Lewis et al: Medical-Surgical Nursing: Assessment and Management of Clinical Problems, 7

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Key PointsChapter 1: Nursing Practice Today

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Nursing

involves the (1) protection, promotion, and optimization of health and abilities;(2) prevention of illness and injury; (3) alleviation of suffering through the diagnosis andtreatment of human response; and (4) advocacy in the care of individuals, families,communities, and populations.

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Nurses offer skilled care to those recuperating from illness or injury, advocate for patients’ rights, teach patients so that they can make informed decisions, support patientsat critical times, and help them navigate the increasingly complex health care system.

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Certification

in nursing specialties (e.g., ambulatory care, critical care, gerontologic, pediatric, psychiatric and mental health, and community health nursing) is offeredthrough a variety of nursing organizations.

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Entry-level nurses with an associate or baccalaureate degree in nursing are prepared tofunction as generalists. With additional preparation, nurses can assume roles such asclinical nurse specialist and nurse practitioner.

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The exact roles (i.e., independent, dependent, collaborative) of the nurse are oftendetermined by state and agency policies. In most cases, the nurse’s role is one of “interdependence and co-participation” with the patient and other health team members.

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Delegation

of nursing interventions to licensed practical nurses/licensed vocationalnurses (LPNs/LVNs) and unlicensed assistive personnel (UAP) is an important functionof the professional nurse.

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Healthy People 2010

is a broad-based program that involves government, private, public,and nonprofit organizations in preventing disease and promoting health.

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Evidence-based practice

(EBP) is the conscientious use of the best evidence (e.g.,findings from research) in combination with clinician expertise and patient preferencesand values in clinical decision-making.

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Nursing informatics

is a specialty that integrates nursing science, computer science, and

Key Pointsinformation science in identifying, collecting, processing, and managing data andinformation to support nursing practice, administration, education, and research.

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The five elements of the

nursing process

are assessment, diagnosis, planning,implementation, and evaluation. Once begun, the nursing process is not only continuous but it is also cyclic in nature.

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Standardized nursing terminologies

can promote continuity of patient care and providedata that can support the credibility of the profession.

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Nursing diagnoses

describe health states that nurses can legally diagnose and treat. Athree-part nursing diagnosis statement includes the problem, etiology, and signs andsymptoms.

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Collaborative problems

are potential or actual complications of disease or treatment thatnurses treat with other health care providers, most frequently physicians.

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The

Nursing Outcomes Classification (NOC)

is a research-based, standardizedlanguage for nursing outcomes. It is used to evaluate the effects of nursing interventions. NOC is a list of measures that describes patient outcomes influenced by nursinginterventions.

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The

Nursing Interventions Classification (NIC)

includes independent and collaborativeinterventions that nurses carry out, or direct others to carry out, on behalf of patients.

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nursing intervention

is any treatment based on clinical judgment and knowledge thata nurse performs to enhance

patient outcomes.

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The setting of specific outcomes with outcome indicators is necessary for systematicmeasurement of the patient’s progress.

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Outcomes may be developed by writing specific outcome statements or choosingoutcomes from the Nursing Outcomes Classification (NOC).

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The Nursing Interventions Classification (NIC) includes treatments (both physiologic and psychosocial) that nurses perform in all settings and specialties.

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NIC and NOC provide a common language for communication among nurses andfacilitate computer collection of standardized nursing data.

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Key Points

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During the

evaluation

phase, the nurse determines whether the patient outcomes andnursing interventions were realistic, measurable, and achievable.

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Assessment, diagnosis, outcomes, interventions, and evaluation of the patient’s responseto care are a critical part of the patient’s record.

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When nursing terminologies are used in information systems for documentation of nursing practice, nurses can track and report on the benefits of nursing care.

Lewis et al: Medical-Surgical Nursing: Assessment and Management of Clinical Problems, 7

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Key PointsChapter 2: Health Disparities

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Determinants of health

are those factors that influence the health of individuals.

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Health disparities

refer to differences in measures in the

health status

among groups of people in a community, a state, or the entire nation.

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Racial, ethnic, and cultural differences exist in the health screening behaviors, treatments provided, and access to health care providers.

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Factors such as stereotyping and prejudice can affect health care seeking behavior inminority populations.

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Discrimination and bias occur when negative treatment occurs based on race, ethnicity,gender, aging, and sexual orientation.

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Use of standardized evidence-based guidelines can reduce health disparities in diagnosisand treatment.

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Interpersonal skills such as active listening, relationship building, and effectivecommunication are basic to the delivery of high quality and equitable health care.

Lewis et al: Medical-Surgical Nursing: Assessment and Management of Clinical Problems, 7

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Key Points

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