GLOSSARY
CLIENT: Patient/Family/Community that utilizes economic goods, services and/or nursing care.
COMMUNICATION ABILITIES: “Effective, accurate, congruent transfer of information, thoughts, and feelings using feedback between individuals and groups in nursing practice (Martin, 1997).”
CRITICAL THINKING is the intellectually disciplined process of actively and skillfully conceptualizing, applying, analyzing, synthesizing, and/or evaluating information, gathered or generated by observation, experience, reflection, reasoning, and/or communication as a guide to belief or action. Critical thinking is not the simple acquisition and retention information; the development of a particular set of skills, and/or the repetitive application of those skills without the critical evaluation of their results. Critical thinking encompasses the eight elements of reason: purpose, point of view, question at issue, information, interpretations and inference, concepts, assumptions, implications and consequences (Paul, 1995).
EXPANDED ROLES are nontraditional, community, specialty, leadership, education, and research roles.
FUNCTIONAL HEALTH PATTERNS: A way to organize information in a holistic way. These patterns delineate the human needs of the person, family, community and group. The patterns, which focus on behaviors that occur with time, present a total picture of the client, rather than just a small part of his or her life. Functional health patterns represent basic health needs and they develop as people strive to meet their needs. These patterns are unique because they are interrelated (Gordon, 1997).
LIFE CYCLE: A sequence of developmental crises that begin in infancy and continue to the death of the individual. Each crisis has the potential for positive or negative resolution. Positive resolution promotes healthy development of the personality (Erikson, 1963).
NCLEX-RN (National Council Licensure Examination for Registered Nursing) In order to protect the public, the National Council of State Boards of Nursing develops the NCLEX-RN licensure examination, which measures the competencies of the entry-level registered nurse and assures the ability of this newly licensed individual to perform safely and effectively. The test plan is practice-based and is revised every three years, after surveying graduate nurses’ frequency of nursing care behaviors and responsibilities as well as the types of clients cared for within the first six to twelve months of employment.
NCLEX-RN CLIENT NEEDS THAT DEFINE NURSING ACTIONS AND COMPETENCIES:
1. Safe, Effective Care Environment
a. Management of care Management of care is a provision of integrated, cost-effective care to clients by coordinating, supervising and/or collaborating with members of the multi-disciplinary health care team. Related care includes but is not limited to: Advance Directives, Case management, client rights, concepts of management, confidentiality, continuity of care, continuous quality improvement, delegation, ethical practice, incident/irregular occurrence/variance reports, informed consent, legal responsibilities, organ donation, consultation and referrals, resource management and supervision.
b. Safety and infection control Safety and infection control involves the protection of clients and health care personnel from environmental hazards. Related content includes but is not limited to accident prevention, disaster planning, error prevention, handling hazardous and infectious materials, medical and surgical asepsis, standard (Universal) and other precautions and use of restraints.
2. Health Promotion and Management
a. Growth and development through the life span Growth and development through the life span involve assisting the client and significant others through the normal expected stages of growth and development from conception through advanced old age. Related content includes but is not limited to aging process, ante / intra / postpartum and newborn, developmental stages and transitions, expected body image changes, family planning, family systems and human sexuality.
b. Prevention and early detection of disease Prevention and early detection of disease involve the management and provision of care for clients in need of prevention and early detection of health problems. Related content includes but is not limited to disease prevention, health and wellness, health promotion programs, health screening, immunizations, lifestyle choices and techniques of physical assessment.
3. Psychosocial Integrity
a. Coping and adaptation Coping and adaptation involves promotion of the client’s ability to cope, adapt and/or problem solve situations related to illnesses or stressful events. Related content includes but is not limited to coping mechanisms, counseling techniques, grief and loss, mental health concepts, religious and spiritual influences on health, sensory/perceptual alterations, situational role changes, stress management, support systems and unexpected body image changes.
b. Psychosocial adaptation Psychosocial adaptation involves management and provision of care for clients with acute or chronic mental illnesses. Related content includes but is not limited to behavioral interventions, chemical dependence, child abuse/neglect, crisis intervention, domestic violence, elder abuse/neglect, psychopathology, sexual abuse and therapeutic milieu.
4. Physiological Integrity
a. Basic care and comfort Basic care and comfort involve the provision of comfort and assistance in performance of activities of daily living. Related content includes but is not limited to assistive devices, elimination, mobility/ immobility, non-pharmacological comfort interventions, nutrition and oral hydration, personal hygiene and rest and sleep.
b. Pharmacological and parenteral therapies Pharmacological and parenteral therapies involve management and provision of care related to the administration of medications and parenteral therapies. Related content includes but is not limited to administration of blood and blood products, central venous access devices, chemotherapy, expected effects, intravenous therapy, medication administration, parenteral fluids, pharmacological actions, pharmacological agents, side effects, total parenteral nutrition and untoward effects.
c. Reduction of risk potential Reduction of risk potential involves reducing the likelihood that clients will develop complications or health problems related to existing conditions, treatments or procedures. Related content includes but is not limited to alterations in body systems, diagnostic tests, lab values, pathophysiology, and potential complications of diagnostic tests, procedures, surgery and health alterations and therapeutic procedures.
d. Physiological adaptation Physiological adaptation involves management and provision of care to clients with acute, chronic or life-threatening physical health conditions. Related content includes but is not limited to alterations in body systems, fluid and electrolyte imbalances, hemodynamics, infectious diseases, medical emergencies, pathophysiology, radiation therapy, respiratory care and unexpected response to therapies. (NCLEX-RN Test Plan information from the National Council of State Boards of Nursing, Inc)
NURSING PROCESS The nursing process is an interactive, problem-solving process used by the nurse as a systematic and individualized way to fulfill the goals of nursing care. It is a deliberate, organized and scientific approach requiring thought, knowledge and judgment. The five phases of the nursing process are Assessing, Diagnosing, Planning, Implementing and Evaluating (Berman, et al., 2008).
Assessing: The first step of the nursing process is assessment. This is an organized and systematic process of data collection from a variety of sources. Data collection contains subjective and objective, current and historical consumer information (Berman, et al., 2008).
Diagnosing: A nursing diagnosis is a clinical judgment about an individual, family or community response to actual and potential health problems/life processes. Data collected is analyzed to assist in formulation of the nursing diagnosis. The format of the nursing diagnosis is actual problem: Problem + Etiology + Defining characteristics/signs and symptoms (PES); and for potential problems: Problem + Risk factors (PR) (Berman, et al., 2008).
Planning: Planning involves a series of steps and the development of strategies to prevent, minimize, or correct unhealthy consumer responses identified in the nursing diagnosis. (Kozier, et al., 1998) The plan includes goal, desired outcomes, and planned nursing interventions (Berman, et al., 2008).
Goal- A statement that designates the absolute desired outcome of nursing intervention, usually long-term and derived from the first clause of the nursing diagnosis. A goal should be patient-centered, realistic, clear, measurable, broad and timed (Berman, et al., 2008).
Desired Outcomes- Statements that add specificity to a broad consumer goal statement. Outcome statements are derived from the second and/or third part of the nursing diagnosis; consumer-centered; timed; specific, observable and measurable responses of consumers; and are essential to the evaluation phase of the nursing process. Expected outcome criteria provide four purposes.
- They provide direction for nursing interventions.
- They provide a time span for planned activities.
- They serve as criteria for evaluation of progress toward goal achievement.
- They enable the consumer and nurse to determine when the problem has been resolved.
Outcome criteria generally include four components:
- Subject, which is the consumer or any part or attribute of the consumer;
- Verb, which denotes an action the consumer is to perform;
- Condition or modifier, which may be added to the verb to explain the circumstances or the what, where, when, or how under which the behavior is to be performed; and
- Criterion of desired performance or the standard, by which a performance is evaluated; the level at which the consumer will perform the specified behavior (Berman, et al., 2008).
Nursing Interventions- Actions that a nurse performs to achieve client goals. Nursing interventions are written during the planning step, and are performed during the implementing step (Berman, et al., 2008).
Implementing: The nurse implements interventions consistent with the established plan of care by doing, delegating and recording in a safe and appropriate manner. The consumer and support persons continue to be encouraged to participate as much as possible. As the nurse puts the plan into effect and evaluates the results, the plan of care is either continued, modified or terminated. This initiates the fifth step, the process of evaluation (Bernal, et al., 2008).
Evaluating: The process of evaluation is a planned, purposeful activity in which clients and health care professionals determine:
- The client's progress toward goal achievement
- The need to revise/modify the client's care plan.
Revision/Modification- The review of nursing diagnosis, consumer goals, outcome criteria, and/or nursing orders as based on analysis of new data from the consumer response to nursing actions.
ROLES OF NURSING
Coordinator of Care: An individual who organizes and facilitates the delivery of comprehensive services to clients using other provider’s services, human and material resources and collaboration with clients, their support services and a variety of providers.
Provider of Care: An individual who provides nursing care to clients using a systematic process of assessment, analysis, planning, intervention and evaluation.
Member of Profession: An individual who accepts responsibility for the quality of nursing care for clients; applies research findings and identification of further research; is aware of legislative, regulatory, ethical and professional standards; aspires to improve the discipline of nursing and its contribution to society; and values the need for life-long learning (BNE, 1993).
REFERENCES
Board of Nurse Examiners for the State of Texas. Annotated Guide to Texas Nursing Practice (1999). Annotations by James H. Willmann.
Board of Nurse Examiners for the State of Texas. Board of Vocational Nurse Examiners. (September 2002). Differentiated Entry Level Competencies of Graduates of Texas Nursing Schools.
Erikson, E. H. (1963). Childhood and society. (2nd ed.) New York: Norton.
Gordon, M. (1994). Nursing diagnosis: Process and application. (3rd ed.) St. Louis: Mosby.
Berman, A., Snyder, S., Kozier, B., Erb, G. (2008). Fundamentals of nursing: Concepts, process, and practice. (8th ed.) Upper Saddle River, NJ: Pearson/Prentice Hall.
Mish, F.C. (Ed.). (1994). Merrian-Webster’s collegiate dictionary. (10th ed.) Springfield, MA: Merrian-Webster, Inc.
Paul, R. (1995). What every student needs to survive in a rapidly changing world. Dillon Beach, CA: The Foundation for Critical Thinking.
Revised Fall, 2007