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NSG 252 exam 2 - Exam 2 study guide based on blueprint given in class

Exam 2 study guide based on blueprint given in class
Course

Fdtns Of Professional Nursing (NSG 252)

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NSG 252 Exam 2

Health belief and behavior models - 5 questions

Models of health and illness:

  • Health Belief Model: Represents link between beliefs and behaviors

> 3 components

1) Perception of susceptibility/seriousness of illness

2) Modifying factors (knowledge, socio-economics)

3) Likelihood that person will take preventative action or change behavior

  • Health Promotion Model: positive, dynamic state (not absence of disease)

> increases pt’s level of well-being

> Desired outcome are health promoting behaviors

> 3 areas of focus

1) Individual characteristics/experiences

2) Behavior specific knowledge and effect

3) Behavioral outcomes (Pt changes behavior)

  • Basic Human Needs Model (Maslow): needs at lower levels of the pyramid must be

met before higher level needs can be met.

  • Holistic Health Model: Attempts to create conditions that promote optimal health

> Dynamic interactions in the emotional, spiritual, cultural, and physical aspects

> Pt is the expert and is involved in the process

> Uses Complementary Alternative Medicine (CAM)

● Transtheoretical Model of Behavior Change Stages:

  • Precontemplation
  • Contemplation
  • Preparation
  • Action
  • Maintenance (MOST DIFFICULT TO ACHIEVE)

Nursing theorists - 5 matching questions

First nursing nursing theorist is florence nightingale

Curriculum era: 1900-1940s – beyond A&P, social sciences and nursing arts

Research era: 1950-1970s – studied attitudes, relationships with other disciplines, work functions.

Avoided medical model of research

Graduate education era: 1950-1970s – Some theorists include: Johnson, King, Rogers, Roy, Orem

and Neumann

Theory era: 1980-1990s – Nursing metaparadigm, nursing journals, conferences, etc.

Theory utilization era: 2000s-today – EBP, research

***Know Johnson, King, Rogers, Roy, Orem and Neumann. Know their theories. They are all

graduate education era theorists.

Peplau’s Interpersonal Theory (middle ranged)

● Establishes effective nurse-patient communication when obtaining a nursing history,

providing patient education, or counseling patients/families

● Theory helps reduce patient anxiety by converting it into constructive actions

● This is done by therapeutic communications that are respectful, nonjudgmental, and

empathetic

● Using four phases: pre-orientation, orientation, working phase, and resolution

Orem’s self care model (grand)

● Based on belief that health care is each individuals own responsibility. Self care is

individual’s ability to perform activities on their own behalf to maintain life.

● Nurse continually assesses patient’s ability to perform self-care and intervenes as

needed to ensure that patient’s needs are met.

Nurses perform three steps:

1. Determine if patient needs nursing care. Identifies self-care deficits.

2. Determine appropriate care and nursing care category.

3. Provides needed care to meet patient’s self-care needs.

Three levels of nursing care:

● Wholly Compensated Care: Nurse provides all of the patient’s care, patient unable to

perform ADL’s (ICU, coma, etc.).

● Partially Compensated Care: Nurse provides for some of the patient’s care needs until

the patient is able to meet their needs themselves. Can perform basic ADLs (post-op

patients, new diabetics).

● Supportive Developmental Care: Patient’s able to meet basic needs with few or no

nursing interventions. Nursing goal is health maintenance and health promotion

(teaching diabetic classes, birthing classes).

King’s model of goal attainment (grand)

● Nurse view a patient as a unique personal system that is constantly

interacting/transacting with other systems (e, nurse, family, friends) nurses help

patients become active participants in their care by working with them to establish goals

for attaining, restoring, or maintaining health

● She is all about achieving goals

● Nursing is about helping the patient set goals and achieve those goals to get a higher

level of health

Kings model on the nursing metaparadigm?

Client is human who exchanges energy with environment to meet needs.

Health is process to reach highest functional levels.

Environment is personal, interpersonal and social systems in the physical world.

Nursing is process that helps to identify needs and goals to meet patient’s needs.

Abdellah’s patient centered care (grand)

● Focus shifted from disease centered, to patient centered.

● First one to to look at nursing diagnosis

● Addresses 21 nursing problems to meet patient's physical, psychological, and social

needs

● Encouraged nurses to use problem-solving skills in the their practice using critical

thinking skills

● Nurses use knowledge from previous experiences to determine a general plan of care

THEN personalize the plan of care to make it patient-centered.

Watson’s model of Human caring (grand)

● Goal was to balance the ART and SCIENCE of nursing. Recognized patient’s spiritual

beliefs as essential to health

● The purpose of nursing is to understand the interrelationships among health, illness,

and human behavior rather than focus on the disease cure model

● Caring occurs when a nurse and patient engage in a transpersonal relationship that

facilitates the patient’s ability for self-healing

Watson’s model on the nursing meta-paradigm

Client is person with needs that grows and develops to reach inner harmony.

Health is dynamic state of development that leads to full potential as human. Illness is failure to

reach inner harmony and potential.

Environment is factors that must be overcome to reach full potential

Nursing is science of caring that assists patients to meet full potential

Johnson behavioral model (grand)

● Believes behavior is a system that is influenced by input from environment, that then in

turn, influences environment.

● Client is person with an organized behavioral system composed of seven subsystems.

The person was composed of these 7 subsystems

She believes behavior is a system that is influenced by input from environment, that then in

turn, influences environment

Health is a high state of wellness and stability

Environment is internal and external stressors that cause change in the patient.

Nursing helps to recognize when barriers have been disrupted and helps restore stability

through implementation of primary, secondary or tertiary interventions.

Benner’s Skill acquisition (middle ranged theory)

● Novice to expert

● Nurses progress through five stages of skill acquisition: novice, advanced beginner,

competent, proficient, and expert

Types of nursing theories - 4 matching and 1 multiple choice

Grand theory: Abstract, broad in scope, and complex; therefore they require further

clarification through research so they can be applied to nursing practice. Does not provide

guidance to specific nursing interventions. Instead provides structural framework for general

ideas about nursing

Grand Theorists:

● Orem

● Johnson

● Neuman

● King

● Roy

● Watson

Middle range theories: More limited in scope and less abstract. They address a specific

phenomenon and reflect practice (administration, clinical, or teaching). Middle range theories expand

on specific concepts or phenomena in specific fields such as uncertainty, incontinence, social

support, and quality of life.

Middle range theorists:

● Peplau

● Benner

Practice theories:

● Less abstract and easier to understand that Grand and Middle range theories

● Bring theory to the bedside

● Narrow scope and focus

● These theories guide nursing care of a specific patient population at a specific time

● Example: pain management protocol for patients recovering from cardiac surgery.

Shared theories (not in the hierarchy of the other 3. I don't think this will be on the list from most

abstract to least)

● Explains phenomena specific to the discipline that developed the theory

Nursing metaparadigm/ metatheory: its 4 components:

● person

● health

● environment/situation

● nursing

Healthcare decisions and law –5 questions

Statutory-elected legislative bodies, US Congress- Nurse Practice Acts

● civil: protects the rights of individuals and provides fair and equitable treatment when civil

wrongs occur: fines or public service ; examples negligence or malpractice

● criminal: protect society as a whole and provide punishment for crimes

The court provides a forum resolved by an independent third party, such as judge or jury. The

plaintiff has the burden of proof against the defendant.

Includes branches of contract law, treaty law, tax law and tort law. Most nurses are involved with tort

law.

Torts

Torts: civil wrongful acts of omission

Torts are common and civil law violations

Intentional torts:

● Assault- verbal threat toward another that places the person in reasonable fear or unwanted

contact

● Battery – intentional offensive touching without consent. Can be harmful and cause injury or

merely offensive to a person’s dignity

● False imprisonment

**5 rights of delegation is on exam

Quasi-Intentional Torts: person may not intend to cause harm to another, but does

Examples:

Invasion of Privacy

Defamation of Character: publication of false statements that result in damage to a persons

reputation

● Slander – spoken defamation

● Libel – written defamation. Includes false charting

Unintentional torts:

Negligence- conduct that falls below accepted standards

Malpractice-nurse owes a duty, yet did not carry out the duty and the patient/client was injured

Malpractice is a type of professional negligence- care falls below a standard

*we are responsible for reporting in timely manner any significant changes of patient status to health

care provider and documenting

Informed consent

● Both a legal and an ethical issue

● The voluntary permission by a client or by the client’s designated proxy to carry out a

procedure on the client

● Claims that they did not grant informed consent before a surgery or invasive procedure can

form the basis of lawsuits

● 18 or older

● Needs official interpreter

● Has right to refuse

● Person preforming procedure is responsible for obtaining consent

● Nursing students do not witness consent

● Exceptions: emergency situations where client is unconscious/unable to give consent

Consent information Includes:

● Treatment proposed

● Material risk involved (potential complications).

● Acceptable alternative treatments.

● Outcome hoped for

● Consequences of not having treatment

The nurses signature as a witness to the consent means the pt voluntarily gave consent, pts

signature is authentic and the pt appears competent.

Advanced Directives

Power of Attorney- financial vs health care- need to know the difference!

Living Wills

Do not resuscitate order (DNR) - may be completed by a physician, Advanced Practice

Registered Nurse (APRN), or a physician assistant (PA) with client’s consent.

DNR CC – DNR Comfort Care

DNRCCA – DNR Comfort Care – Arrest

Delegation

Patient Education – 5 questions

Purpose of patient education

Goal: The primary goal of patient education is to help individuals, families, or communities achieve

optimal levels of health.

Patient education includes:

● Maintenance and promotion of health and illness prevention

● Restoration of health

● Coping with impaired functioning

Nurses roll in patient education:

Education should be PATIENT-CENTERED

Provide accurate, complete information

Information should be provided in patient’s preferred language

Guides patient’s in their decision making process

Helps to prevent readmissions and exacerbations

Do not assume that an educated patient has knowledge on the topic you are teaching

The Joint Commission’s Speak Up program: Helps patients understand their rights when

receiving medical care

Goal of patient education: The primary goal of patient education is to help individuals, families, or

communities achieve optimal levels of health.

Domains of learning:

Cognitive learning (understanding)

● Bloom’s taxonomy again!

● Discussion, lecture, Q&A, independent learning, role play, experiential learning

Affective learning (values, attitudes and beliefs)

● Role play, discussion (groups or one on one) to express feelings and experience support

Psychomotor learning (motor skills)

● Demonstration, practice, return demonstration, gaming

Basic learning principles

1. Motivation to learn

2. Readiness to learn

3. Ability to learn

Ability to learn, Assess for

● Intellectual abilities

● Developmental level

● Distractors (pain, dyspnea, hunger, thirst, etc. - Remember MASLOWS!!)

● Physical ability

● Sensory deficits

Intellectual: is the person able to comprehend what they are being taught. Do they have a health

care background, college degree? Did they graduate high school?

Developmental level: This will determine how you approach the education. For example: with

toddlers – use play to promote education. For adolescents: best to use problem solving techniques

when educating. For adults: try to make the information relevant to their personal situation.

Distractors: Eliminate distractions so they can focus on education. Determine time of day when they

are most alert and can absorb the information.

Physical ability: Think of dexterity with insulin injections, glucose testing

Sensory deficits: Can they hear, see?

Complementary therapies – 4 matching questions

Complementary therapies: treatments in addition to conventional therapies

Alternative therapies: used to replace conventional therapies

Integrative therapies: relationships b/w healthcare providers and pt (team of providers)

Nursing accessible therapies: Relaxation therapy, meditation and breathing, imagery

Training specific therapies:

  • Biofeedback (looking at vitals and stats)
  • Traditional Chinese medicine (cupping, tai chi)
  • Therapeutic touch
  • Natural products and herbs
  • Acupuncture
  • Spirituality
  • Chiropractic therapy

Evidence-based practice and research – 6 questions

Creates improvements in:

  • Quality
  • Safety
  • Patient outcomes
  • Nurse satisfaction
  • Efficiency (reduced healthcare costs)

● Goal is to switch from care based on opinions, experiences, and precedent to ones based on

research and proven evidence.

● Critical discernment: requires nurse to understand research and carefully assess all available

and credible research findings

● PICOT:

  • Person (age, disease, gender)
  • Intervention (treatment, diagnostic test)
  • Comparison (compare typical standard of care with new options)
  • Outcome (wish to achieve)
  • Time (time needed to achieve outcome)

● Steps to EBP

1) Ask PICOT question

2) Search for most relevant evidence (through the use of staff educators, modern

academic journals, APRNs, existing clinical practices)

3) Critically appraise gathered evidence (ranked on a scale of I (strongest) to V

(weakest))

4) Integrate evidence with personal expertise and pt preferences/values (only integrate

if the evidence is strong (I ranking))

5) Evaluate outcomes of changes (Was the change effective? Does it need to be

modified? Should it be discontinued?)

6) Communicate outcomes with others

7) Sustain knowledge used

● Scientific method of research:

  • Foundation of research
  • Most reliable method
  • Systematic approach (step by step)
  • Results of study must be valid, reliable, and generalizable
  • Used to understand, explain, or predict nursing phenomenon
  • Minimize bias/opinion

● Outcomes research:

  • Helps to make informed decisions
  • Focuses on benefits, risks, costs, and holistic effects
  • Observable, measurable effects
  • Focuses on the recipients of the services and not the providers

● Differences between EBP, research, and quality improvement:

EBP: Uses information from research to determine safe and effective nursing care with the

goal of improving patient outcomes.

Research: answers questions, solves problems and generalizes knowledge among nurses.

May or may not improve pt care.

Ethical dilemma process:

Step 1: Ask if this is an ethical dilemma.

Step 2: Gather all relevant information.

Step 3: Clarify values.

Step 4: Verbalize the problem.

Step 5: Identify possible courses of action.

Step 6: Negotiate the outcome.

Step 7: Evaluate the action.

Find/use resources within your organization

Ethical principles:

  • Autonomy: Freedom from external control

> Include Pt in decisions

> Allows a competent person the right to refuse treatments or procedures

  • Beneficence: Positive actions to help others (“doing good for clients”)

> One of the oldest requirements for healthcare providers

> Implies that the best interests of the patient remain more important than self-interest

  • Nonmaleficence: The avoidance of harm or hurt

> Do good but also do no harm (risks vs. benefits conversations)

  • Justice: Fairness and distribution of resources
  • Fidelity: The professional agreement and responsibility accepted as part of professional

practice

> Follow through and do not abandon patients regardless of the circumstances

> Stay faithful to healthcare employer

  • Veracity: Truthfulness

> To not intentionally deceive or mislead clients

> Ex. admit to mistakes, ask for help when needed, assist Pts in facing difficult healthcare

challenges

  • Right to know: Clients have the right to know about their condition, test results, or other

details

> Exception= Placebo effect or medications

Health, wellness and illness – 4 questions

● The World Health Organization defines health as a state of complete physical, mental, and

social well-being, not merely the absence of disease or infirmity.

● Health behaviors are influenced by:

  • Beliefs (definition of health based on one’s own values)
  • Culture (influences reaction to illness)
  • Perception of benefits/demands of health (positive or negative health beliefs)

● Healthy People initiative: evidence-based, national objective for promoting health and

preventing disease/illness (develops goals and objectives to be achieved over the next

decade).

● Equality vs. Equity (everyone has equal benefits vs. everyone being put on a level playing

field).

● Variables influencing health: Internal (emotional/spiritual factors, intellectual background) vs.

external (family role/practices, social factors, culture)

● Illness prevention levels: Primary (vaccines, education, vector control), Secondary

(screenings), Tertiary (therapy, rehab)

● Risk factors: Modifiable (environment, lifestyle, behaviors) vs. nonmodifiable (genetic, age)

● Illness: Acute vs. Chronic

● Impact of illness on Pt and family:

  • Behavioral and emotional change
  • Impact on body image
  • Impact on self-concept
  • Impact on family roles
  • Impact on family dynamics
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NSG 252 exam 2 - Exam 2 study guide based on blueprint given in class

Course: Fdtns Of Professional Nursing (NSG 252)

25 Documents
Students shared 25 documents in this course

University: Miami University

Was this document helpful?
NSG 252 Exam 2
Health belief and behavior models - 5 questions
Models of health and illness:
- Health Belief Model: Represents link between beliefs and behaviors
> 3 components
1) Perception of susceptibility/seriousness of illness
2) Modifying factors (knowledge, socio-economics)
3) Likelihood that person will take preventative action or change behavior
- Health Promotion Model: positive, dynamic state (not absence of disease)
> increases pt’s level of well-being
> Desired outcome are health promoting behaviors
> 3 areas of focus
1) Individual characteristics/experiences
2) Behavior specific knowledge and effect
3) Behavioral outcomes (Pt changes behavior)
- Basic Human Needs Model (Maslow): needs at lower levels of the pyramid must be
met before higher level needs can be met.
- Holistic Health Model: Attempts to create conditions that promote optimal health
> Dynamic interactions in the emotional, spiritual, cultural, and physical aspects
> Pt is the expert and is involved in the process
> Uses Complementary Alternative Medicine (CAM)
● Transtheoretical Model of Behavior Change Stages:
- Precontemplation
- Contemplation
- Preparation
- Action
- Maintenance (MOST DIFFICULT TO ACHIEVE)
Nursing theorists - 5 matching questions
First nursing nursing theorist is florence nightingale
Curriculum era: 1900-1940s – beyond A&P, social sciences and nursing arts
Research era: 1950-1970s – studied attitudes, relationships with other disciplines, work functions.
Avoided medical model of research
Graduate education era: 1950-1970s – Some theorists include: Johnson, King, Rogers, Roy, Orem
and Neumann
Theory era: 1980-1990s – Nursing metaparadigm, nursing journals, conferences, etc.

Students also viewed

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