triage & early response

North had better care and were more organized with supplies and training.

Clara Barton assisted = “Angel of the Battlefield”

African-Americans Union Nurses
Harriet Tubman – established underground railroad

Sojourner Truth – insisted on better sanitation & cleanliness

Susie King Taylor – taught soldiers to read and write

Dorthea DIX during Civil War
Started volunteer training programs (for both sides of war)

No pay, no formal title

Required that nurses be over 35, plain, no jewelry, no hoopskirts

Organized for the North

Civil War in the South
Sallie Thompkins – only woman to hold military rank in Confederacy

Phoebe Pember – matron at Chimborazo Hospital in Richmond
– Documentation! Records now kept on patients
– hospital for the Confederacy
– now a museum

Other Civil War Nurse Leaders
Louisa May Alcott – nurse for 6 week, got ill, became author

Civil War Field Hospitals
Male nurses = assist in surgery/amputations
Female nurses = cooks/laundry/ only helped in nursing when wounded patients ↑

more than 6 million hospitalized

What is true about Crimean War & Civil War
History repeats itself…
They both had epidemics (small pox, thyphoid fever)

Post Civil War
First nursing text

Atlanta Baptist Seminary (later called Spellman College) – 1st nursing school for African-Am female nurses

North segregated by custom, south segregated by law

World War I
US Army Corps Nurses
– most were non-commissioned
– 1st nurse to go before a firing squad (from Belgium)

Need for Nurses
– add campaigns
– 1:3

World War II
Army & Navy Nurses
– 2 year cadet program
– Nurses as military officers
* 1st participated in combat at mobile field hospitals
* “Angels of Bataan”

Nurses during Korean War
Early M*A*S*H units
– launched trauma & critical care

Nurses during Vietnam War
Navy nurse
Corpsmen
Medics

Nurses during War in Iraq
More modern
?

Lessons learned from Civil War
Triage
First Responders
Coordinated, progressive system of response
Surgical field units

Trends in nursing
2nd highest demand for employment
– nurses are the highest # of health care workers

Nursing Shortage
– Pres Bush created nursing scholarships

Lacking nurse educators

Increased workload in hospitals

Nursing Research
Systematic approach used to examine phenomena important to nursing and nurses.

This clinical practice must be based on scientific knowledge = use of scientific method

Evidence generated by nursing research provides support for the quality and cost-effectiveness of nursing interventions.

Nursing Science
The collection and organization of data related to nursing and its associated components.

The purpose of this data collection is to provide a body of scientific knowledge, which provides the basis for nursing practice.

Who was the first Nurse Researcher?
Florence Nightingale

What is researched?
Study of nurses helps us to understand how to improve patient care.

Recent focus is on patient outcomes

Why do we need research in nursing?
Provide descriptions

Explanations

Predictions

Useful to improve nursing care

What does it mean by, “Nursing research is related to and informed by nursing theory and nursing in turn influences them?”
Nursing theory as the abstract generalization of phenomena

Nursing research is the systematic approach to scientifically explain/support the theory

Nursing practices are influenced by results of research and research is fueled by practice

Deductive Reasoning in Research
Researcher works from the more general information to the more specific.

A.k.a, “top down” Researcher starts at the top with a very broad spectrum of information and they work their way down to a specific conclusion.

Begin with a theory about topic of interest & then narrow that down into more specific hypotheses that can be tested. The hypotheses are then narrowed down even further when observations are collected to test the hypotheses. This ultimately leads the researcher to be able to test the hypotheses with specific data, leading to a confirmation (or not) of the original theory and arriving at a conclusion.

Inductive Reasoning in Nursing Research
Moves from specific observations to broader generalizations and theories.

AKA= a “bottom up” approach. The researcher begins with specific observations and measures, begins to then detect patterns and regularities, formulate some tentative hypotheses to explore, and finally ends up developing some general conclusions or theories.

Research with Human Beings
IRB must approve research proposals
– Main goal is to protect the research participants
– Strenuous research guidelines mandated

* Stems form past problems of abuse to research subjects

Steps in the Research Process
PROBLEM identification
Define PURPOSE of study
REVIEW OF LITERATURE
Formulating RESEARCH QUESTION or HYPOTHESIS
STUDY DESIGN – METHOD
Selecting a SAMPLE & SETTING
PILOT STUDY

(Problem, purpose, literature, hypothesis. design-method, sample, pilot) pplhdsp

Steps to Carry out and Analyze Research
DATA COLLECTION
DATA ANALYSIS
MAKING SENSE OF DATA
Discussion of FINDINGS
DISSEMINATION OF FINDINGS

Study Design Methods
Quantitative
(statistical analysis of numerical data, knowledge of very precise topics)

Qualitative
(research designed for discovery rather than verification, looking to explain phenomena or process rather than to verify a cause & effect)
Ex: one on one interviews

Mixed: Triangulation
(The use of various research methods or different data collection techniques in the same study)

Evidence-based Nursing
The process of systematically finding, appraising, and using research findings as the basis for clinical practice

Evidence-based practice challenges nurses to look at the “why” behind existing methods and processes in the search for improvement.

Why is evidence-based nursing important (to practicing nurses and student nurses)?
Uses research for nursing practice

Improves standards of care

Critical awareness or research

Helps in learning to critique research articles

What questions can be asked to make better practices as a result of more research?
Asking ‘Why?’
Asking ‘Why Not?’
Asking ‘How this can be made better?’
Asking ‘Does this make a difference?’

What does ethic in research involve?
Prevention of violations

Protections in place IRB
– self-determination
– privacy
– confidentiality (anonymous)
– fair treatment
– protection from discomfort and harm

Concerns for vulnerable populations

Magnet Status
Nursing-based research!

This encourages the nurse to flourish as a professional, focuses on professional autonomy, decision making at the bedside, involves nursing in determining the nurse work environment, provides professional education and promotes leadership. Magnet recognition means that collaborative working relationships are fostered. Teamwork and positive relationships among different departments and disciplines are demonstrated.

Historical Ethical Abuses in Research
Nazi Germany

Tuskegee Syphilis Study

Protection of Human Subjects
Nuremberg Code
Set of research principle for human experimentation as a result of Nuremberg Trials at end WWII

Declaration of Helsinki
Applicable principles regarding human experimentation developed by the world medical association. Regarded as cornerstone document of human research ethics

NIH Guidelines

IRB (institutional review board)

Once research is done, how do you evaluate it?
Findings
– include statistical significance

What were study limitations

What would you do different next time

Nursing Image
Angel of Mercy/Alleviation of Suffering

o Varied historically: prostitutes, women of wealthy nobility, religious orders.

o Victorian: women innately sensitive- high morals/ sensitivity, breeding, intelligence, and ladylike behavior, including submission to authority

o Current: Professional

How has the nurses image changed over time?
Caps have disappeared
Uniforms have changed
Nurses are generally seen as honest and ethical
Truth is most important

What initiatives are there to improve the image of nursing?
Woodhull study on nursing and media- nurses are essentially invisible to media and consequently to American public
Johnson and Johnson campaign- recruiting efforts
Center for nursing advocacy- to encourage accurate portrayal of nurses in media
Professional, caring, competent

Traditional View of Women and its effects on nursing
Traditional Role of women: western culture- passive, dependent, affectionate, emotional, expressive

Expected to avoid risk raking and conflict; to give in to authority, to seek careers suitable for females

Stereotype of intellectual inferiority

Effects on status and pay

Men in Nursing
Provided care- 11th, 12th, 13th centuries- military religious orders – 1st male commissioned as a nurse 1955

Separate educational programs- up until GI Bill
• GI Bill- post WWII- more funding for education of military corpsmen

6-8% men in nursing today

Special concerns for males in nursing
• Role strain
• Discrimination from practicing nurses, MDs, and the public – “why are they still called “male nurses”??
• Physical strength may be emphasized
• May not be welcomed in some settings
• Hiring preference given to men?
• Seen as having more leadership potential?
• Given preferential treatment by male MDs?
• Earn more money?

Nursing Education
o Hospital Based practical training programs
o University based: 4 year traditional/ 2nd degree programs
o 1869-1900: formal education and training schools for nurses
civil war prompted formal nursing training schools
early schools used Nightingale model

Which Schools Opened in 1873?
• Bellevue Training school for nurses
• Connecticut training school for nurses in New Haven
• Boston Training school for nurses as Mass General
o Linda Richards is first trained nurse in US
• Schools remained segregated

What are the different levels/types of Nursing Education
Licensed Practical Nurse (LPN/LVN) – mainly technical skills, supervised by RN
Hospital – Diploma / On-the-job Experience
Associate Degree – 2 years / Nursing License
Baccalaureate – 1st Yale (1924)
1st 4-year (1923-24) Western Reserve
Arts & Science Foundation
Masters (MSN) – education / administration
1960’s – Focus changed – Clinical Expertise
Role of Advanced Practice Nurse (NP)
Doctoral Programs (Education/Pracitce/Research)
DNSc
PhD
DNP – advanced clinical practice
New focus on Education: Online/Distant Learning

First Professional Organizations
o nurse leaders from US, Canada, UK – met at Chicago World’s Fair (1893)—nursing education

o concerns: lack of uniformity of nursing education programs and need for scientific training

o formed American society for superintendents of training schools for nurses—later, national league for nursing (NLN)

Roots of Nursing Organizations
Isabel Hampton Robb (1896) founded Nurses’ Associated Alumnae of US – later American Nurses Association (ANA).

Bedford Fenwick – founded International Council of Nurses (1899).

National Association for Colored Graduate Nurses (1908) to raise standards & eliminate discriminatory practices.

African American nurses no full participation in ANA till 1950’s.

Other Nursing Leaders
Lavinia Dock: formalized public health nursing @ Henry Street Settlement (NY).

Jessie Sleet Scales: African American nurse established Stillman House – community health services to African Americans in NY

The impact of the Great Depression & Social Legislation on Nursing
In 1920s and 1930s, trained nurses were employed primarily as private duty nurses.

1929 -Depression – no longer funds for private duty

Civil Works Administration (1933) provided nursing employment in rural & school settings.

Hospitals forced to close schools of nursing, & began to hire trained nurses as staff.

Why was the Social Security Act (1935) important?
Public health money for care to mothers, children, & blind

Encouraged the evolution of public health nursing.

Social Security Amendments in 1965
Medicare & Medicaid – access to health care for elderly, poor, & disabled.

Much of hospital care funded by Medicare and Medicaid.

Nurses stayed primarily in hospital settings.

Specialties in nursing – 1960s (psychiatry, critical care, coronary care, nurse practitioners)

What is the Hill Burton Act of 1946
Federal funds to construct hospitals.

Rapid expansion of facilities resulted in nursing shortage (Larger buildings but less staff – as today?)

Traditionalist (Veterans) Generation
[Differences in work ethic/learning]
• Born: 1922-1945
• Nursing School in 40s-50s / early 60s
• Most diploma school / later BSN
• “Greatest Generation” (born betw. 1922-1945 / Nursing career began in 1940’s – 1950’s)
• Built their reputation -WWII; war effort
• Did as they were told
• Did not question authority
• Learned “on the job” and books
• Strong country and work values
• Loyalty – same hospital or company
• **Have earned respect – more formal

Baby Boomers Generation
[Differences in work ethic/learning]
• Born 1945 – 1960 (most faculty):
• Nursing School in late 60’s / 70′ / early 80’s (“hands-on” and textbooks)
• Most BSN / some started with Associate
• Grew up in time of economic prosperity & societal changes (civil rights; marches)
• Value collective action, organizational involvement, causes, &social justice / loyal to cause or an institution
• Highly competitive; sacrifice for success
• Recognition; value respect but “non-traditionalists”
• More relaxed – personal style
• 1970s- still the white dress, hose, shoes, and caps

Gen X Generation
[Differences in work ethic/learning]
• Born 1960 – 1980’s
• Nursing School in late 80’s / 90’s / present
• Nursing in 21st Century
• Commitment to profession BUT within degree
• (Loyalty to one institution is over-valued)
• Value alternative work environment, flexibility, accelerated career mobility
• “Instant gratification” – dynamic work & learning environment; online – instant feedback – emphasis on outcomes not process (hate meetings)
• Task: seeking balance and perspective in lives (they have watched on parents “work themselves to death”, divorce, etc…)

What can we learn from the Generational Differences?
Conflicting values
Different ways of learning
Communication

Discussion—bridging the gap:
• Creating better communication
• Interactive strategies
• Working together

What does the phrase, “not your Mama’s nursing” mean?
• In Past
o Formality – uniforms – starched white with cap
o Stand up when Doctor comes in
o Less decision-making
o Limited men in nursing
o Limited technology – paper documentation
o Limited roles for nurses

Describe Nursing Today
o Professional but less formal (colorful scrubs; name tags)
o Collaboration with Doctors – most of the time….
o More men in profession
o More technology (sometimes complex; sometimes a burden) E-charting
o More decision-making
o More nursing advancement

What has and has not changed in 21st Century Nursing?
What has changed:
• More drugs
• Complex technology
• Teaching methods

What has not changed:
• Patient centered
• Respect for patient
• Striving for best care
• Making patients comfortable / caring!!

What are the employment trends in nursing?
58%- full time nursing

5.7 – Employed RNs are males

Largest number of health care workers in US

Average age (2004)- 46.8 y.o.
• 8.1% of newly licensed RN were under 30

What is the educational preparation of practicing nurses today?
• 17.1% diploma
• 33.7% associate
• 34.2 % bachelors
• 13% master’s or doctorate

What is outlook for employment in nursing?
• Highest growth will be in community settings, and specific hospital sectors: same day surgery, rehabilitation, outpatient cancer centers.
• Home health and long term care have great growth potentials.**
o Clinics, Schools, Home, Daycare, Nursing Homes
• Hospitals: 56.2%
• Community health/Public health: 14.9%
• Ambulatory care: 11.5%
• Nursing homes: 6.3%

What is the Nursing Process
(definition)
o Organizing framework for professional nursing practice
o Given to us by Ida Jean Orlando
o Scientific Problem- Solving Approach
o Deliberate
o Applicable to all Client-Nurse Situations
o May be used with any Nursing theory
o Steps of Nursing Process- nursing care plan developed from these steps
Assessment-

What is SUBJECTIVE data?
Process in which data relating to the patient’s problem are elicited from a patient or a patient’s family. The data are retrieved from the patient’s description of an event rather than from a physical examination, which provides objective data. The interviewer encourages a full description of the onset, the course, and the character of the problem and any factors that aggravate or ameliorate it

o History from patient
o From family members
“my baby had a fever yesterday”- subjective- this is what she is telling you
o Medical records
o Other professionals
o History of present illness
How long has this been happening?
Does anything help?
Has this happened before?
o Past Medical history
What medications are they on?
Any other health problems?

What is OBJECTIVE data?
The process in which data relating to the client’s problem are obtained through direct physical examination, including observation, palpation, percussion, and auscultation, and by laboratory analyses and radiologic and other studies

o Anything that you observe
o Vital signs, height, weight, physical assessment, labs, x-rays, other diagnostic tests

What is the Nursing Diagnosis?
• Information (subjective and objective) collected from patient assessment used to identify a problem/concern/area of interest
• A standardized listing of diagnoses developed by north American nursing diagnosis association (NANDA)
• Developed by analyzing collected information (data)
o A clinical judgment about individual, family or community responses to actual or potential health problems or life processes

How does the nursing diagnosis relate to nursing care?
o Helps determine appropriate nursing actions (interventions)
o Collection of symptoms or behaviors
o Unique to a particular patient care situation
o Nursing diagnosis- not medical diagnosis
o Should be individualized
o Note: not one size fits all!

What are nursing diagnosis statements?
o Standards from north American nursing diagnosis association (NANDA)
o Others may fit better
o Individualize according to each patient situation, age, etc.

Outcome Identification
• NIC= Nursing intervention Classification
• NOC= Nursing Outcome

o IE: nursing Dx: ineffective breathing pattern
NIC: encourage slow, deep breathing; turning; coughing
NOC: client will report that he can breathe comfortably within 20 minutes

Planning Interventions
• Plan is based on:
o Data from assessment (subjective/objective data)
o Nursing diagnosis
o Priority of the patient problems identified
o Age and condition of the patient

Maslow’s Hierarchy of Needs
useful for setting patient priorities
o Self actualization
o Self-esteem
o Love and belonging
o Safety and security- physical and psychological
o Physiological- oxygen, fluids, nutrition, body temperature, elimination, shelter, sex

NANDA
(North American Nursing Diagnosis Association)
Developed standardized interventions and outcomes that complement the nursing diagnoses
o These are called NICS and NOCS

Implementation
• Care is given as planned

Evaluation
do those steps, if something changes start over
• Outcomes that were hoped for are reviewed
• To determine if they have been achieved
• Sometimes re-evaluation of plan is necessary

Important events in nursing in the 1800’s
1850 – Crimean war
1860 – 1st nursing school in London created by Flo
1860’s – Civil war
1880’s – post civil war
1890’s – nurses assoc. established

Important dates in the 1900’s in nursing
– 1st nursing journal published
– WW I advances in nurse care
1920’s – Shepard-Townes act gives federal aid to maternal & child health care
– sigma theta tau founded
1929 – Great Depression
1935 – 1st social security act passed
– changes in WW II
1940’s – nurse trainee bill
1950’s – Korean War
– code for prof. Nurses
1960’s – Medicare/Medicaid
– advance practice nurses
1970’s – Vietnam war
– bill of patient rights
– roe v. Wade (legalize abortion)
1980’s – AIDS increasing epidemic

nursing 100 exam 1-UL Lafayette

Dean of the College of Nursing and Allied Health
Dr. Gail Poirrier, DNS, RN

Associate Dean
Dr. Melinda Oberleitner

BSN Department Head
Dr. Lisa Broussard

BSN Coordinator
Deedra Harrington

caring, art, science, client centered, holistic, adaptive, a helping profession and concerned with health promotion, maintenance, and restoration
Nursing

what two elements make up nursing
science and art

what element of nursing is based on analytical framework, knowledge and skills in critical thinking, familiar with medical terms, procedures, medications, and disease mechanisms, how to work new equipment and machines, and is an evidence based practice
science element of nursing
(“the nursing process”)

what element of nursing is based on caring and respect for human dignity for the whole person (physically, mentally, emotionally, and spiritually), embraces healing fostered by compassion, helping, listening, mentoring, coaching, exploring, presence, supporting, touching, intuition, empathy, service, cultural competence, tolerance, acceptance, nurturing, mutually creating, and conflict resolution
art element of nursing
(“the human touch”)

nursing is the protection, promotion, and optimization of health and abilities, prevention of illness and injury, alleviation of suffering through the diagnosis and treatment of human response, and advocacy in the care of individuals, families, communities, and populations
American Nursing Association (ANA)
-NURSE

nursing encompasses autonomous and collaborative care of individuals of all ages, families, groups and communities, sick or well and in all settings. It includes the promotion of health, the prevention of illness, and the care of ill, disabled and dying people
World Health Organization (WHO)
-NURSE

nursing encompasses autonomous and collaborative care of individuals of all ages, families, groups and communities, sick or well and in all settings. It includes the promotion of health, the prevention of illness, and the care of ill, disabled and dying people. Advocacy, promotion of a safe environment, research, participation in shaping health policy and in patient health systems management, and education are also key nursing roles
International Council of Nurses (ICN)
-NURSE

what are characteristics of a profession
-controlling own work
-special body of knowledge
-plan of formal education
-competence
-control work over preference
-service to society
-self-regulation
-credentialing systems to certify competence
-legal reinforcement of professional standards
-ethical practice
-collegial subculture
-intrinsic rewards
-societal acceptance

leaders in professional nursing who are:
-responsive to health care needs
-evidence-based practice
-safe care
-high quality care
-meaningful use of informatics
-meaningful use of patient care tech
through
-commitment
-quality education
-research
-scholarship
-service
values
-altruism
-autonomy
-caring
-human dignity
-integrity
-lifelong learning
-social justice
this is the aim of UL BSN Program to produce nurses with these characteristics and values

___ defines professional nursing as specifically trained professional that addresses the humanistic and holistic needs of patients, families and environments and provides responses to patterns and/or needs of patients, families, and communities to actual and potential health problems. The professional nurse has diverse roles, such as health care provider, client advocate, educator, core coordinator, primary practitioner, and change agent
Cherry

Nursing has..
-___ that begins in the institution of higher learning and continues throughout the professional career
-an increasing body of knowledge based on theory that is well defined and strengthened through _________
-a ____ process that inculcates the norms and values of the professional culture
– _______ or the ability to govern itself and its practice
– work that has social value and provides a ________ to the public
-adherence to a code of ___
-_____ to the work over personal gain
-education
-evidence
-socialization
-autonomy
-service
-ethics
-commitment

what are the professional nursing roles?
-“the helping role”
-“the teaching-coaching function”
-“the diagnostic and patient- monitoring function”
-“effective management of rapidly changing situations”
-“administration and monitoring of therapeutic interventions and regimens”
-“monitoring of and ensuring the quality of health care practices”
-“organizational and work-role competencies”

According to ____ (1984) nurses use many competencies as they engage in clinical practice. she organized these competencies into seven categories according to the roles and key function that fall within the domain of professional nursing
Benner

in order to assume safe quality patient care based on evidence practice nurses must be mindful of the necessity for…..
-theoretical and conceptual frameworks
-the nursing process
-standards of practice
-nurse practice acts and nurse licensure laws and regulations
-national and international codes of ethics

BSN curriculum components are
-______
-______
-______
-American Association of Colleges of Nursing (AACN)
-Louisiana State Board of Nursing
-University of Louisiana at Lafayette (SAC)

this BSN component involves the essentials of BSN education for professional practice (2008)
American Association of Colleges of Nursing (AACN)

this BSN component involves the Louisiana State Practice Act
Louisiana State Board of Nursing

this BSN component involves the nursing department mission statement
University of Louisiana at Lafayette SAC

what are the essentials defined by the American Association of Colleges of Nursing (AACN) in the year 2008
-provides curricular elements and framework for BSN curriculum
-adresses key stakeholders’ recommendations
-recommends core knowledge required of all healthcare professionals when addressing landmark documents (IOM)

the essentials defined by the AACN in 2009 are:
-there are ___ BSN curriculum essentials
-the essentials include practice focused outcomes that integrate ___, ____, and ____
-essentials 1-9: ____ expected BSN graduate outcomes
-essential 9: describes the generalist nursing practice at the completion of __ nursing education
-achievement of outcomes enable graduates to practice within complex health care systems and assume roles as: ___ of care, __/____/___ of care; and members of a profession
-9
-knowledge, skills, and attitudes
-delineate
-baccalaureate
-provider, designer/manager/coordinator

University of Louisiana Lafayette nursing curriculum consists of:

-didactic courses
-clinical component

the ULL BSN program of studies consists of
-overview of nursing curriculum courses displayed
-academic advisors use curriculum guides to advise students during ___
—-Courses are organized from ___ content to ___
-each subsequent course content is presented to reflect a ______ of knowledge and skill
-semester registration
-simple content to complex content
-higher degree

understand the rigor of nursing:
– knowledge taxonomy is based on the 6 levels of ______
-due to the rigor and demands of the didactic coursework and laboratories, clinical practice experiences, ongoing homework and studying, the BSN students should understand that it is essential that students develop or improve their ____ and ______ skills.
-Bloom’s Taxonomy
-study and time management

[successful matriculation in higher edu]
two personal skills involved in nursing edu
-memory
-motivation

Memory consists of what 3 subcategories:
-_______
-limited space
-gorge and purge; cramming
-_______
-almost unlimited space
-rehearsal
-must be meaningful
-use active learning strategies
-______
-new knowledge builds on old knowledge
-short-term
-long-term
-cumulative

what 2 types of academic motivation are defined
intrinsic
extrinsic

the motivation that comes from within. you do something because you want to or because you gain personal satisfaction by doing it
intrinsic motivation

is motivation that is gained from external rewards
extrinsic motivation

most people have both __ and __ motivation
intrinsic and extrinsic motivation

Nursing success can only be achieved through
-_____
-_____
-_____
-______ and ____
perseverance
setting of realistic goals
strong organization
physical and mental measures

times will get tough and you will get tired but keep your eye on the goal and keep in touch with your motivations
perseverance

there are only 24 hours in a day. work full-time, while going to school full-time and having an active social life may be unrealistic and setting you up for failure and frustration
setting of realistic goals

complete and commit to the time management inventory that includes “to do” lists, personal task schedules, school obligations, family and social obligations. set priorities and avoid over scheduling
strong organization

allows work and life balances
Physical and Mental measures

[study and learning strategies] includes:
– ____
– ____
-unit objectives
-lecture
-assignments and readings
– ____
– ____ and ____
– ____
– ____
-environment
-make study plan
-organization
-practice and repetition
-study groups
-supplemental materials

[prep and study]
-minimum estimated study time is __ hours of study per week per hour
-15 credit hours x 2= minimum of ___ /week
-study environment should be
– ____ free and ___
– turn off ___ and ____
-2
-30
-distraction free and comfortable
-phone and television

[organization and self-direction]
-____: keep a calendar and refer to it daily
-___: check email and Moodle sites frequently
-___: it is the expectation that students will respect all deadlines (due dates) without the need for prompting it
-calendar
-communication
-self-direction

[test anxiety]
Prevention
– adequate preparation
– adequate rest
– arrive __ for tests
– __ before starting
– focus on __ you are doing, not __ you are doing it
-early
-relax and breathe
-what/how

Seeking professional help

-stress management
-counseling

what are 3 concepts that are needed for success in nursing:
planning
preparation
hard work

[t/f]
The mission of the Department of Nursing is to prepare leaders in professional nursing who are responsive to the health needs of diverse cultures through delivery of evidence-based practice, safe and high-quality care, and meaningful use of informatics and patient care technology.
T

According to the “methods of evaluation” in your N100 Course Packet, participation is worth what percentage of your N100 grade?
5%

The combined weight of the 4 on-line Moodle quizzes for NURS 100 is worth what percentage of the total N100 grade?
14%

This Baccalaureate Program Outcome includes the competency of using a holistic approach to provision of care.
core knowledge

According to the Baccalaureate Program Graduate Outcomes and Competencies in your N100 Course Packet, “integrating best practice guidelines with clinical expertise…” is associated with which outcome?
evidence-based practice

Delivering quality nursing care while recognizing the patient’s preference, values and needs is associated with which of the following Baccalaureate Program Graduate Outcomes?
patient centered care

[t/f]
N100 Unit 1 covers Chapter 1 “The Evolution of the Nursing Profession” from your text book Contemporary nursing: Issues, trends, & management.
F

Which Chapter in Contemporary nursing: Issues, trends, & management are you assigned to read for Unit 7, Regulation of Nursing Practice?
Chapter 4

[t/f]
Due dates for N100 assignments can be found in the N100 syllabus?
F

Student responsibilities regarding NURS 100 include which of the following; Check all that apply.
-Students are responsible for checking your email at least weekly and at least (2) two days before the next class.
-Each student is expected to be prepared for each classroom experience.
-Students with disabilities (including learning disabilities requiring extra time and/or quiet room) must notify their instructors as soon as possible and complete a form in Student Services.
-Students are encouraged to sign up for University of Louisiana at Lafayette’s emergency notification system. Information from ULink: ‘FirstCall’

When corresponding with instructors through email or telephone make sure to include your full name and Nursing 100 section number.

[t/f]
it is the expectation that all UL Lafayette nursing students will have a copy of the UL at Lafayette College of Nursing and Allied Health Professions Department of Nursing Student Handbook.
T

The minimum cumulative GPA required for admission into the 200 level nursing courses is
2.8

Each student should be sure that compliance of UL Department of Nursing Core Performance Standards is achievable without unreasonable dependence on technology or intermediaries. These standards have requirements in which of the following skills, attributes and qualities: Check all that apply.
-professional relationships
-behavioral
-critical thinking and communication
-mobility and motor skills
-hearing, visual, tactile

The minimum accepted grade for required courses (both nursing and non-nursing) is a/an
C

A student who changed majors from kinesiology to nursing is now applying for admission to the first nursing clinical course, NURS 208. Which previously taken courses will be included when calculating the student’s cumulative GPA?
only the first 2 KNEA courses

In the event of enrollment limitation (full classes), when considering GPA for admission into any level nursing course, the College Of Nursing and Allied Health Professions [CONAHP] Department of Nursing considers
the cumulative GPA

A student enrolled in Nursing 208 withdraws from the course in the fall semester and then earns a grade of “D” in Nursing 208 in the subsequent spring semester
will not be allowed to major in nursing at ULL

A student who earns a “D” or “F” in 2 or more required non-nursing courses
will not be allowed to major in nursing at ULL

Which criminal background investigation is required for non-licensed and non-certified students for admission into the 208 clinical nursing courses?
level I

Drug and alcohol screening will be conducted at:
SAMHSA and /or CAP-FUDT certified lab

When is a drug and alcohol screen required for UL Nursing Students?
-Suspicion of being under the influence of drug or alcohol anytime during the semester
-Prior to admission into first clinical nursing course
-Randomly
-Clinical nursing students who are involved in an accident/incident or a medication handling discrepancy may be required to submit to testing.

Possible consequences of a positive drug/alcohol screen include:

A. denied admission to clinical nursing courses

B. dismissal from clinical nursing courses

C. test results reported to the Louisiana State Board of Nursing (LSBN)

D. referral to a Louisiana State Board of Nursing (LSBN) approved evaluator for assistance in dealing with drug abuse

A, B, C, and D are correct

When will a student who has had a positive drug/alcohol screen be allowed to return to clinical courses?
With written approval from the Louisiana State Board of Nursing (LSBN) and compliance with drug/alcohol testing requirements

A student who arrives late for an exam will
be allowed to take the exam only if no other students have completed the exam and left the room

While taking an exam in a nursing class, a student’s cell phone starts ringing. This student should
expect an automatic 10% deduction from exam grade

A student misses an exam because of a routine scheduled chiropractic appointment. This is
considered an unexcused absence and the student will not be allowed to make-up the exam

A student who receives a grade of 84% on a nursing exam will earn a letter grade of
C

A student who receives a final grade at 92.99 in a nursing course will earn a letter grade of
B

To appeal a final grade, before contacting the University Ombudsman, the student must first speak with (please indicate the correct order or chain of command)
-his/her instructor
-semester coordinator
-BSN coordinator
-Department head
-associate dean
-dean of the college of nursing

[t/f]
Students who are making less than a “C” grade in a class will be advised by the course faculty or course coordinator with an Interim Advisement Form prior to or during mid-term week of the semester.
T

A student who is absent in excess of 10% of the total clinical clock hours
can be dropped or failed from the course

Which of the following instances would be considered an excused absence (check all that apply)
-ULL Student Government Association (SGA) officer attending the SGA National Convention
-ULL volleyball player attending an out of town volleyball game
-Documented death of a grandparent
-Illness with a physician’s excuse

The deadline for submission of clinical requirements (health screening and drug/alcohol testing) for the Fall semester is
August 1

A map with the emergency evacuation route for Wharton Hall can be found
near the elevators in Wharton Hall

[t/f]
A student who is arrested for drunken driving over the summer break does not need to disclose the incident to the UL College of Nursing and Allied Health Professionals or the Louisiana State Board of Nursing.
F

Each semester, before students can register for classes, students must
attend an advising session

It is the student’s responsibility to refrain from the following on social media sites: Check all that apply:
-Posting derogatory comments about classmates, faculty, staff, or other individuals that are encountered during their academic experience
-Posting of comments that are harassing, threatening, or hostile to faculty, staff, patients, or other students
-Using patient’s identifying information (including but not limited to name, initials, hospital name, physician name, diagnosis, dates of admission).
-Interacting with patients via social networking sites (i.e., accepting/sending “friend” requests with patients)

Submitting inappropriate posts on Moodle, Facebook, Twitter, YouTube and sending inappropriate emails or voice mails are all examples of
uncivil behavior

Please match the bulletin board with its location
Freshman:
Sophomore:
Junior/Senior:
ULSNA:
-across from VLW room 304
-outside of door 210 in VLW
-3rd floor hallway VLW
-1st Floor VLW across from elevators

A forum for students to confer with the BSN Coordinator, Department Head, Associate Dean and Dean of the College of Nursing and Allied Health Professions is
BSN Student Advisory Council