According to Benner, a.

Novice
an expert nurse goes
b. Advanced Beginner
through five levels of
proficiency. Identify c. Competent
them.
d. Proficient

e. Expert

Novice Beginning nursing student or any nurse entering a situation in which there is no previous
experience. The learner learns via a specific set of rules and procedures, which are usually
stepwise and linear.

Advanced beginner A nurse who has had some level of experience with the situation. This experience may only be
observational in nature, but the nurse is able to identify meaningful aspects or principals of
nursing care.

Competent A nurse who has been in the same clinical position for 2 to 3 years. This nurse understands the
organization and specific care required by the type of patients. He or she is a competent
practitioner who is able to anticipate nursing care and establish long-range goals. In this phase
the nurse has usually had experience with all types of psychomotor skills required by this specific
group of patients.

Proficient A nurse with more than 2 to 3 years experience in the same clinical position. This nurse perceives
a patient's clinical situation as a whole, is able to assess an entire situation, and can readily
transfer knowledge gained from multiple previous experiences to a situation. This nurse focuses
on managing care as opposed to managing and performing skills.

Expert A nurse with diverse experience who has an intuitive grasp of an existing or potential clinical
problem. This nurse is able to zero in on the problem and focus on multiple dimensions of the
situation. He or she is skilled at identifying both patient-centered problems and problems related
to the health care system or perhaps the needs of the novice nurse.

What are the ANA a. Assessment

Standards of
b. Diagnosis
Practice?
c. Outcomes Identification

d. Planning

e. Implementation

f. Evaluation

Assessment The registered nurse collects comprehensive data pertinent to the patient's health and/or the
situation.

Diagnosis The registered nurse analyzes the assessment data to determine the diagnosis or issues.

Outcomes The registered nurse identifies expected outcomes for a plan individualized to the patient or the
Identification situation.

Implementation a. Coordination of care: The registered nurse coordinates care delivery.

 b. Health Teaching and Health Promotion: The registered nurse uses strategies to promote health
and a safe environment.

c. Consultation: The graduate level-prepared specialty nurse of advanced practice registered

nurse provides consultation to influence the identified plan, enhance the abilities of others, and
effect change.

d. Prescriptive Authority and Treatment: The advanced practice registered nurse uses
prescriptive authority, procedures, referrals, treatment, and therapies in accordance with state
and federal laws and regulations.

Evaluation The registered nurse evaluates progress toward attainment of outcomes.

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

ANA Standards of a. Ethics

Professional
b. Education
Performance.
c. Evidence-Based Practice and Research

d. Quality of Practice

e. Communication

f. Leadership

g. Collaboration

h. Professional Practice Evaluation

i. Resources

j. Environmental Health

Ethics The registered nurse practices ethically

Education The registered nurse attains knowledge and competency that reflects current nursing practice.

Evidence-Based The registered nurse integrates evidence and research findings into practice.
Practice and Research

Quality of Practice The registered nurse contributes to quality nursing practice.

Communication The registered nurse communicates effectively in all areas of practice.

Leadership The registered nurse demonstrates leadership in the professional practice setting and the
profession.

Collaboration The registered nurse collaborates with health care consumer, family, and others in the conduct of
nursing practice.

Professional Practice The registered nurse evaluates her or his own nursing practice in relation to professional practice
Evaluation standards and guidelines, relevant statutes, rules, and regulations.

Resources The registered nurse uses appropriate resources to plan and provide nursing services that are
safe, effective, and financially responsible.
Environmental Health The registered nurse practices in an environmentally safe and healthy manner.

nursing's code of the philosophical ideals of right and wrong that define the principles you will use to provide care
ethics. to your patients.

Autonomy Independent nursing interventions that the nurse initiates without medical orders.

Caregiver Helps the patient maintain and regain health, manage disease and symptoms, and attain a
maximal level of function and independence.

Advocate Protects patients' human and legal rights and provides assistance in asserting these rights.

Educator Explains, demonstrates, reinforces, and evaluates the patient's progress in learning.

Communicator Is central to the nurse patient relationship.

Manager Has personnel, policy, and budgetary responsibility for a specific nursing unit.

Advanced Practice There are four core roles :

Registered Nurse
Certified Nurse Specialist (CNS)
(APRN)
Certified Nurse Practitioner (CNP)
Four core roles.
Certified Nurse Midwife (CNM)

Certified RN Anesthetist (CRNA)

Clinical Nurse Expert clinician in a specialized area of practice.

Specialist (CNS)

Nurse Practitioner Detects and manages self-limiting acute and chronic stable medical conditions.

Certified Nurse- Involves independent care for women in normal pregnancy, labor, and delivery and care of
Midwife (CNM) newborns.

Certified Registered Provides surgical anesthesia

Nurse Anesthetist
(CRNA)

Nurse Educator Works primarily in schools of nursing and staff development.

Nursing Manages patient care and the delivery of specific nursing services within a health care agency.
Administrator

Nurse Researcher Investigates problems to improve nursing care and to expand the scope of nursing practice.

How did Florence She saw the role of nursing as being in charge of a patient's health based on the knowledge of
Nightingale see the how to put the body in such a state as to be free of disease or to recover from disease.
role of the nurse in
the early 1800s?

Clara Barton Founder of the American Red Cross

Lillian Walk and Mary Opened the Henry Street Settlement, focusing on the health needs of the poor.
Brewster
Mary Adelaide Instrumental in moving nursing education into universities.
Nutting

Mary Mahoney First professionally trained African-American nurse.

What are the external a. Nurses' self-care

forces that have
b. Affordable care act (ACA) and rising health care costs
affected nursing
practice in the c. Demographic changes of the population
twenty-first century?
d. Human rights

e. Increasing numbers of medically underserved

compassion fatigue a term used to describe burnout and secondary traumatic stress, which impact the health and
wellness of nurses and the quality of care provided to patients.

Identify the a. Teamwork and Collaboration

competencies of the
b. Evidence-Based Practice
QSEN initiative.
c. Quality Improvement

d. Safety

e. Informatics

Teamwork and Function effectively within nursing and interprofessional teams, fostering open communication,
Collaboration mutual respect, and shared decision making to achieve quality patient care. Examples: Recognize
the contributions of other heath team members and patient's family members. Discuss effective
strategies for communicating and resolving conflict. Participate in designing methods to support
effective teamwork.

Evidence-Based Integrate the best current evidence with clinical expertise and patient/family preferences and
Practice values for delivery of optimal health care. Examples: Demonstrate knowledge of basic scientific
methods. Appreciate strengths and weaknesses of scientific bases for practice. Appreciate the
importance of regularly reading relevant journals.

Quality Improvement Use data to monitor the outcomes of care processes and use improvement methods to design
and test changes to continuously improve the quality and safety of heath care systems.

Safety Minimize risk of harm to patients and providers through both system effectiveness and individual
performance

Informatics Use information and technology to communicate, manage knowledge, mitigate error, and
support decision making

genomics. describes the study of all the genes in a person, as well as interactions of those genes with each
other and with that person's environment.

Associate's degree Emphasizes advanced knowledge in basic sciences and research based clinical courses.

Baccalaureate degree A 4 -year program that includes social sciences, arts, and humanities.

Master's degree Emphasizes research-based clinical practice

Doctor of Philosophy Rigorous research and theory development.

Doctor of Nursing A practice-focused doctorate.

Practice

In-Service education Instruction or training provided by health care agencies.

Continuing education Formal, organized educational programs offered by various institutions.

Nurse Practice Acts The purpose is to regulate the scope of nursing practice and protect public health, safety, and
welfare.

The examination of A standardized minimum knowledge base for nurses.

RN licensure
provides:

The factor that best 3. Better education of nurses

advanced the practice
of nursing in the
twenty-first century
waS

American Nurses A group that lobbies at the state and federal level for advancement of nurses' role, economic
Association interests, and health care is the:

CHAPTER 2

Length of Stay (LOS) The number of days a person stays in a healthcare facility.

Professional Review the quality and cost of hospital care

Standards Review
Organizations

Prospective Payment Grouped inpatient hospital services for Medicare patients into diagnosis related groups (GRDs)
System

Utilization Review Review admissions and identify and eliminate overuse of diagnostic and treatment services
Committee ordered by physicians caring for patients on Medicare

IOM institute of Medicine

Diagnostic Related each group has fixed reimbursement amount based on case severity, rural/urban/regional costs,
Groups and teaching costs.

Capitation Fixed premium

Managed Care Prepaid health plans that provide comprehensive health care to members. Focus is prevention,
Organization early intervention, and outpatient care.

PPACA Patient Protection and Affordable Care Act, "Obamacare"

Preferred Provider Limits enrollee's choice to a list of "preferred" hospitals, physicians, and providers.
Organization

Medicare A federal program of health insurance for persons 65 years of age and older

Medicaid extended health insurance to welfare recipients

Primary Care (Health Prenatal and well-baby care, Nutrition Counseling, Family Planning, Exercise, Yoga and
Promotion) meditation Classes

Preventive Care Blood Pressure and cancer screenings, Immunizations, Mental Health counseling and crisis
prevention, Community Legislation (seat belts, air bags, helmets, etc.)

Secondary Acute Care Emergency Care, acute medical-surgical care, radiological procedures for acute programs (XRays,
CT scans)

Tertiary Care complex, institution based, highly specialized; Intensive Care, Subacute Care

Restorative Care care used after rehabilitation to maintain a person's function and increase independence;
Cardiovascular and Pulmonary Rehab, Orthopedic Rehab, Sports MEdicine, spinal cord injury
programs, home care

Continuing Care Assisted Living, Psychiatric and Older Adult day care

Discharge planning Planning that focuses on post-discharge continuity of care.

Rehabilitation Restore to fullest physical, mental, social, vocational, and economic potential possible.

Extended Care Facility Provides intermediate nursing, medical, or custodial care for patients recovering from acute
illness or those with chronic illness or disability

Skilled nursing facility Skilled care from licensed nursing staf

(SNF)

Nursing informatics Uses information and technology to communicate, manage knowledge, mitigate error, and
support decision-making

Vulnerable Children, women, and older adults most threatened by urbanization

Populations

Quality Improvement Actions to improve the quality of care given. Focuses on improvement of health-care related
processes.

Performance Organization analyzes and evaluates current performance and uses the results to develop
Improvement focused improvement actions. Typically are clinical projects conceived in response to identified
clinical problems and designed to use research findings to improve clinical practice.

Quality Improvement Plan: Review available data to understand existing practice condition or problems to identify the
Program PDSA need for change

Do: Select intervention on basis of the data reviewed and implement change

Study: Evaluate the results of the change

Act: If the process change is unsuccessful with positive outcomes, act on the practices by
incorporating them into daily unit performance.

Adult day care Facility for the supervised care of older adults
centers
-provides activities such as meals and socialization during specified day hours.

Acute care Pattern of health care in which a patient is treated for an acute episode of illness.

Assisted living Residential living facility where patients' have their own assigned rooms and share a social dining
and activity area.

Globalization Increased connection of the world's economy, culture, and technology

 -one of the forces reshaping the healthcare delivery system

Homecare Health service provided in the patient's residence to promote, maintain, or restore health or
minimize the effects of illness and disability

Hospice Family Centered care that allows patients to live with comfort, independence, and dignity while
easing the pains of terminal illness

Integrated Delivery Network facilities, providers, and services organized to deliver a continuum of care to a
Networks population of patients served at a capitated cost

Pay for Performance Quality improvement program that rewards excellence through financial incentives to motivate
change to achieve measurable improvement and improve patient care quality and safety

Respite care Service that provides short-term relief or time off for people providing home care to an individual
who is ill, disabled, or frail

Work Redesign Formal process used to analyze the work of a certain work group and change the actual structure
of the jobs performed

CHAPTER 3

community based Health promotion, disease prevention, and restorative care

care focus

Public health nursing Focus requires understanding the needs of a population who have one or more personal or
environmental characteristics in common. Understands factors that influence health promotion
and health maintenance

Population A collection of individuals

Community health Nursing practice in the community, with the primary focus on the health care of individuals,
nursing families, and groups in a community. The goal is to preserve, protect, promote, or maintain
health

Community based Care takes place in community settings such as the home or a clinic, where the focus is on the
nursing needs of the individual or family.

-Involves the safety needs and acute and chronic care of individuals and families

-enhances their capacity for self-care

-promotes autonomy in decision-making. Nurse remain focused on the individual and family and
the values of the individual, family, and community are respected and incorporated

-Uses critical thinking

-Reduces cost

-Provides direct access to nurses

Changing Patient's Set strong, caring relationships with patients and their families
Health

Vulnerable Groups of patients who are more likely to develop health problems as a result of excess health
populations risks, who are limited and access to healthcare services, or who depend on others for care:
examples of Patients who are abused, immigrant population, those who experience poverty and
vulnerable homelessness, older adults, patients with mental illnesses, patients who abuse substances
populations

overall goals of Increase life expectancy and quality of life and eliminate health disparities through an improved
healthy people 2020 delivery of health care services. This is done through assesment of healthcare needs of
individuals, families, and communities. Development and implementation of public health
policies, and improved access to care

What could a Health programs such as adolescent smoking prevention, sex education, and proper nutrition
comprehensive
community
assessment lead to in
the community?

What is an example Gathering information on incident rates for identifying and reporting new infections or diseases,
of assessment that is determining adolescent pregnancy rates, and reporting the number of motor vehicle accidents by
done on communities teenage drivers.
that can help fulfill
the goal of healthy
people 2020?

Substance Includes the use of illegal drugs, abuse of alcohol and prescribed medications such as antianxiety
agents an opioid analgesics

Caregiver Develop a caring partnership to recognize actual and potential health care needs and identify
community resources

roles of a community- Caregiver, case manager, change agent, patient advocate, collaborator, counselor, educator, and
based nurse epidemiologist

Case manager Ability to establish an appropriate plan of care based on the assessment of patients and families
and to coordinate needed resources and services for patients well being across a continuum of
care

Patient advocate identify where to go for services, how to reach individuals with appropriate authority, services to
request, and how to follow through with information they receive

Change agent Involves identifying and implementing new and more effective approaches to problems.
Mediator for problems within a patient's community.

collaborator Need to be confident in working not only with individuals and their families but also with other
related health care through. Necessary to develop a mutually acceptable time that will achieve
common goals.

Counselor Must know community resources. Have patient identify and clarify health problems and choose
appropriate courses of action to solve problems. Help patients reach decisions that are best for
them

Educator Help patients and families game the skills and knowledge needed to learn how to care for
themselves. examples include prenatal care, infant care, child safety, and cancer screening
Epidemiologist Involved in case finding, health teaching, and tracking incident rates of an illness. Responsible for
community surveillance for risk factor

CHAPTER 4

Assumptions are the 'taken for granted' statements that explain the nature of the concepts, definitions,
purpose, relationship and structure of a theory

Neumans theory in focus their care on the systems responses to the stressors.
practice

Neumans model uses an open system approach to describe how patients systems deal with stressors in their
environments

Concepts can be simple or complex and relate to an object or event that comes from individual perceptual
experineces

Phenomenon is the term, description idea or responses about an event, a situation, process, a group of events
or a group of situations

Theory contains a set of concepts, definitions, and assumptions or propositions that explain a
phenomenon

Theory and scientific are vital links to one another, providing guidelines for decision making,problem solving and
inquiry nursing interventions

Orem's self care has value in helping nursing design interventions to promote the patients self care in managing
deficit theory illness such as asthma, heart failure, diabetes or arthritis explains the factors within a patients
living situation that support or interfere with his or her self care ability nurse should help pt until
they are able to start doing themselves.

Nursing Theory is a conceptualization of some aspect of nursing that describes, explains, predicts, or prescribes
nursing care

Nursing is the diagnosis and treatment of human response to actual or potential health problems

Environmental includes all possible conditions affecting patients and they settings in which their health care
situation needs occur

Person is the recipient of nursing care, including individual patients, groups, families and communities

elements of the The direct the activity of the nursing profession, including knowledge development, philosophy
nursing paradigm theory, educational experience, research and practice

metaparadigm of The person,health environmental/situation and nursing

nursing includes 4
links

Paradigm a pattern of thought that is useful in describing the domain of a discipline

Domain perspective of a profession. It provides the subject, central concepts, values and beliefs,
phenomena of interest and central problems of a discipline
As a system the input, output, feedback, and contenT
nursing process has
the following
components

Input for the nursing is the data or information that comes from a patients assessment (eg. how the patient interacts
process with the environment and the patient psychological function

Output is the end product of a system; and in the case of the nursing process it is whether the patients
health status improves, declines, or remains stable as a result of nursing care

Feedback serves to inform a system about how it functions. The outcomes are part of the feedback system
to refine the plan of care

content is the product and information obtained from the system, using the nursing process as an
example the content is the information about the nursing interventions

Grand theories doesn't provide guidance for specific nursing interventions: but it provides the structural
framework for broad abstract ideas about nursing. systematic and broad in scope

Middle range theories reflect practice ( administration, clinical or teaching) tends to focus on a specific fiend of nursing
such as uncertainty, incontinent, social support, quality of life and caring, rather than reflect on a
wide variety of nursing care situations

Descriptive theories are the first level of theory development. they describe phenomena, speculate on why they occur
and describe their consequences.these theories explain, relate and in some situations, predict
nursing phenomena

Perspective theories address nursing interventions for a phenomenon, describe the conditions under which the
prescription occurs and predict the consequences.

Interdisciplinary explains a systematic view of phenomenon specific to the discipline of inquiry. Knowledge and
theory the use of this theory helps pediatric nurses design appropriate therapeutic play interventions for
ill toddlers or school age children

2 types of system open and closed

theory

open system such as a human organism or a process such as the nursing process interacts with the
environment, exchanging information between the system and environment

closed system such as a chemical reaction within a test tube does not interact with the environment

Maslows hieracy of is an interdisciplinary theory that is useful for designating priorities of nursing care
needs
there are 5 levels of 1st is the most basic level, includes physiological needs such as air, water and food
the hieracy of basic
human needs

2nd level includes safety and security needs which involve physical and psychological needs

3rd level contains love and belonging needs, inducing friendship, social relations and sexual love

4th level encompasses esteem & self esteem needs which involve self confidence, usefulness,
achievement and self worth

5th level need for self actualization, the state of fully achieving

nightingales theory provides nurses with a way to think about patients and their environment. concept of the
"descriptive theory" environment wasn't the focus of nursing care. The focus of nursing is caring through the
environment and helping the patient deal with symptom's and changes in function related to an
illness

Peplau's focuses on interpersonal relations between the nurse, the patient and the patients family and
iNTERPERSONAL develop the nurse, patient relationship
Theory

Henderson's Theory Defines nursing as, assisting the individual sick or well in the performance of those activities that
will contribute to health recovery, or peaceful death and the individual would perform unaided if
her or she had the necessary strength, will or knowledge with 14 basic needs

Leininger's Culture cultural diversity, and the goal of nursing care is to provide the patient with culturally specific care
Care theory

Roys theory Identify types of demands placed on patient, assess adaption to demands, and help patient adapt

Watson Theory Promotes health, restore patient to health and prevent illness

Benner & Wrubel focus on patient need for caring as a means of coping with stressors or illness

Betty Neuman's focus on patients need for caring as a means of coping with stressors or illness with 5 concepts.
theory psychological, physiological, sociocultural, development and spiritual

Theoretical knowledge includes and reflects on the basic values , guiding principles, elements and phases of a
conception of nursing

King's theory nurse should work with patient to develop goals for care

Experiential is bases on nurses' experience in providing care to patients. you achieve this through personal
knowledge knowledge gained through reflection on care experiences, synthesis, and integration of the art
and science of nursing

AACN Synergy Model matching nurse competencies to patient needs, improving outcomes

Kolcaba's Theory of The nurse strives to relieve patients' distress.

Comfort
Middle Range Theory influenced by evidence based practice (EBP)

CHAPTER 5

evidence-based helps you make effective, timely, and appropriate clinical decisions in response to the broad
practice political, professional, and societal forces present in today's health care environment.

Seven steps of EBP 0. cultivate a spirit of inquiry

1. ask a clinical question in PICOT format

2. search for the most relevant and best evidence

3. critically appraise the evidence you gather

4. integrate all evidence with your clinical expertise and patient preferences and values

5. evaluate the outcomes of practice decisions or changes using evidence

6. share the outcomes of EBP changes with others

developing a PICOT P-patient population of interest

question
I-intervention of interest

C-comparison of interest

O-outcome

T-time

peer-reviewed reviewed for accuracy, validity, and rigor by a panel of experts familiar with subject before it is
published

AHRQ Agency for Healthcare Research and Quality; includes clinical guidelines and evidence summaries.

CINAHL Cumulative Index of Nursing and Allied Health Literature; includes studies in nursing, allied health,
and biomedicine.

Common databases MEDLINE, CINAHL, PubMed

clinical guidelines systematically developed statements about a plan of care for a specific set of clinical
circumstances involving a specific patient population.

meta-analysis and a researcher asks a PICOT question, reviews the evidence available, summarizes what is currently
systematic review known, and reports of evidence supports a change in practice or if furthur study is needed.

RCT randomnized controlled trials: most precise experimental study

abstract breif summary of an article

introduction contains info about the purpose of the article

literaTure review or offers an argument about what led the author to conduct the study
background

manuscript narrative middle section, or narrative of the article

hypotheses predictions made about the relationship or difference between study variables

variable concept, chracteristic, or trait that vary among subjects.

methods or design explains how research study was organized and conducted to answer the research question.

results or conclusions clinical and research articles summary section.

clinical implications explains if the findings from a study should be applied in practice

nursing research identifies new knowledge, improves professional education and practice, and uses resources
effectively.

outcomes research helps patients, health care providers, and those in health care policy make informed decisions on
the basis of current evidence.

care delivery observable and measurable effects of some intervention or action

outcomes

scientific method foundation of research and most reliable and objective method to gain knowledge.

valid, reliable, and The scientific method is a systematic, step by step process that provides support that the findings
generalizable from a study are_______,_______, and ________.

empirical data gathered through the use of observations and assessments and use the data to discover new
knowledge

quantitative nursing study of nursing phenomena that offers precise measurements and qualification
research

experimental study tightly controls conditions to eliminate bias and ensure that findings can be generalized to similar
groups of subjects.

historical research studies designed to establish facts and relationship concerning past events.

exploratory research initial study designed to develop or refine the dimensions of phenomena, or to develop or refine
a hypothesis about the relationships among phenomena.

descriptive research study that measures characteristics of persons situations, or groups and the frequency with which
certain events or characteristics occur.

experimental research study where the investigator controls the study variable and randomly assigns subjects to
different conditions to test the variable.

correlational research study that explores the interrelationships among variables of interest without any active
intervention by the researcher.
controlled trials with studies that test interventions, but where the researchers have not randomized the subjects into
randomnization control or treatment groups

nonexperimental descriptive studies that explain or predict phenomna

research

case control study where researchers study one group of subjects with a certain condition at the same time as
another group of subjects who do not have the condition.

correlational studies describe the relationship between two variables

surveys obtain information regarding the frequency, distribution, and interrelation of variables among
subjects in the study.

evaluation research a form of quantitative research that determines how well a program, practice, procedure, or
policy is working

qualitative nursing study of phenomena that are difficult to quantify or categorize such as patient's perceptions of
research illness or quality of life.

inductive reasonig develops generalizations or theories from specific observations or interviews

research process an orderly series of steps that allows a researcher to move from asking the research question to
finding the answer

Nursing process- Identify area of interest or clinical problem

Assessment

Nursing process- Develop research question(s)/hypothesis

Diagnosis

Nursing process- determine how study will be conducted

Planning

Nursing process- Conduct the study

Implementation

Nursing process- Analyze results of the study; use of the findings

Evaluation

informed consent (1) research subjects are given full and complete information about the purpose of a study,
procedures, data collection, potential harm and benefits, and alternative methods of treatment.

informed consent (2) research subjects are capable of fully understanding the research and the implications of
participation

informed consent (3) research subjects have the power of free choice to voluntarily consent or decline participation in
the research

informed consent (4) research subjects understand how the researcher maintains confidentiality or anonymity.

confidentiality guarantees that any information a subject provides will not be reported in any manner that
 identifies the subject.

quality improvement improves local Work processes to improve patient outcomes and efficiency of health systems
knowledge focused trigger questions regarding new information on a topiC

problem focused a question you face while caring for a client

trigger

HEALTH AND WEL

Healthy People Public (1) attain high-quality, longer lives free of preventable disease, disability, injury, and premature
Health Goals death; (2) achieve health equity, eliminate disparities, and improve the health of all groups; (3)
create social and physical environments that promote good health for all; and (4) promote quality
of life, healthy development, and healthy behaviors across all life stages

Health a state of complete physical, mental, and social well-being, not merely the absence of disease or
infirmity

Health Belief Model The relationship between a person's beliefs and behaviors

Maslow's Hierarchy of the interrelationships of basic human needs

Needs

Holistic health Model nurses consider patients to be the ultimate experts concerning their own health and respect
patients' subjective experience as relevant in maintaining health or assisting in healing

Health Promotion focuses on: (1) individual characteristics and experiences; (2) behavior-specific knowledge and
Model affect; and (3) behavioral outcomes, in which the patient commits to or changes a behavior

Health Promotion activities such as routine exercise and good nutrition that help patients maintain or enhance their
present levels of health

Illness Prevention activities such as immunization programs that protect patients from actual or potential threats to
health

Passive Strategies of individuals gain from the activities of others without acting themselves
Health Promotion

Active Strategies of individuals adopt specific health programs (For example, weight reduction and smoking-cessation
Health Promotion programs)

Primary Prevention true prevention; precedes disease or dysfunction and is applied to patients considered physically
and emotionally healthy (Health promotion)

Secondary Prevention focuses on individuals who are experiencing health problems or illnesses and are at risk for
developing complications or worsening conditions (Early diagnosis and prompt treatment)

Tertiary Prevention occurs when a defect or disability is permanent and irreversible. It involves minimizing the effects
of long-term disease or disability by interventions directed at preventing complications and
deterioration (Restoration and rehabilitation)

Risk Factor any situation, habit, or other variable such as social, environmental, physiological, psychological,
developmental, intellectual, or spiritual that increases the vulnerability of an individual or group
to an illness or accident

Precontemplation not intending to make changes within the next 6 months

Contemplation considering a change within the next 6 months

Preparation making small changes in preparation for a change in the next month

Action actively engaged in strategies to change behavior, lasts up to 6 months

Maintenance Stage Sustained change over time; begins 6 months after action has started and continues indefinitely

Illness a state in which a person's physical, emotional, intellectual, social, developmental, or spiritual
functioning is diminished or impaired

Acute Illness usually reversible, has a short duration, and is often severe

Chronic Illness persists, usually longer than 6 months, is irreversible, and affects functioning in one or more
systems

Illness Behavior how people monitor their bodies, define and interpret their symptoms, take remedial actions,
and use the resources in the health care system

Cultural awareness

Health Disparity a particular type of health difference that is closely linked with social, economic, and/or
environmental disadvantage. Members of this group bear a burden of disease, injusry, and
voilence unproportional to the size of the group

Health Care Disparities differences among populations in the availability, accessibility, and quality of health care services
aimed at retention, treatment, and management of diseases and their complications\

Marginalized Groups more likely to have poor health outcomes and die at an earlier age because of a complex
interaction between individual genetics and behaviors; public and health policy; community and
environmental factors; and quality of health care

Culture Associated with norms, values, and traditions passed down through generations. Also perceived
to be the same as ethnicity, race, nationality, and language but also includes other facets such as
gender sexual orientation, location class and immigration status.

Intersectionality Dynamic framework perspective that recognizes we all belong simultaneously to multiple social
groups within changing social and political contexts

Oppression a formal and informal system of advantages and disadvantages tied to our membership in social
groups, such as those at work, at school, and in families. Impacts an individual's access to
resources such as health care, housing, education, employment, and legal services.

Transcultural Nursing a comparative study of cultures to understand their similarities and differences and differences
among them.

Culturally Congruent care that fits a person's life patterns, values, and system of meaning. The goal of transcultural
Care nursing. Bridge cultural gaps to provide meaningful and supportive care for all patients. Combine
your knowledge about a cultural group with an attitude of helpfulness and flexibility to provide
quality, patient-centered, culturally congruent care.

Illness The way that individuals and families react to disease

Disease A malfunctioning of biological or psychological processes

Cultural Competency the enabling of healthcare providers to deliver services that are respectful of and responsive to
the health beliefs, practices, and cultural and linguistic needs of diverse patients. Allows systems,
agencies and groups of professionals to function effectively to understand the needs of groups
accessing health information and health care and thus helping to eliminate disparities

According to the -Value diversity

National Center for
Cultural Competence -Conduct a cultural self-assessment
(NCCC) framework,
-Manage the dynamics of difference
culturally competent
organizations: -Institutionalize cultural knowledge

-Adapt to diversity

Campinha-Bacote's Cultural awareness

model of cultural
Cultural knowledge
competency
Cultural skills

Cultural encounters

Cultural desire

World View Historical and social realities that shape how people perceive others, how they interact and relate
to reality, and how they process information. "The way people tend to look out upon the world or
their universe to form an picture or value stance about life or the world around them"

Cultural Assessment Comprehensive assessment to understand the patient's world view, including how their religious
values affect their willingness to receive care

Explanatory Model his or her views about health and illness and its treatment

Linguistic Competence the ability of an organization and its staff to communicate effectively and convey information in a
manner that is easily understood by diverse audiences

Health Literacy the ability to obtain, process, and understand health information needed to make informed
health decisions

Teach Back an intervention tion that helps you to confirm that you have explained what a patient needs to
know in a manner that the patient understands. An ongoing process of asking patients for
feedback through explanation or demonstration and presenting information in a new way until
you feel confident that you communicated clearly and your patient has full understanding of the
information. Use open-ended questions to verify his or her understanding.

Teach Back Method Plan your approach

Tips
Use handouts, pictures, models

Clarity

Practice

Cultural Encounter an intervention that involves a nurse directly interacting with patients from culturally diverse
backgrounds

Cultural Desire The motivation of a health care professional to "want to"—not "have to"—engage in the process
of becoming culturally competent

Core Measures key quality indicators that help health care institutions improve performance, increase
accountability, and reduce costs. All core measures such as screening for depression and
controlling high blood pressure are consistent with national health priorities. Intended to reduce
mortality, complications, inpatient readmissions and health disparities.

LEARN Listen - with empathy and understanding to patient's perception of problem

(communication
Explain - your perceptions of the problem (physiological, psychological, spiritual, and/or cultural)
technique)
 Acknowledge - and discuss cultural differences and similarities between you and your patient

Recommend - treatment involving patient

Negotiate - agreement (incorporate selected aspects of patient's culture into patient-centered

plan)

RESPECT Rapport - connect on a social level

(communication
Empathy - remember the patient has to come to you for help
technique)
Support - ask about and try to understand barriers to care and adherence

Partnership - be flexible with regard to issues of control

Explanations - check often for undersanding

Cultural Competence - respect the patient and his or her culture and beliefs

Trust - selfdisclosure may be difficult for some patients

ETHNIC Explanation - patient explains his or her perception of problem

(communication
Treatment - which types of treatments has the patient tried?
technique)
Healers - has the patient sought advice from alternative health practitioners?

Negotiate - try to find an option that is mutually acceptable

Intervention - agree on an appropriate intervention/alternate treatment

Collaboration - include patient, family members, other healthcare professionals, healers and
community resources

C-LARA Calm yourself down

(communication
Listen to patient's and family's perspective
technique)
Affirm : express connection with feeling, perspective or principle that was shared

Respond to what was said

Add : share additional information or educate

CHAPTER 10

family durability -is a system of support and structure within a family that extends beyond the walls of the
household.

-intrafamilial system of support and structure that may extend beyond the walls of the household

family resiliency -is the ability of a family to cope with expected and unexpected stressors

family diversity -is the uniqueness of each family unit

-attention to uniqueness

family is defined biologically, legally, or as a social network with personally constructed ties and
ideologies

nuclear familY The ____ family consists of husband and wife (and perhaps one or more children)
extended family The _____ family includes relatives (aunts, uncles, grandparents, and cousins) in addition to the
nuclear family.

single-parent family The ____ family is formed when one parent leaves the nuclear family because of death, divorce,
or desertion or when a single person decides to have or adopt a child.

blended family The ____ family is formed when parents bring unrelated children from prior adoptive or foster
parenting relationships into a new, joint living situatuion.

alternative family The ____ family has relationships that include multi-adult households, "skip generation" families
(grandparents caring for grandchildren), communal groups with children, "nonfamilies" (adults
living alone), cohabiting partners, and homosexual couples.

Families ____ represent more than a set of individuals, more than a sum of its individual members, and
are diverse

smaller Families are ____.

no children Couples are having ____ children.

blended families Remarriage results in ____ families.

homosexual _____ couples are family units.

delaying Women are ____ childbirth.

single-parent families _____ families are prevalent.

homelessness _____ continues to be a major health problem. The fastest growing of this population is families
with children. For these families, we wonder what happens to the children? Where do they go to
school? Who takes care of their immunizations? Dental health?

family violence _____ statistics are growing. Emotional, physical, and sexual abuse cross all socioeconomic and
cultural categories

acute or chronic illness ____ takes a toll on the family unit: cardiac, respiratory, renal, and neurological problems can be
devastating to families financially, emotionally, and physically. Sudden events such as
cardiac/respiratory arrest or trauma challenge even the best family unit.

structure ___ is based on organization.

-relationships are numerous and complex

function ____ involves the processes used by the family to achieve goals.

-processes include goal setting, conflict resolution, caregiving, nurturing, and use of resources.`

-class and ethnicity ___ and ___ produce different access to the health care system.

-health behaviors --The family's beliefs, values, and practices influence ____.

family health system is a holistic model used to assess and care for families

developmental stage _____: each stage has its own challenges, needs, and resources

family nursing ____ is based on the assumption that all people, regardless of age, are members of some type of
family; to provide care, you need to know about families and family theory.

Family as Context ______: When you look at the family this way, you will want to remember that the primary focus
is on the health and development of individual members who exist within a specific environment.
Their needs will change depending on their developmental stage. As you care for one patient, you
also care for their entire family.
Family as Patient _____: You will want to look at family processes and relationships. When you make assessments,
you will look at patterns that influence how families reach their health care goals.

Family as System Remember that looking at the family as a system requires that you look at the family as context
and as a patient. These two perspectives are not mutually exclusive. You may use them
simultaneously.

caregivers -usually a daughter or daughter-in-law

-conflicting responsibilities for aging parents, children, spouse, and job

-frequently tries to "do it all"

-may not recognize need for help or request help

-may not focus on own health care

interventions Potential ____:

-help families establish realistic priorities

-suggest that family members use family leave plans or obtain some "flex time" from their
employer.

-explore resources (e.g., delivery of meals, respite care)

education A nurse provides family ____.

cultural background Always recognize and respect the family's _____.

"culturagram" Cultural assessment educators encourage the use of a _____

critical thinking and Drawing conclusions based on cultural backgrounds requires ____ and ____
careful consideration

Caregivers Assess the family for the existence of ____ who provide daily or respite care for older adult family
members.

Burden Assess for caregiver _____.

spouses or middle- Caregivers are most often ____ or ____

aged children

social network Later-life families have a different ___ from younger families.

Instruction Take time to individualize and reinforce ____

abuse _____ of older adults in families occurs across all social classes.

What are the 3 1. patient teaching

Caregiver Role Strains?
2. interventions

3. evaluation

Patient Teaching _____: Teach family members to identify caregiving role strain.

-change in appetite, sleeping, leisure activities

 -caregiver is fearful when learning

-loss of interest in personal appearance

-problems may intensify with status change

family-focused A _____ approach to care will help you identify their resources. These resources will be used to
help the family meet its goals

challenges ____ when dealing with family include discharge planning and cultural sensitivity.`

individual members Family structure and functions influence the lives of its ______.

family members ______ influence one another's health beliefs, practices, and status.

Attitude The concept of family is highly individual; care focuses on a patient's ____ toward the family
rather than on an inflexible definition of family.

health The family's structure, functioning, and relative position in society significantly influence its _____
and ability to _____ to health problems.
respond

context, patient, A nurse can view the family in three ways: as _____, as _____, or as ______.
system

family health Measures of ____ involve more than a summary of individual members' health.

caregivers Family members as _____ are often spouses who are either older adults themselves or adult
children trying to work full-time and care for aging parents.

cultural sensitivity ______ is vital to family nursing. Some members have differing beliefs, traditions, and restrictions,
even within the same generation.

caregiving Family ______ is an interactive process that occurs within the context of the relationships among
its members.