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Roles Final Exam

50 Questions
6 Image of Nursing
1] Discuss the roles of the professional nurse 1?
Member of the Profession
Provider of Patient- Centered Care
Patient Safety Advocate
Member of the Health Care Team
2] Identify factors, both past and present, that influence the image of nursing 3?
Nursing has been identified as an emerging profession for at least 150 years. The historical context of nursings
image is often traced back to Florence Nightingale.
The image of professional nursing continues to evolve and is significantly affected by the media, womens issues and
roles, and a high technology health care environment.
The publics perception of nurses
o Most trusted but not always satisfied with their care.
o Nurses are recognized as advocates, educators, and managers of care.
o It is assumed by the general public, if you are an RN you know what you are doing and have skills to safely
care for them.
o The society at large sees nurses as providing individual care, explaining things and responding to needs and
watching over them.
o What are patients saying about us?
Pavalkos 8 dimensions of a profession
o 1.A Profession has Social Values
As nurses, we focus not only on the treatment component of patient care as a part of our nursing
practice, but also on wellness and health promotion issues.
The goal is to shift the focus of healthcare so that primary prevention becomes more valued. As this
shift occurs, nurses will become increasingly important because of their ability to be teachers of
health promotion activities and managers of wellness, which are activities that have an impact on
social values
o 2.A Profession has a Training or Educational Period
An educational process for any professional is critical, because it transmits the knowledge base of
the profession and, through research and other scholarly endeavors, advances the practice of the
o 3.A profession has Elements of Self-Motivation
Political activity is a way of translating social values into action. Nursing faces special challenges
when, for example, nurses must go on strike for better pay and benefits or demonstrate a united
front to gain federal funding rather than continuing a passive role in such issues.
o 4.A Profession has a Code of Ethics
o 5.A Profession has a Commitment of Lifelong Work
This means that a professional sees his/her career as more than just a stepping stone to another
area of work or as an intermittent job.
Nursing constitutes the largest health care occupation, and more jobs are expected for RNs than any
other occupation.
Thus, nursing as a career has a great potential for financial rewards, involvement in a variety of
professional endeavors, several different areas of practice, and a commitment to lifelong work.
o 6.Members Control their Profession
Nurses are not entirely autonomous. Although nurses have the challenge to ensure that members of
the profession honor the trust given them by society, they also work under professional and
legislative control.

Among these controls, are the 50 state boards of nursing, which regulate the scope of nursing
practice within each state and the professional practice standards that are supported both at the
local and national levels.
o 7.A Profession has a Theoretical Framework
Nursing continues to be based in the sciences and humanities, but nursing theory is evolving.
Based on evidence-based nursing science.
o 8.Members of a Profession Have a Common Identity and Subculture
Nursing colleagues reflect attitudes and values about the profession. Many schools of nursing have
alumni associations, student nurse associations, and nursing honor societies or clubs on campus.
These groups provide social interaction during the nursing education years and are great ways to
network later in ones career.
Belonging to a professional organization or a specialty organization helps professional nurses
maintain certifications and network with peers, and it enhances collegiality and scholarship.
Is nursing a profession?
o Nursing is a dynamic profession that has:
Code of ethics
Standards of practice education
Factors that influence the image of nursing
o The collective effect of
Appearance, behavior, and communication as professional image. (Rizk & Bofinger , 2008)
Professionalism plays a role in patient satisfaction & the patients decision to return for future care
Redefining our image
o Value nursing and project that image daily
o Take ourselves seriously
o Recognize the value of what we do
o Believe in ourselves and our colleagues
Political Clout
o Of the approximately 2.6 million registered nurses in the United States, fewer than 7% are members of
national nursing organizations
o These low numbers influence our nursing image and ability to become politically effective
The future of nursing
o The Institute of Medicines (IOM) released its landmark report on THE FUTURE of Nursing, initiated by the
Robert Wood Johnson Foundation increasing BSN prepared nursed by 80% and doubling the population of
nurses with doctoral degrees. (2010)
Recruitment into the profession
o Evolving nursing shortage, expected to peak in the next 10 years
o To recruit the brightest & best it is essential that the role of the nurse be better understood (knowledge,
skills, cognitive and interpersonal skills) vs. traditional role (caring, compassionate)
Nursing Today
o Katherine Thomas, MN, RN, FAAN
Executive Director for the Texas Board of Nursing (BON) since November 1995.
o Mary Wakefield, PhD, RN
Highest serving nurse - Administrator of the Health Resources and Services Administration (HRSA)
by President Barack Obama on February 20, 2009

8 Nursing Theory
1] Describe the origins of the nursing theory 2?
Nursing Theory: an articulated and communicated conceptualization of invented or discovered reality in or
pertaining to nursing for the purpose of describing, explaining, predicting or prescribing nursing care.
Can be applied to all areas of nursing

By nurses and for nurses providing care to patients/clients either directly or indirectly.
Way of identifying the professions unique knowledge base.
Expressed in propositions (if then) or hypotheses (test of relationships)
Explanations or observations composed of concepts in relation to one another.
Differentiates the focus of nursing from other professions.
Provides structures for professional nursing:
o Practice, education, and research.
o Theories are testable (clinical trials)
What Nursing Theory is NOT: managed care, primary nursing, team nursing, OB nursing,surgical nursing,home health
nursing, any specialty nursing areae.
Nursing theory is based on evidence-based care
o Concepts: lead to theories which are testable, used in practice, education and research.
o [Prof Kirk said he will have a multiple questions regarding the 3 types]
Three types
Empirical: easily observed (a patient)
Inferential: indirectly observed (Sadness)
Abstract: not observable (integrity)
Concepts essential to all Nursing theories
Person or client (recipients of nursing care)
Environment (Internal and external surroundings)
Health/illness (persons state of well-being)
Nursing (discipline that provides client care interventions)
o Book: Theories are words or phrases (Concepts) joined together in sentences, with an overall theme, to
explain, describe, or predict something. Theories helps us understand and find meaning in our nursing
experience and also provide a foundation to direct questions that provide insights into the best practices
and safe patient care. Theory helps define nursing as a profession.
o History of Nursing theory: Florence Nightingale is considered to be the first nursing theorist. She saw nursing
as a profession, a trade, a necessary occupation, something to fill and employ all my faculties, I have always
felt essential to me, I have always longed for; consciously or not The first thought I can remember and the
last was nursing work. (pg 173)

2] Identify some of the well-known nursing theories 1?

Person influenced by environment
Environment important to health
Nurses should support environment to assist patient in healing
Theory based on interpersonal process
Theory= Self-care nursing theory
Nursing-actions to overcome or prevent self-care limitations or to provide self-care if someone is
unable to do so.
Book: Orem sees the person as composed of physical, psychological, interpersonal, and social
aspects. Orems theory would ask, What can the patient do for himself or herself? And what can I,
as the nurse, need to do for the patient? What are the patients self-care deficit?
Theory=Science of unitary human beings
The person and environment are one thing and cannot be separated.
Theory= Adaptation model
Person is a bio-psycho-social being seeking equilibrium
Notes: this is seen in the core values, nursing philosophy.

Book: As nurses, we are to assess how well the person is coping and adapting to stimuli. The stimuli
could be any stressors that are making a person ill or causing the person to no adapt.

Book: Theory= Behavioral System Model.

Theory is that the person is a behavior system and a biological system seeking balance,


Theory=Systems Model
Focuses on prevention, or prevention as intervention as a response to stressors.
Primary Prevention
Secondary Prevention
Tertiary Prevention
Flexible and normal lines of defense
Lines of resistance
Book: Primary prevention is what a person does to prevent illness (ex: exercises, sleeps 8 hrs, and
eats a balanced diet). Secondary prevention is what done when an illness strikes. (Ex; patient with
MI comes to the ER, the staff interventions are to prevent the patient from dying). Tertiary
prevention is what is done to rehabilitate a person after an illness or accident, such as cardiac
rehabilitation or stroke rehabilitation (goal is to move the person back to primary).
Theory=Goal attainment model
Person interacts with environment
Health is a dynamic state of well-being
Nurse interacts with patient to set goals
Notes: The feeling the patient gets when they reach a goal. Understand patients disease, help them
be able to brush their teeth, manage their chronic illness and be able to live with it.
Theory= Theory of Human Caring
Person is a mind-body-soul connection
caring occasion or caring moment
Notes: example is pulling a chair next to the patient and looking at them at the same level, rather
than standing over them.
Theory=Culture care theory
- Nursing is a transcultural caring discipline and profession.
Health is culturally defined
Book: Nursing is a transcultural caring discipline and profession. Nurses need to be mindful of folk
practices or generic health care practices.
First Lady of Nursing
Patricia Benner
Proposes that a nurse could gain knowledge and skills without actually learning theory.
Five levels of Nursing
Advanced beginner
*each level reflects movements and build on past experiences/skills
Notes: must know this concept. This is how we move up, get promoted, must meet these levels.

3] Examine the main points of selected nursing theorists 1?

Look at question 2
o Nursing Theorist vary according to

Personal philosophy, scientific orientation, experience in nursing, terms, abstraction, and view of nursing.
General: broad definitions
Systems: interrelated parts that form a whole
Interpersonal: psychodynamics, nurse-client relationships.

4] Formulate examples of theory application to nursing practice 2?

Patient settings
Preop, Labor, psychiatric patient, nursing curriculum, managing a nursing unit, organizing an internal medicine clinic,
pediatric patients, home health, hospice care, long-term care facilities, and rehabilitative therapy. `
o *Notes: These were Case study examples used in my presentation. Again look at question 2 to apply the
theory to the example given on exam.
o Case Study 1:
o Stella C. is a 49-year-old obese single woman who recently has been diagnosed with type 2 diabetes. She
stated in your assessment pain and numbness in both lower extremities and no knowledge about type 2
o You are the nurse caring for Stella and need to determine
o What can the patient do for herself?
o What are the patients self-care deficits?
o What can I do for the patient?
Answer: [Dorothea Orem-Self Care Nursing Theory]
Explanation: The patient can self-monitor her blood glucose, comply with the prescribed
diet, exercise, and comply with the medication regimen.. The patient might not be able to
move around due to pain and numbness in both lower extremities. The nurse can educate
her on her newly diagnosis, diet, exercise method, and dose, route, timing, and indication of
o Case Study 2
o Ashley has been trying to conceive for the past 2 years and shes been unsuccessful. She recently visit your
clinic and found out she has been unsuccessful due to an infertility disorder. She feels hopeless and
distressed. She states, I cannot bare this. You sit next to her to harmonize her mind, body and soul
through a caring relationship.
Answer: [Jean Watson-Theory of Human Caring]
Explanation: Infertility is difficult to accept and may lead to loneliness, emotional distress,
stress, depression, anxiety, and marital conflict. Watson believes that love, compassion, and
forgiveness form patients and nurses are essential to the healing process. Watson also sees
the person as a mind-body-soul connections and the nurse comes in contact with the person
during a caring occasion and its our duty to promote restoration
o Case Study 3
o You enter a patient room and observe the sheets undone, overbed table in the way, pillows on the floor,
and the blinds closed. You assess the patient and you decide to rearrange the room, clean up the mess, and
open the blinds to make the patients room more convenient and therapeutic.
Answer: [Martha Rogers-Science of Unitary Human Beings]
Explanation: Rogers believed that nurses promote the synchronicity between human
beings and their environment/universe.
o Case Study 4: You are reviewing the patients care plan and integrate the patients psychological,
intellectual, spiritual, and environment components to assist the patient in their healing process.
Answer: Florence Nightingale- Her model did not have a specific name.
Explanation: She believed health was a result of environments, physical and psychological
Moral Principles

10 Ethical Issues
1] Analyze personal values that influence approaches to ethical issues and decision making Nonmaleficence
Values are core beliefs that guide and motivate attitudes and actions

Values are personal beliefs that we hold in high regard often influence behavior. Personal beliefs differ among
individuals that may vary over time given life experiences. What is right or wrong for one may not be the same
values that others embrace
ANA approved nine provisions of Code of Ethics for nurses in 2001. Researchers have found that nurses make
intuitively based ethical decisions based on own values/moral code. Important to examine your personal values in
r/t ANA code of ethics for which you will be held accountable.

2] Discuss the moral implications of the american nurses association and the nurses codes of ethics 3?
o Morals- are individual beliefs and cultural values about what is right and wrong.
o The code of ethics is a statement to society that outlines values, concerns and goals of the profession. It should be
compatible with the individual nurses personal values and goals. The code provides direction for ethical and
behavior by repeatedly emphasizing the obligations and responsibilities that the nurse-patient relationship entails.
Code of ethics imply that the patient care is foremost.
o Many cite that the code of ethics lack legal enforceability, but this is due because the code is a moral statement of
Deontological - All life is worthy of respect

Teleological - That which causes a good outcome is a good action

3] Discuss the role of the nurse in ethical healthcare issues Situational - Decisions made in one situation cannot be generalized
to another situation

Nurses are involved as individuals and professionals. You must agree to responsibly care for all of your
patients, if you do not agree with the policy/procedure regarding abortion, the patient still merits your care.
If that care has to do with assisting abortions and it violated your own principles then you should consider
changing jobs.
o Commonly referred to as Mercy killing, greek word that means good death, it implies painless actions to
end the life of someone suffering from an incurable or terminal disease. Classified as: active, passive or
Active: involves the administration of a lethal drug or another measure to end life and alleviate
suffering. Is illegal, and will be prosecuted.
Passive: involves the withdrawal of extraordinary means of life support
Voluntary:involves situations when the dying individual expresses the desire regarding the
management and time of death to a physician who then provides the lethal dose to the patient.
Futile care and physician- assisted suicide
o End of life care is one of the most frequent occurring ethical issue. Futility refers to the medical intervention
without realistic hope of benefit to the patient. An example of futility would be the continuation of ICU care
for a patient in a persistent vegitative state who would, on discharge from the hospital, return to a nursing
home incapable of interacting with the environment. Nurses need to stay informed about institutional
guidelines regarding medical futility and need to communicate clearly regarding the outcomes of care. With
primary force of withdrawal of treatment for the welfare of the patient and not due to economic concerns.
o PAS- physician assisted suicide- affect the nursing practice because a decision to perform PAS may involve
the nurse. The physician may be the one who orders the lethal dose but it is the nurse who would have to
administer it. Nurses need to be aware of the legal and ethical implications of such an order. The
administration of a lethal dose for the explicit purpose of ending a patients life is an illegal act that can be
prosecuted as a homicide. From an ethical point this can be seen as the ultimate act of mercy yet an illegal
act in the U.S. escept in Montana, Oregon, and Washington states.
o There are almost 110,000 people on the transplant list and majority of the individuals will die without a
transplant because of the shortage of available organs. On what basis should one receive an organ? Many
questions arise in the complexity surrounding organ transplantation.
Fetal Tissue
o Fetal tissue from elective abortions has been Identified as potentially beneficial in the treatment of
parkinsons disease and other degenerative disorders because of its unique embryonic qualities. Nurses
need to be informed regarding the issues, and consider their own personal viewpoint and how it can affect
nursing care.

In Vitro Fertilization
o This procedure involves the fertilization of a mothers ovum with a fathers sperm in a glass laboratory dish
followed by implantation of the embryo in the mothers uterus.
o Opponents argue that this is an unnatural act and removes the biological act of procreation from the
intimacy of marriage. Cost is also criticized, opponents of the procedure argue that it should be covered by
insurance and couples are lobbying to choose the sex of the baby.
o Nursed will be able to provide education to patients about genetic and genomic testing. Based upon
research, improvements in the recognition of family disease traits and emerging disease treatments are
discovered, nurses will play an increasingly important role in the study and application of genetic findings.

4] Apply moral/ethical principles to selected situations seen in nursing practice today 4?

Autonomy- A patients right to self-determination without outside control. The freedom to make choices and
decisions about one's own care without interference.
Beneficence- Duty to actively do good for patients.
Nonmaleficence- duty to prevent or avoid doing harm, whether intentional or unintenional.
Fidelity- duty to be faithful to commitments. Can involve keeping information confidential and maintaining privacy
and trust.
Justice- Duty to treat all patients fairly, without regard to age, socioeconomic status or other variables.
Veracity- Duty to tell the truth
Three approaches to ethical decision making
o Deontological- All life is worthy of respect
o Teleological- That which causes a good outcome is a good action
o Situational- decisions made in one situation cannot be generalized to another situation

11 Patients Rights
1] Discuss the patients bill of rights 1?
What is the patients bill of rights?
To help patients feel more confident in the US healthcare system:
o Assures that the health care system is fair and it works to meet patients' needs
o Gives patients a way to address any problems they may have
o Encourages patients to take an active role in staying or getting healthy
To stress the importance of a strong relationship between patients and their health care providers
To stress the key role patients play in staying healthy by laying out rights and responsibilities for all patients and
healthcare providers
Information for patient
o Patients have the right to receive accurate, easily understood information to help them make informed
decisions about their health plans, professionals and facilities
Choice of providers and plans
o Patients have the right to a choice of health care providers that is sufficient to ensure access to
appropriate high quality health care.
Access to emergency services
o Patients have the right to access emergency healthcare services when and where the need arises
WITHOUT needing to wait for authorization and without any financial penalty
Taking part in treatment decisions
o Patients have the right and responsibility to fully participate in all decisions related to their healthcare.
Patients who are unable to fully participate in treatment decisions have the right to be represented by
parents, guardians, family members, or other conservators
Respect and nondiscrimination
o Patients have the right to considerate, respectful care from all members of the health care system at all
times and under all circumstances.
Confidentiality of Health Information

Patients have the right to communicate with healthcare providers in confidence and to have the
confidentiality of their individually identifiable healthcare information protected.
o Patients also have the right to review and copy their own medical records and request amendments to
their records.
Complaints and appeals
o Patients have the right to a fair and efficient process for resolving differences with their health plans,
healthcare providers, and the institutions that serve them, including a rigorous system of internal review
and an independent system of external review
Consumer responsibilities
o it is reasonable to expect and encourage patients to assume reasonable responsibilities:
Maximize healthy habits e.g., exercising, not smoking, and eating healthy diet.
Become involved in care decisions.
Work collaboratively with providers in developing and carrying out agreed upon treatment
Disclose relevant information and clearly communicate wants and needs
Show respect for other patients and health workers.
Make a good faith effort to meet financial obligations.
Report wrongdoing and fraud to appropriate resources or legal authorities
Patient Bill of rights: 8 key areas:
Information for patients
Choice of providers and plans
Access to emergency services
Taking part in treatment decisions
Respect and nondiscrimination
Confidentiality (privacy) of health information
Complaints and appeals
Consumer responsibilities
HIPAA health information privacy
Your health information is protected by federal law
Who must follow these laws?
o Health Insurance Companies, Medicare, Medicaid
o Health Care Providers
o Health Care Clearinghouses
Who is not required to follow these laws?
o Life insurers
o Employers
o Workers compensation carriers
o Schools and school districts
o Some law enforcement agencies and municipal offices
What information is protected
o Information put in medication record
o Conversation about care and treatment
o Information in the health insurers computer system
o Billing information
Consequences of HIPAA violations
o In addition to Federal violation, failure to
o comply with HIPAA also violate:
Nursing Code of Ethics
Texas Board of Nurse Examiners Standard of
School of Nursing
Legal Consequences
o Civil or Criminal penalties

o Fines plus imprisonment

Professional Consequences
o Disciplinary action by Board of Examiners
Academic Consequences
o Reprimand
o Dismissal from SoN
Who has access to PHI? Need to know Principle
o PHI should be shared with as few individuals as needed to ensure patient care and then only to the
extent demanded by the individuals role.
o As a nursing student, you will discuss PHI only as it applies to your education or your patients care
Protecting your patients PHI
o Take all reasonable steps to make sure that individuals without the need to know do not overhear
conversations about PHI.
o DO NOT conduct discussion about PHI in elevators or cafeterias.
o Do not let others see your computer screen while you are working.
o When preparing care plans or other course required documents take extra care to:
identify the patient/client by initials only
use other demographic data only to the extent necessary to identify the patient and his/her
needs to the instructor.
Protect your printer output

12 Differentiated Levels of Education and Practice

1] Compare and contrast local educational entry levels into the nursing profession 5?
Licensed vocational nurses
o Can provide nursing care under a supervised directed scope of practice
o Can only implement aspects of the plan of care
o Provides care to patients and their families
o Contribute to activities that promote the development and practice of vocational nursing
o Perform decision making in nursing practice
o Assist in determining patient needs
o Reports data
o Provide basic nursing care
Diploma and associate degree nurses
o Can provide nursing care under a broad array of healthcare service
o Implements the whole plan of care
o Provides care to patients and their families
o Participates in activities that promote the development and practice of professional nursing
o Perform decision making in nursing practice
o Determines patient needs based on educational level
o Analyses assessment data
o Provide comprehensive nursing care to patients and their families
Baccalaureate nurses
o Formulates goals and outcomes to reduce patient risk
o Provides care to patients, families, and the community
o Promote the practice of professional through leadership activities and advocacy
o Perform decision making in nursing practice and comprehensive patient care
o Determine patient needs and has synthesis of knowledge based on educational level
o Synthesizes comprehensive assessment data
o Provide comprehensive nursing care to patients, their families, populations, and communities
Employers and healthcare institutes have different policies that specify the scope of practice for each type of nurse
They all use clinical reasoning and knowledge based on their specific level of education
Main difference between the three levels is the LVN can only identify problems/data, the associate nurse can
evaluate patients and their families, BSNs can evaluate patients, their families, and the wider population

2] Discuss future trends in nursing education 2?

Future trends include online degree programs
Bridge programs Ex = BSN/MSN program
External degree plan Designed to help individuals work and go to school
Proprietary nursing school A for profit school with a nursing program
Accelerated program
Nursing degrees dont end at BSN Masters and doctorate degrees are also available
Advance nursing practice
o Nurse practitioner
o Certified nurse-midwife
o Clinical nurse specialist
o Certified registered nurse anesthetist
Future Trends
o Changing student profile Student population includes older students, minorities, those changing their
career path
o Educational mobility Growth of web based learning programs
o Shortage of RNs
o Shortage of qualified nursing faculty
Aging of the nurse faculty population
Increasing number of part time faculty
Large number of nursing faculty who arent prepared at the doctorate level
o Technology and education Change educational curriculum based on changing technology employed in the
health care field
o Changing health care settings Major shift from inpatient to outpatient nursing care
o Aging population


13 Professional Organizations
1] Discuss the importance of belonging to professional nursing organizations 1?
American Nurses Association
What do associations do?
o Set the standards of practice for the profession
o Maintain the Code of Ethics
o Promote the profession to the public
o Educate their members on issues through continuing education and publications
o Advocate for their members on the Federal and State level
o Provide opportunities for members to interact, discuss trends and disseminate knowledge
Nursing Associations
o There are over 100 specialty organizations
Focus on the clinical aspects of each specialty
Focus on areas that are unique to the specialty
o American Nurses Association
Focus on the issues that affect all of nursing and patient care
History of ANA
o Deplorable working conditions and the need to protect the public from incompetent women who
claimed to be trained nurses propelled nursing leaders to form an association of trained nurses
o In September 1896, The Nurses Associated Alumnae of the United States and Canada was formed
Renamed the American Nurses Association in 1911
Goals of the association
o To establish and maintain a code of ethics; to elevate the standards of nursing education; to promote
the usefulness and honor, the financial and other interests of nursing.
A sample of Historical accomplishments


1901 Helped secure passage of a bill creating the Army Nurse Corps under the direction of a properly
trained nurse
o 1913 With the Red Cross, ANA developed a plan that took public health nursing to rural communities.
o 1934 ANAs House of Delegates approved an 8-hour work day for nurses
o 1945 ANA intensified efforts to recruit nurses for military service as an alternative to President
Roosevelts proposal to draft nurses into military services.
o 1955 ANA helped pass a bill to commission male nurses in the Reserve Nurse Corp
o 1965 ANA was the first association of health care professionals to endorse the creation of Medicare.
o 1976 Nurse Training and Health Services Bill, vetoed by President Ford, was overridden by Congress,
recognizing the existing and expanding role for nurses in delivering health care.
o 1986 Helped to create the National Institute for Nursing Research at NIH.
o 1998 ANA supported the Patient Right to Know Act with provisions for anti-discriminatory language,
coverage of emergency care and prohibitions of gag clauses in managed care plans.
ANA Goals Today
o 1.Professional Practice and Excellence ANA successfully champions professional nursing excellence
through standards, code of ethics and professional development, such as credentialing and lifelong
o 2. Healthcare and Public Policy ANA is an acknowledged leader in the formulation of effective
healthcare and public policy as they affect the profession and the public.
o 3. Knowledge and Research ANA is the recognized source for accurate, comprehensive health policy
information based on knowledge from research.
o 4. Unification ANA facilitates unification and advancement of the profession.
o 5. Workforce and Workplace Advocacy ANA with its partners and through its organizational
relationships is the leader in promoting improved work environments and the value of nurses as
professionals, essential providers and decision makers in all practice settings.
ANAs Foundational work
o Code of Ethics for Nurses
A statement of the ethical obligations and duties of every individual who enters the nursing
The professions non-negotiable ethical standard
An expression of nursings own understanding of its commitment to society
o Nursing Scope and Standards
23 current standards
Produced in cooperation with the Specialty Nurses Organizations
o Nursings Social Policy Statement
Reflects a new definition of nursing
ANA working for nurses on capitol hill
o Nurse Reinvestment Act
Provides federal funding for scholarships and training
Funded for $150 million in 2006 a 120% increase from 2000 funding levels of ~$68 million.
o Smallpox Emergency Personnel Protection Act of 2003
Assures the proper administration of vaccinations
Compensates individuals injured by the vaccine
ANA promoting nursing
o Coverage for the work of ANA and Nursing in prominent magazines, newspapers, radio and television
o Nurses have topped Gallups professional honesty and ethics poll every year but one since 1999 when
nurses were first added to the poll
In 2001, Firemen were rated number one
ANA proving the value of nursing
o ANAs National Database for Nursing Quality Indicators (NDNQI) helps to demonstrate the positive
impact of the appropriate mix of nursing staff on patient outcomes
Provides data at the unit level
Develops a database to
inform practice and policy

ANA, along other nursing organizations, has funded research to help quantify the economic value of
ANA representing nurses
o ANA represents nursing at numerous tables (and is often the only nurse in the room!)
Institute for Healthcare Improvement Saving 100,000 Lives Campaign; National Quality Forum;
U.S. Department of Health and Human Services; Agency for Healthcare Research and Quality;
Centers for Disease Control and Prevention; Centers for Medicare and Medicaid Services;
National Institutes of Health; National Institute for Occupational Safety and Health; U.S.
Department of Labor; American Hospital Association; American Health Care Association Long
Term Care Commission; American Medical Association; American Medical Informatics
Association; American Public Health Association, American Society of Bioethics and Humanities;
e-Health Initiative; Families USA; Hospitals for a Healthy Environment; International Council of
Nursing; Institute for Healthcare Improvement; Institute of Medicine; Joint Commission of
Accreditation of Health Care Organizations; National Association for Home Care; National
Coordinating Council for Medication Error Prevention and Reporting; National Coalition of
Health Professional Education in Genetics; National Council of Patient Information & Education;
National Conference of State Legislators
o Just to name a few!
State nurses association
o Key in protecting the Nurse Practice Acts in each state
o Instrumental in advancing the rights of advanced practice nurses in each state
o The voice for nurses at the state legislature
ANA and the state nurses associations work to coordinate this effort to be more effective
Belonging is Important!
o More nurses belonging to nursing associations.
Gives additional power to the association when speaking in front of Congress and other
regulatory bodies
Gives additional funds for associations to do work on behalf of the profession
Puts nursing in a position to direct health care policy versus reacting to it
Membership gives you:
o A voice in the decisions being made for the profession
o The opportunity to receive discounts and benefits as a member
o Discounts on certification
o Free continuing education
o Access to members only information
o A chance to interact with nurses around the country



Association of perioperative registered nurses

o Prof. Quintanas association!
o Once you have 2 years experience in your specialty field, you can become eligible to get your specialty
nursing certification (CNOR- certified nurse operating room)
Process in which a certifying agency certifies a nurses knowledge, skills, and abilities in defined
role in clinical area of practice.
o Once you have this certification the next challenge is to maintain it. The best way to do so is to belong to
a professional nursing organization, in this case the AORN.
o By doing so, you have access to numerous journals, & CE contact hours.
o You normally need 20 contact hours every 2 years to maintain your RN, in addition to this, specialty
nurses have to earn 125 contact hours every 5 years, 75 of those must be related to the specialty
(perioperative nursing)
o Benefits of belonging to the AORN: journals, CE, most up to date evidence based practice info at your
hands (it is one central resource), also offers conferences which allows you to get together with other
members in your specialty area. Also provides a platform for networking.
Other organizations (from the book)

American Nurses foundation and the american academy of nursing

o Serve special purposes in support of research and recognition of nursing colleagues. The American
Nurses foundation was established as a tax exempt corporation to receive money for nursing research.
International Council of Nurses
o Established in 1899, the focus of this organization is on worldwide healthcare and nursing issues; it
meets every 4 years and is headquartered in Geneva, Switzerland
National League for nurses
o NLN places community-based healthcare education and healthcare delivery at the center of its focus
and activities.
o NLN fosters improvement in nursing services and nursing education and offers annual educational
summits so that nursing faculty and leaders in all types of nursing education programs can come
National student nurses association
o Mentors the professional development of future nurses and facilitates their entrance into the profession
by providing educational resources, leadership opportunities, and career guidance.
National organization for associate degree nursing
o Open to associate degree nursing graduates, educators, and students.
o The mission is to be the advocate for associate degree nursing education and practice while supporting
advanced nursing education through academic progression.
American association of colleges of nursing
o The national voice for university and 4-year college educational programs in nursing.
o Mission is to serve the public interest by assisting deans and directors in improving and advancing
nursing education, research, and practice. Publishes a bimonthly nursing journal called the Journal of
Professional nursing.
American board of nursing specialties
o Creates uniformity in nursing certification; represents more than 25 specialty nursing organizations that
promote specialty practice and address certification issues associated with specialty practice
The american red cross
o International organization of approx. 120 red cross organizations around the world.
o Voluntary agency that is supported by contributions and plays an important role in providing disaster
relief and education in first aid and home health and in organizing volunteers to assist in hospitals and
nursing homes.
Texas Nurses Association (TNA)
o The Texas Nurses Association (TNA) is a statewide membership-based professional association of
licensed nurses. Founded in 1907, TNA is the oldest and largest nursing association in Texas.
o Our members represent all segments of nursing practice, bedside to administration, consulting to
advanced practice, and education to legislation. TNA members come from all practice settings: Hospital,
home and community health, public health, higher education, long-term care, school health, and policy.
o As diverse as they are, TNA members share a common purpose: Advancing excellence in nursing. It's a
pursuit that requires commitment, involvement, and leadership - fortunately, these are inherent traits
of nurses.
o TNA is not a union. We are a voluntary organization that works with everyone to get good things
accomplished for nurses and their patients.


14 Quality Patient Care

1] Describe the history and evolution of quality in healthcare 1?
Philip Crosby is the father of zero defects. He proposed simplifying thing so that everyone can understand. He
believes in the importance of communicating quality efforts and their results to the entire organization. This is how
the Six Sigma methods crossed over into health care.
Joseph M. Juran is a valuable forefather who emphasize the Pareto principle which means that 80% of problems are
caused by 20% of sources, people of things. If you can fix the 20% then can you pretty much fix the entire system.
His work marked the beginning of total quality management.

Edward Deming is considered the father of quality initiatives. His teaching embraced the philosophy that quality is
everyones responsibility within an organization.
In the 1990s TJC first began to mandate the use of continuous quality improvement

2] Discuss nursing standards and evidence-based nursing practice 1?

Several agencies have developed standards that guide quality in health care.
o American Nurses Association (ANA) - Standards of Nursing Care
o The Joint Commission (TJC) - accredits healthcare organizations
o The Agency for Healthcare Research and Quality (AHRQ) - established clinical practice treatment guidelines
o Institute of Medicine (IOM)
o Quality and Safety Education for Nurses
3] Describe the role of the professional nurse in quality and performance improvement 1?
Nurses Role in CQI (Continuous Quality Improvement)
o Enhance the value of healthcare
o Serve as patient advocates/report safety risks
o Serve in performance improvement teams
o Assist in designing effective improvements in care
o Help in collecting data
o Be knowledgeable about quality improvement tools and possess personal competencies
o Utilize EBP in patient care
o Help formulate new protocols/policies/guidelines that will enhance quality care
o Utilize safety reporting systems
4] Identify tools and processes for continuous quality improvement 3?
o Root cause analysis
o Six Sigma (SS)
Originally a quality concept created to minimize the defects of a production process to a certain variation,
called six sigma; uses statistics to enhance the quality of business processes
Concept developed into an organizational ideology and philosophy that incorporates all management,
customer, and business related activities as potential contributions to defects in a system
Six Sigma management attempts to address all issues that are not value adding to the organization and all
relationships that are not value adding
Issue/problem statement identified, team chosen, charter developed, goals prioritized
Team members should include only those who want to be part of solution
Key performance indicators (KPI)/things that the team wants to change
Identify responsible parties for data collection/analysis
Analyze phase
Identify gaps
Avoid blame and move quickly
Improve phase
PDSA (Plan, do, study, act) cycle to plan and implement
Control phase
Controls established, new protocols/policies written up, staff educated, continuous monitoring of
KPIs initiated


5] Compare and contrast the roles of the regulatory agencies, employer, and health care team members in quality and
performance improvement 3?
The ANA, The Joint Commission, and the Agency for Healthcare Research and Quality all have standards of nursing

Sentinel event Unexpected occurrence involving death or loss of limb or function

Organizations use several methods of quality improvement Use quality teams, working groups, or quality circles
Continuous quality improvement (CQI) Forms, methods, and analytical techniques that assist in understanding a
Refer to question 3 and 4

15 Legal Issues
1] Relate the nursing practice act to the governance of professional nursing 1?
Nursing Practice Act of each state is an example of statutory law and it is comprised of statutes and rules, both of
which are the most common types of laws affecting nurses.
The nursing license sets certain standards that you must follow as a nurse in the state in which you are both licensed
and practice. Should you not live up to these standards, a state board of nursing can take disciplinary action against
you, which in rare instances may include revoking your ability to practice as a nurse.
Common Legal Terms
Statutes of limitations- laws that set the time limits for when a case may be filed. These limitations vary from state
to state.
Defamation- Civil wrong in which individuals reputation in the community/professional community has been ruined.
Deposition- Out of court oral testimony given under oath before a court reporter.
Diversion Program- Program for treatment and rehabilitation of substance abusers
Expert Witness- person who has specific knowledge, skills and experience regarding a specific care and whose
testimony will be allowed in court to prove the standard of care
Good Samaritan Law-law that provides civil immunity to professionals who stop and render care in an emergency.
Interrogatory-process of discovering the facts regarding a case through a set of written questions exchanged
through attorneys representing the parties in the involved case.
Jurisdiction- courts authority to accept and decide cases.
Malpractice- improper performance of professional duties resulting in harm to another person.
Negligence-failure to act as an ordinary prudent person when such failure results in harm to another.
Plaintiff- person who files the lawsuit and is seeking damages for a perceived wrong doing.
Reasonable Care- level of care/skill that is rendered by competent health care worker of similar
education/experience providing services to an individual.
Standard of Care- set of guidelines based on various types
Telemedicine-- using telecommunication technology, usually interactive, to provide medical information and
Torts-- civil (not criminal) wrongs committed by one person against another person or property, includes the legal
principle of assault and battery
Whistleblower-- individual on the inside who reports incorrect or illegal activities to an agency with the authority
to monitor or control those activities
Whistleblower Statute-- law that protects a whistleblower from retaliation. Usually involves specific criteria about
how whistle was blown
2] Discuss the functions of the Texas Board of Nurse Examiners 2?
The Texas BON = agency designated to apply the laws to individuals
It acts under the police power granted to each state from the federal govt to protect the safety of its residents
Grants licenses after a candidate has successfully met all the requirements (particular to the state)
Continues to monitor your practice and to investigate complaints regarding this practice
BON have the authority to censure, to place a license on probation, to suspend, to revoke, or to deny licensure-each of these actions can be temporary or permanent


3] Describe the professional nurses responsibilities for obtaining and maintaining a license to practice 1?
To obtain-- must successfully complete the requirements for the BON specific to the state such as high school
education, successful completion of a nursing education program, application to the appropriate national and state
agencies, fee payment, not being a felon, and passing the NCLEX appropriate for licensure level

If you move to a different state it is important to keep your past state board informed of your current residence so
that you receive important documents in a timely manner that can affect your future ability to practice Also be
informed of the new states practice requirements before beginning to practice
o Do not let anyone borrow it
o Do not let anyone copy it (if you do, write copy across it, but its illegal in some states)
o If you lose it, report it immediately and take necessary steps to make a duplicate
o Periodically check to make sure that you are in good standing at the BON because of the issues related to
identity theft
o Be sure that the BON knows whenever you change your address, whether you move across the street or
across the nation
o Practice nursing according to the scope and standards of practice in your state
o Know your state law so you will not do anything that could cause you to be disciplined by the removal of
your license
o Meet all renewal requirements on time

4] Identify legal issues involved in the medical record and nursing documentation including the use of electronic medical
records (EMR) 1?
Medical record is the first piece of evidence requested by attorney of plaintiff with nurses notes being the first
part of the record examined
Their integrity, accuracy, and completeness will make a claim defensible or indefensible
Good documentation = best defensive actions a nurse can take
Documentation should be thoroughly and factually done documentation in the book is described as being able to
put on play based on your notes on what was done for the patient
BOX 20-3 Guidelines for defensive charting (p. 466)
o All entries should be accurate and factual
o Make corrections appropriately and according to agency or hospital policies. Do not ever destroy any info
that is or has been in the chart
o If there is info that shouldve been charted but wasnt--make a late entry noting the time the charting
actually occurred and the specific time the charting reflects
o All identified pt problems, nursing actions taken, and patient responses should be noted. Do not describe a
patient problem without including the nursing actions taken and the patient response
o Document why you did not do something that you would routinely do...ex. pt refused to ambulate b/c
o Be as objective as possible in charting. Ex. bad ambulated, tolerated well --good ambulated complete
length of hall, no shortness of breath noted, pulse rate 98 and respirations 22
o Each page of the chart should contain the current date and time
o Follow through with who saw the pt and what measure were initiated: when physician visited, if called doc
for a problem document response, the nursing actions, and pts response.
o Make sure notes are legible and clearly reflect the info intended-- make sure notes make sense
o Pertinent notes from other providers should also be reviewed
Federal govt is encouraging the switch to EMR b/c will improve accessibility, quality, and efficiency of health care
same rules of documentation apply
Believed that EMR will promote more accurate and safe record keeping-- ex. Illegible handwriting will not be a
problem some programs have automatic safeguards to catch errors


5] Identify the elements of nursing malpractice and discuss ways to minimize legal risks in personal practice 7?
Patient safety
o Nurses responsible for:
Know how to use equipment and dont use it if not working properly; use as directed by
manufacturer; make sure equipment is properly maintained and that records are kept of the
maintenance; make sure equipment is available for use
Removing obvious hazards such as chemicals that can be mistaken for meds

Making the environment free of hazards such as inappropriately placed furniture or equipment and
spills on the floor
Knowing how to document correctly if an incident occurs
Following the fall protocol/ policies to prevent patient falls
Improper treatment
Problems with monitoring
o Nurse should not delegate to another the responsibility for assessing and evaluating patient care and
progress-- if some portions of this duty are handled by other the nurse who is primarily responsible for the
care of patient must still be aware of the findings and confirm when they indicate a change in pt condition or
progress-- critical to document changes
o Critical to communicate b/w caregivers when reporting changes in patients condition
Medication errors
o Box 20-4 Tips for being at your best when administering medications
Be careful if you have been interrupted during the task
If you are fatigued be very careful and follow all steps thoroughly
Listen to your patients-- they can tell you if what you are planning to do is diff or unusual-- do a
second check
Never do a procedure you do not know how to do at the appropriate standard of performance
Never be afraid to admit you made a mistake
Keep current and up to date in your practice knowledge base
Do not rush when you are especially busy-- set priorities
Failing to follow proper procedures and policies
o Including failure to report-- nurse needs to know what areas must be reported, who should report, how the
report should be accomplished, and to whom a report should be made
Report incidences and occurrences-- otherwise can be seen as negligence
Includes reporting other health care professionals whose behaviors are unprofessional
Duty to report evidence of child or adult or elder abuse and neglect
Report communicable diseases
Report certain deaths under suspicious circumstances
Report certain types of injuries that are or could be caused by violence
Report evidence of medicare fraud
Failure to communicate adequately
o Make sure read back all verbal and phone orders
o Have translators available
Also always communicate with the
patient what you are doing and why
you are doing it