Test Bank Professional Nursing Concepts

Challenges 7th Edition Black

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Now in full-color, this best-selling, easy-to-read text introduces you to the issues and
trends you're likely to encounter in any nursing practice setting. Each stand-alone
chapter explores a specific topic and gives insightful discussions of issues such as the
health care delivery system, professionalization in nursing, standards and scope of
practice, socialization and nursing theories surrounding the profession, and political
action facing nurses.

o Case studies help you empathize with real patients.

o Critical thinking questions and challenges enable you to apply
chapter-relevant information to scenarios and envision a
personal philosophy of nursing.
o Evidence-based Practice boxes offer insight and highlight
research that affects patient care.
o News Notes tie information from the text to real-life nursing
situations.
o Cultural Consideration Challenges help you develop
cultural sensitivity and familiarize you with cultural
influences.
o Interview boxes explore the issues of culture
and faith from the perspectives of practicing
nurses.
o Updated content on topics such as the
socialization of nursing, nursing activism,
evidence-based practice, and nursing
education degree programs, ensures that you
have the most up-to-date and relevant
information for your career.
o A variety of student activities for each chapter
on the Evolve companion website help you
apply topics presented in the text.
• Front Matter
• Dedication
• Reviewers
• Preface
• Acknowledgments
• Interactive Review – Professional Nursing
• CHAPTER 1 Nursing today: A time of transformation
• Learning outcomes
• Status of nursing in the United States
• Numbers
• Gender
• FIG 1-1 Distribution of women and men in the overall RN population. The great
disparity between the percentage of women and men in nursing is clearly evident.
• Age
• Race and ethnicity
• Education
• FIG 1-2 RN and the U.S. populations by race/ethnicity, 2008. The proportion of
nurses who are white, non-Hispanic is greater than their proportion in the U.S.
population.
• FIG 1-3 Initial nursing education of RNs working in nursing, 2008. ADN education
accounts for almost half of RNs’ basic nursing education, although 55.6% of nurses
report having a bachelor's or higher degree as their highest education. NSSRN,
National Sample Survey of Registered Nurses.
• Employment opportunities for nurses
• FIG 1-4 Although most nurses work in hospitals, nurses in home health settings
often enjoy long-term relationships with their patients.
• Hospital-based nursing
• EVIDENCE-BASED PRACTICE NOTE
• FIG 1-5 Hospital staff nurses work closely with the families of patients, as well as
with the patients themselves.
• Community health nursing
• Nurse entrepreneurs
• BOX 1-1 KAY WAGONER, PhD, RN
• Kay Wagoner, PhD, RN (Cardiovascular Nurse Specialist).
• Office-based nursing
• Occupational and environmental health nursing
• Military nursing
• School nursing
• FIG 1-6 School nurses manage a variety of students’ health problems, from
playground injuries to chronic illnesses such as asthma and diabetes.
• Hospice and palliative care nursing
• Telehealth nursing
• Faith community nursing
• INTERVIEW
• Nursing informatics
• Nursing opportunities requiring advanced degrees
• Nurse educators
• Advanced practice nursing
• FIG 1-7 Advance practice nurses by specialty area, 2008. Although most nurse
practitioners work in single roles, some work in dual advanced practice roles.
• Nurse practitioner
• Clinical nurse specialist
• BOX 1-2 SEBASTIAN WHITE, MSN, FNP, BC-ADM, RN
• Sebastian White, MSN, FNP, BC-ADM, RN.
• Certified nurse-midwife
• Certified registered nurse anesthetist
• Clinical nurse leader
• Issues in advanced practice nursing
• Employment outlook in nursing
• Key points
• Critical thinking questions
• Activities
• References
• CHAPTER 2 The history and social context of nursing
• Learning outcomes
• Historical context of nursing
• Mid–nineteenth-century nursing in england: The influence of florence nightingale
• FIG 2-1 Florence Nightingale (1820–1910), founder of modern nursing.
• 1861–1873: The american civil war: An impetus for training for nursing
• After the civil war: Moving toward education and licensure under the challenges of
segregation
• The first training schools for nurses and the feminization of nursing
• FIG 2-2 Nurses training in the bacteriologic laboratory at Bellevue Hospital, New York
City, circa 1900.
• FIG 2-3 Mary Eliza Mahoney (1845–1926), the first trained African-American nurse in
the United States.
• Historical Note 2-1
• Professionalization through organization
• Nursing's focus on social justice: The henry street settlement
• FIG 2-4 Lillian Wald (1867–1940), nurse and social activist. Wald founded the Henry
Street Settlement, which is still in operation today, and was one of the founders of
the National Association for the Advancement of Colored People (NAACP).
• FIG 2-5 Little deterred the Henry Street Settlement nurses from making their daily
rounds on their patients in New York's Lower East Side.
• Historical Note 2-2
• A common cause but still segregated
• FIG 2-6 Jessie Sleet Scales, a visionary African-American nurse, was among the first
to bring community health nursing principles to the slums of New York City around
1900.
• War again creates the need for nurses: Spanish-american war
• Professionalization and standardization of nursing through licensure
• FIG 2-7 Red Cross nursing in the Spanish-American War, circa 1898. Nurses on deck
of the hospital ship Relief near Cuba.
• FIG 2-8 A World War I Red Cross nursing poster, 1918. “Not one shall be left behind!”
by James Montgomery Flagg is typical of World War I recruitment posters. Nurses
answered the call in record numbers.
• 1917–1930: The challenges of the flu epidemic, world war I, and the early depression
era
• FIG 2-9 Mary Breckinridge, founder of the FNS, on her way to visit patients in rural
Kentucky.
• Historical Note 2-3
• 1931–1945: Challenges of the great depression and world war II
• World war II: Challenges and opportunities for nursing
• Historical Note 2-4
• 1945–1960: The rise of hospitals: Bureaucracy, science, and shortages
• 1961–1982: The great society, vietnam, and the change in roles for women
• FIG 2-10 The Vietnam War Women's Memorial, dedicated in 1993, was established
to honor women who served in Vietnam, most of whom were nurses.
• 1983–2000: Challenges for nursing: HIV/AIDS and life support technologies
• 2001–2015: The post–9/11 era, natural disasters, and health care reform
• Social context of nursing
• CRITICAL THINKING CHALLENGE 2-1
• Gender
• FIG 2-11 Despite their small numbers, men in nursing play an important role in the
profession.
• BOX 2-1 FROM FLIGHT MEDIC TO FLIGHT NURSE: ONE MAN'S STORY
• Christopher McGrath, RN.
• Image of nursing
• The woodhull study on nursing and the media
• The johnson & johnson campaign
• FIG 2-12 An example of an advertisement that depicts men in nursing in a favorable
way.
• BOX 2-2 THE WOODHULL STUDY AT A GLANCE
• Purpose of the study
• Key study findings
• Key study recommendations
• The truth about nursing
• FIG 2-13 Population projections, ages 65 to 84 years and ages 85 years and over:
2000–2050.
• National population trends
• Aging of america
• BOX 2-3 CHECKLIST FOR MONITORING MEDIA IMAGES OF NURSES AND NURSING
• Prominence in the plot
• Demographics
• Personality traits
• Primary values
• Sex objects
• Role of the nurse
• Career orientation
• Professional competence
• Education
• Administration
• Diversity
• Diversity in the profession
• Technologic developments
• FIG 2-14 Advanced technology is used to enhance clinical decision making in
novices. Here students use a human simulator in a laboratory setting to refine their
skills.
• FIG 2-15 National supply and demand projections for full-time equivalent (FTE) RNs,
2000–2020. In 2000 the national supply of FTE RNs was estimated at 1.89 million,
whereas the demand was estimated at 2 million, a shortage of 110,000, or 6%. Based
on what is known about trends in the supply of RNs and the anticipated demand, the
shortage is expected to grow relatively slowly until 2010, by which time it will have
reached 12%. At that point, demand will begin to exceed supply at an accelerated
rate, and by 2015 the shortage will have almost quadrupled to 20%. If not addressed,
and if current trends continue, the shortage is projected to grow to 29% by 2020.
Factors driving the growth in demand include an 18% increase in population, a larger
proportion of elderly persons, and medical advances that heighten the need for
nurses.
• Initiatives to provide a stable supply of registered nurses
• Summary of key points
• Critical thinking questions
• Activities
• References
• CHAPTER 3 Nursing's pathway to professionalism
• Learning outcomes
• Characteristics of a profession
• FIG 3-1 According to experts, professionals are motivated by altruism, a desire to
help others.
• From occupation to profession
• Professional preparation
• Professional commitment
• Interprofessionality
• TABLE 3-1 COMPARISON OF CHARACTERISTICS OF OCCUPATIONS AND
PROFESSIONS
• Nursing's pathway to professionalism
• Kelly's criteria
• “The services provided are vital to humanity and the welfare of society.”
• “There is a special body of knowledge that is continually enlarged through research.”
• “The services involve intellectual activities; individual responsibility (accountability)
is a strong feature.”
• “Practitioners are educated in institutions of higher learning.”
• “Practitioners are relatively independent and control their own policies and activities
(autonomy).”
• “Practitioners are motivated by service (altruism) and consider their work an
important component of their lives.”
• “There is a code of ethics to guide the decisions and conduct of practitioners.”
• FIG 3-2 The Wheel of Professionalism in nursing.
• BOX 3-1 THE FLORENCE NIGHTINGALE PLEDGE
• “There is an organization (association) that encourages and supports high standards
of practice.”
• Miller's wheel of professionalism in nursing
• Standards established by the profession itself
• Nursing's social policy statement: The essence of the profession
• A contract with society
• Nursing: Scope and standards of practice
• The code of ethics for nurses
• BOX 3-2 SELF-ASSESSMENT: AM I A PATIENT-CENTERED NURSE?
• Collegiality as an attribute of the professional nurse
• Barriers to professionalism in nursing
• Varying levels of education for entry into practice
• BOX 3-3 POINTS ON PROFESSIONALISM
• Gender issues
• Historical influences
• BOX 3-4 REPAVING THE PATH TO PROFESSIONALISM IN NURSING EDUCATION
• Isabel Hampton Robb.
• External conflicts
• Internal conflicts
• Nursing image and professionalism: Are these related?
• CRITICAL THINKING CHALLENGE 3-1
• Final comments
• CRITICAL THINKING CHALLENGE 3-2
• Summary of key points
• Critical thinking questions
• Activities
• References
• CHAPTER 4 Legal aspects of nursing
• Learning outcomes
• FIG 4-1 Branches of the U.S. federal government were established by the
Constitution to provide for a balance of power.
• American legal system
• Nursing as a regulated practice
• Statutory authority of state nurse practice acts
• Executive authority of state boards of nursing
• Licensing powers
• Licensure examinations
• Mobility of nurses: Licensure by endorsement
• Nurse licensure compact
• Legal risks in professional nursing practice
• Malpractice
• BOX 4-1 MALPRACTICE: PROFESSIONAL NEGLIGENCE
• CRITICAL THINKING CHALLENGE 4-1
• BOX 4-2 STANDARDS OF CARE: A CASE EXAMPLE
• Delegation
• BOX 4-3 SIX MAJOR CATEGORIES OF NEGLIGENCE THAT RESULT IN
MALPRACTICE LAWSUITS
• BOX 4-4 FIVE RIGHTS TO ENSURE SAFE DELEGATION
• Informed consent
• Confidentiality
• FIG 4-2 Professional nurses may be called on to witness a patient's signing of
informed consent documents. The primary provider, however, is responsible for
providing necessary information to the patient or legal guardian.
• FIG 4-3 Nurses have an obligation for confidentiality but are not protected by
privileged communication statutes. In some cases, nurses are required to report
what a patient has told them.
• The health insurance portability and accountability act of 1996
• Social media: Maintaining confidentiality and hipaa standards
• BOX 4-5 A CAUTIONARY TALE: THE FAR-REACHING EFFECT OF DIGITAL
TECHNOLOGY
• Assault and battery
• Evolving legal issues and the nurse
• Role changes in health care
• Prescriptive authority
• Supervision of unlicensed assistive personnel
• EVIDENCE-BASED PRACTICE NOTE
• Payment mechanisms for nurses
• Patient self-determination act
• Preventing legal problems in nursing practice
• Practice in a safe setting
• Communicate with other health professionals, patients, and families
• Meet the standard of care
• BOX 4-6 FOUR DOCUMENTS YOU SHOULD OWN
• Carry and understand professional liability insurance
• BOX 4-7 BASIC TYPES OF PROFESSIONAL LIABILITY INSURANCE POLICIES
• Occurrence policies
• Claims-made policies
• BOX 4-8 GUIDELINES FOR PREVENTING LEGAL PROBLEMS IN NURSING PRACTICE
• Promote positive interpersonal relationships
• Summary of key points
• Critical thinking questions
• Activities
• References
• CHAPTER 5 Ethics: Basic concepts for nursing practice
• Learning outcomes
• BOX 5-1 TO BE GUARDIANS OF THE ETHICAL TREATMENT OF PATIENTS
• Basic definitions
• BOX 5-2 NURSES’ ETHICAL REASONING SKILLS MODEL
• CRITICAL THINKING CHALLENGE 5-1
• Approaches to moral reasoning
• Kohlberg's stages of moral reasoning
• Gilligan's stages of moral reasoning
• EVIDENCE-BASED PRACTICE NOTE
• Ethical theories
• Deontology
• Utilitarianism
• Virtue ethics
• Principalism
• Ethical principles
• Autonomy
• Beneficence
• Nonmaleficence
• Justice
• CULTURAL CONSIDERATIONS CHALLENGE
• Fidelity
• Veracity
• BOX 5-3 THE FLORENCE NIGHTINGALE PLEDGE
• Nursing codes of ethics
• American nurses association's code of ethics for nurses
• BOX 5-4 INTERNATIONAL COUNCIL OF NURSES CODE OF ETHICS FOR NURSES:
PREAMBLE
• International council of nurses code of ethics for nurses
• Ethical decision making
• Ethical decision-making model
• TABLE 5-1 COMPARISON OF NURSING PROCESS WITH ETHICAL DECISION-MAKING
MODEL
• CASE STUDY 5-1 YOUR HOSPICE PATIENT WANTS TO DIE ... AND HE WANTS YOU
TO HELP HIM
• Navigating ethical dilemmas in nursing
• Dilemmas resulting from personal value systems
• BOX 5-5 CHILDHOOD VALUE MESSAGES
• BOX 5-6 DISTRESS IN AN EXPERT LABOR AND DELIVERY NURSE
• Dilemmas involving peers’ and other professionals’ behavior
• BOX 5-7 ETHICAL USE OF SOCIAL MEDIA
• Sociocultural influences posing ethical challenges: Social media and substance
abuse
• Dilemmas regarding patients’ rights
• Patient self-determination act
• Ethical issues related to immigration and migration
• Dilemmas created by institutional and social issues
• Dilemmas created by patient data access issues
• Summary of key points
• Critical thinking questions
• Activities
• References
• CHAPTER 6 Becoming a nurse: Defining nursing and socialization into professional
practice
• Learning outcomes
• Defining nursing: Harder than it seems
• Why define nursing?
• Definitions clarify purposes and functions
• Definitions differentiate nursing from other health occupations
• Definitions influence health policy at local, state, and national levels
• Definitions focus educational curricula and research agendas
• Evolution of definitions of nursing
• Nightingale defines nursing
• Early twentieth-century definitions
• Post–world war ii definitions
• Professional association definitions
• American nurses association.
• Royal college of nursing.
• International council of nurses.
• Definitions developed by state legislatures
• CRITICAL THINKING CHALLENGE 6-1
• Becoming a nurse: Shaping your professional identity
• FIG 6-1 During formal socialization, students internalize the knowledge, skills, and
beliefs of nursing in planned educational experiences and interactions with faculty
and other nurses.
• Education and professional socialization
• Factors influencing socialization
• A new factor influencing socialization: Distance learning
• Models of professional socialization
• Cohen's model of basic student socialization
• TABLE 6-1 COHEN'S MODEL OF BASIC STUDENT SOCIALIZATION
• Benner's stages of nursing proficiency (basic student socialization)
• TABLE 6-2 BENNER'S STAGES OF NURSING PROFICIENCY (BASIC STUDENT
SOCIALIZATION)
• BOX 6-1 FROM NOVICE TO EXPERT: “HOW DID YOU KNOW THAT?”
• Actively participating in one's own professional socialization
• BOX 6-2 A DO-IT-YOURSELF GUIDE TO PROFESSIONAL SOCIALIZATION
• Socialization to the work setting
• BOX 6-3 TIME MANAGEMENT SELF-ASSESSMENT
• FIG 6-2 Setting priorities is an important aspect of time management. Use this grid
to determine whether a task should go to the top, middle, or bottom of your daily “to
do” list or whether it is a time-waster and should be ignored.
• CULTURAL CONSIDERATIONS CHALLENGE
• “Reality shock”: When ideals and reality collide
• FIG 6-3 Self-care is an important aspect of managing the stress of a new career.
• Summary of key points
• Critical thinking questions
• Activities
• References
• CHAPTER 7 The education of nurses: On the leading edge of transformation
• Learning outcomes
• Development of nursing education in the united states
• FIG 7-1 Florence Nightingale's nurses in Scutari, Turkey during the Crimean War.
Nightingale's unstoppable spirit led to the development of education that
transformed nursing.
• Early studies of the quality of nursing education
• FIG 7-2 Enrollments in basic RN programs by program type, 2008.
• Educational pathways to becoming a registered nurse
• Diploma programs
• Baccalaureate programs
• Influences on the growth of baccalaureate education
• Baccalaureate programs today
• FIG 7-3 Clinical experience is a vitally important aspect of every basic nursing
program. This student is working with her elderly patient in a hospice setting.
• Associate degree programs
• BOX 7-1 WENDY WOITH, PhD, RN
• Wendy Woith, PhD, RN.
• FIG 7-4 St. Basil's Cathedral on Red Square in Moscow, Russia. Dr. Woith and
colleagues have traveled widely in Russia to do research and teach in collaboration
with the Russian Nurses Association.
• External degree programs
• BOX 7-2 LANDMARKS IN THE HISTORY OF NURSING EDUCATION
• Articulated programs
• Alternative educational programs in nursing
• Baccalaureate programs for registered nurses
• Programs for second-degree students
• Online and distance learning programs
• Accreditation of educational programs
• Graduate education in nursing
• Master's education
• Doctoral education
• History of doctoral education in nursing
• Current status of doctoral education in nursing
• BOX 7-3 A SAMPLE OF CERTIFYING ORGANIZATIONS IN NURSING*
• Certification programs
• BOX 7-4 AREAS OF CERTIFICATION OFFERED BY THE AMERICAN NURSES
CREDENTIALING CENTER (ANCC) IN 2009
• Nurse practitioner (NP) certification areas
• Clinical nurse specialist (CNS) certification areas
• Other advanced-level certification areas
• Specialty certifications
• Continuing education
• Challenges in nursing education
• Faculty and other resource shortages threaten nation's supply of nurses
• A step in the transformation of nursing education: Quality and safety education for
nurses
• BOX 7-5 CHANGING MEANINGS OF QUALITY AND SAFETY IN NURSING EDUCATION
• Linda R. Cronenwett, PhD, RN, FAAN.
• Summary of key points
• Critical thinking questions
• Activities
• References
• CHAPTER 8 Critical thinking, the nursing process, and clinical judgment
• Learning outcomes
• BOX 8-1 EXPERT CONSENSUS STATEMENT REGARDING CRITICAL THINKING AND
THE IDEAL CRITICAL THINKER
• Defining critical thinking
• Critical thinking in nursing
• BOX 8-2 USING CRITICAL THINKING SKILLS TO IMPROVE A PATIENT'S CARE
• BOX 8-3 NOVICE THINKING COMPARED WITH EXPERT THINKING
• Novice nurses
• Expert nurses
• BOX 8-4 SELF-ASSESSMENT: CRITICAL THINKING
• Characteristics of critical thinkers: How do you measure up?
• The nursing process: An intellectual standard
• Phases of the nursing process
• Phase 1: Assessment
• Types of data
• FIG 8-1 A face-to-face interview with a patient is a primary means of collecting data
and requires good interviewing skills, observation, and listening.
• Methods of collecting patient data
• Organizing patient data
• Confidentiality of patient data
• Phase 2: Analysis and identification of the problem
• Distinctions between medical and nursing diagnosis
• BOX 8-5 WRITING NURSING DIAGNOSES
• Writing nanda-i nursing diagnoses.
• Prioritizing nursing diagnoses
• BOX 8-6 BLOOM'S TAXONOMY
• Phase 3: Planning
• Writing patient goals and outcomes
• CULTURAL CONSIDERATIONS CHALLENGE
• Selecting interventions and writing nursing orders
• Types of nursing interventions.
• Writing the plan of care
• FIG 8-2 The nursing process is a dynamic, nonlinear tool for critical thinking about
human responses.
• Phase 4: Implementation of planned interventions
• Phase 5: Evaluation
• Dynamic nature of the nursing process
• BOX 8-7 NURSING PROCESS CASE STUDY OF A HIGH-PRIORITY DIAGNOSIS
• Developing clinical judgment in nursing
• BOX 8-8 CLINICAL JUDGMENT: NINE KEY QUESTIONS
• BOX 8-9 SELF-ASSESSMENT: DEVELOPING SOUND CLINICAL JUDGMENT
• Summary of key points
• Critical thinking questions
• Activities
• References
• CHAPTER 9 Communication and collaboration in nursing
• Learning outcomes
• Therapeutic use of self
• The traditional nurse-patient relationship
• The orientation phase
• Developing trust.
• Tasks of the orientation phase.
• The working phase
• The termination phase
• BOX 9-1 DIFFERENCES IN SOCIAL AND PROFESSIONAL RELATIONSHIPS
• Social relationships
• Professional relationships
• Developing self-awareness
• Professional boundaries
• Reflective practice
• BOX 9-2 NURSE'S RELATIONSHIP WITH PATIENT RESULTS IN DISCIPLINARY
ACTION
• BOX 9-3 PRINCIPLES FOR DETERMINING PROFESSIONAL BOUNDARIES
• BOX 9-4 MODEL FOR STRUCTURED REFLECTION
• Avoiding stereotypes
• Becoming nonjudgmental
• Thinking differently about nurses and patients: Caring and human relatedness
• Patient-centered care
• FIG 9-1 Nonverbal communication consists of grooming, clothing, gestures, posture,
facial expressions, tone and volume of voice, and actions. Nonverbal communication
is particularly important to patients using mechanical ventilation or whose ability to
speak is otherwise impaired.
• Communication theory
• Levels of communication
• Elements of the communication process
• FIG 9-2 The five major elements of the communication process.
• Operations in the communication process
• Perception
• Evaluation
• Transmission
• Factors influencing perception, evaluation, and transmission
• How communication develops
• Criteria for successful communication
• Feedback
• Appropriateness
• Efficiency
• Flexibility
• Becoming a better communicator
• Listening
• BOX 9-5 COMMUNICATION PATTERNS SELF-ASSESSMENT
• Using helpful responding techniques
• FIG 9-3 Being an active listener is an important part of communication. Identify three
things in this photograph that demonstrate active listening by the nurse.
• Empathy
• Open-ended questions
• Giving information
• Reflection
• Silence
• Communication across differing languages
• BOX 9-6 MINIMIZING LANGUAGE BARRIERS: WORKING WITH A MEDICAL
INTERPRETER
• CULTURAL CONSIDERATIONS CHALLENGE
• Avoiding common causes of communication breakdown
• Failing to see the uniqueness of the individual
• Failing to recognize levels of meaning
• Using value statements and clichés
• Giving false reassurance
• Failing to clarify
• Practicing helpful responses
• CRITICAL THINKING CHALLENGE 9-1
• Interaction one
• Interaction two
• Communication with professional colleagues
• Effective use of electronic communication devices
• Communication in today's multicultural workplace
• FIG 9-4 These two iconic figures—Donna Reed and Janis Joplin—were each
emblematic of the sociohistorical and cultural contexts of their respective decades,
just a few years apart.
• BOX 9-7 SELECTED CHARACTERISTICS OF A MULTIGENERATIONAL NURSING
WORKFORCE
• Interprofessional collaborative practice: Prescription for improved patient outcomes
• BOX 9-8 KEY COMPONENTS NECESSARY FOR EFFECTIVE INTERPROFESSIONAL
COLLABORATION
• Final comment
• Summary of key points
• Critical thinking questions
• Activities
• References
• CHAPTER 10 Illness, culture, and caring: Impact on patients, families, and nurses
• Learning outcomes
• FIG 10-1 In times of illness, roles in families change. A daughter is caring for and
comforting her elderly mother.
• Illness
• Acute illness
• Chronic illness
• BOX 10-1 TYPES OF ILLNESS
• BOX 10-2 COMMENTS OF A PATIENT WITH A CHRONIC DISEASE: SYSTEMIC LUPUS
ERYTHEMATOSUS
• Adjustment to illness
• Disbelief and denial
• Irritability and anger
• Attempting to gain control
• Depression and grief
• Acceptance and participation
• BOX 10-3 STATES OF ACUTE ILLNESS
• The sick role
• BOX 10-4 INTERNAL AND EXTERNAL INFLUENCES ON ILLNESS BEHAVIOR
• Illness behaviors
• Internal influences on illness behaviors
• Dependence and independence.
• Coping ability.
• CASE STUDY 10-1 Dependence vs. Independence
• Example 1: Dependence
• Example 2: Independence
• Resourcefulness.
• Resilience.
• Spirituality.
• FIG 10-2 In this illustration of a hospital scene during the Siege of Paris in 1870, two
nuns pray for a dying man. Religion and nursing have been partners for centuries.
• External influences on illness behaviors
• Past experiences.
• Culture.
• The culturally competent nurse.
• Stereotyping.
• CASE STUDY 10-2 CULTURAL EXPRESSION OF PAIN
• Communication.
• Personal space and structure.
• Values.
• Role expectations.
• Ethnopharmacology.
• Ethnocentrism.
• FIG 10-3 Nurses administering chemotherapy in an outpatient setting often see the
same patients over time. A cultural assessment at the onset of treatment can be
useful in helping the patient feel accepted and supported as she faces the
challenges of having cancer.
• CULTURAL CONSIDERATIONS CHALLENGE
• Cultural assessment.
• CULTURAL CONSIDERATIONS CHALLENGE
• Etiquette and social customs
• Nonverbal patterns of communication
• Client's explanation of problem
• Nutrition assessment
• Pain assessment
• Medication assessment
• Psychosocial assessment
• INTERVIEW
• Impact of illness on patients and families
• Impact of illness on patients
• Guilt
• Anger
• Anxiety
• BOX 10-5 LEVELS OF ANXIETY
• Mild anxiety
• Moderate anxiety
• Severe anxiety
• Panic
• Symptoms of anxiety.
• Responses to anxiety.
• Stress
• Differentiating between stress and anxiety.
• Internal, external, and interpersonal stressors.
• Responses to stress.
• Stress and illness.
• Coping with stress.
• BOX 10-6 BREATHING EXERCISES
• BOX 10-7 RELAXATION EXERCISES
• Neck and shoulders
• Arms and hands
• Head
• Stomach
• Legs and feet
• Coping with stress through education.
• BOX 10-8 PERSONAL STRESS INVENTORY
• BOX 10-9 BARRIERS TO PATIENT LEARNING
• BOX 10-10 PRINCIPLES OF ADULT LEARNING
• Impact of illness on families
• BOX 10-11 BASIC TEACHING TIPS FOR PATIENTS AND FAMILIES
• BOX 10-12 POTENTIAL REACTIONS TO ILLNESS IN A FAMILY MEMBER
• Impact of caregiving on nurses
• Caring for self while caring for others
• BOX 10-13 CREATE A BALANCED LIFE CARE PLAN FOR YOURSELF
• Magnet recognition program
• FIG 10-4 By spending time having fun outside of the hospital, these nurses are taking
care of themselves. Self-care is crucial in creating a long and healthy nursing career.
• Developing and maintaining a life-work balance
• Summary of key points
• Critical thinking questions
• Activities
• References
• CHAPTER 11 The science of nursing and evidence-based practice
• Learning outcomes
• FIG 11-1 Florence Nightingale's painstaking detailing of mortality statistics in the
Crimean War demonstrated the effectiveness of nursing care over the course of a
year. The area of each colored wedge, measured from the center, is proportional to
the statistic being represented. Blue wedges represent deaths from contagious
diseases such as cholera and typhus; pink wedges, deaths from wounds; and gray
wedges, deaths from all other causes. Originally from Nightingale's book Notes on
Matters Affecting the Health, Efficiency and Hospital Administration of the British
Army, published in 1858.
• Science and the scientific method
• Basic, clinical, and translational science
• Inductive and deductive reasoning
• Limitations of the strict definition of scientific method in nursing
• What is nursing research?
• TABLE 11-1 COMPARISON OF RESEARCH AND PROBLEM SOLVING
• TABLE 11-2 PICO AS A TOOL FOR EVALUATING INTERVENTIONS (WITH EXAMPLE)
• Evidence-based practice: Bridging the gap between research and practice
• BOX 11-1 NATIONAL INSTITUTE OF NURSING RESEARCH: MISSION, GOAL, AND
INVESTMENT IN THE SCIENCE OF HEALTH
• BOX 11-2 SIGMA THETA TAU INTERNATIONAL
• The research process
• Identification of a researchable problem
• Review of the literature
• Formulation of the research question or hypothesis
• Design of the study
• Data-collection instruments
• Data-collection protocol
• BOX 11-3 NURSING RESEARCH
• BOX 11-4 NURSING RESEARCH
• Data analysis plan
• Participant selection
• Informed consent and institutional review
• CULTURAL CONSIDERATIONS CHALLENGE
• Implementation of the study
• Data collection
• Data analysis
• Drawing conclusions based on findings
• Discussion and/or clinical implications
• Dissemination of findings
• Relationship of nursing research to nursing theory and practice
• Financial support for nursing research
• Roles of nurses in research
• TABLE 11-3 LEVELS OF EDUCATIONAL PREPARATION AND PARTICIPATION IN
NURSING RESEARCH
• Summary of key points
• Critical thinking questions
• Activities
• References
• CHAPTER 12 Conceptual and philosophical bases of nursing
• Learning outcomes
• FIG 12-1 This is the foundation of nursing—its concepts and subconcepts basic to
the profession.
• Systems
• FIG 12-2 Major components of a general systems model.
• Components of systems
• Examples of systems
• Open and closed systems
• BOX 12-1 KEY CONCEPTS ABOUT SYSTEMS
• Dynamic nature of systems
• Application of the systems model to nursing
• Person
• FIG 12-3 Maslow's hierarchy of needs. Understanding this hierarchy helps nurses
prioritize their care.
• Human needs
• Maslow's hierarchy of needs
• Assumptions about needs
• Adaptation and human needs
• Homeostasis
• Environment and suprasystem
• Family systems
• Nuclear and extended families
• Single-parent families
• Cultural systems
• CULTURAL CONSIDERATIONS CHALLENGE
• Social systems
• Social change
• Social support
• Poverty
• BOX 12-2 RECENT LIFE CHANGES QUESTIONNAIRE
• Community, national, and world systems
• Nurses’ potential impact on the environment/suprasystem
• FIG 12-4 The health-illness continuum—a holistic health model.
• Health
• Defining health
• A national health initiative: Healthy people 2020
• BOX 12-3 HEALTHY PEOPLE 2020: TOPIC AREAS AND LEADING HEALTH
INDICATORS
• Health beliefs and health behaviors
• FIG 12-5 People of all ages are recognizing the benefits of regular exercise.
• Health beliefs model
• Self-efficacy and health-related behaviors
• Locus of control and health-related behaviors
• Nurses and health beliefs models
• “Dr. google” and the influence of the internet
• BOX 12-4 ASSESSING HEALTH-RELATED SITES ON THE INTERNET
• Devising a personal plan for high-level wellness
• Putting it all together: Nursing
• Holistic nursing
• BOX 12-5 SELF-ASSESSMENT: DEVELOPING A PERSONAL PLAN FOR HIGH-LEVEL
WELLNESS
• Beliefs
• FIG 12-6 Professional nurses maintain a posture of acceptance and calm, even when
patients appear to be angry or upset. This man may simply be very sad or anxious.
• Three categories of beliefs
• Values
• Nature of human values
• Process of valuing
• BOX 12-6 PROFESSIONAL NURSING VALUES
• Values clarification
• BOX 12-7 CLARIFYING YOUR VALUES
• Choosing freely
• Choosing among alternatives
• Choosing after considering the consequences
• Complement to other values
• Prize and cherish
• Public affirmation
• Action
• Values undergirding nursing's social policy statement
• Philosophies and their relationship to nursing care
• Branches of philosophy
• Philosophies of nursing
• Individual philosophies
• Collective philosophies
• BOX 12-8 DEVELOPING YOUR OWN PHILOSOPHY OF NURSING
• Use this guide to write your own your philosophy of nursing.
• Philosophy of nursing in a hospital setting.
• Philosophy of a school of nursing.
• Developing a personal philosophy of nursing
• Summary of key points
• Critical thinking questions
• Activities
• References
• CHAPTER 13 Nursing theory: The basis for professional nursing
• Learning outcomes
• BOX 13-1 NURSING THEORY AND THE PROFESSIONAL NURSE
• TABLE 13-1 THREE PHILOSOPHIES OF NURSING: THREE DIFFERENT RESPONSES
TO THE SAME PATIENT SITUATION
• Philosophies of nursing
• Nightingale's philosophy
• FIG 13-1 Virginia Henderson.
• Using nightingale's philosophy in practice
• Henderson's philosophy
• BOX 13-2 REMEMBERING VIRGINIA HENDERSON
• Using henderson's philosophy in practice
• BOX 13-3 HENDERSON'S 14 BASIC NEEDS OF THE PATIENT
• BOX 13-4 WATSON'S 10 CARITAS PROCESSES
• Watson's philosophy
• Using watson's philosophy in practice
• Clinical example: Watson's philosophy of caring
• Conceptual models of nursing
• TABLE 13-2 THREE MODELS OF NURSING: THREE DIFFERENT RESPONSES TO THE
SAME PATIENT SITUATION
• Orem's self-care model
• Orem and nursing practice
• King's interacting systems framework and theory of goal attainment
• Using king's model in practice
• Roy's adaptation model
• Using roy's model in practice
• Clinical example: Roy's adaptation model
• TABLE 13-3 THREE THEORIES OF NURSING: THREE DIFFERENT RESPONSES TO
THE SAME PATIENT SITUATION
• Theories of nursing
• Peplau's theory of interpersonal relations in nursing
• Using peplau's theory in practice
• Orlando's nursing process theory
• Using orlando's theory in practice
• Leininger's theory of culture care diversity and universality
• Using leininger's theory in practice
• FIG 13-2 Leininger's sunrise model, created to facilitate the application in practice of
the Theory of Culture Care Diversity and Universality.
• Clinical example: Leininger's theory of culture care diversity and universality
• Middle-range theories of nursing
• CULTURAL CONSIDERATIONS CHALLENGE
• The theoretical challenges for nursing education, practice, and research
• Theory-based education
• BOX 13-5 IMPORTANCE OF THEORY AT FOUR LEVELS OF NURSING EDUCATION
• CRITICAL THINKING CHALLENGE 13-1
• Theory-based practice
• Theory-based research
• Summary of key points
• Critical thinking questions
• Activities
• References
• CHAPTER 14 Health care in the United States
• Learning outcomes
• Today's health care system
• FIG 14-1 Healthy People 2020 Framework. U.S. Department of Health and Human
Services, Office of Disease Prevention and Health Promotion. Available at
www.healthypeople.gov.
• BOX 14-1 EXAMPLES OF HEALTH PROMOTION AND MAINTENANCE, EARLY
DETECTION, AND ILLNESS PREVENTION ACTIVITIES
• Health promotion/maintenance
• Early detection
• Illness prevention
• Major categories of health care services
• Health promotion and maintenance
• Illness prevention
• Diagnosis and treatment
• Rehabilitation and long-term care
• Classifications of health care agencies
• Governmental (public) agencies
• Federal agencies.
• State agencies.
• Local agencies.
• Voluntary (private) agencies and non-governmental organizations
• Not-for-profit or for-profit agencies
• Level of health care services provided
• Primary care services.
• Secondary care services.
• Tertiary care services.
• Subacute care services.
• Organizational structures within health care agencies
• Organizational structure
• BOX 14-2 BOARD OF DIRECTORS RESPONSIBILITIES (NOT-FOR-PROFIT
ORGANIZATIONS)
• Board of directors.
• Chief executive officer.
• Medical staff.
• Medical staff governance.
• Nursing staff.
• Nursing organization governance.
• Maintaining quality in health care agencies
• FIG 14-2 This is a simple version of an organizational chart showing lines of
responsibility in a large health care setting.
• Accreditation of health care agencies
• Continuous quality improvement and total quality management
• A continuing challenge: Health care disparities
• CULTURAL CONSIDERATIONS CHALLENGE
• 1. Infant mortality
• 2. Cancer screening and management
• 3. Cardiovascular disease
• 4. Diabetes
• 5. Human immunodeficiency virus infection/AIDS
• 6. Immunizations
• The health care team
• Physicians
• Physician assistants
• Unlicensed assistive personnel
• Licensed practical nurses/licensed vocational nurses
• Dietitians
• Pharmacists
• FIG 14-3 An important part of the work of pharmacists is consulting with patients
about their medications.
• FIG 14-4 Collection and safe management of blood are critical aspects of care in the
hospital.
• Technologists
• Respiratory therapists
• Social workers
• Therapists
• Administrative support personnel
• The nurse's role on the health care team
• Provider of care
• TABLE 14-1 KEY ELEMENTS OF THE ROLE OF NURSE ADMINISTRATOR
• Educator
• Manager
• Researcher
• Collaborator
• Patient advocate
• Nursing care delivery models
• BOX 14-3 PRINCIPLES FOR SELECTING A CARE DELIVERY MODEL
• BOX 14-4 ADVANTAGES AND DISADVANTAGES OF TEAM NURSING
• Advantages
• Disadvantages
• Team nursing
• FIG 14-5 Sick infants and those born prematurely frequently have long stays in
neonatal intensive care units, where primary nursing is often practiced.
• Primary nursing
• Case management nursing
• BOX 14-5 ADVANTAGES AND DISADVANTAGES OF PRIMARY NURSING
• Advantages
• Disadvantages
• BOX 14-6 ADVANTAGES AND DISADVANTAGES OF CASE MANAGEMENT NURSING
• Advantages
• Disadvantages
• Patient-centered care
• BOX 14-7 ADVANTAGES AND DISADVANTAGES OF PATIENT-CENTERED CARE
• Advantages
• Disadvantages
• Financing health care
• Basic economic theory
• Supply and demand
• Principles of the free-market economy
• Price sensitivity in health care
• Additional influences on the health care market
• Economics of nursing care
• EVIDENCE-BASED PRACTICE NOTE
• History of health care finance
• Current methods of payment for health care
• Private insurance
• Medicare
• Medicaid
• TABLE 14-2 FACTS ABOUT MEDICARE AND MEDICAID
• Personal (out-of-pocket) payment
• Workers’ compensation
• Nurses’ role in managing health care costs
• FIG 14-6 How the U.S. health care dollar is spent: Hospital care and
physician/clinical services account for more than half of health care expenditures.
• Health care reform and universal access
• Summary of key points
• Critical thinking questions
• Activities
• References
• CHAPTER 15 Political activism in nursing: Communities, organizations, government
• Learning outcomes
• FIG 15-1 The State of the Union address is delivered once a year by the President of
the United States to a joint session of Congress and is attended by the justices of
the Supreme Court and members of the President's Cabinet. All three branches of
government are represented at this important address.
• FIG 15-2 President Barack Obama at a White House signing ceremony of the SCHIP
legislation 2 weeks after taking office in January, 2009. He said, “I refuse to accept
that millions of our children fail to reach their full potential because we fail to meet
their basic needs.”
• Policy and politics
• Power, authority, and influence
• Policy
• Politics
• Linking practice, policy, and politics
• Professional organizations
• Joining a professional organization
• Types of associations
• Purpose and activities of organizations
• Nurses and unions
• Benefits of belonging to professional associations
• Developing leadership skills
• FIG 15-3 “When nurses are on the outside, there's something wrong on the inside.” –
So noted DeAnne McEwen, Co-President of the CNA at a rally and 1-day RN strike on
September 22, 2011. Twenty-three thousand RNs, members of the CNA/NNU, were
protesting proposed cuts in nurses’ health care coverage and retiree benefits and
widespread cuts in patient care services. Nurses carried signs that read, “Some cuts
don't heal.”
• Certification and continuing education
• BOX 15-1 ATTRIBUTES AND COMPETENCIES NEEDED BY FUTURE NURSE LEADERS
AND MANAGERS*
• Political activism
• Practice guidelines and position statements
• Other benefits
• Deciding which associations to join
• Political activism in the governmental arena
• BOX 15-2 NATIONAL STUDENT NURSES ASSOCIATION'S CODE OF ACADEMIC AND
CLINICAL CONDUCT
• Preamble
• A code for nursing students
• Becoming active in politics: “The personal is political”
• FIG 15-4 Gale Adcock, MSN, RN, FNP.
• BOX 15-3 A NURSE'S VOICE IN LOCAL POLITICS
• Getting involved
• BOX 15-4 COMMUNICATION IS THE KEY TO INFLUENCE
• FIG 15-5 Lillian Wald was an early nurse activist who is credited with establishing
public health nursing. Her tireless work on behalf of impoverished immigrants in
New York City embodied her belief that the work of nurses was significant in
improving the health of vulnerable people. She was also a member of the founding
group of the National Association for the Advancement of Colored People.
• Nurse citizens
• Nurse activists
• BOX 15-5 KEY QUESTIONS FOR NURSES WHO WANT TO MAKE A DIFFERENCE IN
HEALTH POLICY
• FIG 15-6 Rep. Eddie Bernice Johnson (D-Texas), nurse in Congress.
• FIG 15-7 Rep. Carolyn McCarthy (D-N.Y.), nurse in Congress.
• Nurse politicians
• FIG 15-8 Rep. Lois Capps (D-Calif.), nurse in Congress.
• FIG 15-9 Sen. Richard Durbin (D-Ill.), friend of nursing.
• FIG 15-10 Sen. Barbara Mikulski (D-Md.), friend of nursing.
• We were all once novices
• Nursing awaits your contribution
• Summary of key points
Critical thinking questions

Activities

References

CHAPTER 16 Nursing's challenge: The call for transformation

Learning outcomes

FIG 16-1 “One is silver and the other gold.” We can honor the best of our past and
traditions, yet transform nursing to meet the exciting challenges of the changing
times.

FIG 16-2 From the “Unsung Heroes” Project, artist Stacey Bentley created this badge
that symbolizes the story of Nurse Annette Barwick, a charge/triage maternity nurse
at the Royal Infirmary. Nurse Barwick related her pride in her nursing caps, first
wearing disposable paper caps as a student (represented at the top), then getting
the blue stripe on her nursing cap at graduation (in the middle), and finally receiving
her “real” cap with a stripe at graduation (bottom). This project honors the material
traditions of nursing.

The challenge: Care of self

The challege: Care of the profession

Joining professional organizations

Protecting the image of nursing

Maximizing your education

Promoting civility

FIG 16-3 The continuum of incivility goes from simple acts such as being distracting
and eye-rolling to aggressive behaviors and bullying.

The challenge: Care of the environment

FIG 16-4 Sea ice thickness comparison (10-year average), using 1955 as the baseline
and projecting to 2050.

The natural environment

The work environment

Genetics and genomics

The final challenge: Focus, unite, act

Summary of key points

Critical thinking questions

Activities

References

NANDA Approved Nursing Diagnosesmedia

Epilogue

Glossary