Question

1. One of the results of the 2005 Hurricanes Katrina and Rita in Louisiana has been an increase in the influx of Spanish-speaking workers. Incorporating cultural and linguistic competence to meet the health needs of this population would include

a. having health care professional staff from different Spanish-speaking countries at health care facilities.

b. ensuring health services are in varying locations.

c. ensuring that all signage is posted completely in Spanish.

d. having all health care workers speak Spanish.

2. A mechanism health care organizations need to incorporate into their strategic plan for culturally and linguistically appropriate services includes

a. goals, policies, accountability and oversight mechanisms addressing these  services.

b. partnerships with community agencies.

c. mechanisms for client service reimbursement.

d. staff con? ict resolution policies.

3. Kwanzaa was created in the 1960s to raise awareness and pride for the African- American community. While its tenets can be applied to all people, this particular celebration was developed to celebrate a specific

a. social class.

b. religion.

c. ethnicity.

d. cultural group.

4. Parish Nursing is an aspect of nursing that is becoming more utilized. One of the bases of parish nursing is the premise that

a. it is easier to provide health services to a de? ned religious community.

b. a faith community has an impact on the health of its members.

c. illness is prevented through parish nursing.

d. members of a religion follow de? ned health practices.

5. After the Vietnam War, many Vietnamese immigrated to the United States and settled in areas where they could maintain many of the cultural customs and traditions of Vietnam, including festivals, Saturday schools to educate the children in the Vietnamese language and planting communal gardens. This is an example of

a. heritage consistency.

b. acculturation.

c. socialization.

d. religious preference.

6. A seminal event in the boomer generation that can still elicit comment today is the question

a. ”How did the Challenger tragedy affect you?”

b. ”Where were you when John F. Kennedy was shot?”

c. ”Do you remember Pearl Harbor?”

d. ”What were you doing on September 11, 2001?”

7. A complaint of the boomer generation about the following generations regards work ethic. The “nester” generation born between 1979 and 1984 is more likely to embrace an ethic

a. of employer loyalty.

b. seeking to fit their lifestyle.

c. seeking maximum financial gain.

d. loyal to one’s skills in the marketplace.

8. The best outcome for health care facilities incorporating cultural care into their practices is

a. increased numbers of clients seeking care at these facilities.

b. improved health outcomes for the clients at these facilities.

c. better health care provided by the facility’s staff.

d. increased reimbursement by insurance companies for provided health services.

9. An important consideration when making a home health visit to a client is to:

a. give a general idea of when the visit will be made.

b. bring a gift to the client’s home on the initial visit.

c. just show up at the client’s home.

d. inform the client the approximate time the visit will be made.

10. Certain cultures place emphasis on eating speci? c foods during pregnancy and after childbirth to ensure a healthy mother and infant. This cultural phenomena is an example of

a. time orientation.

b. environmental control.

c. biological variation.

d. social organization.

11. Touch is an important component of nursing, but using it without understanding the client’s cultural background can be a violation of their

a. social organization.

b. environmental control.

c. space and territoriality.

d. time orientation.

12. Before doing any teaching it is important the client understands what is being taught. The most effective method to determine if the client understands any health teaching is by

a. ask the client if they understand what was said in the teaching.

b. speaking slowly and carefully to the client.

c. having the client repeat back what was said in his/her own words.

d. interpreting the client’s facial gestures.

13. Native Americans have a higher susceptibility to diabetes than other population groups within the United States. This is considered a(n)

a. biological variation.

b. component of heritage consistency.

c. social organization pattern.

d. environmental control.

14. While the Census Bureau has placed race as a sociopolitical construct, placing oneself into a racial category can still present a challenge. Those who consider themselves “Creole” would be more likely to place themselves into the category labeled

a. White.

b. Asian.

c. Black or African American.

d. Hispanic or Latino.

15. While shifts in the population profile are occurring, what is an important consideration to address in health care?

a. More physicians need to be trained to deliver health care.

b. Cultural health needs of varying groups must be considered.

c. Health care providers need to be younger to care for an aging population.

d. Health care needs to be streamlined for consistent care delivery.6

16. With the percentage of the 65+ population greatest among White non-Hispanics in the 2000 Census, health planning needs would indicate

a. there is no need to increase manufacture of childhood immunizations.

b. cultural accommodations for other minority groups can be decreased.

c. planning needs for other segments of the population can be revised downwards.

d. this population will have greater demands on the health care system as they age.

17. Twelve percent of the population in 2000 was age 65 or over. Long-term implications for health for this group include

a. developing systems to provide health care only to those older citizens who remain healthy.

b. providing health care that is focused on gerontological needs.

c. providing health insurance for all age groups.

d. developing medications to prolong life at any cost.

18. A hurdle immigrants face coming to a new country is

a. rejecting their old customs in favor of new customs.

b. having their children learn the customs of the new country.

c. finding their own cultural group in the new country.

d. learning a new way of life that differs from their former way of life.

19. In 1970, the highest percentage of foreign-born legal permanent residents becoming citizens came from Europe. What is true today? The majority of foreign-born legal permanent residents are from

a. Asia.

b. Mexico, China, and the Philippines.

c. Europe.

d. South America.

20. Many people who come to the United States to live seek to get a “green card.” The green card

a. confers automatic U.S. citizenship.

b. legally restricts the holder from becoming a citizen.

c. defines the person as being in the country unlawfully.

d. allows the person legal permanent residency.

21. When seeking permanent U.S. citizenship, legal permanent residents take a naturalization exam that questions them on

a. knowing the Pledge of Allegiance.

b. being able to recite or sing the national anthem.

c. elements of the U.S. government.

d. the Congressional district they live in.

22. Among the very real concerns for all residents of the United States, citizens and legal permanent residents, is the rise in undocumented people entering the country. What impact is this having on health care?

a. Increased numbers of undocumented people are straining health care resources.

b. The rise in undocumented people is contributing to the rise in exotic and rare diseases in the country.

c. There is a concern that undocumented people will lead to bioterrorist attacks.

d. Health insurance is being given to all people in the country ensuring universal coverage.

23. One recognized deterrent to poverty is

a. the presence of two parents in a family structure.

b. not needing to have housing assistance.

c. not needing to utilize food stamps.

d. living in a household of a male income earner.

24. While income is not a restrictor for engaging in health-promoting behaviors, higher income improves them through

a. living in better housing.

b. membership in health clubs in suburban areas.

c. increasing opportunities through nutrition and access to facilities.

d. access to better jobs.

25. Many people and groups have provided definitions of health, but the most widely used definition is that from

a. Nightingale.

b. Rogers.

c. Murray and Zenter.

d. WHO (World Health Organization

26. As people progress through a health profession education program, definitions of health become

a. easier to explain to others.

b. aligned with the client seeking care.

c. more abstract and technical.

d. well articulated and understandable.

27. In attempting to define health, what can occur?

a. Listing categories of health will enable understanding of health.

b. Ambiguity is resolved when health definitions are discussed.

c. Terms and meanings can be challenged by others.

d. A full acceptance can be achieved by all parties.

28. Health status and determinants are used to

a. account for health care expenditures.

b. enforce legislation pertaining to health.

c. determine federal dietary guidelines.

d. measure the health of a nation.

29. Healthy People 2010 represents

a. health policies providing monetary incentives to states who reach the benchmark goals by 2010.

b. a plan to improve the health of everyone in the United States in the ? rst decade of this century.

c. mandated legislation that will result in a healthier population by 2010.

d. a monitoring system evaluating the health of all citizens.

30. As with the many variant definitions of health, illness also has many meanings. Illness and the sick role assigned to it are legitimized by

a. the insurance company that pays for the illness treatment.

b. the person having the illness.

c. the health care profession that diagnoses the illness.

d. society’s view of the illness.

31. Among the sick role components is the

a. mandate of appearing ill and suffering from the illness.

b. necessity of taking medications and staying in bed.

c. exemption from performance of certain normal social obligations.

d. refusal to look to other sources of health care treatments beyond those prescribed.

32. During the stage of patient status, it is expected that

a. symptoms are being experienced, leading to a diagnosis.

b. the patient do all they can do to recover from their illness.

c. the illness is now socially recognized and identified.

d. the person shifts into the role as it is determined by society.

33. Assuming the sick role according to Suchman means the person

a. is aware that something is wrong and responds emotionally.

b. seeks scientific confirrmation that something is wrong.

c. seeks help and shares the problem with family and friends.

d. goes under the control of a physician who plans a treatment of care.

34. A person who has cancer may have followed this illness trajectory:

a. presenting symptoms, followed by treatment and recovery.

b. acute illness, unstable status, deterioration, and recovery.

c. diagnosis, treatment, unstable status, death.

d. presenting symptoms, followed by diagnosis and treatment.

35. When Suchman divides the illness experience into its various stages, the medical care contact stage implies the person is

a. cognitively and physically aware that something is wrong.

b. under medical control and following a prescribed treatment protocol.

c. seeking scientific c rather than lay diagnosis in order to interpret what it all means.

d. seeking help and information from family and friends. 10

36. While HEALTH is considered a balance of the person, ILLNESS would be considered

a. the imbalance of one’s being in and outside the world.

b. actual symptomatology physically manifested.

c. part of the human condition that all must experience.

d. the absence of elements that contribute to health.

37. While complementary alternative medical (CAM) treatments are used by people of all backgrounds, recent research indicates CAM use is greater by

a. men.

b. those who have never been hospitalized.

c. people with rudimentary education.

d. women.

38. Alternative medical traditions are considered

a. an essential component of a cultural heritage medical tradition.

b. for use in concert with other aspects of health care.

c. out of the realm of a person’s cultural heritage medical tradition.

d. traditional methods of health care.

39. The evil eye is defined differently by different populations. Evil is thought to be cast in the Philippines through the

a. mouth or eye.

b. eye or touch.

c. foot.

d. breath.

40. The saying, “An apple a day keeps the doctor away, an onion a day keeps everyone away,” is thought to protect HEALTH by

a. recognizing the special antibiotic properties contained within onions.

b. advertising that onions have special healing abilities.

c. protecting the person from coming in contact with those who might be ill.

d. affirming the belief in the power of onions to prevent disease.

41. Religion has an important role in HEALTH, and ILLNESS can be considered

a. violating dietary practices.

b. failure to wear special amulets to ward it off.

c. a necessary part of religious culture.

d. punishment for breaking a religious code.

42. Eucalyptus is a folk herbal remedy that has applications today. It is used for

a. nasal congestion and sore throat.

b. infant colic.

c. toothache pain.

d. fever.

43. Allopathic medicine terms alternative treatments as complementary or alternative. An alternative therapy for rehabilitation might include ________ as treatment.

a. macrobiotics

b. Santeria

c. Voodoo

d. biofeedback

44. The difference between complementary and alternative medicine is that complementary medicine

a. can be used together with allopathic medicine.

b. is never used with allopathic medicine.

c. lessens a patient’s discomfort with allopathic treatments.

d. replaces allopathic medicine as a primary form of treatment.

45. A reason why people seek alternative care treatments is

a. allopathic treatments may cause adverse effects that a person can’t tolerate.

b. training for alternative care practitioners is closely regulated and licensed.

c. insurance reimburses alternative care treatments at the same rate or better than allopathic treatments.

d. it has a better empirical basis than do allopathic treatments.

46. Many people of Catholic faith pray to ________ for the grace of a happy death.

a. St. Teresa of Avila

b. St. John of God

c. St. Roch

d. St. Joseph

47. While shrines that attract pilgrims can be religious or secular in nature, an essential component to all of them is the

a. feeling of peace and serenity that is conducive to healing.

b. location of the shrine.

c. presence of water so pilgrims can take samples home.

d. numbers of people who are attracted to that site.

48. Lourdes, France, is the site of a revered Roman Catholic shrine. Many people with illnesses visit the shrine with the hope of

a. becoming more prosperous.

b. gaining a better job.

c. receiving a cure through a miracle.

d. being able to live a long life.

49. Historically, early forms of HEALING for illness were equated with

a. performing set rituals to prevent illness.

b. finding the person causing the illness.

c. sacrificial offerings.

d. removing the evil causing the illness.

50. Among alternative treatment modalities utilized during an illness may be the

a. consultation of a healer outside the medical establishment.

b. strict adherence to the prescribed medical regimen.

c. willingness to seek a second medical opinion.

d. refusal to allow any medical treatment to be performed.

51. A potential explanation for healers being used in addition to or instead of traditional medical personnel is their

a. unique language that is characteristic of their calling.

b. exclusive dialogue with the person who is ill.

c. formal relationship with the client.

d. willingness to be available at any time.

52. An illness of the spirit is treated through repentance and is considered

a. physical healing.

b. spiritual healing.

c. inner healing.

d. deliverance.

53. The six-week postpartum check that women have after having a baby closely matches the crucial ________ day practice of ancient times.

a. seventh

b. fortieth

c. third

d. tenth

54. Baptism dates for children have significance within various religions. Water is the common element in baptism as water signifies

a. protecting the child from illness.

b. cleansing the child either from evil or other maladies.

c. the relation of the child to God.

d. dedication of the child to a family group.

55. Wearing white clothes in the Buddhist tradition indicates

a. mourning the death of a relative.

b. recognition of a religious holiday.

c. joy for the birth of an infant.

d. celebration for a marriage.

56. The decline in the use of patent medicine utilization in the United States began with

a. the passage of the Food and Drug Act.

b. increased popularity of over-the-counter medicines.

c. the rise in alternative health care practitioners.

d. Medicare reimbursement for prescription medications.

57. An important health protection practice among Black American Baptists is

a. drinking blackstrap molasses.

b. eating fresh lemons.

c. wearing camphor around the neck in the winter.

d. taking a daily shot of whiskey.

58. Chicken soup is considered a universal HEALTH restoration intervention in which tradition?

a. French

b. Pacific Islander

c. Eastern European Jewish

d. Italian

59. As a HEALTH maintenance practice, the use of cod liver oil is advocated by those of the

a. German Catholic tradition.

b. Italian Catholic tradition.

c. Iranian (U.S.) Islamic tradition.

d. English Episcopal tradition.

60. A HEALTH protection practice among Irish-American Catholics is drinking

a. senna tea.

b. yeast.

c. hot peppermint tea.

d. wine daily.

61. Fr. John’s medicine is suggested as a HEALTH protection practice from November to May for

a. English American Episcopalians.

b. Canadian Catholics.

c. Native American Baptists.

d. Italian American Catholics.

62. Among the HEALTH restoration practices for menstrual cramps for Irish American Catholics is

a. applying Vicks on the abdomen.

b. drinking cod liver oil in orange juice.

c. applying warm oil to the stomach.

d. drinking hot milk sprinkled with ginger.

63. Activities for HEALTH maintenance for Swedish-American Protestants include

a. walking distances on a regular basis.

b. dressing appropriately for the weather.

c. going to a physician twice a year whether needed or not.

d. starting each day with prayer.

64. While dressing properly for season and weather is an important HEALTH protection practice for Iranian-American Moslems, it is also important to

a. keep onions under the bed to keep nasal passages clear.

b. eat sorghum molasses.

c. keep feet from getting wet in the rain.

d. prevent evil spirits by not looking at a mirror at night.

65. A constant for any culture is the

a. ability for it to change quickly to adjust to new challenges.

b. requirement that all members of the culture act the same.

c. socialization into its traditions, language and practices.

d. necessity for its members to be homogenous in all their decisions.

66. Socialization into the health care culture includes an assumption that

a. effective treatment can only be done by educated and licensed professionals.

b. the more technological the intervention, the greater bene? t it yields.

c. interventions for health events must follow a prescribed protocol.

d. alternative complementary treatments have validity.

67. Contemporary per capita U.S. health care expenditures are expected to

a. increase as part of the overall gross domestic product.

b. decrease as health care becomes available for all citizens.

c. match those of other Western countries.

d. have the United States achieve the highest health status in the world.

68. Specified government efforts for health insurance have resulted in

a. decreasing the amount that Medicare covers for prescription medications.

b. decreasing the percentage of uninsured children under age 18.

c. increasing coverage for prenatal and well-baby care.

d. increasing the percentage of uninsured children under age 18.

69. Technology and scientific advances in health care have resulted in more conditions being treated than in previous decades. The most expensive costs for care are for which conditions?

a. Cardiac disease

b. Conditions resulting in transplantation

c. Diabetes care

d. Pulmonary disease

70. In the early part of the twentieth century, health care efforts focused on controlling infectious diseases and improving

a. maternal and child health.

b. the requirements of the medical profession.

c. chronic diseases.

d. health care costs.

71. The United State relies heavily on guest worker/migrant labor for its agriculture industry. Health care can be offered for this population but faces a potential barrier of

a. language.

b. access.

c. racism.

d. homelessness.

72. What differentiates CULTURALCARE from modern medical care in philosophy is that

a. sufficient money, technology and science are used to cure or remedy.

b. premature death must be avoided.

c. holistic care is predicated on cultural health traditions and needs.

d. disease and injury are avoided through health promotion and maintenance.

73. HEALTH for American Indians has a basis in the

a. curing of those conditions that affect the spirit.

b. respecting of others’ beliefs in healing traditions.

c. harmony between nature and the ability to survive.

d. optimism that life creates positive forces.

74. Evil spirits are associated with illness by the

a. Sioux.

b. Cherokee.

c. Passamaquoddy.

d. Hopi.

75. In determining the cause for illness, medicine men and women look for the

a. dietary practices of the person being seen.

b. past medical history as a determinant.

c. spiritual cause of the problem of the person seen.

d. physical symptoms displayed.

76. Use of sand paintings as diagnosis in the Navajo tradition helps to

a. provide an atmosphere of calming for the medicine man.

b. determine cause and treatment of the illness.

c. ensure that appropriate payment is made by the family.

d. create symbolic representations of the client and family.

77. A sequela related to alcohol abuse in American Indians is the rise in

a. malnourishment among children.

b. breast cancer rates.

c. domestic violence against women.

d. unintentional injuries.

78. The provision of health services through the Indian Health Service means

a. having one master health guideline blueprint for consistency of care.

b. partnering and assisting tribes in planning the best delivery of care.

c. allotting health resources based on population numbers.

d. following prescribed federal guidelines and procedures.

79. Comparing household income levels of $150,000 or more within the Asian subpopulations, the population that has the higher income level is

a. Chinese.

b. Filipino.

c. Indian.

d. Indonesian.

80. The initial impetus for Asian immigration to the United States, specifically with the Chinese population, resulted from the

a. favorable immigration status for the Chinese.

b. high unemployment rates in China.

c. need for cheap labor building railroads in the nineteenth century.

d. demand for menial service jobs.

81. A second-class physician in Chinese medicine:

a. pays the patient’s family if the patient dies.

b. has to wait for patients to become ill before treating them.

c. consults Taoist writings for diagnosis and prescription.

d. receives payment only if the patient is cured.

82. The health and disease beliefs in Ayurveda teach that

a. humans are distinct beings within the universe.

b. disease arises when a person is out of harmony with the universe.

c. at birth, people are not in balance and their lives are spent getting into balance with the universe.

d. living and nonliving things have minor connections with one another.

83. Feeling the pulse is important for a Chinese physician because it

a. can help refine a diagnosis.

b. is only felt on the wrist.

c. indicates a specific treatment.

d. is considered the storehouse of the blood.

84. In acupuncture, needles are inserted at predetermined points called meridians because

a. puncturing the meridians helps to restore yin and yang balance.

b. the best anesthetic response is done through meridian puncture.

c. meridians represent specific yin and yang points.

d. only specific needles can puncture the meridians.

85. While Blacks are represented in every socio-economic group, the percentage of those living in poverty in 2005 was approximately

a. thirty percent.

b. twenty percent.

c. fifty percent.

d. twenty-five percent.

86. Speaking a language other than English at home is highest among immigrants from

a. Nigeria.

b. Somalia.

c. Sudan.

d. Niger.

87. A diabetic Muslim may refuse insulin

a. because it implies the person has not led a holy life.

b. because any injectable medication is forbidden.

c. during Ramadan.

d. if it has a pork base.

88. The leading authority figure within the Black familial structure is the

a. oldest adult child.

b. female.

c. male.

d. minister.

89. When a Black person is being examined, skin pallor can be recognized by

a. palpation.

b. checking the sclera.

c. the absence of underlying red tones.

d. slow blood return.

90. Scars that form at a wound site growing beyond the normal boundaries of the wound are

a. melasma.

b. pseudofolliculitis.

c. keloids.

d. a pigmentary disorder.

91. Educational comparisons of high school graduation and college attendance between Hispanics and non-Hispanic whites indicate

a. Hispanics have a lower rate of graduation and attendance than their

non-Hispanic counterparts.

b. similar percentages of attendance between both groups.

c. more Hispanics attend college than their non-Hispanic counterparts.

d. a higher proportion of non-Hispanic whites fail to complete high school.

92. The largest Hispanic group in the United States comes from Mexico. Which is a true statement reflecting this population?

a. Employment levels are above the national average.

b. Employment in professional areas is stagnant.

c. Migrant farm work is the predominant employment.

d. Most live in urban areas.

93. Visiting a curandero(a) implies a person is seeking

a. holistic care encompassing social, physical, and psychological purposes.

b. care not offered by the medical establishment.

c. care for spiritual distress.

d. specialized herbal preparations not used by the medical establishment.

94. Teas used to treat mental illnesses in the Hispanic population are herbs common in the United States. Yerba buena is an herb used to treat nervousness. Its English name is

a. spearmint.

b. basil.

c. orange leaves.

d. chamomile.

95. The percentage of live births to women receiving third-trimester or no prenatal care is higher for Hispanics than the general population. This would imply that

a. more prenatal services are needed for the general population.

b. some prenatal care is better than no prenatal care.

c. Hispanics possibly have better self-care prenatal practices than the general population.

d. live birth rates would be comparable if all women received appropriate prenatal care.

96. In examining the median age of population groups, the oldest group is

a. African Americans.

b. Hispanics.

c. Whites.

d. Native Americans.

97. While German Americans believe in the germ theory of infection, another potential cause of ILLNESS can be

a. stress-related occurrences.

b. envy by others toward that person.

c. a voodoo curse.

d. unholy actions done in life.

98. Treating a cough in the German tradition may include

a. eating chicken soup.

b. putting wet warm compresses on the chest.

c. drinking lemon juice and whiskey.

d. rubbing goose grease on the chest.

99. To treat a cough, a traditional Polish remedy is

a. taking garlic oil.

b. a mustard plaster on the chest.

c. drinking hot lemonade with whiskey.

d. goose grease rubbed on the throat.

100. When compared to all races, the White population has a higher

a. percentage of low birth-weight infants.

b. percentage of women receiving prenatal care.

c. infant mortality rate.

d. crude birth rate.

 

 

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Students are required to maintain weekly reflective narratives throughout the course to combine into one course-long reflective journal that integrates leadership and inquiry into current practice as it applies to the Professional Capstone and Practicum course.

In your journal, you will reflect on the personal knowledge and skills gained throughout this course. The journal should address a variable combination of the following, depending on your specific practice immersion clinical experiences:

1. New practice approaches
2. Intraprofessional collaboration
3. Health care delivery and clinical systems
4. Ethical considerations in health care
5. Population health concerns
6. The role of technology in improving health care outcomes
7. Health policy
8. Leadership and economic models
9. Health disparities

Students will outline what they have discovered about their professional practice, personal strengths and weaknesses that surfaced, additional resources and abilities that could be introduced to a given situation to influence optimal outcomes, and finally, how the student met the competencies aligned to this course.

APA style is required for the body of this assignment, solid academic writing is expected, and in-text citations and references should be presented using APA documentation guidelines.

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Ana Willis

C304 Task 1

 

When I think of nursing theory the first person that comes to mind is Florence Nightingale. She is well known for her environmental adaptation theory. In her theory she discusses ventilation and warming, noise, variety, diet, light, cleanliness, and chattering hopes and advices. I feel that her theory influences my values and goals. Her theory is also used every day in the hospital facility I work in (Cherry and Jacob, 2017).

Nightingales theory has influenced my nursing values by ensuring that I provide a safe environment for my patients. Patient rooms should be clean, well lit, and free of clutter to implement non-maleficence. Her theory has influenced my values such as altruism and dignity. I provide individualized care to my patients while respecting their morals. Every person is different and their care needs to be catered to their needs. As a nurse I am always concerned with the patient’s altruism. Safety is key and the driver in everything I do as a nurse. If safety is not up held then everything else fails.

Nurses apply Florence Nightingales theories in their practice to promote excellent nursing practices in many ways. There are restricted visitor’s hours to promote rest and reduce noise. Patients are put on specific diets depending on their health history to promote healing and further harm. For example, Nurses monitor the amount of fluids that patients take in that are admitted for Congestive Heart Failure to ensure they do not further complicate their disease process. In the morning nurses raise the blinds to let in the natural light so patients are aware that is a day time and time to be up and not sleeping. This helps to combat delirium in patients and helps them get the proper rest. Nurses also ensure the rooms are clean, linens are changed daily, patients are bathed daily and as needed, and housekeeping tends to the patient rooms every day. Not only does cleanliness apply to the patients but it also applies to the nurses. In current practice nurses must wash their hands with antimicrobial soap before entering and after leaving a room. To combat boredom of patients and have a variety of activities nurses can offer art therapy, music therapy, or pet therapy. There are many other things that nurses can do for patients in their nursing practice that are influenced by Florence Nightingales nursing theory.

Currently in my professional practice I also do many of the mentioned things above that align with Florence Nightingales nursing theory. When I bathe my patients I implement the use of CHG wipes that not only clean the patient but also provide cleanliness to help prevent infections. I also wash my hands prior to entering a room, assessing a patient, and upon exiting a room. While in a patient room I try to limit noise and distractions to help promote rest and healing. At the facility I work at we do not have strict visiting hours but we do have quiet time where we dim the lights and try to limit visitors to advocate rest. I am upfront with my patients about their care but at the same time am respectful of their feelings. I do not fill them with false hopes or tell them things that are untrue about their care or diagnosis. Everything that I do in my practice relates to Florence Nightingales nursing theory in some sort of way.

There were many influential nurses in the nineteenth and twentieth century. The two that I would like to discuss are Linda Richards and Lillian Wald. Linda Richards was born in 1841. Richards was America’s first trained nurse in 1900. She is known for creating the first system of keeping written medical records. Prior to her creating individualized written records nurses were expected to report important facts orally from memory. Richards contribution helped to change the process of giving report and keeping medical records. By keeping written records nurses are now able to keep an accurate history on the patient. When information is given by mouth facts can be misconstrued or completely left out. Richards contributions differ from Wald’s because Richards changed the process of nursing. Wald’s contribution recognized the need to expand nursing to a more in need population. Both women made drastic changes for the nursing community (Campbell, n.d.).

Lillian Wald was born in 1867. Wald is considered to be the founder of public health nursing. Wald recognized that poverties areas needed access to affordable healthcare. Patients were charged based on a fee sliding scale. She also started the first American public school of nursing in New York City and founded the Henry Street Settlement. The Henry Street Settlement was known for its large playground in the lower east side. The Settlement opened more branches in New York to provide services such as health care, community programs, and employment to everyone. She was recognized in the New York Times as “one of the 12 greatest living American women” and received the Lincoln Medallion for being an “Outstanding Citizen of New York” (Hansan, 2018)

The works of these two ladies influence my professional nursing practice in many ways. Richards introduction of charting patient information helps with effective communication skills. With the help of my charting I am able to effectively communicate the patients care to the oncoming nurse and members of the healthcare team accurate information. By charting the information items are not as easily missed and I am able to look back throughout my shift to ensure I didn’t miss anything. Charting is used in the court of law as proof to what did and did not happen. The rule of thumb in nursing is “if it wasn’t charted, it didn’t happen”. Having the ability to chart patient information also allows for implementation, interventions, and evaluations. I am able to see what the Doctors chart and view their orders which allows me to implement their plan of care and provide interventions that align with the plan of care. I am also able to evaluate things that have happened on different shifts like when wound care was last done and when it needs to be redone.

Wald’s recognition of the need for public health nursing and providing care to everyone in a community has changed nursing in a drastic way. By providing extended care to everyone in my practice I am able to provide nursing care to everyone in my community. Due to the diversity of my community I am able to care for people from all different walks of life and see a variety of different disease processes. I am also able to provide care to people who may not have received care before if it wasn’t for Wald. As a nurse I also volunteer in my community for a variety of things that offer public health nursing to members of my community. By doing this I am able to implement education to these individuals that they may not have ordinarily received (Hansan, 2018).

The State Board of Nursing and the American Nurses Association (ANA) differ in various ways. The State Board of Nursing is state specific. It is a regulatory body that sets the standards for safe nursing care, decides the scope of practice for nurses in its jurisdiction, and issues licenses to qualified candidates. The State Board of Nursing covers issues such as public health, safety and welfare, and help to develop nursing licensure exams (“What is a State Board of Nursing?”, 2018). While the ANA is a professional organization that represents the entire RN population. The ANA requires RN to pay a fee to become a member. The ANA helps to advance nursing and be the “voice” of its members. Once a member of the ANA you are given resources to further your career, access to journals, discounts on certification exams, discounts on personal benefits, ANA meetings and conferences, live webinars, and many other benefits. The ANA is a nationwide organization (“About ANA”, n.d.).

The State Board of Nursing is in every state and each state has its own individual set of rules. These rules are established by the Nursing Practice Acts (NPAs). The NPA set rules and regulations into place that establish the qualifications for state licensure. The State Board of Nursing is responsible for issuing and renewing nursing licenses, reviewing applications for nurse applicants, and enforcing disciplinary action (“What is State Board of Nursing?”, 2018).

The ANA is a membership only professional organization. It prides itself in improving the quality of healthcare for all. It currently has members in all 50 states and U.S. territories. The ANA has two types of membership. The lowest type of membership has limited access. The ANA collaborates with other nursing organizations to address and solve issues that affect the nursing profession. The ANA recognizes problems within the nursing profession and finds solutions to improve the practice. They also offer many benefits to their members (“The History of the American Nurses Association”, n.d.).

Both of these organizations influence my nursing practice. The ANA helps to make changes to better nursing. The changes that they make allow me to practice safely and have adequate resources in my nursing practice. I am actually a member of the ANA. By being an ANA member I received a discount on the CMSRN exam. I am now a CMSRN. I frequently receive education opportunities from the ANA which allow me to have advanced knowledge in specific areas. They also send me CEU opportunities at a discounted rate which I need to maintain my RN license. The State Board of Nursing (BON) helps my nursing practice by requiring education to maintain my license. This education helps to ensure I am up to date with the frequent changes in healthcare. BON is also responsible for allowing me to renew my license which I need in order to practice as an RN.

I live in the state of Virginia. In the state of Virginia you are required to have continued competency hours which must include 15 contact hours and 640 practice hours or 30 contact hours. Licensure is required to be renewed every 2 years. In order to renew a fee is applied. If license requirements are not maintained then disciplinary action such as probation or loss of license can occur (Kluwer, 2018).

In the United States there are compact and non-compact states. Compact states allow you to practice in other compact states without having to obtain an additional license, but your original residence needs to be located in a compact state (Douglas, n.d.). If you reside in a non-compact state, then you are not able to practice in any other state. In order to practice in other states then you have to obtain a separate license for that state. You are allowed to obtain as many single state licensures as you want. You are required to adhere to the rules and regulations in the state that you are working (Papandrea, 2016).

The Food and Drug Administration (FDA) and the Center for Medicare and Medicaid Services (CMS) both play vital roles in the healthcare system, but they do differ. The FDA is responsible for making sure that drugs and devices are safe and effective. The FDA monitors things such as medications, vaccines, medical devise, and blood products. CMS is responsible for deciding if the product is needed for the condition of the patient or can improve function to the patient. CMS is also responsible for determining the amount that healthcare providers get reimbursed (Richardson, 2015).

The FDA influences my clinical practice by the types of medications I administer to patients. The medications I administer have to be approved by the FDA. They also decide what medical devices are safe and effective for patients. Their determinations play a factor in what I have available to adequately care for my patients. If a patient is on a medication that has been taken off of the market by the FDA it is my responsibility to inform the doctors that the patient is taking this medication. Which means that is up to me to be aware of medications that I administer.

The CMS is the main decider in determining if patients qualify for certain medications and equipment. This plays a role in my clinical practice when it comes to safely discharging a patient. There are times when a patient needs certain medications or equipment in order to be discharged but CMS doesn’t feel it is necessary, so the patient gets denied. This then can possibly make the discharge unsafe. It is then up to me to work with the medical team and social worker to troubleshoot how we can get the patient the things that they need in order to be discharged safely. This also comes in to play when a patient needs physical therapy services at discharge, but CMS doesn’t approve them because they are out if rehab days or don’t feel it is necessary. It again is up to the whole medical team including myself to figure out how we can get the patient what they need to have a safe discharge. This plays a large part in my advocacy for my patients.

As an RN one of my major roles is being a patient advocate as well as promoting patient safety. When a patient request to use alternative therapy I have to use my clinical judgement to determine if this option is safe. There are times when a patient requests alternative therapy that will not jeopardize the care or safety and are beneficial to the patient. I have to advocate for my patient to the medical team that the patients request is feasible and would benefit the patient. However on the other hand if a patient request alternative therapy that I feel is not safe then it is up to me to educate the patient on their decision and possible consequences.

The Nurse Practice Act in the state of Virginia is to ensure that there are criteria that is met in regard to healthcare professionals. The Nurse Practice Act covers things such as licensure requirements, responsibilities of healthcare professionals, Board of Nursing member requirements, legal matters concerning nurses, requirements for schools that would like to open a nursing school, etc. The Nurse Practice Act plays a role in my professional practice by setting rules that I must abide by as an RN. In my practice if I break rules outlined in the Nurse Practice Act there can be consequences such as suspension or permanent loss of my RN license. Also the Nurse Practice Act states what my scope of practice is as an RN. This guides me in my practice to make sure that I am not practicing outside of my scope. It also states the amount of continuing education I am required to maintain in order to maintain my license. In my practice I make sure that I accrue the proper amount of continuing education to maintain my license. The Nurse Practice Act of Virginia outlines the scope of practice of an RN. As an RN in the state of Virginia RNs are responsible for administering medications and treatments as long as it has been prescribed by an authorized person, delegate tasks to unlicensed persons that is defined by the board, to receive compensation for services while caring for people with illnesses, those who are injured or those who require health maintenance, and also responsible for teaching and educating those who will be providing nursing care. In the state of Virginia RNs are allowed to delegate tasks to unlicensed persons that are defined by the board. Even if the task is delegated it is still the responsibility of the RN to ensure that the task gets completed (Douglas and Hershkowitz, 2018).

As an RN I play many roles and wear many hats. One of those roles is a scientist in my professional practice. As a scientist I am always investigating different outcomes and treatments. I am always asking the team about the disease process and how different interventions work in different ways. When I come across things that are unfamiliar to me or rare I frequently research to find out more about the symptoms or disease process. I also use scientific based evidence when providing care to my patients.

As an RN I also play the role of detective in my professional practice. I frequently am asking a lot of questions like a detective does. I am investigating my patient and their disease process. Certain answers I get can help to answer things that we may not have known before or to help the patients healing process or decrease their length of stay. I also pay a lot of attention to detail when I care for my patients. Any slight change in a patient could be an indicator of an underlying cause such as a urinary tract infection that causes an elderly patient to suddenly become confused. In my professional practice I also document everything like a detective. In the nursing world if it wasn’t documented then it didn’t happen.

Lastly as an RN in my professional practice I am also a manager in the healing environment. In my professional practice I am responsible for providing a healing environment. I try to ensure that my patients get adequate rest by clustering my care. I try to minimize noise when coming in and out of the patient’s room and limit interruptions. I administer medications in a timely manner to ensure that things like antibiotics aren’t missed. If an antibiotic is consistently late then over time that causes a patient to miss a dose. Before leaving a room I always make sure to check that my patient is comfortable since this promotes rest which promotes healing.

The ANA Code of Ethics has nine provisions. Two provisions that I am going to discuss are Provisions two and three. Provisions two states that “The Nurse’s Primary Commitment Is to the Patient, Whether an Individual, Family, Group, Community, or Population”. The third provision states “The Nurse Promotes, advocates for, and Protects the Rights, Health, and Safety of the Patient” (Hegge, 2015).

Provision two plays a role in my professional practice by not only caring for the patient but also caring for the family involved. While caring for my patient I also care for the family member if they are present. I check in on the family member just as I check in on the patient. I make sure that they are comfortable, don’t need anything to drink or eat, and provide them essentials if they do not have their own. It is important to not only help the patient but also the family member at this critical time in their lives.

Provisions three speaks to my everyday practice. Everything I do as a nurse follows provisions three. As a nurse it is my responsibility to keep my patients free from harm, protect their rights, and advocate for them. When speaking with a patient I ensure to keep their information confident. Where I work the rooms are semi-private, so it is very important to ensure patient privacy. When administering medications I ensure that the patient doesn’t have any allergies listed to the medications that I am giving. When patients have been NPO for an extended amount of time I always ensure that they are placed on fluids for proper hydration and talk with the team to advocate when we can get them off NPO status.

In clinical practice medications errors can happen. Sometimes a patient can be given a wrong dose of medication or a completely wrong type of medication. In this type of error, provisions two can be applied since it states that the nurses primary concern is the patient. In this scenario the nurses primary concern would be the patient. As the nurse you would want to monitor the patient for any adverse reactions to the medication error. If family was present, you would notify the family of the error as well as the patient since you are caring for them as a whole like provision two states. The nurse would be responsible for notifying the team of the error and informing the patient of the error. Making sure that the patient is safe and that the patient has medications available in case an adverse reaction occurred would tie into provisions three. Advocating to the team the error and the need for any additional monitoring from the nurse would have the patient’s safety at the forefront.

Four leadership qualities that I think represent excellence in nursing are respect, trustworthiness, critical thinking, and a team player. As a leader at the bedside your teammates and your patient should be able to respect you. If you are not respected as a leader then people will not value your opinions, follow your lead, or ask you for help. If patients do not respect you then they will not be compliant with your care. Respect should be given all around and in order to be an effective leader you need to be respected. As a leader at the bedside you should be trustworthy. In order to work effectively as a team you need to be trustworthy. If your teammates cannot trust you then the team will fall apart. You should be able to talk to leader and know that what is discussed will be confidential and kept between the two of you. If a patient does not trust you then they will not trust you with their care or to be an advocate for them which may hinder their healing. As a leader at the bedside you must have critical thinking skills. As a nurse it is very important to have critical thinking skills. Nursing is not black and white and a lot of the times the answer is not always in front of you. As a leader newer nurses should feel comfortable going to you when they need someone with more experience to help them critically think. One of the most important traits as a leader at the bedside is being a team player. A leader needs to be willing to help out and not afraid to get their hands dirty. In nursing you need to work well as a team to help get through difficult situations. A leader should be willing to help out in times of need. As a leader there may be things that you may not want to do but you do them because you are part of the team. The team not only consist of nurses but include everyone on the interdisciplinary team. Nursing is very stressful and having a leader with all of these qualities helps make the job a little bit easier.

Within the nursing and interdisciplinary team it is important to be respected. These teams work together to provide the best care possible to patients and if any member of that team is not respected then the patient is the one who suffers. If there is no respect, then things may not be taken seriously or done in a timely manner. If the person giving an order is not respected, then the order may not get done to it’s full potential which can cause patient harm or a delay in care. It is also important to have a trustworthiness in the nursing and interdisciplinary team that you are working with. Not only does the nurse need to trust them but the patient does too. If the nurse is not trusted, then the team may not believe what is reported by the nurse. If the patient doesn’t trust the nurse or the team then they may be reluctant to share information that is pertinent to their diagnosis. As a nursing team or interdisciplinary team critical thinking is a must. If you are not able to critically think then things may be missed when assessing a patient. Critical thinking is what nursing is about. It is especially important to be able to critically think in emergency situations. When there are new graduate nurses that are working, they may have not developed the skill to critically think so it is important to have that skill as a seasoned nurse. Lastly being a team player is important when on a nursing or interdisciplinary team. There may be times that a fellow nurse has fallen behind or needs additional help and that is where being a team player comes into play. If you are not a team player, then that nurse will continue to struggle, and her patients will suffer as a result of this. Eventually nurses get burnt out if they do not have a nursing team that are willing to help out. On a nursing team you should be willing to help out fellow nurses. I always say that teamwork makes the dreamwork! No matter how bad the day is if you have a group of nurses that have good teamwork then ultimately the day will not seem as bad.

Work environment is impacted by nursing leadership, decision making, and professional development. If the work environment has poor nursing leadership then the turnover rate will be high on the unit. However if the work environment lacks communication, teamwork, and effectiveness then this may drive nursing leadership away. Leadership may not have the energy or ability to fix a team that is dysfunctional. Decision making is also affected by the work environment. If there is always high stress situations and lack of support, then decision making will be affected in a negative way. If nurses are always stressed, then the decisions that they make will not be of best judgement. If there is a lack of seasoned nurses on a unit then that will also negatively affect decision making. New graduate nurses do not have the experience or gained the skills to always make right decisions. Their decisions make be impacted by their knowledge in the situation. On the other hand if the unit works well together and there is less stress then the decision making would probably be more adequate. When your brain is well rested and under minimal stress it makes better decisions. Professional development is impacted by the work environment as well. If I am constantly stressed, then I am not going to think about professional development because my free time is not going to be spent on advancing my career. If you have leaders that push for professional development and help you along the way, then you may be more prone to advancement. I personally have a nurse educator that is a big advocate for professional development and walks with you every step of the way. She meets with you weekly to check on your progress and to answer any questions. This helps the process for advancement run more smoothly and help with any barriers that may come across. Prior to knowing how much she helped I was not wanting to advance professionally because the amount of time I would have to spend outside of work on the paperwork. As a nurse education is a continuous thing since healthcare is always changing.

 

 

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