Your emails and suggestions help me to know what is working and what to add :)
In response to the overwhelming number of questions I am getting about how to approach this exam I have decided to offer online or telephone tutoring of sorts :) I can be available via Skype, FaceTime, and phone. Sometimes it helps to go over this stuff verbally and I know husbands and boyfriends are not always the best study partners. You know more than you think you do! Sometimes it just helps to talk it out though and realize how much you have actually retained from your studies. Feel free to contact me to schedule a time: jlmargolis@gmail.com
I seem to be getting the most traffic on this post so I will see if I can add anything that I used to study. All the terms listed here are what I focused on afar taking my practice exams so I didn't include all the things that I already knew. Check back because I continue to add to all the pages.
Terms/concepts to be familiar with: (I am currently going in and filling in my notes I took on these topics to study)
For some of these you don't need memorize all of the details, more just simple word association or bullet points. For example: ANA Code of Ethics, 2001- professional self regulation, ethical obligations and duties for practice
Or for the theorists:
Peplau- interpersonal relation
Leininger- cultural, diversity, universality
Orem- self care
Rogers- unitary
Roy- adaptation
Watson- caring
King- attainment
Neuman- systems
A lot of people stress about not knowing the wars. Do not fret, my dears!!! There will be no "in fourteen hundred ninety two Columbus sailed the ocean blue" type questions. Just know the names of the major wars and what their specific contribution to modern day nursing was.
For example: The urgent need for nurses after WWII led to the development of educational programs for nursing. Mildred Montag was the key player in advancing nursing education. Boom. That's all. You don't need to know everything about it, just extract the take home point.
I mean, you know the Crimean War didn't result in community colleges- it was like, a reeeeeeeally long time ago, right??? And not many people were headed off to the good ol' community college during World War One either. So you can automatically rule those out. Most of the time you can rule out two answers right off the bat, and that's with out even studying and just using basic common sense and common knowledge. So right there you have a 50% chance of picking the right answer. Add in a little study time and you're golden!!
Isabell Hampton Robb- she shortened the nursing work day and had student nurses spend more time in the class room. I remember this because of her name, she "robbed" the hospitals of their free labor!! Most importantly she founded the nursing school at Johns Hopkins. So for her:
Isabel Hampton Robb- shortened work day, founded Hopkins.
Don't try to memorize more than you need to!!
A couple more:
Clara Barton- school teacher, Red Cross
Dorothea Dix- reformed treatment of mentally ill
Linda Richards- first trained nurse
Lillian Wald- founder public health nursing
Mahoney- first African American nurse
Lavinia Dock- women's rights, constitution, women's right to vote
Breckenridge- Frontier Nursing, midwifery
If you can learn to associate these short words and phrases you can pass this test. EASILY!!!
Break the information into the smallest little bites possible. Don't overwhelm yourself.
Another notecard- Front: Margret Sanger Back: birth control, Planned Parenthood
As far as the papers- well the two big ones are going to be the ANA 1965 and ANA 1985.
The 1965 deals with educational preparation of nurses (remember, big picture) and next is 1985. Well, most educational programs were evolving in the 60's so by 1985 they were done with that and the profession had been established so in 1985 they began to address ethical issues.
1965- education
1985- ethics
If you can learn and remember more, then great, but these short cuts should at least be able to help you pick out the right answer in a pinch. It's really all I memorized for most of them.
1. What are the legal implications of giving the wrong medication or med errors? Medication safety.
- CPOE has avoided medication errors by decreasing the amount of errors due to difficulty reading handwriting*
- Other contributors to med safety: approved abbreviations, CPOE, med barcodes, smart pump IV administration
- OBRA (Omnibus Budget Reconciliation Act)*- mandates national standard of care in skilled nursing communities
- regulates nursing assistants
- addresses concerns about errors in healthcare by establishing safety goals, i.e. wrong patient, wrong site (do not mix up these safety concerns with those of OSHA, just sayin')
- requires investigation into sentinel events or near misses
5. OBRA
6. State Nurse's Practice Act
- primary function is to define the parameters of professional nursing, including education and scope of practice
- Primary Prevention: directed toward promoting health and preventing development of disease or injury. Examples: TB skin testing @ annual health care check up, Pt. participation in immunization clinic
- Secondary- screening, diagnosis, treatment. Examples: pap smear, mammograms
- Tertiary- Reduce disabilty and rehab pts. Examples: teaching (i.e. use of an inhaler), therapy, training
- Felony- violation of criminal law
- Libel- written defamation of character
- Malpractice- negligence by a professional in performing duties
- Harm
- Duty
- Breach of Duty
- Causation
- 3 year study resulting in "entry into practice" controversy. The paper's position was that:
- education should be in institutions of higher learning
- minimum prep should be bachelors
- minimum for LPN should be associates
- education for assistants should be in vocational institutions rather than on the job
- 3 year study
- about appropriate education and credentialing for basic nursing practice
- modes for delivery of nursing care
- developing and testing nursing knowledge
- provide criminal and civil immunity from liability when the healthcare provider volunteers to help a person in an emergency
- limit's nurses autonomy over their clinical practice
- varies among institutions
- using surveys to document patient experiences is an example of quality assurance
16. Nursing audits
- are used to compare nursing care to set standards and benchmarks
18. ANA Code of Ethics, 2001
- is a code for self regulation
- it is a statement of ethics obligations and duties
- the process of forming one's own individual values through identification and examination
- may be written or oral
- a signature or witness is not needed
22. Beneficience*
23. Justice
24. Veracity
25. Respondant Superior
- Holds employer responsible or liable for the acts of a negligent employee when those acts are conducted in the course and scope of employment
- What does this mean? If you are acting under the policies and procedures of your institution, the institution is responsible
27. Legal guidelines for documentation
28. Nursing profession's greatest responsibility to the public
29. Utilitarianism*
- "the end justifies the means"
- the rightness or wrongness of an action depends on the consequence of the action
- moral standards are independent of consequences
*The way I separate these two is the story of the man that steals milk to feed his starving baby. The utilitarian view would be that he made the right choice. The stealing was wrong but it was better than letting the baby die of starvation, so it was ultimately the right thing to do. The deontological viewpoint would be that the act of stealing was wrong, end of story.
31. Natural law
32. ANA Standards of Nursing Practice
33. Role of an ethics committee
34. Nonmaleficience
35. American's with Disabilities Act
36. OSHA, 1970
37. Purpose of theory development
38. Role of expert witness
39. Criminal behavior
42. Sexual Harassment
43. legal liability
44. Ada M. Stewart
- health counseling to factory workers
- spiritual healing
- visited the sick in their homes
48. Isabel Hamilton Robb
- founded Hopkins nursing
- had nursing students work hours reduced (I remember this one because she 'Robbed' the hospital of their free help!)
- Henry Street Settlement
- visiting nursing service
- first afreican american graduate
- founded Red Cross, was teacher
- political activist
- introduced nursing into school setting
- Frontier Nursing Services
- Midwifery
55. Expectations of a nurse with a higher education degree
56. Mildred Montag
- wanted to develop associates degree nursing programs as a response to the nursing shortage after WWI
58. Hildegard Peplau
59. Healthy People, 2010
60. The Brown Report
- analyzed the nursing needs as a profession
- focused on educational preparation for nurses
- faulted length of workday
63. Dorothea Orem
64. Martha Rogers
65. Jean Watson
66. License renewal
- what is required for license renewal and who regulates renewal
- birth control
- Autocratic- leader assumes complete control over the decisions and activities of a group
- Democratic- also called participative, a sense of equality among the leader and other participants
- Laizze-faire- also called non directive, leader relinquishes power to the group such that an outsider could not identify the leader
- how to prioritize, delegate, and whom to notify when you are overwhelmed
- understand the role of an advocate (by telling the docs a patient doesn't want something, by requesting appropriate meals, etc)
- know what you should and shouldn't delegate to unlicensed personnel and if you so delegate know your responsibility in making sure the work is done correctly and timely
73. Functional Nursing*
- requires ancillary staff to perform simple tasks
- a disadvantage is fragmented care
- one person gives all meds to all pts, one nurse changes all beds, one nurse gives all baths, etc
- evolved out of dislike for functional nursing post WW2
76. Critical Pathways*
- tools or guidelines that direct care by identifying expected outcomes
- means of reducing variations in care
- reduce resource utilization
- improve pt outcomes
78. Peer Review
79. Nursing Care Plans
80. Continuity of care
- an uninterrupted process across settings in which a person seeks care
- reduces duplication of testing
- discharge planning begins at the time of admission
- structuring nursing roles based on education, experience, and competence
- scientifically accepted general principle that governs practice
- theory based practice has been a major influence in moving nursing into a professional status. Basing nursing practice on theory on theory allows for a testable, specialized knowledge base, which is a characteristic of a profession
84. PEW, 1995
- advised that nursing distinguish between the different levels of nursing
- a means to advance the economic and general welfare of nurses.
- an agreement between an employer and a group of employees with respect to wages and other conditions of employment
87. Primary goal of managed care*
- control costs
89. Primary outcome of DRG's*
- Diagnosis Related Group
- purpose is to control costs
- example: pt gets admitted for pneumonia, the hospital is expected to care for that patient for a preset amount of money. Lets say $2000.00. If the hospital spends $2800.00, in prolonged admission, extensive testing, etc...the hospital eats that $800. Some say that pts are prematurely discharged to stay under DRG's set payment amount. The amount paid according to the DRG is increased with added comorbidities. The same patient admitted for pneumonia for $2000.00 would get additional money if they had congestive heart failure or COPD.
- Health Maintenance Organization
- subscriber receives all care through a group of affiliated providers
- do not allow out of network service
92. Increased consumer awareness
93. Capitation
- used to keep costs low and manageable
- physician is seen as the "gatekeeper"
- decisions are made based on a predetermined set of protocols
- neither too much or too little care is provided
- costs are controlled
- stake holders, for profit
- federal government insurance for persons 65 and older or disabled
- Part A covers hospitalization, home care, and hospice
- Part B offers partial coverage of physician services for a monthly premium
- state medical assistance
- provides care to those meeting categorical and income requirements
- costs are shared by fed and state
- tools or guidelines that direct care by identifying expected outcomes
- they are another means of cost control
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