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Test 1 Blueprint

1. Health Promotion pg. 280-281, 287 (application, health promotion)

-A variety of programs can be used for the promotion of health:
A) Information Dissemination- the most basic type of health promotion
program. Billboards, posters, brochures newspaper features, books, and
health fairs, all offer opportunities for the dissemination of health promotion
B) Health Risk Appraisal and Wellness Assessment- explain to individuals the
risk factors that are inherent in their lives in order to motivate them to reduce
specific risks and develop positive health habits.
C) Lifestyle and Behavior Change- require the participation of the individual
and are geared toward enhancing the quality of life and extending the life
D) Environmental Control Programs- developed in response to the continuing
increase of contaminants of human origin that have been introduced into our
environment. Most common concerns are toxic and nuclear waste, nuclear
power plants, air and water pollution, and herbicide and pesticide use.
2. Health Promotion pg. 280-281, 287 (application, health promotion)
3. Nurse Practice Acts pg. 54-56 (application, safety and infection control)
-Each state has a nurse practice act, which protects the public by legally defining
and describing the scope of nursing practice. State nurse practice also legally
control nursing practice through licensing requirements.
-Nurse practice acts vary from state to state, and it is the nurses responsibility to
know the states practice acts of the state in which he or she practice in.
-Grounds to disciplinary action if not followed.
4. Standards of Care pg. 57 (application, safety and infection control)
-the purpose of standards of care is to protect the consumer. They are the skills and
learning commonly possessed by a member of a profession.
-These standards are used to evaluate the quality of care nurses provide and,
therefore, become legal guidelines for nursing practice.
-Nursing Standards of Care are classified in two:
Internal Standards of Care
o Nurse job description
o Education
o Expertise
o Individual institutional policies and procedures
External Standards of Care
o Nurse practice acts
o Professional organizations (e.g., ANA )
o Nursing specialty-practice organizations (e.g., Emergency Nurse
Association, Oncology Nursing Society)
o Federal organizations and federal guidelines (e.g., The Joint
Commission and Medicare)
-ANA is generic in foundation

5. Nursing Roles pg. 16-17 (application, safety and infection control)

-Nurses assume many roles when they provide care to clients.
Client Advocate
Change Agent
Case Manager
Research Consumer
Expanded Career Goals
-Often the nurse is asked to obtain a signed consent form. The nurse is not
responsible for explaining the procedure but for witnessing the signature. (pg. 62)
-Nursing signature informs 3 things
TBON Roles of a nurse: HAPP
Member of a Healthcare team
Patient safety Advocate
Provider of Patient centered care
Member of a Profession
Standards of Professional Performance:EEEQLCCPRE
Evidence based practice and research
Quality of practice
Professional practice evolution
Resource utilization
Environmental health
6. Patient Advocate pg.93-94 (application, psychosocial integrity)
-An advocate is one who expresses and defends the cause of another.
-Advocacy requires accepting and respecting the clients right to decide, even if the
nurse believes the
decision to be wrong.
Functions of an advocate:
Informs clients about their rights and provides them with the information they
need to make informed decisions
Supports clients in their decisions, giving them full or at least mutual
responsibility in decision making when they are capable of it.

In mediating the advocate directly intervenes on the clients behalf, often by

influencing others

7. Professionalism pg.17 (analysis, safety and infection control)

-professionalism refers to professional character, spirit, or methods. It is a set of
attributes, a way of life that implies responsibility and commitment.
-Nursing professionalism owes much to the influence of Florence Nightingale.
8. Autonomy pg. 85 (application, safety and infection control)
-Refers to the right to make ones own decisions. Nurse who follow this principle
recognize that each client is unique, has the right to be what that person is, and has
the right to choose personal goals.
-Inward autonomy- people have the ability to make choices
-Outward autonomy- if their choices are not limited or not imposed by others.
-Honoring the principle of autonomy means that the nurse respects a clients right
to make decisions even when those choices seem to the nurse not to be in the
clients best interest.
-Respect for autonomy means that people should not be treated as impersonal
sources of knowledge or training.
9. Organizational Skills pg. 19 (application, management of care)
-Governance- the establishment and maintenance of social, political, and economic
arrangements by which practitioners control their practice, their self-discipline, their
working conditions, and their professional affairs.
10. Economic Challenges PP
-Prolonging life
-Delaying onset of disease
-Emerging genetic technology
-Gene therapy
Sophisticated computers
-Space travel and need to monitor astronauts
-Internet information not always accurate
-No state boundaries raises license issues
Cost of Healthcare began rising due to:
o Technological advances
o Aging population
o Health-related lawsuits
Cost containment measures include:
o Diagnostic related groups (DRG)
o Mass or built purchasing
o Early intervention and preventative services
o Shifting emphasis from in-patient to out-patient
Changes in employment opportinuties
o Shifting emphasis from in-patient to out-patient
o Same-day surgery


Home healthcare
Physical fitness programs
Community health education programs

11. Patient Abandonment

1. Sleeping on the job
2. Leaving without notice
3. Failing to completely initiate agreed assignment
4. Leaving the assigned patient care area
12. Standards of Practice pg.16 (application, management of care)
-The purpose of the ANA Standards of Practice is to describe the responsibilities for
which nurse are accountable.
o 1. Assessment- the RN collects comprehensive data pertinent to the
health care consumers health and/or the situation.
o 2. Diagnosis- the RN analyzes the assessment data to determine the
diagnosis or issues.
o 3. Outcomes Identification- the RN identifies expected outcomes for a
plan individualized to the healthcare consumer or the situation
o 4. Planning- the RN develops a plan that prescribes strategies and
alternatives to attain expected outcomes
o 5.Implementation- the RN implements the identified plan
5A. Coordination of Care- the RN coordinates care delivery
5B. Health Teaching and Health Promotion- the RN employs
strategies to promote health and a safe environment
5C. Consultation- the graduate-level prepared specialty nurse or
advanced practice RN and the nursing role specialist provide
consultation to influence the identified plan, enhance the
abilities of others, and effect change
5D. Prescriptive authority and Treatment- the advanced practice
RN uses prescriptive authority, procedures, referrals, treatments,
and therapies in accordance with state and federal laws and
o 6. Evaluation- the RN evaluates progress toward attainment of
13. Standards of Practice pg.16 (application, management of care)
14. Standards of Practice pg.16 (application, safety and infection control)
15. Nurse Certification pg. 9-12 (application, safety and infection control)

-The practice of nursing is controlled from within the profession through state
boards of nursing and professional nursing organizations. These groups also
determine the content and type of education that is required for different levels or
scopes of nursing practice.
o Last 9-12 months and include both classroom and clinical experience.
At the end of the program graduates Take the NCLEX-PNn to obtain
o Practical nurses work under the supervision of a RN in numerous
settings (hospitals, nursing homes, rehab centers, and home health
Diploma Degree
o In early years nursing education took form in apprenticeship programs
o 3-year diploma programs were the dominant nursing programs and the
major source of nursing graduates from the late 1800s to mid 1960s
o Has declined since a resolution by the ANA in 1965 recommended that
education for those who work in nursing should be placed in
institutions of learning within the general system of education.
Associates Degree
o Arose in the early 1950s, were the first and only educational programs
fornursing that were systematically developed from planned research
and controlled experimentation. Most take place in community
o In the US, ASNs were started after Mildred Montag published her
doctoral dissertion, The Education of Nursing Technicians, in 1951.
Proposed a 2-year program in community colleges as a solution to
nursing shortages due to WWII.
o Currently 44% of all new RNs each year have a ASN
Bachelors Degree
o The firast school of nursing in a university was established at the
University of Minnesota in 1909
o Most were 5-years in length
o More than 800 BSN programs are now available in the US and 34% of
RNs are educated in these programs
o Located in senior colleges and universities and are 4-years in length
Masters Degree
o The first clinically focused masters degree program was established at
Rutgers University in New Jersey in 1954.
o Generally take 2-years to complete
o Provide specialized knowledge and skills that enable nurses to assume
advanced roles in practice, education, and administration.
Doctoral Programs
o Began in the 1960s in the US
o Currently offer either a doctor of philosophy (PhD) or a doctor of
nursing practice (DNP)
o In 2004, the AACN voted to establish the DNP as the level of education
required to assume advanced practice roles such as nurse practitioner,

clinical nurse specialist, nurse midwife, and nurse anesthetist. Will

become effective in 2015 and eventually will replace masters degree.
16. Benners Stages pg. 19 (analysis, safety and infection control)
-Benners model (2001) describes 5 levels of proficiency in nursing based on the
Dreyfus general model of skill acquisition.
Stage I, Novice: No experience (e.g., nursing student). Performance is limited,
inflexible, and governed by context free rules and regulations rather than
Stage II, Advance Beginner: Demonstrates marginally acceptable
performance. Recognizes the meaningful aspects of a real situation. Has
experienced enough real situations to make judgments about them.
Stage III, Competent: Has 2 or 3 years of experience. Demonstrates
organizational and planning abilities. Differentiates important factors from
less aspects of care. Coordinates multiple complex care demands.
Stage IV, Proficient: Has 3 to five years of experience. Perceives situations as
wholes rather than in terms of parts as in stage II. Uses maxims as guides for
what to consider in a situation. Has holistic understanding of the client, which
improves decision making. Focues on long term goals.
Stage V, Expert: Performance in fluid, flexible, and highly proficient; no longer
requires rules, guidelines or maxims to connect an understanding of the
situation to appropriate action. Demonstrates highly skilled intuitive and
analytic ability in new situations. Is inclined to take a certain action because it
felt right.
17. Supervision
18. Metaparadigm pg. 41 (application, health promotion)
-Four major concepts central to nursing: person, environment, health, and nursing.
Person (client)- the recipient of nursing care.
Environment- the internal and external surrounding that affect the client.
Health- the degree of wellness or well being that the client experiences.
Nursing- the attriubutes, characteristic, and actions of the nurse providing
care on behalf of, or in conjunction with the client.
19. Nursing Theorists pg. 42-48 ()
- Nursing theory guides knowledge development and directs education, research,
and practice although each influences the others.
- The nursing experts in each are helps to ensure that work in the other areas
remain relevant current, useful, and ultimately influences health.
Nightingales Environmental Theory (mainly environment)
-First nurse theorist
-Described nursing 150 years ago as establishing an environment that allows
persons to recover from illness.
-The 5 environmental factors:
1.Pure or fresh air/ventilation
2. Pure water

3. Efficient drainage
4. Cleanliness/effluvia
5. Light(direct sunlight)/light
-Deficiency in these 5 factors produce lack of health or illness.
-Nightingale also stressed the importance of keeping the client warm, maintaining a
noise free environment, and attending the clients diet in in terms of assessing
intake, timeliness of the food, and its effect on the person.

Peplaus Interpersonal Relations Model
-central to Peplaus theory is the existence of a therapeutic relationship between the
nurse and the client.
-4 Phases:
1. Orientation: nurse assists the client to understand the problem and the
extent of the need for help
2. Identification: assure the person that the nurse understands the clients
3. Exploitation: power shift from nurse to client.
4. Resolution: once older needs are met, new and more mature ones emerge
-Peplaus model continues to be used by clinicians when working with individuals
who have psychological problems.
Hendersons Definition of Nursing
-Henderson sees the nurse as concerned with both healthy and ill individuals,
acknowledges tha nurse interact with clients even when recovery may not feasible,
and mentions the teaching and advocacy roles of the nurse.
-14 essential functions that help client toward independence
Neumans Systems Model (NEUMAN STRESSES ME OUT!)
-reconstitution is the state of adaptation to stressors.
-3 stressors
Intrapersonal-within the individual(infection)
Interpersonal-between individuals(unrealistic role expectations)
Extra personal-outside the person(financial concerns)
-3 preventative levels
Primary-protecting and strengthening


-Sister Callista Roy focuses on the individual as a psychosocial adaptive system that
employs a feedback cycle of input(stimuli), throughput(control process), and output
process(behaviors of adaptive response).
-4 Adaptive modes
1. Physiological mode- whole body system
2. Self-concept mode- two components
o Physical- sensation and body image
o Personal self- self-ideal, self-consistency, moral self
3.role function mode-social integrity
4.interdepence mode- relation with other, affection and attention

-the whole being greater than the sum of its parts
-two energy fields, human and environment
Leiningers Cultural Care Diversity and Universality Theory
-Madeline Leininger, a nurse anthropologist, put her views on transcultural nursing
in print in the 1970s, established the Journal of Transcultural Nursing in 1986, and
then in 1991 published her book Culture Care Diversity and Universality: A Theory
in Nursing.
- States that care is the essence of nursing and the dominant, distinctive, and
unifying feature of nursing. -She emphasizes that human caring, although a
universal phenomenon, varies among cultures in its expressions, processes, and
pattersn; it is largely culturally derived.
-Sunrise Model-Emphasizes that health and care are influenced by elements of the
social structure, such as technology, religious and philosophical factors, kinship and
social systems, cultural values, political and legal factors, economic factors, and
educational factors.
-In order for nurses to assist people of diverse cultures, Leininger present 3
intervention modes:
Culture care preservation and maintenance
Culture care accommodation, negotiation, or both
Culture care restructuring and repattering
-Leininger states her theory is the only one unequivocally focused on culture care.
Watsons Human Caring Theory
-Jean Watson believes the practice of caring is central to nursing; it is the unifying
focus for practice.
-all about caring
- Carative factors translated into clinical caritas process:
1. Formation for a humanistic-altruistic system of values, practice of lovingkindness and equainimity withing context of carinf consciousness.

2. Installation of faith-hope, being authentically present, and enabling and

sustaining the deep belief system and subjective life world of self and onebeing-cared for.
3. Cultivation of sensitivity of ones self and others, cultivation of ones own
spiritual practices and transpersonal self, going beyond ego self.
4. Development of a helping trusting, human caring relationship, developing
and sustaining a helping-trusting, authentic caring relationship.
5. Promotion and acceptance of the expression of positive and negative
feeling, being present to and supportive of the expression of positive and
neghative feelings as a connection with deeper spitrit of self and the one
being cared for.
6. Systematic use of a creative problem-solving caring process, creative use
of self and all ways of knowing as part of the caring process; to engage in
artistry of caring-healing practices.
7. Promotion of transpersonal teaching-learning, engaging in genuine
teaching-learning experience that attends to unity of being and meaning
attempting to stay within others frame of reference.
8. Provisin for a supportive, protective, and/or corrective mental, physical,
societal, and spiritual environment, creating healing environment at all
levels (physical as well as non-physical), subtle environment of energy and
consciousness, whereby wholeness, beauty, comfort, dignity, and peace are
9. Assistance with gratification of human needs, assisting with basic needs,
with an intentional caring consciousness, administering human care
essentials which potentiate alignment of mindbodyspirit, wholeness, and
unity being in all aspects of care, tending to both embodied spirit amd
evolving spiritual emergence.
10. Allowance for existential-phenomenological-spiritual forces, opening and
attending to spiritual-muysterious, and existential dimensions of ones own
life-death; soul care for self and the one being cared for.

Parses Human Becoming Theory

-Proposes 3 assumptions about human becoming (1999)
1. Human becoming is freely choosing personal meaning in situations in the
intersubjective process of relating value priorities.
o Meaning arises prom a persons interrelationship with the world and
refers to happenings to which the person attaches varying degrees of
2. Human becoming is cocreating rhythmic patterns or relating in mutual
process with the universe.
o Rhythmicity is the movement toward greater diversity.
3. Human becoming is contrascending multidimensionally with the emerging
o Cotranscendence is the process of reaching out beyond the self.
-Parse contends that the client, not the nurse, is the authority figure and decision
maker. The nurses role involves helping individuals and families in choosing the
possibilities for changing the health process.

Orems General Theory of Nursing (3 Ss: self-care requisite, self-care

requisite, systems)
-Dorothea Orems theory, first published in 1971, includes 3 related concepts: selfcare, self-care deficit, and nursing systems.
Self-care based on 4 concepts
Self-care- activities an individual performs independently
throughout life to promote and maintain personal well-being.
Self-care agency- an individuals ability to perform self care
Self-care agent (individual who performs self care
Dependent care agent (person other than individual who
provides the care)
Self-care requisites- also called self-care needs are measure or
actions taken to provide self care. There are three categories:
1. Common to all people. Maintaining intake and
elimination of air, water and food; balancing rest, solitude,
and social interaction; preventing hazards to life and wellbeing; performing normal human functioning.
2. Developmental requisites result from maturation or are
associated with conditions or events, such as adjusting to
a change in body or the loss of a spouse.
3. Health deviation requisites result from illness, injury or
disease or its treatment. Include actions such as seeking
healthcare assistance, carrying out prescribed therapies,
and learning to live with the effects of illness or
Self-care deficit- results when self-care agency (individuals ability to perform
self-care activitiers) is not adequate to meet the known self-care demand.
o Orems self-care deficit theory explains not only when nursing is
needed but also how people can be assisted through five methods of
helping: acting or doing for, guiding, teaching, supporting, and
providing an environment that promotes the individuals abilities to
meet current and future demands.
Three types of nursing systems:
o 1. Wholly compensatory systems are required for individuals who are
unable to control and monitor their environment and process
o 2. Partly compensatory systems are designed for individuals who are
unable to perform some, but not all, self-care activities.
o 3. Supportive-educative (developmental) systems are designed for
persons who need to learn to perform self-care measures and need
assistance to do so.
Kings Goals Attainment Theory
-Imogene Kings theory of goal attainment (1981) was derived from her conceptual
framework and shows the relationship of personal systems (individuals),
interpersonal systems (groups such as nurse-client), and social systems (such as
educational systems, healthcare systems).

-This process describes the nature of and standard for nurse-client interactions that
lead to goal attainment- that nurses purposefully interact and mutually set, explore
and agree to achieve goals. Goal attainment represent outcome.
-Kings theory highlights the importance of a clients participation in decisions that
influence care and focuses on both the process of nurse-client interaction and the
outcomes of care.
Faye Abedellah
-Identified 21 nursing problems that became foundation of nursing diagnoses.
-Influenced by Maslows Hierarchy of Basic Human Needs and Von Bartlaffnys
general systems theory.
-Offer a holistic approach to the development of nursing diagnoses and client care.
-Provides an appropriate method for organization of textbook topics.

Maslows Hierarchy of Needs

Love and belonging
Safe and security

20. Levels of Prevention pg.100, 281 (application, reduction risk)

-Leavell and Clark (1965) defined 3 levels of prevention: (the three levels may
overlap in practice)
Primary Prevention: purpose is to decrease the risk of exposure of the
individual or community to disease
o A) Health promotion
o B) Protection against specific problems (e.g., immunization against hep
Secondary Prevention: goal is to identify individuals in an early stage of a
disease process and to limit future disability.
o A) Early identification of health problems
o B) Prompt intervention to alleviate health problems
Tertiary Prevention: Focuses on restoration and rehabilitation with the goal of
returning the individual to an optimal level of functioning.
21. Levels of Prevention pg. 100, 281 (application, health promotion)
22. Nursing Theorists pg. 42-48 ()
23. Nursing Theorists pg. 42-48 ()

24. Metaparadigm pg. 41 (application, management of care)
25. Nursing Theorists pg. 42-48 ()
26. Nursing Theorists pg. 42-48 ()
27. Systems Theory pg. 437 & PowerPoint (application, health and promotion)
-Nurses are increasingly using systems theory to understand not only biological
systems but also systems in families, communities, and nursing and health care.
Using systems theory for health promotion of the family, the nurse considers how
each element of the system affects the others.
Raw Material
Result of process
-Through put
Work of the system
-Feedback Loop
Message that becomes part of the input

28. Purpose of Theories pg. 41 & 48

(application, management of care)
-Direct links exist among theory, education, research, and clinical practice. In many
cases, nursing theory guides knowledge development and directs education,
research, and practice although each influences the other. The interface between
nursing experts in each area helps to ensure that work in the other areas remains
relevant, current, useful, and ultimately influences health.
-Theory can be used to broaden our perspectives in nursing and facilitate the
altruistic and humanistic values of the profession.
-Assist the nursing discipline in clarifying beliefs, values, and goals.
-Help to define the unique contribution of nursing in the care of clients.
-Standards of clinical practice are developed out of nursing theories.
29. Criteria for Profession pg. 17-19 (application, management of care)
-A profession has been defined as an occupation that requires extensive education
or a calling that requires special knowledge, skill, and preparation.
Specialized Education

An important aspect of professional status.

In US today there are 5 means of entry into registered nursing: hospital
diploma, associate degree, baccalaureate degree, masters degree,
and doctoral degree.
Body of Knowledge
o Nursing is establishing a well-defined body of knowledge and expertise
Service Orientation
Service orientation differentiates nursing from an occupation persued
primarily for profit. Many consider altruism (selfless concern for others) the
hallmark of a profession. Must be, however, guided by certain rules, policies,
and codes of ethics.
Ongoing Research
o 1940s- nursing research was at an early stage of development
o 1950s- increased federal funding and professional support helped
establish centers for nursing research.
o 1960s- studies were often related to the nature of the knowledge base
underlying nursing practice.
o 1970s- nursing research has been focused on practice related issues
since the 70s
Code of Ethics
o The nursing profession requires integrity of its members; that is, a
member is expected to do what is considered right regardless of the
personal cost.
o A profession is autonomous if it regulates itself and sets standards for
its members.
Professional Organization
o Operation under the umbrella of a professional organization
differentiates a profession from an occupation.
o The ANA is a professional organization that advances the nursing
profession by fostering high standards of nursing practice, promoting
the economic and general welfare of nurses in the workplace,
projecting a positive and realistic view of nursing, and by lobbying the
congress and regulatory agencies on healthcare issues affecting nurses
and the public.

30. Definition of Nursing pg. 13 (comprehension)

-Florence anightingale- the act of utilizing the environment of the patient to assist
hi8m in his recovery.
-Virginia Henderson- the unique function of the nurse is to assist the individual, sick
or well, in the performance of those activities contributing to health or its recovery
that he would perform unaided if he had the necessary strength, will, or knowledge,
and to do this in such a way as to help him gain independence as rapidly as
- ANA(1973)- direct, goal oriented, and adaptable to the needs of the individual,
the family, and ther community during health and illness
-ANA(1980)-nursing is the diagnosis and treatment of human response to actual or
potential health problems

-ANA(recent 2003)-nursing is the protection, promotion, and optimization, of health

and abilities, preventions of illness and injury, alleviation of suffering through the
diagnosis and treatment of human response, and advocacy in the care of
individuals, families, communities, and populations
-Texas Board of Nursing Definition of Nursing- Professional nursing means the
performance of an act that requires substantial specialized judgment and skill, the
proper performance of which is based on knowledge and application of the
principles of biological, physical, and social science as acquired by a completed
course in an approved school of professional nursing.
-MVC Nursing Program- Nursing is an art and a science which is patient centered
and designed to assist the individual to achieve and maintain maximum functioning
through the life span. MVC Student Handbook
31. Nurse Practice Act pg. 54-56 (comprehension)
32. Hospital Regulation pg. 720 (comprehension)
-Joint Comission (National Patient Safety Goals for Hospitals and Long Term Care)
Improve the accuracy of patient/resident identification
Improve the effectiveness of communication among caregivers
Improve the safety of using medication
Reduce the risk of health-care associated infections
Accurately and completely reconcile medications across the continuum of
Reduce the risk of resident harm resulting from falls
Prevent health-care associated pressure ulcers
The hospital identifies safety risks inherent in its patient population
33. Standards of Practice pg. 16 (comprehension)
34. Nursing Roles pg. 16-17 (comprehension)
36. Nursing Theorists pg. 42-48 ()
35. Nursing Action
-Provider of service
Standards of care
Contractual obligation
Contractual relationships
37. Concepts in Theory pg. 40 (comprehension)
-Concepts are often called the building blocks of theories.
-Florence Nightingale

-Interactive Theory
-Systems Theory
-Developmental Theory
38. Vietnam War Memorial pg. 4-5 (comprehension)
-11,000 American military women stationed in Vietnam were nurses
-most were volunteers fresh out of school, youngest medical personnel ever to
-sits near the Vietnam Veteran Memorial
-4 figures- one tending to the chest wound of a soldier, another looking for a
helicopter for assistance, and the third kneeling while staring at an empty helmet.
39. Public Health Nursing?
40. Nursing Roles pg. 16-17 (comprehension)