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CHAPTER I HISTORICAL AND CONTEMPORARY OF NURSING PRACTICE

Kaiserswerth School in Germany where Florence Nightingale recieved her training in Nursing Harriet Tubman known as the Moses of her peoplefor her work with the Underground Railroad. During the american civil war (1861-1865), took care of the sick. Soujerner Ttruth, abolitionist, Underground railroad agent, preacher, and womens rights advocate and took care of the sick during the civil war with Harriet Tubman Dorothea Dix was the Union Superintendent of Female Nurses during the Civil War Elizabeth Kenney one of Australian nurse who fight for poliomyelitis during the World War II Florence Nightingale founder of modern nusing Clara Barton organized the American Red Cross Linda Richards was the first American trianed nurse, known for introducting nurses note and doctors order. Pioneer of psychiatric nursing and industrial nursing Mary Mahoney was the first African American trianed nurse Lilian Wald founder of Public Health Nursing Lavinia Dock a feminist, active in protest for womens right and a friend of Wald Margaret Higgins Sanger founder of Planned Parenthood, was imprisoned for opening the first birth control information clinic in Baltimore Mary Brechinridge established the Frontier nursing Service DEFINITION OF NURSING Florence nightingale define nursing as the act of utilizing the environment of the patient to assisst him in his recovery. Nightingale considered a clean, well ventilated and quite environment essential for recovery. She considered as the first nursing theorist. Virginia Henderson define nursing as the unique function of the nurse is to assisst the individual, sick or well in the performance of those activities contributing to health of its recovery (or to peaceful death) that he would perform unaidedif he had the necessary strenght, will or knowledge, and to do this in such a way as to help him gain independent as rapidly as possible 1973 American Nurses Association define nursing as direct, goal oriented, and adaptable to the needs of individual, the family abd community during health and illness 1980 ANA change the definition into Nursing is the diagnosis and treatment of human responses to actual or potential health problems

1995 most recent definition of nursing by ANA is Nursing is the protection, promotion and optimization of health and abilitie, prevention of illness and injury, alleviation of suffering through the diagnosis and treament of human response and advocacy in the care of individuals, families, communities and populations Consumers is an individual, group of people or a community that uses a service or commodity. Recipient of nursing is sometimes called consumers, sometimes, patient, sometimes client. Patient comes from a Latinword patient means to suffer or to bear. Patient is a person who is waiting for or undergoing medical treatment and care Client who engages the advice of services of another who is qualified to provide this service. Client is more preffered term. SCOPE OF NURSING Promoting health and Wellness Preventing Illness Restoring Health Caring for the Dying

ROLES AND FUNCTIONS OF THE NURSE 1. Caregiver giving direct care for the client 2. Communicator to identify client problems, communication is the integral part to all nursing roles 3. Teacher, the nurse help client ot learn about their health and health care procedures they need to perform, nurse also assesses client learning needs and readiness to learn 4. Client Advocate protect the client, represent the client needs and assissting in the client rights 5. Counselor helping the client to cope up with stressful psychologic or social problems to develop improved interpersonal relationships, and to promote personal growth. 6. Change Agent assissting client to make modifications of his behavior 7. Leader influence to other to achieve a specific goal 8. Manager delegates activities to ancillary workers and other nurses and supervices and evaluate their performance 9. Case Manager works with the multidisciplinary health care team to measure the effectiveness of the casemanagement plan and to monitor outcomes 10. Research Consumer to improve client care CRITERIA OF A PROFESSION

Profession has been deifned as an occupation that require extensive education or a calling that requires special knowledge, skills\ and preparation. Professionalism refers to professional character, spirit, or methods, a set of attributes a way of life that implies responsibility and committment. Influence by Florence Nightingale Professionalization is the process of becoming professional, that is, of acquiring characteristics considered to be professional 1. 2. 3. 4. 5. 6. 7. Specialized Education Body of Knowledge Service Orietntation Ongoing research Code of Ethics Autonomy Professional Organization

EXPANDED CAREER ROLES FOR NURSES 1. 2. 3. 4. 5. Nurse Practitioner employed in health care agencies or community based setting Clinical Nurse Specialist consider to be an expert in a specialized area of practice Nurse Anesthetist assist the anesthesiologist Nurse Midwife assisst in prenatal, postnaltal care and manages deliveries of normal deliveries Nurse Researcher investigate nursing problem to improve nursing care and to refine expand nursing knowledge 6. Nurse administrator manages client care, including the delivery of nursing service 7. Nurse Educator employed in nursing program at educational institutions, and in hospital staff education 8. Nurse Entrepreneur manages health related business BENNERS STAGES OF NURSING EXPERTISE Stage I NOVICE No experienced, infelxible (nursing student) perfomance is limited, governed by contextfree rules and regulations rather than experience Satege II ADVANCE BEGGINER Demonstrate marginally acceptable performance, recognize the meaningful aspects of a real situation. Has experienced enough real situation to make judgments about them Stage III COMPETENT has 2-3 years of experience, demonstrate organizational and planning abilities, diffirentiate important factors from lessaspects of care. Coordinates multiple complex care demands Stage IV PROFICIENT has 3 to 5 years of experience, percieves situation as wholes rather than in terms of parts, as in stage II. Uses maxims as guides, has holistic understanding of teh client which improves decision making. Focuses on leng-term goal Stage V EXPERT performance is fluid, flexible, and highly proficient; no longer requires rules, guidelines, maxims, demonstrate highly skilled intuitive and analytic ability in new situations, is inclined to take a certain action because it felt right

CHAPTER II NURSING EDUCATION, RESEARCH and EVIDENCE-BASED PRACTICE


Types of Educational Programs in Nursing 1. Licensed Practical (Vocational) Nursing Programs usually last for 9 or 12 months and provide both classroom and clinical experiences. LPNs (LVNs) provide basic direct technical care to clients 2. Registered Nursing Programs 3 major educational route a. Diploma Programs Nightingale established the Nightingale Training School for Nurses at St. Thomass Hospital in England in 1860. b. Community College/Associate Degree Programs c. Baccalaureate Degree Programs - first school of nursing in a university setting was established at the University of Minnesota 3. Graduate Nursing Education a. Masters Programs generally take from 1.5 to 2 years, MA, MS, MN MSN b. Doctoral Programs degrees of doctor of Philosophy (PhD), doctor of nursing science (DNS or DNSc), nursing doctorate (ND) 4. Continuing Education refers to formalized experiences designed to enlarge the knowledge or skills of practitioners, this is more specific and shorter 5. In-Service education administered by an employer; it is designed to upgrade the knowledge or skills of employees NURSING RESEARCH AND EVIDENCE-BASED PRACTICE Evidence-based practice(EBP) the use of some form of substantiation in making clinical decisions. This substantiation or evidence, can arise from tradition, authority, experience, trial and error, logic or reason, or research. Approaches of Nursing Research 1. Quantitative Research progresses through systematic, logical steps acoording to specific plan to collect information, often under conditions of considerable control, that is analyzed using statistical procedures. This is often viewed as hard science and uses deductive reasoning and the measurable attributes of human experience. 2. Qualitative Research is often associated with naturalistic inquiry, which explores the subjective and complex experiences of human beings. Naturalistic investigation emphasizes the understanding of human experience as it is lived, usually through careful collection and analysis of qualitative materials that are narative and subjective. Protecting the Rights of Human Subjects 1. Right not to be harmed physically, emotionally, socially, legal and financial, confidentiality and privacy

2. Right to Full Disclosure act of making clear the clients role in a research situation, is a basic right. Patient consent is part of this 3. Right of Sell-Determination means that participants should feel free from constraints, coercion, or any undue influence to participate in a study 4. Right of privacy and Confidentiality privacy enables a client to participate without worrying about later embarassment. Confidentiality means that any information a participants relates will not bemade public or available to others without the participants consent. Quantitative Research Process Polit and Beck (2005) define research as systematic inquiry that uses disciplined methods to answer questions or solve problems 1. State a Research Question or Problem Four Criteria in formulating a research problem a. Significance if it has the potential to contribute to nursing science by enhancing client care, testing or generating a theory, or resolving a day-to-day clinical problem, the question is so what b. Researchability means that the problem can be subjected to scientific investigation c. Feasisibility pertains to the availabilityof time as well as the material and human resources needed to investigate a research problem or question d. Interest of the researcher Note: Dependent variableis the behavior, characteristics, or outcome that the researcher wishes to explain or predict. Independent Variable is the presumed cause of or influence on the dependent variable. Descriptive research has no dependent variables 2. Define the Studys Purpose or rationale researcher intends to do with the researcher problem identified, it includes what will the researcher do, who will be the participants, and where tha data will be collected 3. Review the Related Literature provides the foundation on which to build new knowledge 4. Formulate Hypothesis and Define Variables HYPOTHESIS is a prediction of the relationship among two or more variables. OPERATIONAL DEFINITIONS definitions that specify the instruments or procedures by which concepts will be measured. 5. Select a Research Design to Test the Hypothesis a research design is the overall plan for conducting the study to answerthe research questions or test the research hypotheses. It includes study setting, the sample, and the type of data to be collected as well as strategies to control extraneous variables and reduces bias. a. Experimental Design the investigator manipulates the independent variable by administering an experimental treatment to some participants while withholding it from others. b. Quasi-experimental Design the investigator manipulates the independent variable but wihtout either the randomization or control that characterizes true experiments c. Nonexperimental Design the investigator does no manipulation of the independents varaible

6. Select the Population, Sample and Setting POPULATION includes all possible members of the group who meet the criteria for the study. SAMPLE is the segment of the population from whom the data will actually collected. 7. Conduct a Pilot Study is a DRESSED REHEARSAL 8. Collect the Data reserach process relies on empirical data or an informationcollected from the observable world. VALIDITY is the degree to which an instrument measures what it is supposed to measure. RELIABILITY is the degree of consistency with which an instrument measures a concept or variable. 9. Analyze the Data in this srep, the collected data are orgnized, coded and analyzed for the purpose of answering the research question or testing the hypothesis. Central Tendency Mean computed by summing all scores and dividing by the number of subjects Median representing the exact middle score or value in a distribution of scores Mode value that occurs more frequently Variablity Range difference between the highest and lowest Variance or dispersion, equal to the square of standard deviation Standard Deviation average to which score deviate from the mean 10. Communicate Conclusions and implications through journals or books Qualitative Research Process The intent of qualitative research is to thoroughly describe and explain a phenomenon. The researcher collect narrative data through interviews or observation. Ethnography provides a framework to focus on the culture of a group of people Phenomenology investigates peoples life experiencesand how they interpret those experiences and how they interpret those experiences Grounded theory focuses on generation of categories or hypotheses that explain patterns of behavior of the people in hte study

CHAPTER 3 NURSING THEORIES and CONCEPTUAL FRAMEWORKS


Theory has been identified as a supposition or system of ideas that is proposed to explain a given phenomenon. Also used to describe, predict, and control a phenomena. Concepts often called the building blocks of theories Conceptual Framework is a group of related ideas statements or concepts Paradigm refers to a pattern of shared understandings and assumptions about reality and the world. FOUR METAPARADIGM FOR NURSING Metaparadigm originates from the Greek word meta means with and paradigm means pattern. 1. 2. 3. 4. Person or client the recipient of nursing care Environment the internal and external surroundings that affect the client Health a degree of wellness or well-being that the client experiences Nursing the attributes, characteristics, and actions of teh nurse providing care on behalf of, or in conjunction with, the client

Philosophy is a belief system,often an early effort to define nursing phenomena, and serve as the basisfor later theoretical formulations Florence Nightingale ENVIRONMENTAL THEORY the act of utilizing the environment of the patient to assisst him in his recovery. Five environmental factors: Pure or fressh air, pure water, efficient drainage, cleanliness, and light(direct sunlight) Peplaus Interpersonal Relations Model Hildegard Peplau is a psychiatris nurse, use of therapeurtic relationship between the nurse and the client. Phases a. Orientation client seek help and the nurse assisst the client to understand the problem b. Identification - cleint assumes a posture of dependence, interdependence, or independence and the nurses focus is to assure the person that the nurse know the interpersonal meaning of the clients situation. c. Exploitation client derives full value from what the nurse offers through the relationship, Power shifts from the nurse to the client. d. Resolution old needs and goals are put aside and new ones adopted. Once older needs are resolved, newer and more mature ones emerge. Virginia Henderson 14 Basic human needs Martha Rogers The science of Unitary Human Beings, Roger views the person as an irreducible whole, the whole being greater than the sum of its parts.

Dorothea Orem Self Care Theory: self care (activities an individual performed independently throughtout life to promote and maintain personal well bieng), self care agency (individuals ability to perform self-care activities), self care requisites (self care needs) and therapeutic self care demand (refers to actions to maintain well-being. Imogene King Goal Attianment Theory Betty Neuman System Model, She is a community health nurse and clinical psychologist, developed a model based on the individuals relationship to stress, the reaction to it, and reconstitution factors that are dynamic in nature. Callista Roy - Adaptation Model, she defines adaptation as the Process and outcome whereby the thingking and feeling person uses conscious awareness and choice to create human and environmental integration Madeleine Leininger Cultural Care diversity and Universality Theory, she states that care is the essence of nursing and the dominant, distinctive and unifying feature of nursing and care varies in culture. Jean Watson Human Caring Model Parse Human Becoming theory, emphasizes how individual choose and bear responsibility for patterns of presonal health

CHAPTER 4 LEGAL ASPECT OF NURSING


LAW the sum total of rules and regulations by which a society is governed. As such, law is created by people and exists to regulate all persons SOURCES OF LAW 1. Constitutional Law supreme law of the country (ex. Due process, equal protection) 2. Legislation (Statutory Law) - law enacted by legislative body (ex. Nurse practice act) 3. Administrative Law when a sate legislature passess a statue, an administrative agency is given the authority to create rules and regulations to enforce the statutory law. 4. Common Law laws evolvong from court decisions TYPES OF LAW a. Public Law body of law that deals with relationships between individuals and the governmental agencies. Inportant segment of this law is criminal law, which deals with actions against the safety and welfare of the public (e.g., homicide, manslaguhter, and theft) b. Private law or Civil Law deals with relationships among private individuals o Contract Law involves the enforcement of agreeements among private individuals or the payment of compensation for failure to fulfill the agreements (ex. Nurse and client, nurse and employer, nurse and agensy and nurse and insurance) o Tort Law defines and enforces duties and rights among private individuals that are nor based on contractual agreements. (ex. Negligence, malpractice, invasion of privacy, assault and battery) Plaintiff who claims that his legal right have been infringed on by one or more other persons or entries reffered to as defendants Verdict means decision Burden of Proof duty of proving an assertion of wrongdoing Credentialing process of determining and maintaining competence in nursing practice License a legal permit that a government agency grants to individuals to engage in the practice of a profession and to use a particular title. Standards of Care skills and learning commonly possessed by members of a profession Liability is the quality or state of being legally responsible for ones obligations and actions to make financial restitution for wrongful acts Contractual Obligations refer to the nurses duty of care, that is, dut yot render care, established by the presence of an expressed or implied contract

Respondeat Superior let the master answer means the master assumes responsibility for the conduct of the servant and can also be held responsible for malpractice by the employee. Right is a priviledge or fundamental power to which an individual is entitled unless it is revoked by law or given up voluntarily Responsibility obligation associated with a right Collective Bargaining formalized decision making processbetween representatives of management (employer) and representatives of labor (employee) to negotiate wages and conditions of employment, including work hours, working environment, and fringe benefits of employment. InformedConsent an agreement by a client to accept a course of treament or a procedure after being provided complete information, including the benefits, and risks of treatment, alternatives to the treatment, and prognasis if not treated by a health care provider. a. Express Consent either an oral or written agreeement, usually invasive procedure b. Implied Consent exist when the individuals nonverbal behavior indicates agreement. Delegation transfer of responsibility for the performance of an activity from one person to another while retaining accountability for the outcome. Euthanasia act of painlessly putting to death persons suffering from incurable or distressing disease Crime an act committed in violation of publiclaw and punishable by a fine or imprisonment a. Felony a crime of a serious nature such as murder, punishable by a term in prison. Second degree murder is called manslaughter b. Misdemeanor an offense less serious nature and is usually punishable by a fine or short-term jail sentence or both. Tort a civil wrong committed against a person or a persons property 1. Unintentional Tort a. Negligence misconduct or practice that is below the standard expected of an ordinary, reasonable and prudent person. b. Gross Negligence involves extreme lack of knowledge, skills, or decision making that the person clearly should have known would put others at risk for harm c. Malpractice is professional negligence that is, negligence that occcured wgile the preson was performing as a professional. Six elements to prove a malpractice: DUTY nurse must have relationship with the client that involves providing care and following an accceptable standard of care, BREACH OF DUTY there must be a standard of care that is expected in the expected in the specific situation but that the nurse did not observe, FORESEEABILITY a link must exist between teh nurses act and the injury suffered, CAUSATION it must be proven that the harm occured as a direct result of the nurse could have known that failure to follow the standard of care could result in such harm, HARM OR INJURY plaintiff must demonstrate some type of harm or injury (physical, financial or emotional), DAMAGES

Res ipsa Loquitur the thing speaks for itself 2. Intentional Tort - the defendant executed tha act on purpose or with intent a. Assault threat to touch abother person unjustifiably b. Battery willful touching of a person (or persons clothes or even something the person is carrying) that may or may not cause harm c. False Imprisonment unjustifiable detention of person without legal warrant to confine the person d. Invasion of Privacy e. Defamation is a communication that is false, or made with a careless disregrard for teh truth, and results in injury to the reputation of a person. LIBEL defamation by means of print, writing or pictures. SLANDER defamation by spoken words, stating unpriviledge or false words by which reputation is damage.

CHAPTER 6 HEALTH CARE DELIVERY SYSTEM


Health Care System is the totality of services offered by all health disciplines TYPES OF HEALTH CARE SERVICES 1. Primary Prevention: Health Promotion and Illness Prevention adequate and proper nutrition, weight control and excercise, and stress education. Illness prevention involves immunizations, identifying risk factors for illnesses, and helping peolpe take measures to prevent this illnesses from occurring, it also includes environmental programs. 2. Secondary Prevention: Diagnosis and Treatment early detection of disease 3. Tertiary Prevention: Rehabilitation, Health Restoration and Pallative Care the goal is to help peolpe move to their previous level of health (i.e, to their previous capabilities) or to the highest level they are capable of given their current health status. Pallative care is providing comfort and treatment for symptoms TYPES OF HEALTH CARE AGENCIES AND SERVICES 1. Public Health government (official) agencies, their funds are from taxes. 2. Physicians Offices 3. Ambulatory Care Centers they may or may not be associated with an acute care hospital also termed as CLINIC 4. Occupational Health Clinics industrial clinic setting for employee health care 5. Hospitals 6. Subacute Care Facilities generally more intensive than long-term care and less than acute care 7. Extended Care (Long-Term Care) Facilities formerly called as nursing homes, care for elderly, client who require rehabilitation and custodial care 8. Retirement and Assissted Living Centers consist of separate houses, condominiums, or apartments for residents, clients are unable to remain at home but do notrequire hospital or nusing home care 9. Rehabilitation Centers usually are independent community centers or special unit, (e.g., drug and alcohol rehabilitation). This type of nursing requires specialized skills and knowledge 10. Home Health Care Agencies 11. Day Care Centers care for infants and children while their parents are at work 12. Rural Care 13. Hospice Services originally hospice was a place for travelers to rest now it is imporiving or maintaining the quality of life until death 14. Crisis Centers provide emergency services to clients experiencing life crises 15. Mutual Support and Self-Help Group PROVIDERS OF HEALTH CARE 1. Nurses licensed practical nurse under RN, advanced practice nurses, nurse midwives, RN anesthetists, clinical nurse specialists

2. Alternative (Complementary) Care Provider chiropractors, hebalist, acupuncturists, massage therapists, reflexologists, holistic health healers 3. Case manager role is to ensure that clients recieved fiscally sound, appropriate care in the best setting (e.g., nurse, social worker, occupational therapist, physical therapist 4. Dentist diagnose an treat dental problems 5. Dietitian or Nutritionist has special knowledge about the diets required to maintain health and to treat disease, supervise the preparation of meals to ensure that clients receive the proper diet 6. Occupational Therapist assisst client with impaired function to gain the skills to perform activities of daily living 7. Paramedical Technologist laboratory technologists, radiological technologists and nuclear medicine technologists are just three kinds of pramedical technologists. Paramedical means having same connection with medicine. 8. Phramacists prepares and dispenses pharmaceuticals in hospital and community setting. They monitor and evaluate the actions and effects of medications 9. Physical Therapists assisst client with musculoskeletal problems, treat movement dysfunctions by means of heat, water, excercise, massage and electric current, assess client mobility and strenght, providing therapeutic measures and teaching new skills (e.g., how towalk with an artificial leg) 10. Physician responsible for medical diagnosis and for determining the therapy required by a person who has a disease or injury 11. Physician Assisstant takes under the direction of a physician 12. Podiatrist diagnose and treat foot conditions and perform surgery and prescribed medications 13. Respiratory Therapist care of clients with repiratory problems, knowledgeable about oxygen therapy devices, intemittent positive pressure breathing respirators, artificial mechanical ventilators, and accessory devices used in inhalation therapy 14. Social Worker counsels clients and their support persons regarding problems such as finances, marital difficulties, and adoption of children. 15. Spiritual Support Personnel Chaplains, pastors rabbis, priests, and other religious or spiritual advisors attend the spiritual needs of clients. 16. Unlicensed Assisstive Personnel are health care staff who assume delegated aspects of basic client care. These task include bathing, assissting with feeding, and collecting specimens. FACTORS AFFECTING HEALTH CARE DELIVERY a. b. c. d. e. f. g. h. i. Increasing number of Elderly Advances in Technology Economics Womens Health Uneven Distribution of Services Access to Health Incurance Homeless and The Poor Health Insurance Portability and Accountability Act (HIPAA) Demographic Changes

FRAMEWORKS FOR CARE 1. Managed Care describes a health care system whose goals are to provide cost-effective, quality care that focuses on decreased costsand improved outcomes for group of clients 2. Case Management describes a range of models for integrating health care services for individuals or groups. Also involves multidisciplinary teams that assumes collaborative responsibility for planning, assessing etc.. Both case management and manage care systems aften use critical pathways (also called crtitical path, interdisciplinary plans, anticipated recovery plans, interdisciplinary action plan and actions plans) tool that specifies interdisciplinary assessment, interventions, treatment and outcomes. 3. Patient-Focused Care is delivery model that brings all services and care providers to the client. 4. Differentiated Practice is a system in which the best possible use of nursing personnel is based on their educational preparation and resultant skills sets. This model further requires the delineation of roles 5. Shared Governance model inwhich nursing staff are cooperative with administrative personnel in making, implementing, and evaluating client care policies, focuses to encourage participation of nurses in decision making at all levels of the organization 6. Case Method referred to as total care, is one the earliest nuring models developed. One nurse is assisgned to and is responsible for the comprehensive care of a group of clients within 8-12 hour shift, this is considered the precursor of primary nursing 7. Functional Method focuses on the job to be completed, economical and efficient, also permits centralized direction and control. Disadvantage is not meeting the clients emotional needs. 8. Team Nursing delivery of individualized nursing care to clients by a team led by a professional nurse 9. Primary Nursing system in which one nurse is responsible for overseeing the total care of clients 24 hours a dat, 7 days a week, provide comprehensive, individualized, and consistent care. Assess and prioritize client needs, this is the first-line manager of the clients care with all its inherent accountabilities and responsibilities. RESPONSIBILITIES of CASE MANAGER/DISCHARGE PLANNERS Assessing clients and their homes and communities Coordinating and planning care Collaborating with other health professionals Monitoring clients progress Evaluating client outcomes

CHAPTER 7 COMMUNITY NURSING and CARE CONTINUITY

CHAPTER 8 HOME CARE Home Care involves a wide range of health care professionals providing services in the home setting to people recovering from an acute illness or injury, or who are disabled, or who have a chronic condition. Home Health Care Nursing or Visiting Nursing includes thenursing services and products provided to clients in theri homes that are needed to maintain restore or promote their physical, psychologic and social well-being. The focus of home health care is individuals and their families unlike community health nursing focuses on individual, families and aggregate groups Hospice Nursing support and care of the dying person and family, is often considered a subspeciality of home health care nursing HOME HEALTH CARE SYSTEM 1. Referral Process client maybe referred to a home health care providers by a physician, nurse, social worker, therapists, discharge planner, or family member. The initial visit, often referred to as opening the case 2. Home Health Agencies a. Official or public agencies operated by state or local governments, funded by tax b. Voluntary or private not-for-profit agencies are supported by donations, charity c. Private, proprietary agencies are for-profit organizations and are governed by individual owners or national coporations d. Institution-based agency under a parent organization such as hospital 3. Private Duty Agencies referred to as a registry which contracts with individual practitioners (e.g., nurse or home health aides) to care for the client in the home. The client may require care coverage from the agency for 4 to 24 hours a day. 4. Durable Medical Equipment Companies provides health care equipment for the client at home 5. Reimbursement ROLES OF HOME HEALTH NURSE 1. 2. 3. 4. Advocate Caregiver Educator Case Manager or Coordinator

CHAPTER 10 CRITICAL THINGKING AND NURSING PROCESS Critical Thinking In nursing practice is a discipline specific, reflective reasoning process that guides a nurse in generating, implementing, and evaluating apporaches for dealing with client care and professional concerns. Essential to safe, competent, skillful nursing practice

Nurses uses critical-thinking skills in a variety of ways: Nurses use knowledge from other subjects and fields Nurses deals with change in stressful environments Nurses make inportant decisions

TOP 10 REASONS TO IMPROVE THINKING 10. Things arent what they used to be or waht they will be 9. Patients are seeker with multiple problems 8. More consumer involvement (patients and families) 7. Nurses must be able to move from one setting to another 6. Rapid change and information explosion requires us to develop new learning and workplace skills 5. Consumers and payers demand to see evidence of benefits, efficiency and results 4. Today progress often create new problems that cant be solved by old ways of thinking 3. Redisigning care delivery and nursing curricula is useless if students and nurses dont have the thinking skills require to deal with todays world 2. It canbe done it doesnt have to be that difficult 1. Your ability to focus your thinking to get the result you need can make the difference between whether you succeed or fail in this fast paced-world INCENTIVE SPIROMETRY a treatment device that promotes alveolar expansion SKILLS in CRITICAL THINKING a. Critical Analysis application of a set of questions to a particular situation or idea to determine essential information or ideas and discard superfluous information and ideas. Socaratic Questioning bis a technique one can use to look beneath the surface, recognize and examine assumptions, search for inconsistencies, examine multiple points of view, differentiate what one knows from what one merely believes

b. Incentive reasoning from specific examples (premises) to a generalized conclusions c. Deductive reasoning from general premise to the specific conclusions DIFFERENTIATING TYPES OF STATEMENTS STATEMENT DESCRIPTION Facts Can be verified by investigation Inferences Conclusions drawn from facts, going beyond facts to make a statement about something not currently known Evaluation of facts or information that reflects values or other criteria; a type of opinion Beliefs formed over time and include judgements that may fit facts or be in error

Judgments Opinions

EXAMPLE Blood pressure is affected by blood volume If blood volume is decreased (e.g., hemorrhagic shock) the blood pressure will drop It is harmful to the clients health if blood pressure drops too low Nursing intervention can assisst in maintaining the clients blood pressure within normal limits

ATTITUDES THAT FOSTER CRITICAL THINKING 1. Independence individuals think for themselves 2. Fair-indedness assessing all viewpoints with the same standards and not basing their judgments on personal or group bias or prejudice 3. Insight into Egocentricity critical thinkers are open to the possibility that their personal biases or social pressures and customs could unduly affect their thinking 4. Intellectual Humility means having an awareness of the limits of ones own knowledge. Critical thinkers are willing to admit what they do not know; they are willing to seek new information and to rethink their conclusions in light of new knowledge 5. Intellectual Courage to Challenge the Status Quo and Rituals one is willing to consider the examine fairly ones own ideas or views, especially those to which one may have strongly negative reaction 6. Integrity requires that individuals apply the same rigorous standards of proof to their own knowledge and beliefs as they apply to the knowledge and beliefs of others 7. Perseverance finding effective solutions to client and nursing problems 8. Confidence believe that well-reasoned thinking will lead to trustworthy conclusions 9. Curiosity critical thinkers are filled with a lot of questions NURSING PROCESS is a systematic, rational method of planning and improving individualized nursing care Problem Solving the nurse obtains information that clarifies the nature of the problem and suggest possible solutions