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Sunday, September 28, 2025 11:17 AM
ESSENTIAL FEATURES OF THE PROFESSIONAL NURSE
• Provision of a caring relationship that facilitates health and healing
• Attention to the range of human experiences and responses to health and illness within the
patient’s physical and social environments
• Integration of assessment data with knowledge gained from an appreciation of the patient’s or
group’s subjective experience
• Application of scientific knowledge to the processes of diagnosis and treatment through the
use of judgment and critical thinking
• Advancement of professional nursing knowledge through scholarly inquiry
• Influence on social and public policy to promote social justice
• Assurance of safe, quality, and evidence-based practice
10 GUIDNG PRINCIPLES OF PERSON CENTERED CARE
• All team members are considered caregivers.
• Care is based on continuous healing relationships.
• Care is customized and reflects patient needs, values, and choices.
• Knowledge and information are freely shared between and among patients, care partners,
physicians, and other caregivers.
• Care is provided in a healing environment of comfort, peace, and support.
• Families and friends of the patient are considered an essential part of the care team.
• Patient safety is a visible priority.
• Transparency is the rule in the care of the patient.
• All caregivers cooperate with one another through a common focus on the best interests and
personal goals of the patient.
• The patient is the source of control for their care.
BLENDED COMPETENCIES
• Nurses have to consider the whole patinet and the whole picture
• Skills
○ Cognitive skills—using critical thinking; a systematic way to form and shape one’s
thinking
○ Technical skills—manipulating equipment skillfully to produce desired outcome
○ Interpersonal skills—promoting the dignity and respect of patients and establishing
caring relationships
○ Ethical/legal skills—establishing a personal moral code and professional role
responsibilities
DEVELOPING THE METHOD OF CRITICAL THINKING
• Purpose of thinking
• Adequacy of knowledge
• Potential problems
• Helpful resources
• Critique of judgment/decision
TECHNICAL COMPETENCIES
• What are examples of technical equipment that a nurse must be familiar with?
• Vital sign monitors – blood pressure cuffs (manual and automatic), pulse oximeters, and
thermometers.
• Infusion devices – IV pumps, syringe pumps, and PCA (patient-controlled analgesia) pumps.
• Oxygen delivery systems – nasal cannula, simple face mask, non-rebreather mask, and
Venturi mask.
• Suction equipment – wall suction units, portable suction machines, and Yankauer tips.
• Cardiac monitoring equipment – ECG/EKG machines and telemetry monitors.
• Point-of-care testing devices – glucometers, pregnancy test kits, rapid strep or flu tests.
• Wound care and negative pressure wound therapy devices – wound vacs.
• Specialty beds and equipment – low-air-loss beds, SCDs (sequential compression devices),
and Hoyer lifts for safe patient transfers.
INTERPERSONAL COMPETENCIES
• Use interactions with patinets and significant others and colleagues to promote human dignity
and respect
NURSING PROCESS
• Directs the nurse and patinet
• Assessing—collecting, validating, and communicating of patient data
○ Critical first phase and provides baseline data
○ ONGOING so nurse can be alert when changes occur
○ Uses nursing history: health status, actual potential problems, risks, the need for nursing
care
○ Purposeful, prioritized, complete, systematic, factual, relevant and recorded in
standardized manner
• Diagnosing—analyzing patient data to identify patient strengths and problems
• Planning—specifying patient outcomes and related nursing interventions
• Implementing—carrying out the plan of care
• Evaluating—measuring extent to which patient achieved outcomes
• The nursing process is
○ Systematic—part of an ordered sequence of activities
○ Dynamic—great interaction and overlapping among the five steps
○ Interpersonal—human being is always at the heart of nursing
○ Outcome oriented—nurses and patients work together to identify outcomes
○ Universally applicable—a framework for all nursing activities
PROBLEM SOLVING AND THE NURSING PROCESS
• Trial-and-error problem solving
○ Testing any number of solutions until one is found that works for that particular
problem.
• Scientific problem solving
○ 7 step-process, used most correctly in a controlled laboratory setting
• Intuitive thinking
○ Direct understanding of a situation based on background of experience, knowledge, and
skill
• Critical thinking
○ Logical, scientific, and evidenced-based decisions
POTENTIAL ERRORS IN DECISION MAKING
• Bias
○ Placing excess emphasis on first data received
○ Stating the problem in a way to support one’s choices
• Failure to consider the total situation
○ Using inaccurate data
○ Failing to prioritize or rank the problems in order of importance
○ Using unrealistic goals
• Impatience
○ Failing to identify multiple solutions
○ Incorrectly implementing the decision
○ Failing to use appropriate resources
TYPES OF ASSESSMENTS
• Initial
○ After admission
○ Creates a complete database of health information, set priorities and form a baseline for
future comparisons
• Focused
○ Gathering data about a specific problem that’s already been identified
○ Identify new or overlooked problems
• Quick priority
○ Short, focused, prioritized assessments to gain the most important information
○ They can flag existing problems and risks
• Emergency
○ Identify life threatening problems
▪ A long-term care facility resident who begins choking in the dining room
▪ a bleeding patient brought to the emergency department with a stab wound
▪ an unresponsive patient in the rehabilitation unit
▪ a factory worker threatening violence are all candidates
• Time lapsed
○ Scheduled to compare patients current status to the baseline
○ Residential settings and receiving care over long periods of time
▪ Homebound patients with visiting nurses
○ Can be both comprehensive or focused
DIAGNOSIS
• Actual statements
○ clinical judgment about an undesirable response to a condition (can be individual,
family, or community)
• Risk for
○ Clinical judgment about vulnerability of an individual, family, community for
development of an undesirable response.
• PES
○ Problem statement
○ Etiology: x medical dx
○ Signs and symptoms
• RF ONLY HAVE TWO PARTS
• Prioritize actual before risk for dx EXCEPT SAFETY
• Usually need at least 5 part interventions per dx
• Always use SMART goals
VALUES
• Value- a belief about the worth of something, about what matters, that acts a standard to
guide one’s behavior.
• Value System- organization of values in which each is ranked along a continuum of
importance, often leading to a personal code of conduct.
• Values are formed during one’s lifetime; influenced by environment, family, and culture.
• Values influence belief about:
○ Human needs
○ Health
○ Illness
○ Practice of health behaviors
○ Human response to illness
VALUES ESSENTIAL TO THE PROFESSIONAL NURSE
• Altruism: concern for welfare and well-being of others
• Autonomy: right to self-determination
• Human dignity: respect for inherent worth and uniqueness of individuals and populations
• Integrity: acting according to code of ethics and standards of practice
• Social justice: upholding moral, legal, and humanistic rights
LEGAL DIMENSIONS
• Nurses are often the subject of both civil and criminal negligence cases
• Nurse practice acts
○ Regulated by each state, directly affects your nursing practice (Texas BON)
○ Protects the public by defining the legal scope of nursing practice
○ Practicing beyond those limits makes you vulnerable to charges
• Standards
○ Developed by the profession itself; not mandatory but serve as guidelines
○ Professional organizations, ex: ANA’s standards of practice (SOP)
• Credentialing - professional competence is ensured and maintained
○ Accreditation
○ Licensure
○ Certification
CRIME VS TORT
• tort:
○ a wrong committed by a person against another person or that person’s property; tried
in civil court
▪ Intentional
• Assult and battery
• Defamation of character
• Invasion of privacy
• False imprisionment
• Fraud
▪ Unintentional
• Negligence
• Malpractice
○ Hurting someone privately and they can sue you for money
• Crime:
○ wrong against a person or the person’s property as well as the public
▪ Misdemeanor: punishable by fines or less than 1 year imprisonment
▪ Felony: punishable by imprisonment for more than 1 year
○ Breaking a law that affects society
MOST FREQUENT ALLEGATIONS AGAINST NURSES
• Failure to ensure patient safety
• Improper treatment or performance of a treatment
• Failure to monitor and report
• Medication errors and reactions
• Failure to follow agency procedure
• Documentation
• Equipment use
• Adverse incidents
• Clients with HIV
THE IMPAIRED NURSE
• Between 10%-15% of all nurses may be impaired or in recovery from alcohol or drug addiction
• Pattern of dependency is unique because they have greater access to drugs in the work
environment
• Impaired nurses can become dysfunctional in their ability to provide safe, appropriate patient
care.
• Nurses have an ethical and moral duty to patients, colleagues, the profession of nursing, and
the community to take action.
• Texas Peer Assistance Program for Nurses (TPAPN)
○ Safeguards patients by providing early identification, support, monitoring, accountability
and earned advocacy to Texas nurses who have an identified substance use and/or
mental health condition or related incident, so the nurse may return to safe nursing
practice.
INCIDENT REPORTS
• Complete name of person and names of witnesses
• Factual account of incident
• Date, time, and place of incident
• Pertinent characteristics of person involved
• Any equipment or resources being used
• Any other important variables
• Documentation by physician of medical examination of person involved
SENTINEL EVENTS
• Sentinel Event - as an unexpected occurrence involving death or serious physical or
psychological injury, or the risk thereof.
• Known as “never events”
• Serious injury specifically includes loss of limb or function.
• These events signal the need for immediate investigation and response
• A root cause analysis (RCA) is performed and changes are implemented
• Examples:
○ Wrong side surgery
○ Suicide
○ Operative and postoperative complications
COMMUNICATION
• Plays a big role in patinet safety
• Nurse and pt
• Nurse and nurse
• Nurse and other health team members
COMMUNICATION PROCESS
• Developed by David Berlo in 1960
1. Stimulus or referent
2. Sender or source of message (encoder)
3. Message itself
4. Medium or channel of communication
▪
5. Receiver (decoder)
LEVELS OF COMMUNICATION
• Intrapersonal
○ Self-talk; communication within a person
○ Affects nurses behavior (can enhance or detract)
• Interpersonal
○ Occurs between two or more people with a goal to exchange messages
○ How you will spend most of your day
○ The ability to communicate affects problem solving, goal attainment, team building, etc.
• Group
○ Small-group- two or more people
○ Organizational communication- council meetings, meetings with other disciplines
• Group dynamics- how individuals group members relate to one another during the
process
FACTORS INFLUENCING COMMUNICATION
• Developmental level
• Gender
• Sociocultural differences
• Roles and responsibilities
• Space and territoriality
• Physical, mental, and emotional state
• Values
• Environment
THE HELPING RELATIONSHIP
• Relationships between healthcare providers and patients do not develop but occur through
purposeful communication.
• Characterized by an unequal sharing of information
• Built on the patient’s needs
• The nurse is the helper, and the patient is the person being helped.
• Communication is the means used to establish rapport and helping–trust relationships.
• Dynamic, purposeful, and time limited
• Person providing assistance is professionally accountable for the outcomes and the means
used to attain them
FACTORS THAT PROMOTE EFFECTIVE COMMUNICATION
• Dispositional traits
• Is a characteristic or customary way of behaving
• WHO YOU ARE
• Example traits:
• Warmth and friendliness
• Openness and respect
• Empathy
• Honesty, authenticity, trust
• Caring
• Competence
• Rapport builders
• Rapport is a feeling of mutual trust experienced by people in a satisfactory relationship
• WHAT YOU DO TO CONNECT WITH THE PATIENT
• Example rapport builders:
• Specific objectives
• Comfortable environment
• Privacy
• Confidentiality
• Patient vs. task focus
• Utilization of nursing observations
• Optimal pacing
BLOCKS TO COMMUNICATION
• Failure to perceive the patient as a human being
• Failure to listen
• Nontherapeutic comments and questions
• Using clichés
• Using closed questions
• Using questions containing the words “why” and “how”
• Using questions that probe for information
• Using leading questions
• Using comments that give advice
• Using judgmental comments
• Changing the subject
• Giving false assurance
• Using gossip and rumors
• Using disruptive interpersonal behavior
DISRUPTIVE INTERPERSONAL BEHAVIOR
• Incivility
• Rude, intimidating, and undesirable behavior directed at another person
▪ Big problem among healthcare workers (especially new graduate nurses)
• Rude, can be one time or occasional
▪ Interrupting someone, rolling their eyes, making snide remarks
• Bullying
▪ Horizontal violence/nurse bullying
▪ Negative communication between nurse and physician
▪ Repeated, targeted and intentional
▪ Spreading rumors, constant criticism, isolating someone on purpose
• Organizational response to disruptive behaviors
▪ Zero tolerance policies regarding disruptive behavior
▪ Reporting systems available to identify unprofessional behavior