Personal & Vocational Concepts

PN 101

Learning Styles

Visual Learners: Learn best by watching. Sit in the front of the

class Stay focused on the

instructors facial expression & body language

Make notes & highlight important points

“Picture” a procedure rather than memorizing steps

Learning Styles

Auditory Learners: Learn best by hearing. Read aloud,

concentrate on hearing the words

Listen to the instructors words instead of taking notes. Ask permission to tape the lectures.

Find a “study buddy” to discuss the course content

Learning Styles

Kinesthetic Learners: Learn best by doing. Handle the equipment

before practicing the procedure

Move while reading or studying (rocking, Stairmaster)

Draw boxes & circles around key concepts, make diagrams

What Type of Learning Style Do You Have?

What Type of Learner are You?

Traditional Adult Learner—learners coming directly from high school or other program of study

Returning Adult Learner—learners who have been out of school for several years

Recycled Adult Learner—learners with prior education beyond high school in disciplines other than nursing

Geared for Success

Each type of adult learner has qualities that help ensure success

Traditional adult learners—are experienced in educational environment and learning procedures and skills

Returning adult learners—are serious, motivated, self-directed learners

Recycled adult learners—are self-directed learners who are also experienced in educational learning procedures and skills

Liabilities, Pitfalls, and Hidden Dangers Dangers shared by all

adult learners: Fear of failure Negative mental

attitude Dwelling on lack of

success in the past

(Cont'd…)

Liabilities, Pitfalls, and Hidden Dangers(…Cont’d)

Dangers for the traditional adult learner: Increased difficulty in new educational setting Social activities Employment

(Cont'd…)

Liabilities, Pitfalls, and Hidden Dangers(…Cont’d)

Dangers for the returning adult learner: Physical changes with age Rusty educational skills Social responsibilities

(Cont'd…)

Liabilities, Pitfalls, and Hidden Dangers(…Cont’d)

Dangers for the recycled adult learner: Personal responsibilities Overconfident attitude Poor study habits

Responsibilities of a Learner

The first responsibility of the learner is to learn. Instructors alone are not responsible for

successful learning or failure Instructors alone are not responsible for failure

to learn Instructors help students learn how to learn

Other Responsibilities of the Learner

Abide by rules and policies. Follow recognized channels of

communications. Be prepared for classes and clinical

experiences. Think ahead about future assignments. Set your goals higher than minimum

standards. Seek out resources beyond required

readings, if a topic needs clarification

Other Responsibilities of the Learner

(…Cont’d)

Be responsible for your own thoughts and behavior. Be present and on time for classes and clinical

experiences. Enter into class discussions when asked. Treat with respect everyone with whom you come

into daily contact. Seek out instructors when you are having difficulties. Keep a record of your grades as each course

proceeds. (DISCUSSION POINT- CONCORDE)

Getting Organized

Calendar Index cards Post-It notes Time line Computer, tablet Smart phone

(DISCUSSION POINT- CONCORDE)

Other Planning Activities

Setting priorities Which activities are most important? Difference between important activities and

urgent activities Delegating tasks

Significant other Children Friends Relatives

Study Skills

Lack of study skills is a primary reason for lack of success in school.

High school/college learning skills do not always translate to the practical/vocational nursing program.

General Hints

Concentration: ability to focus on task at hand

Concentration hindered by distractions External Internal

External Distractions

Come from outside yourself Examples:

Hunger Personal study area Lighting Background noise Internet Peers/Family

Internal Distractions

Come from inside yourself

Examples: Mental fatigue Boredom Daydreaming

Note Taking VS. Note Making

Note taking: trying to capture all the speaker’s words

Note making: condensing main ideas Understand the information; don’t memorize it Two methods of note making:

Outlining: hierarchy of information Mapping: graphic organization of information

Comprehension

Reading with understanding and comprehension is necessary to: Store information in long-term memory Enable recall of information

PQRST method Preview – overview of material Question – develop questions to be answered Read – read the material State – repeat material in your own words Test – test yourself on what you remember

Visual Strategies

Draw idea sketches Process of drawing will facilitate

understanding Use color

Highlighters, crayons, felt-tip pens used to categorize information according to color

Preparing for a Test

Preparation begins the first day of class

Clarify content to be covered in test

Clarify test format Periodically review

material Organize your time

before the test

Taking a Test

Arrive with time to spare Ignore peer chatter that may increase

anxiety just before the test Keep a positive mental attitude Silently rehearse facts Take slow, deep breaths to reduce tension Follow the directions on the test Scantrons: Attention to detail

Hints for Multiple-Choice Questions

Read all options before selecting an answer Eliminate obviously wrong options Remember the course subject matter and

eliminate unrelated options

Hints for Short Answer Questions

Think before writing Give the information that is requested Look for verbs in questions (“list,” “compare,”

“contrast”) and provide answers accordingly Give objective, concrete answers Write complete sentences when the

directions require it

Classroom Learning Strategies

Never skip class unless faced with an emergency (SEE CONCORDE POLICY !! DISCUSS !!) Come to class prepared Listen to verbal cues that will inform you of key

points during lectures The instructor speaks at a much slower rate than

you are capable of thinking, grab key points Look over your notes as soon after class as

possible Be mentally present in class

(Cont'd…)

Classroom Learning Strategies(…Cont’d)

Lectures Brief lectures (minilectures) enhance reading assignments and

clarify information Lectures are passive learning that don’t actively involve the

student, unless instructor stops for student input Active learning helps students make the most of lectures/topics Discussion buddies/small group activities help students stay

actively involved “You can repeat a reading assignment, but you can never

repeat a missed class.”

(Cont'd…)

Classroom Learning Strategies

Lecture-discussion The instructor shares several ideas with the class, then

stops to let the class discuss the ideas The instructor acts as the discussion leader

Cooperative learning A technique that emphasizes individual accountability for

learning while working in small groups Helps students:

be actively involved in learning develop critical-thinking skills develop positive relationship with peers

Other Learning Resources(…Cont’d)

Nursing skills lab Allows students to practice and

develop the physical aspects of nursing skills

Skills must be practiced “You recall 10% of what you

hear, 20% of what you see, 50% of what you read, and 90% of what you do”

(Cont'd…)

Other learning Resources(…Cont’d)

LRC: Learning Resource Center (computer lab, library)

Audio-visual materials, texts for checkout Includes DVDs, Gale Learning Resources for research “A picture is worth a thousand words” Provides an additional sensory channel for learning

(Cont'd…)

Other Learning Resources(…Cont’d)

Internet Offers unlimited resources

on many subjects Search engines, such as

Google help students zero in on exact information; are most effective when the subject is narrow

We will discuss research sources that are allowed, such as Gale and Mayo Clinic, CDC, NIH, etc

(Cont'd…)

Critical Thinking

Critical thinking: Entails purposeful, informed, outcome-focused

thinking Driven by patient, family, and community needs Based on the principles of the nursing process Uses logic and intuition Calls for strategies that make the most of human

potential Constantly reevaluating, self-correcting, and

striving to improve

(Cont'd…)

Critical Thinking

Critical thinking: Used to resolve problems Used to find ways to improve a situation even

when no problem exists Answers the question “How can we do this

better?”

Critical Thinking & Practical Nursing

The principles of critical thinking: Collecting data in an organized way Verifying the data in an organized way Arranging the data in an organized way Looking for gaps in information Analyzing the data Testing it out

(Cont'd…)

Critical Thinking & Practical Nursing

(…Cont’d)

For the practical/vocational nurse to think critically, it is necessary to: Access information. Comprehend information. Store comprehended information in long-term memory. Recall the comprehended information when needed. Know what to do when information is not in long-term

memory.

Define Nursing

Definition by Virginia Henderson: “The unique function of the nurse is to assist

the individual, sick or well, in the performance of those activities contributing to health or its recovery (or to peaceful death) that he would perform if he had the necessary strength, will, or knowledge.”

Major Events that Shape NursingHistorical Overview

Historical Overview

Nursing evolves as society and health care needs and policies change.

Nursing responds and adapts to these changes, meeting new challenges.

Nursing Pioneers

Florence Nightingale joined the first ever school of nursing at age 31 in 1851 in Kaiserswerth, Germany.

In 1853 she became the superintendent of a charity hospital where quality of patient care improved.

Florence Nightingale“The Lady with the Lamp”

During the Crimean War in Turkey (1855), the soldiers wounded were recovering in atrocious conditions.

The Secretary of War requested that Florence and 38 nurses leave England for Turkey to assist.

She assisted in bringing the infection rate down from approx. 90% to 3%

Nursing; From Occupation to Profession

In 1860 Florence Nightingale established the nursing school at St. Thomas Hospital in London.

A nurses residence was provided Strict admission procedures 1 year training, including instruction & practical

experience Complete records where kept on the students as well

as where they employed after graduation. This became known as a “registry”.

Nursing Education

What is an LPN?

Role of the LPN

Practical/vocational nurses Provide patient care under general

supervision of an RN, physician, podiatrist, or dentist

Function interdependently Work in various sites of employment

Majority work in long-term care settings, such as extended-care units and nursing homes

Nursing Education

What is an RN?

The Role of the RN

Role of registered nurses: Function independently in nursing Plan care Coordinate all the activities of care Provide care that requires more specialized

knowledge and judgment Teach patients, families, and other members of the

health care team Act as patient advocate

(Cont'd…)

Nursing Education

ADN Baccalaureate Master’s PhD

Nursing Education- broad perspective, many typesRegistered nurses Associate degree (ADN) program

2-year educational program Baccalaureate nursing program

4-year educational program, and if more is sought:

(Master’s add approx. 2 years) (PhD-approx. 2 years more)

Role of the RN

RN postgraduate educational opportunities

Advanced practice registered nurse (clinical nurse specialist, nurse practitioner, etc.)

Master of Nursing programs Doctoral degree programs

The Nursing Personnel Part of the Health Care TeamStudent nurses Have a responsibility to give safe care and act under

instructor supervision

Nursing assistants Training includes minimum 75 hours of instruction

with clinical practice

(Cont'd…)

The Nursing Personnel Part of the Health Care Team

Clerk receptionists/Med. Office Mgmt. Job responsibility is mainly secretarial Unit secretary Supervise and coordinate management

functions for patient units

Members of the Health Care Team

Emergency care Emergency medical technicians (EMTs) Registered nurse (RN) Emergency room doctor X-ray technician Radiologist Family physician Orthopedic surgeon Lab personnel

Members of the Health Care Team

(…Cont’d)

Surgery Anesthetist Surgical technician Anesthesiologist R.N. L.P.N. “float”

(Cont'd…)

Members of the Health Care Team(…Cont’d)

Postanesthesia Care Unit (PACU) PACU registered nurse Transport aide Staff nurse

(Cont'd…)

Members of the Health Care Team(…Cont’d)

Intensive care RNs Clerk receptionist Medical records department Pharmacist Respiratory therapy department Transport aide

(Cont'd…)

Members of the Health Care Team(…Cont’d)

Surgical floor/discharge team Nurse manager Team leader Practical/vocational nurse (LPN/LVN) Physical therapist (PT) Physical therapy assistant (PTA) Social worker Patient care technologist (PCT) Dietitian Housekeeper

(Cont'd…)

Members of the Health Care Team

Extended-care unit Physical therapist (PT) Physical therapy assistant (PTA) RN/LPN Nursing assistant (NA) Occupational therapist (OT) Day supervisor

The Goal of the Health Care Team

To restore optimal physical, emotional, and spiritual health Health care includes a large number of

specialized services. It is impossible for one person to provide all

the necessary knowledge, expertise, and skills.

Each team member needs to have good communication skills.

The Nursing Process

An orderly way of developing a plan of care for the individual patient.

Five-Step RN Nursing Process

1. Assessment (Data Collection)

2. Diagnosis

3. Planning

4. Intervention

5. Evaluation

Four-Step LPN Nursing Process

1. Assessment (Data Collection)

2. Planning

3. Intervention

4. Evaluation

Role Differences Between RNs and LPN/LVNs RN’s Role

Nursing diagnosis Independent role in all process areas

LPN/LVN’s Role No nursing diagnosis Dependent role in some process areas Independent role in some process areas

LPN Nursing ProcessPhase 1: Data Collection Systematic information gathering Information verification Information communication Continuing data collection Measuring and collecting data accurately

LPN Nursing ProcessPhase 2: Planning Assist RN in developing nursing diagnosis Assist RN in developing outcomes Assist RN in developing nursing interventions

LPN Nursing ProcessPhase 3: Implementation Nursing action Maintaining patient safety Teaching in support of RN’s teaching Reporting and documenting

LPN Nursing ProcessPhase 4: Evaluation Assisting in determining patient progress

toward meeting desired goals and outcomes Communicating findings

Healthcare Settings

Proprietary (For-Profit) Hospitals

General serve full range of medical conditions

experienced by patients more than 6,000 in the U.S.

Specialized deal with a particular disease or condition limited to one type of patient more than 1,000 in the U.S.

Teaching and Research Hospitals(such as O.H.S.U., U. of WA. Med.) Emphasis is on serious or unusual conditions Training sites for health care professionals Conduct research into and development of

treatments Almost always affiliated with medical schools Access to highly skilled practitioners

Ambulatory VersusAcute Care Settings Ambulatory care

outpatient; often less expensive for people who live independently or are cared

for at home provides assessment, treatment, and care

coordination Acute care

inpatient in general and specialized hospitals patients acutely ill and require more skilled

nursing care

Free Clinics

Alternative means of providing primary health care

For people who cannot afford traditional health services

As free of “red tape” as possible

Rehabilitation Services

Focus on return of function and prevention of further disability

Can take place in: rehabilitation centers long-term care facilities outpatient facilities group residential homes patient’s home base

Nurses play an important role.

Long-Term Care Facilities

The purpose of long-term care (LTC) is to help people who have disabilities or require chronic care. LTC includes: postacute care residential care nursing home intermediate care skilled care (“SNF”) assisted care

Community HealthNursing Services Improve health through public education Screen for early detection of disease, such as

HIV, tuberculosis For people who need care outside the acute

care setting who may be at risk

Home Health Agencies

Public or private agencies that provide home health services.

Focus on teaching self-care. Services include: RN/LPN skilled nursing;

physical and speech-language, and occupational therapy; medical-social and homemaker-health aide services

Other Health Care Settings

Adult day care: for individuals who are not yet ready for nursing homes

Wellness: nutritional counseling, weight-reduction, smoking cessation, stress reduction, etc.

Hospice: end-of-life services for the terminally ill delivered at home, at a free-standing center, or in the hospital

Nursing Laws & Ethics

Ethical Issues in 21st Century Health Care in vitro fertilization artificial insemination surrogate motherhood cloning organ donation

Including cadaver, child, and aborted fetus donations

stem cell research/procedures

(Cont'd…)

Ethical Issues in 21st Century Health Care(…Cont’d)

abortion euthanasia Death with Dignity Act advance directives

living wills, power of attorney right to die

Ethics, Morals, and Values

Ethics—a system of standards or moral principles that directs actions as being right or wrong

Morals—system dealing with right or wrong behavior (conduct) and character

Values—the worth a person assigns to an idea or action

Nursing Ethical and Legal Responsibilities Nursing ethics: the values and principles

governing nursing practice, conduct, and relationships Responsibilities: focused on ideal behavior,

morality, and higher standards

Legal aspects: state statutes that apply to licensed persons and the situations in patient care that could result in legal action Responsibilities: focused on rules, regulations,

and obligations mandated by law

Ethical Codes in Nursing

NAPNES Codes—National Association of Practical Nurse Educators and Services

NFLPN Codes—National Federation NFLPN Codes—National Federation of Licensed Practical Nursesof Licensed Practical Nurses

Nurse Practice Acts—published by each state

Principles of Ethics

Nonmaleficence (Do No Harm): the principle of doing the least amount of harm possible to a patient

Most beneficial treatments involve risk of harm to the patient to some extent

Examples: skin puncture drug side effects physical movement/transfer of patients

Beneficence

Two major nursing duties associated with beneficence: Put patient interests first Place the good of patients before one’s own

needs includes organizational and other work-related

needs

Autonomy (Free to Choose)

Four steps of autonomous decisions: Thinking through all the facts Deciding on the basis on an independent

thought process Acting based on a personal decision Undertaking a decision voluntarily, without

pressure from anyone else

(Cont'd…)

Autonomy (Patient and Staff)

Patient’s right to privacy choose care based on personal beliefs accept or reject treatment avoid needless exposure

Personal values may be contrary to medical ethics patient can refuse care for religious, cultural,

or personal reasons

Fidelity (Be True)

Fidelity: Acting in patients’ best interests when they are unable to make free choices does not include paternalistic decisions must differentiate between your own feelings

and those of the patient maintain patient confidentiality

Justice (Fair to All)

Justice: give patients their due and treat each patient fairly and equally (i.e., with dignity and respect)

avoid letting personal ethics and values interfere with patient justice

Beneficent Paternalism

a disrespectful attitude toward the patient and his or her contribution to personal care and recovery “I know what’s best for you” discounts the patient’s self-knowledge often occurs with female patients in response to

female-specific health issues Examples:

deciding in advance that a patient fits into a certain category

developing a care plan without patient input influencing a patient’s choice

Nursing Lawsuits

Assault & Battery Defamation Fraud False Imprisonment Invasion of Privacy Negligence Malpractice

Nurse Practice Act

Basic terminology Content

definition of nursing definition of LPN/LVN use of title LPN/LVN elements of unprofessional conduct functions of the state board of nursing

State Board of Nursing

Functions of the state board of nursing (or nurse regulatory board)

Disciplinary responsibility Disciplinary process

Nursing Licensure

NCLEX-PN® Examination Working as an LPN/LVN in other states

interstate endorsements multistate licensure

(Nurse Licensure Compact) border recognition

Criminal Versus Civil Action

Criminal action—involves people and society as a whole and relationships between individuals and government

Civil action—protects individual rights and results in payment of money to the injured person

Intentional and Unintentional Torts

Intentional tort—intended to cause harm to the patient (threat or actual physical harm)

Unintentional tort—an action that is not meant to cause harm to the patient, but does

The Four Elements Needed to Prove Negligence Duty—the nurse’s responsibility to provide

care in an acceptable way Breach of duty—the fact that the nurse did

not adhere to the nursing standard of care Damages—the patient must prove that the

nurse’s negligent act caused injury or harm Proximate cause—a reasonable cause-and-

effect relationship must be shown between the omission or commission of the nursing act and the harm to the patient

Legal Action Process

Steps for bringing legal

action by a patient

Depositions

Giving testimony

Charting (Legal Documentation)

Focus charting—use of focus to label nurses’ notes, categories of data, action and response, and flow sheets

Charting by exception—nurse and physician chart only was is the “exceptional” finding/data. Findings “in the norm” need not be charted in this system.

Liability

Personal liability—holds nurses responsible for their own behavior, including negligence

Institutional liability—a type of vicarious liability; assumes the health facility provides certain safeguards to keep patients from harm

Patient Rights

Patient’s Bill of Rights

Health Insurance Portability and

Accountability Act (HIPAA)

JCAHO Patient Safety Goals

Patient’s Right to Consent

General (implied) consent—routinely obtained on admission in the form of a signed general admission form

Informed consent—must be obtained by physician for invasive procedures after patient has been told all pertinent information

Authorized consent—type of consent obtained from parents for all children younger than age 18

End-of-Life Issues

Advance Directives Living will—a legal document stating a person’s

wishes for end-of-life care when there is no hope of recovery and the patient can no longer make a competent decision

Durable power of attorney—a legal document (valid throughout the U.S.) that names a health care proxy to make medical decisions on behalf of the person executing it, if that person is no longer able to speak for himself or herself

(Cont'd…)

End-of-Life Issues(…Cont’d)

Do-not-resuscitate order (DNR) Advance directives POLST Removal of life support systems Death with Dignity Act Organ donation

Good Samaritan Acts

Laws that stipulate that a person who renders emergency care in good faith at the scene of an accident is immune from civil liability for his or her action while providing the care

Practical Application of Ethics and Law in Difficult Situations Late entry Verbal orders, misunderstood? Questionable order, nurse disagrees Understaffed unit

(Cont'd…)

Practical Application of Ethics and Law in Difficult Situations(…Cont’d)

Documenting someone else’s care Illegal alteration of a patient’s record Personal criticism of nurse in patient’s record Illegible physician’s order Telephone orders

(Cont'd…)

Practical Application of Ethics and Law in Difficult Situations(…Cont’d)

Signing a will Possible negligence Standing orders, for how long is it legal? Discharge instructions Patient education

Questions