Professional Nurse Interview Questions NUR 3805
Professional Nurse Interview Questions NUR 3805
Unit I: Foundations of Professional Nursing Practice 17 CHAPTER 2: Socialization to Professional Nursing Roles 17 CHAPTER 3: Historical Foundations of Professional Nursing 37 CHAPTER 4: Ethical Foundations of Professional Nursing 53 CHAPTER 5: Legal Foundations of Professional Nursing 74 CHAPTER 6: Knowledge Development in Nursing 99 Unit II: Professional Nursing Roles 120 CHAPTER 7: The Nurse as Health Promoter and Care Provider 120 CHAPTER 8: The Nurse as Learner and Teacher 140 CHAPTER 9: The Nurse as Leader and Manager 170 CHAPTER 10: The Nurse’s Role in Evidence-Based Health Care 191 CHAPTER 11: The Nurse’s Role in Quality and Safety 204 CHAPTER 12: The Nurse’s Role as Political Advocate 231 CHAPTER 13: The Nurse as Colleague and Collaborator 245 Unit III: Processes Guiding Professional Practice 264 CHAPTER 14: Communicating Effectively 264 CHAPTER 15: Managing Change 284 CHAPTER 16: Technology and Informatics 300 Unit IV: Professional Nursing in a Changing Health Care Environment 315 CHAPTER 17: Nursing in an Evolving Health Care Delivery System 315 CHAPTER 18: Providing Care in Home and Community 327 CHAPTER 19: Global Health 354 CHAPTER 20: Dimensions of Holistic Health Care 380 CHAPTER 21: Nursing in a Culturally Diverse World 395 CHAPTER 22: Nursing in a Spiritually Diverse World 422 CHAPTER 23: Nursing in a Culture of Violence 441 Unit V: Into the Future 456 CHAPTER 24: Advanced Nursing Education and Practice 456 CHAPTER 25: The Future of Nursing 475 Index 493 This page intentionally left blank Begin Thinking LIKE A NURSE using your PEARSON RESOURCES Simplify your study time by using the resources included with this textbook at http://www.nursing.pearsonhighered.com Further enhance your Clinical Reasoning with the additional resources below. For more information and purchasing options visit www.mypearsonstore.com.
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Think Like a Nurse in Clinical Thinking Like a Nurse for NCLEX-RN® Success Clinical references across the nursing curriculum available! e to th ® N ned Alig CLEX-R 3 N Plan 1 0 2 Test www.mynursinglab.com Learn more about and purchase access to MyNursingLab. www.mypearsonstore.com Find your textbook and everything that goes with it. Professional Nursing Practice Seventh Edition This page intentionally left blank Professional Nursing Practice Concepts and Perspectives Seventh Edition Kathleen Koernig Blais, Ed.D., RN Florida International University Janice S. Hayes, PhD, RN University of Northern Colorado Boston Columbus Indianapolis New York San Francisco Amsterdam Cape Town Dubai London Madrid Milan Munich Paris Montreal Toronto Delhi Mexico City São Paulo Sydney Hong Kong Seoul Singapore Taipei Tokyo Publisher: Julie Levin Alexander Publisher’s Assistant: Sarah Henrich Executive Editor: Pamela Fuller Development Editor: Barbara Price Editorial Assistant: Professional Nurse Interview Questions NUR 3805
Erin Sullivan Project Manager: Cathy O’Connell Program Manager: Erin Rafferty Director, Product Management Services: Etain O’Dea Team Lead, Program Management: Melissa Bashe Team Lead, Project Management: Cynthia Zonneveld Full-Service Project Manager: Peggy Kellar, iEnergizer Aptara®, Ltd. Manufacturing Buyer: Maura Zaldivar-Garcia Art Director/Cover and Interior Design: Maria Guglielmo Vice President of Sales and Marketing: David Gesell Vice President, Director of Marketing: Margaret Waples Senior Product Marketing Manager: Phoenix Harvey Field Marketing Manager: Debi Doyle Marketing Specialist: Michael Sirinides Marketing Assistant: Amy Pfund Media Product Manager: Travis Moses-Westphal Media Project Manager: Lisa Rinaldi Composition: iEnergizer Aptara®, Ltd. Printer/Binder: Courier/Kendallville Cover Printer: Courier/Kendallville Cover Image: Jennifer Gottschalk/Shutterstock Credits and acknowledgments borrowed from other sources and reproduced, with permission, in this textbook appear on appropriate page within text. Notice: Care has been taken to confirm the accuracy of information presented in this book. The authors, editors, and the publisher, however, cannot accept any responsibility for errors or omissions or for consequences from application of the information in this book and make no warranty, express or implied, with respect to its contents. The authors and publisher have exerted every effort to ensure that drug selections and dosages set forth in this text are in accord with current recommendations and practice at time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package inserts of all drugs for any change in indications of dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug. Copyright © 2016, 2011, 2006 by Pearson Education, Inc. All rights reserved. Manufactured in the United States of America. This publication is protected by Copyright, and permission should be obtained from the publisher prior to any prohibited reproduction, storage in a retrieval system, or transmission in any form or by any means, electronic, mechanical, photocopying, recording, or likewise. To obtain permission(s) to use material from this work, please submit a written request to Pearson Education, Inc., Permissions Department, 221 River Street, Hoboken, New Jersey 07030. Many of the designations by manufacturers and sellers to distinguish their products are claimed as trademarks. Where those designations appear in this book, and the publisher was aware of a trademark claim, the designations have been printed in initial caps or all caps. Library of Congress Cataloging-in-Publication Data Blais, Kathleen, author. Professional nursing practice : concepts and perspectives/Kathleen Koernig Blais, Janice S. Hayes. — Seventh edition. p. ; cm. Includes bibliographical references and index. ISBN 978-0-13-380131-6 — ISBN 0-13-380131-4 I. Hayes, Janice S., author. II. Title. [DNLM: 1. Nursing. 2. Nurse’s Role. 3. Nursing Theory. Professional Nurse Interview Questions NUR 3805
WY 16 AA1] RT84.5 610.73—dc23 2015004901 ISBN-10: 0-13-380131-4 ISBN-13: 978-0-13-380131-6 Dedication I dedicate this book to all who have taught me; my teachers past and present; my students, who continue to challenge me and make me a better teacher; and, most of all, David, Sarah, Harrison, and Margaret. Kathleen Blais This work is dedicated to Sierra, Marc, Otto, and Vinnie who motivate and inspire me to reach out to a new generation of nurses. Janice S. Hayes This page intentionally left blank About the Authors Kathleen Blais Kathleen Blais received her Diploma in nursing from Temple University Hospital School of Nursing (Philadelphia, Pennsylvania), her BSN and MSEd from Florida International University (Miami, Florida), MSN from the University of Miami (Miami, Florida), and EdD from Florida Atlantic University (Boca Raton, Florida). She has taught in both undergraduate and graduate nursing programs. Dr. Blais has held faculty and academic leadership positions throughout her career. She is currently a Professor Emerita of Nursing at Florida International University Nicole Wertheim College of Nursing and Health Sciences. Janice S. Hayes Janice Hayes received her BSN from the University of Evansville, MSN from Indiana University, and PhD from Purdue University. She has taught both in undergraduate and graduate nursing programs as well as providing research leadership with clinical institutions. Dr. Hayes has maintained a research trajectory in the areas of development risk and trauma outcomes. She has served as the Assistant Director for Graduate Programs in the School of Nursing at the University of Northern Colorado. ix This page intentionally left blank Thank You Thanks go to our colleagues from schools of nursing around the world, who generously gave their time to help create this book. These professionals helped us plan and shape our book by contributing their collective experience and expertise as nurses and teachers, and we made many improvements based on their efforts. Contributors Catherine E. Dingley, PhD, RN, FNP Post Doctoral Research Fellow University of Utah Salt Lake City, Utah Kathleen Dunemn, PhD, APRN, CNM-BC Associate Professor University of Northern Colorado Greeley, Colorado J. Craig Phillips, PhD, LLM, RN, ARNP, PMHCNS-BC, ACRN Associate Professor of Nursing University of Ottawa Ottawa, Ontario, Canada Rhonda D. Squires, PhD, APRN-BC, FNP Assistant Professor University of Northern Colorado Greeley, Colorado Reviewers Barbara Celia, EdD, RN Clinical Assistant Professor Drexel University College of Nursing and Health Professions Philadelphia, Pennsylvania A. Kate Eby, MN, APRN, ONC, FNP-C, CNE Lecturer, RN-BSN Program Frostburg State University Frostburg, Maryland Sarah Gabua, DNP, RN Adjunct Professor Ferris State University Big Rapids, Michigan Kristine M. Gill, PhD., RN Associate Professor of Nursing, Emeritus The University of Akron Akron, Ohio Irma Lorraine Goodrich, ABD, MSN, BSN, RN Instructor of Nursing/Interim Director Eastern New Mexico University Portales, New Mexico Linda Pennington Grimsley, PhD Assistant Vice President for Academic Affairs & Professor of Nursing Albany State University Albany, Georgia Patricia Hall, MSN/Ed, RN Faculty University of South Florida College of Nursing Tampa, Florida Kim Clevenger, EdD, MSN, RN, BC Baccalaureate & RN-BSN Program Coordinator/ Associate Professor of Nursing Morehead State University Morehead, Kentucky Terri Hood-Brown Assistant Professor Ohio University Zanesville, Ohio Fredi de Yampert, PhD, RN Interim VP for Academic Affairs Nursing Department Chair Finlandia University Hancock, Michigan Sara K. Kaylor, Ed.D, RN, CNE Assistant Professor The University of Alabama Capstone College of Nursing Tuscaloosa, Alabama xi xii THANK YOU Ramona S. Kerner, DHEd, RN, CNOR Assistant Professor Southeastern Louisiana University School of Nursing Hammond, Louisiana Neal Rosenburg, PhD, COI, RN Dean and Associate Professor Nevada State College Henderson, Nevada Marilyn Meder, PhD, RN Assistant Professor Kutztown University Kutztown, Pennsylvania Polly Royal, DNP, RN Clinical Assistant Professor Purdue University West Lafayette, Indiana Maria Olenick, PhD, FNP, RN Chair of Undergraduate Nursing Florida International University Nicole Wertheim College of Nursing and Health Sciences Miami, Florida Melody F. Sharp, DNP, RN Director, Post-Licensure & Accelerated BSN Associate Professor Jefferson College of Health Sciences Roanoke, Virginia Barbara Patterson, EdD, MS, RN, CNE Professional Nurse Interview Questions NUR 3805
Associate Dean, School of Nursing Southwestern Oklahoma State University Weatherford, Oklahoma Jessica Spellman, MSN, RN, CCRN The Ohio State University Associated Clinical Faculty Columbus, Ohio Judith Miller Peters, Ed.D, RNC Associate Professor of Nursing Loma Linda University School of Nursing Loma Linda, California Jennifer L. Taylor, PhD, RN Associate Professor Director of Undergraduate Programs Lindenwood University St. Charles, Missouri Jenny Radsma, PhD, RN Associate Professor University of Maine at Fort Kent Fort Kent, Maine Linda J. Thomas, PhD, MSN, RN, CNE RN-BSN Coordinator Murray State University Murray, Kentucky Patricia L. Reid, MSN, RN, CNS Director of Continuing Education The Ohio State University Columbus, Ohio Janet Weber, EdD, RN Director RN-BSN Program Southeast Missouri State University Cape Girardeau, Missouri Desma R. Reno, PhD(c), APRN, GCNS-BC Assistant Professor Southeast Missouri State University Cape Girardeau, Missouri Evelyn M. J. Yeaw, PhD, RN Professor Emerita The University of Rhode Island Kingston, Rhode Island Susan Rieck, PhD, RN Associate Professor & Assistant Dean Northern Arizona University Flagstaff, Arizona Benson K. L. Yeung, MSN, RN Lecturer and Clinical Faculty California State University, School of Nursing Los Angeles, California Preface A dynamic healthcare environment requires growth and change in the nursing profession. Skills in communication and interpersonal relations are needed for nurses to be effective members of collaborative interdisciplinary healthcare teams. Critical thinking and creativity are necessary as nurses implement care with clients of diverse cultural and spiritual backgrounds in a variety of settings. Nurses must be prepared to provide care not only in hospital settings but also in community and residential settings, such as work sites, schools, faith-based communities, homeless shelters, and prisons. The nurse’s unique role demands a blend of nurturance, compassion, sensitivity, caring, empathy, commitment, courage, competence, and skill that comes from a broad knowledge base of the arts, humanities, biological and social sciences, and the discipline of nursing. Nurses need skills in teaching, collaborating, leading, managing, advocacy, political involvement, and applying theory, research, and evidence to practice. An understanding of holistic healing modalities and complementary therapies used in the care of patients and clients is becoming more essential. Knowledge of global health includes the nurse’s understanding of nursing and health care as practiced around the world and how health/disease conditions in other countries can affect the health status of citizens and residents of our own country. Quality and safety in health care are of primary concern to the profession. This book addresses content by which nurses build their repertoire of nursing knowledge. This content includes, but is not limited to, wellness, health promotion, and disease/injury prevention; holistic care; multiculturalism, global health; nursing history; technology and informatics; nursing theories and conceptual frameworks; nursing research; quality and safety; and professional empowerment and politics. Professional Nursing Practice: Concepts and Perspectives, 7th Edition, is intended as a text for registered nurses who are in transition or bridge programs to achieve a baccalaureate or higher degree in nursing. It may also be used in generic nursing programs or in transition or bridge programs for vocational nurses (LPNs or LVNs) to complete the professional nursing baccalaureate degree. This text addresses the areas of knowledge that professional nurses require to be effective in the changing healthcare environment. The organization of this text emphasizes the foundational knowledge related to professional nursing, including nursing history, nursing knowledge development, ethics, and legal aspects; the roles of professional nurses, including health promoter and care provider, learner and teacher, leader and manager, research consumer, advocate, and colleague and collaborator; the processes guiding nursing, including communication, change, and technology and informatics; nursing in a changing healthcare delivery system, including healthcare economics, holistic health care, global health, cultural and spiritual dimensions of client care, and nursing in a culture of violence; graduate education and advanced nursing practice; and nursing in the future. NEW TO THIS EDITION All chapters have been revised to reflect current professional nursing knowledge based on foundational knowledge: • A new chapter, Chapter 11, “The Nurse’s Role in Quality and Safety,” addresses quality and safety education for nurses (QSEN). Regulations, quality indicators, and benchmarking are discussed as they apply to professional nursing. • A new chapter, Chapter 19, “Global Health,” describes the goals of global health, demographic and epidemic shifts, communicable and noncommunicable diseases around the world, health systems models in the global environment, and nursing roles, responsibilities, and opportunities in global health. • New content on healthcare reform and implementation of the Affordable Care Act of 2010 as it has implications for nursing has been added to this edition. • New content on nursing knowledge development and evidence-based practice has been added. • Chapter summaries are now presented as a bulleted list of chapter highlights to facilitate student preparation for exams. Hallmark Features The seventh edition of Professional Nursing Practice: Concepts and Perspectives retains several of the features that have been well received by faculty and students who have used previous editions: • All new to this edition, Research Currents (formerly called Evidence for Practice) boxes that describe quantitative and qualitative research studies relevant to chapter content and relate them to clinical or professional practice. xiii xiv PREFACE • Critical Thinking Exercises that require readers to apply concepts from chapters to exemplar situations. • Reflect On . . . sections that ask the reader to contemplate her or his own practice and beliefs about professional nursing in relation to the chapter content. • Interviews of practicing nurses, which can be found in two chapters: Chapter 19, “Providing Care in the Home and Community,” and Chapter 24, “Advanced Nursing Education and Practice.” The profiles include information about why these practitioners chose their specific practice areas, what qualities they think are necessary to be a nurse in that area, what their practice entails, and what encouragement they would offer a nurse considering practice in this area. The profiles provide useful first-person perspectives for readers. • InfoQuest, which directs students to Internet-based information resources related to chapter content. Organization This edition is organized into five units, with an introductory chapter preceding the first unit. Units and chapters can be used independently or in any sequence. Some nursing programs use this text for first-semester nursing students in a professional socialization course. Other nursing programs use the text at the end of their nursing program in a professional transition course. And yet other programs use the text as a primary text in one course and a secondary text in other professional role courses. • Chapter 1, “Beginning the Journey,” was created to assist registered nurses as they return to school. It provides information regarding factors influencing nurses’ return to school for baccalaureate and higher degrees and overcoming barriers that may interfere with student success. New content in this chapter includes learning with technology and evaluating Internet sites. • Unit I, “Foundations of Professional Nursing Practice,” focuses on professionalism, including socialization, and historical, legal, ethical, and knowledge development of nursing. • Unit II, “Professional Nursing Roles,” includes information on the professional roles of health promoter and care provider, learner and teacher, leader and manager, research consumer, advocate, and colleague and collaborator. It also addresses quality and safety in providing health care. • Unit III, “Processes Guiding Professional Practice,” focuses on communicating effectively, managing change, and using technology and informatics. • Unit IV, “Professional Nursing in a Changing Health Care Environment,” includes chapters devoted to healthcare economics, providing care in the home and community, global health, holistic health care, nursing in a culturally diverse world, nursing in a spiritually diverse world, and nursing in a culture of violence. • Unit V, “Into the Future,” looks at the nurse’s professional development and the future of nursing. It includes chapters on advanced nursing education and practice and concludes with visions for the future of nursing and health care. We hope this book helps learners appreciate the proud heritage of professional nursing, understand what is meant by professional, view nursing as a profession, and develop knowledge and abilities that will contribute to the advancement of the profession. In addition, we hope the knowledge gained will help nurses provide quality care in a constantly changing healthcare environment. ACKNOWLEDGMENTS We extend our sincere thanks to the many talented and committed people who assisted in the birthing of this text: • Barbara Kozier and Glenora Erb, without whom this text would never have been conceived. Every day that we write, we think of them with fondness and respect. • The reviewers who provided many discerning comments and suggestions that expanded our thinking and writing. • Barbara Price, Developmental Editor, who provided suggestions and encouragement throughout the process of this revision. Her commitment to the manuscript, understanding of writing demands, and technical and personal support throughout the project contributed positively to this revision. • Pamela Fuller, Acquisitions Editor, who initiated the work on this edition. • Peggy Kellar of iEnergizer Aptara®, Ltd. for vital attention to details and Margaret Ritchie for copyediting. • To all who helped create and manage the media supplements. Their work provides a contemporary dimension to readers’ use of this edition. • Most importantly, our many students, who have challenged and taught us and, in doing so, have helped to guide the direction of this book. Contents About the Authors ix Thank You xi Preface xiii Chapter 1: Beginning the Journey 1 Factors in Society That Promote the Nurse’s Return to School 1 Changing Trends of Nursing as a Profession 2 Factors That Influence the Nurse’s Return to School 5 Education for Initial and Continuing Licensure 5 Credentialing Requirements 6 Professional Role Transition 7 Bridges’s Model of Transition 7 Spencer and Adams’s Model of Transition 8 Strategies for Success: What It Will Take to Get There 9 Time Management 10 Money 10 Social Supports 10 Working With Faculty 12 Technology Skills 13 Study Skills 13 Pedagogic Features for Using This Text 15 Chapter Highlights 16 References 16 Unit I: Foundations of Professional Nursing Practice 17 Chapter 2: Socialization to Professional Nursing Roles 17 Challenges and Opportunities 18 Professionalism 18 Nursing as a Discipline and Profession 18 Pavalko’s Occupation-Profession Continuum Model 19 Scope and Standards of Nursing Practice 21 Professional Socialization 22 Critical Values of Professional Nursing 23 Professional Nurse Interview Questions NUR 3805
The Initial Process of Professional Socialization 24 Ongoing Professional Socialization and Resocialization 25 Kramer’s Postgraduate Resocialization Model 25 Dalton’s Career Stages Model 26 Benner’s Stages From Novice to Expert 26 Role Theory 26 Elements of Roles 27 Boundaries of Nursing Roles 29 Role Stress and Role Strain 29 Reducing Role Stress and Strain 31 Stress Reduction Strategies 31 Managing Role Stress and Role Strain 31 Chapter Highlights 35 References 35 Chapter 3: Historical Foundations of Professional Nursing 37 Challenges and Opportunities 38 Nursing in History 38 Nursing in Primitive Societies 38 Nursing in Ancient Civilizations 39 The Role of Religion in the Development of Nursing 40 The Development of Modern Nursing 41 The Development of Nursing in the Americas 42 Historical Leaders in Nursing 43 The Founders 44 Men in Nursing 44 The Risk Takers 45 The Social Reformers 46 Nursing: A History of Caring 47 The Development of Professional Nursing Organizations 48 American Nurses Association 48 National Student Nurses’ Association 49 National League for Nursing 49 xv xvi CONTENTS American Association of Colleges of Nursing 49 Canadian Nurses Association 49 International Council of Nurses 49 Sigma Theta Tau International 50 Specialty Nursing Organizations 50 Special-Interest Organizations 50 Chapter Highlights 51 References 52 Chapter 4: Ethical Foundations of Professional Nursing 53 Challenges and Opportunities 53 Values 54 Values Transmission 54 Values Clarification 55 Identifying Personal Values 55 Helping Clients Identify Values 56 Moral and Ethical Behavior 56 Moral Development 56 Lawrence Kohlberg 57 Carol Gilligan 58 Moral and Ethical Theories or Frameworks 59 Moral and Ethical Principles 59 Ethics in Nursing 60 Nursing Codes of Ethics 61 Types of Ethical Problems 63 Making Ethical Decisions 63 Specific Ethical Issues 67 Strategies to Enhance Ethical Decision Making 69 Advocacy 70 The Advocacy Role 70 Professional/Public Advocacy 70 Chapter Highlights 72 References 73 Chapter 5: Legal Foundations of Professional Nursing 74 Challenges and Opportunities 75 The Legal System 75 Constitutions 75 Statutory Law 75 Administrative Law 76 Judicial or Decisional Law 76 Types of Legal Actions 76 Safeguarding the Public 76 Credentialing 77 Licensure 77 Registration 79 Certification 79 Accreditation 79 Standards of Care 79 Potential Liability Areas 80 Negligence and Malpractice 80 Documentation 82 Delegation 83 Restraints 84 Informed Consent 85 Advance Healthcare Directives 88 Do-Not-Resuscitate Orders 89 Adverse Events and Risk Management 89 Death and Related Issues 90 The Impaired Nurse 92 Sexual Harassment 93 Nurses as Witnesses 94 Collective Bargaining 95 Chapter Highlights 96 References 97 Chapter 6: Knowledge Development in Nursing 99 Challenges and Opportunities 99 Worldviews and Knowledge Development 100 Defining Terms 101 Theory Development in Nursing 101 Early Knowledge Development in Nursing 102 Selected Nursing Theories 104 Rogers’s Science of Unitary Human Beings 104 Orem’s Self-Care Deficit Theory of Nursing 105 King’s Goal-Attainment Theory 105 Neuman’s Systems Model 106 Roy’s Adaptation Model 107 Benner’s Novice to Expert 108 The Caring Theorists 109 Middle-Range Theory 112 Relationship of Theories to the Nursing Process and Research 116 Chapter Highlights 118 References 118 CONTENTS xvii Professional Nurse Interview Questions NUR 3805
Unit II: Professional Nursing Roles 120 Chapter 7: The Nurse as Health Promoter and Care Provider 120 Challenges and Opportunities 121 Defining Health Promotion 121 Healthy People 2020 123 Leading Health Indicators 124 Four Foundation Health Measures 124 Health Promotion Activities 126 Types of Health Promotion Programs 127 Sites for Health Promotion Activities 128 Health Belief Models 129 Health Locus of Control Model 129 The Health Belief Model 130 Health Promotion Models 131 Pender’s Health Promotion Model 131 Neuman Systems Model 133 Stages of Health Behavior Change 134 The Nurse’s Role in Health Promotion 136 Chapter Highlights 138 References 138 Chapter 8: The Nurse as Learner and Teacher 140 Challenges and Opportunities 141 Nurses as Learners 141 The Learning Process 143 Theories of Learning 143 Behaviorism 143 Social Learning Theory 144 Cognitivism 144 Humanism 145 Categorization 146 Constructivism 146 Multiple Intelligences 146 Bloom’s Domains of Learning 146 Applying Learning Theories 148 Cognitive Learning Processes 149 Acquiring Information 149 Processing Information 149 Using Information 149 Factors That Facilitate Learning 149 Motivation 149 Readiness 149 Active Involvement 149 Feedback 150 Simple to Complex 150 Repetition 150 Timing 150 Environment 151 Factors That Inhibit Learning 151 Emotions 151 Physiological Factors 151 Cultural and Spiritual Factors 151 Literacy 152 Health Literacy 152 Nurses as Teachers 153 The Art of Teaching 155 Guidelines for Learning and Teaching 156 Assessing Learning Needs 156 Planning Content and Teaching Strategies 159 Implementing a Teaching Plan 163 Evaluating Learning and Teaching 164 Special Teaching Strategies 165 Teaching Clients of Different Cultures 167 Documentation of Teaching 168 Chapter Highlights 168 References 169 Chapter 9: The Nurse as Leader and Manager 170 Challenges and Opportunities 171 Nursing Leadership 171 Leadership Characteristics 172 Leadership Style 173 Nursing Management 177 Resources 177 Management Competencies 178 Management Roles 179 Magnet Recognition 181 Nursing Delivery Models 182 Total Patient Care 182 Functional Method 182 xviii CONTENTS Team Nursing 183 Primary Nursing 184 Interdisciplinary Team Model 184 Case Management 185 Differentiated Practice 186 Shared Governance 186 Mentors and Preceptors 187 Networking 188 Chapter Highlights 189 References 189 Chapter 10: The Nurse’s Role in EvidenceBased Health Care 191 Challenges and Opportunities 191 Evidence-Based Practice 192 Research in Nursing 193 Roles in Research 194 Historical Perspective 195 Ethical Concerns 195 Approaches in Nursing Research 196 Steps in the Research Process 197 Using Research in Practice 198 Critiquing Research Reports 198 Integration of Research into Practice 198 Chapter Highlights 202 References 203 Chapter 11: The Nurse’s Role in Quality and Safety 204 Challenges and Opportunities 205 Overview of Patient Safety and Quality 205 Historical Context 205 Current Trends and Concepts 208 Professional and Regulatory Standards of Safety and Quality 210 Professional Nurse Interview Questions NUR 3805
The Joint Commission 210 Centers for Medicare and Medicaid Services 213 State Regulatory Agencies 213 Other Influential Organizations 214 Evaluating Patient Safety and Quality of Care 215 Quality Indicators: Measuring Performance 215 Benchmarking and Comparing Safety and Quality 217 Improving Patient Safety and Quality of Care 218 Methods and Tools 218 Just Culture Principles 223 Teamwork and Collaboration 224 Patient-Centered Care 226 Chapter Highlights 227 References 228 Chapter 12: The Nurse’s Role as Political Advocate 231 Challenges and Opportunities 231 Power 232 Empowerment 232 Sources of Power 232 Caring Types of Power 234 Laws of Power 234 Politics 235 Nursing and Political Action 235 Strategies to Influence Political Decisions 236 Developing Political Astuteness and Skill 239 Seeking Opportunities for Political Action 240 Chapter Highlights 243 References 243 Chapter 13: The Nurse as Colleague and Collaborator 245 Challenges and Opportunities 246 Collaborative Health Care 246 Collaborative Practice 247 The Nurse as a Collaborator 248 Benefits of Collaborative Care 250 Factors Leading to the Need for Increased Collegiality and Collaboration 252 Healthcare Consumers 252 Personal Responsibility Initiatives 252 Changing Demographics and Epidemiology 253 Healthcare Access 253 Technological Advances 253 Competencies Basic to Collaboration 253 Communication Skills 253 Mutual Respect and Trust 254 CONTENTS xix Giving and Receiving Feedback 254 Decision Making 255 Conflict Management 255 Interprofessional Health Care 256 Physicians 256 Pharmacists 257 Dietitians and Nutritionists 258 Social Workers 258 Physical Therapists 259 Occupational Therapists 259 Speech-Language Pathologists 260 Respiratory Therapists 260 Interprofessional Focus 261 Global Collaboration 261 Chapter Highlights 261 References 262 Unit III: Processes Guiding Professional Practice 264 Chapter 14: Communicating Effectively 264 Challenges and Opportunities 265 Definitions of Communication 265 The Communication Process 266 Sender 267 Message 267 Channel 267 Receiver 267 Response 267 Factors Influencing the Communication Process 268 Developmental Stage 268 Gender 269 Roles and Relationships 269 Sociocultural Characteristics 269 Values and Perceptions 269 Space and Territoriality 269 Environment 270 Congruence 270 Interpersonal Attitudes 270 Types of Communication 271 Oral/Verbal Communication 271 Nonverbal Communication 272 Therapeutic Communication 273 Written Communication 274 Barriers to Communication 277 Nursing Documentation 277 Methods of Documentation 279 Communicating Through Technology 280 Chapter Highlights 282 References 283 Chapter 15: Managing Change 284 Challenges and Opportunities 285 Meanings and Types of Change 285 Spontaneous Change 285 Developmental Change 285 Planned Change 286 Change Theory 286 Approaches to Planned Change 286 Change Strategies 288 Frameworks for Change 289 Managing Change 292 Change Agent 292 Steps in the Change Process 293 Resistance to Change 294 Examples of Change 296 Chapter Highlights 298 References 299 Chapter 16: Technology and Informatics 300 Challenges and Opportunities 300 Professional Nurse Interview Questions NUR 3805
Nursing Informatics, Healthcare Informatics, and Technology 301 Nursing Roles and Education 301 Technology and Informatics 302 Informatics Frameworks 303 Issues Related to Information Technology 304 Ethical Concerns 305 Confidentiality of Medical Records and Data 305 Data Integrity 305 Caring in a High-Tech Environment 305 The Technology Explosion 306 Evolution of Technology 306 Computer Technology in Practice, Education, Research, and Administration 307 xx CONTENTS Current Applications of Information Technology in Practice 309 Physician Order Entry 309 Clinical Information Systems 309 Wireless and Portable Devices 309 Electronic Health Record 310 Evidence-Based Practice 310 Telehealth 310 Chapter Highlights 312 References 313 Unit IV: Professional Nursing in a Changing Health Care Environment 315 Chapter 17: Nursing in an Evolving Health Care Delivery System 315 Challenges and Opportunities 316 Changes in Health Care in the United States 316 Healthcare Cost Issues 317 Demand Versus Supply of Health Care 317 Paying for Health Care 317 Cost Containment Strategies 318 Access to Health Care 318 Concepts of Health, Wellness, and Well-Being 319 Health 319 Wellness and Well-Being 320 Case Management 320 Health Care Economics 321 Billing Methods 321 International Perspectives 322 Nursing Economics 323 Financial Management 323 Profit Versus Not-for-Profit Organizations 323 Costs and Budgeting 324 Chapter Highlights 325 References 326 Chapter 18: Providing Care in Home and Community 327 Challenges and Opportunities 328 Community Health Nursing: An Integrated Approach 329 Definitions of Community and Community Nursing 330 Philosophical Paradigms of Community Nursing Practice 330 Community-Oriented Nursing Practice 332 Community-Based Nursing Practice 332 Public Health Nursing Practice 332 Settings for Community Nursing Practice 333 Public Sector Settings 333 Public–Private Partnership Settings 336 Private Sector Settings 337 Nursing in Rural Communities 339 Home Health Nursing 340 Definitions of Home Health Nursing 340 Perspectives of Home Health Nursing 341 Differences Between Home Health Nursing and Hospital Nursing 342 Influencing Community Health Outcomes 343 Assessment and Community Engagement 343 Diagnosing 346 Planning and Implementation 350 Evaluation 351 Chapter Highlights 351 References 352 Chapter 19: Global Health 354 Challenges and Opportunities 355 Understanding Global Health 355 Goals of Global Health 356 Principles of Global Health 357 Human Rights and Ethical Considerations 360 Global Health Concerns 361 Demographic and Epidemic Shifts 362 Communicable Disease 362 Noncommunicable Disease 366 Environment and Health 367 Health Systems in a Global Environment 368 Governmental and Intergovernmental Systems 368 CONTENTS xxi Community Development Assistance Agencies 369 Nongovernmental Systems 370 Health Delivery Systems Around the World 371 Health System Models 371 Nursing and Global Health 372 Nursing Roles in Global Health 373 Nursing and Health Professions Organizations 373 Nursing Opportunities in Global Health 375 Nurse Migration 375 Chapter Highlights 377 References 377 Chapter 20: Dimensions of Holistic Health Care 380 Challenges and Opportunities 381 The Expanding View of Health Care 381 Complementary and Alternative Medicine 381 Holistic Nursing 382 Health Promotion and Healthy Lifestyles 383 Primary, Secondary, and Tertiary Prevention 384 Transition to Integrative Health 385 Complementary Therapies 386 Biologically Based Therapies 387 Manipulative Body-Based Therapies 389 Energy Therapies 390 Mind-Body–Based Therapies 391 Chapter Highlights 393 References 394 Chapter 21: Nursing in a Culturally Diverse World 395 Challenges and Opportunities 397 Concepts Related to Culture 397 Characteristics of Culture 399 Components of Culture 400 Culture and Health Care 400 Leininger’s Sunrise Model 400 Purnell’s Model for Cultural Competence 402 Integrating Cultural Knowledge in Care 403 Barriers to Integrating Culture and Care 403 Conveying Caring to Diverse Groups 404 Selected Cultural Parameters Influencing Nursing Care 406 Health Beliefs and Practices 406 Family Patterns 407 Communication Style 409 Space Orientation 411 Time Orientation 412 Nutritional Patterns 412 Pain Responses Professional Nurse Interview Questions NUR 3805
413 Childbirth and Perinatal Care 413 Death and Dying 415 Providing Culturally Competent Care 416 Chapter Highlights 420 References 420 Chapter 22: Nursing in a Spiritually Diverse World 422 Challenges and Opportunities 423 Concepts Related to Spirituality 424 Spirituality, Religion, and Faith 424 Spiritual Development 426 Prayer and Meditation 428 Selected Spiritual and Religious Beliefs Influencing Nursing Care 429 Holy Days 429 Sacred Writings and Symbols 430 Dress 430 Health Beliefs and Practices 431 Childbirth and Perinatal Care 432 Pain, Suffering, and Their Spiritual Meaning 432 Death and Dying 432 Spiritual Distress 433 Providing Spiritually Competent Care 434 Spiritual Assessment 434 Diagnosing, Planning, and Implementing Spiritually Competent Care 434 Chapter Highlights 439 References 439 xxii CONTENTS Chapter 23: Nursing in a Culture of Violence 441 Advanced Nursing Practice 459 Types of Advanced Practice 460 Regulation of Advanced Practice 465 The International Perspective 467 The Future of Advanced Practice Nursing 468 Challenges and Opportunities 441 Violence in Society 442 Family Violence and Abuse 442 Intimate Partner Abuse 443 Family Violence and Children 443 Elder Abuse 446 Selecting a Graduate Program 469 Professional Career Goals 469 Personal and Family Factors 470 Program Characteristics 470 Violence in the Community 447 Exposure to Community Violence 447 School Violence 447 Chapter Highlights 472 References 473 Violence in the Workplace 448 Risks to the Healthcare Workforce 448 Horizontal or Lateral Violence 448 Chapter 25: The Future of Nursing 475 Challenges and Opportunities 475 Driving Forces for Change 476 Assessing the Effects of Violence and Abuse 449 Planning/Implementing Interventions for the Abused 450 Healthcare Reform 476 Population Changes 477 Past Events That Have Affected Nursing 477 Short-Term Interventions 450 Long-Term Interventions 450 Events That Promoted Nursing’s Growth and Development 477 Events That Have Indirectly Affected Nursing 478 Social Movements and Technological Initiatives That Have Affected Nursing 479 Prevention of Violence and Abuse 451 Terrorism and Public Health 452 Threats of Mass Destruction 452 Strengthening the Public Health System 453 Looking Toward the Future of Nursing 480 Chapter Highlights 454 References 454 Computer Technology and Its Effect on Health and Nursing Care 481 Healthcare System Changes 482 Regulatory Changes 483 Continued Medical, Surgical, and Pharmacological Advances 483 Unit V: Into the Future 456 Chapter 24: Advanced Nursing Education and Practice 456 Applying Past Lessons to the Future 485 Visions of Tomorrow 485 Challenges and Opportunities 456 Advanced Nursing Education 457 Preparation for Advanced Nursing Practice 457 Master’s Degree in Nursing 459 Chapter Highlights 490 References 491 Index 493 1 Beginning the Journey Chapter Outline Factors in Society That Promote the Nurse’s Return to School Changing Trends of Nursing as a Profession Factors That Influence the Nurse’s Return to School Education for Initial and Continuing Licensure Credentialing Requirements Professional Role Transition Bridges’s Model of Transition Spencer and Adams’s Model of Transition Strategies for Success: What It Will Take to Get There Time Management Money Social Supports Working With Faculty Technology Skills Study Skills Pedagogic Features for Using This Text Chapter Highlights Objectives 1. Examine changes in society that promote the nurse’s return to school for further education. 2. Examine changes in the profession that promote the nurse’s return to school for further education. 3. Apply models of transition to professional role change. 4. Identify strategies that will assist the nursing student in the formal academic setting. 5. Identify helpful approaches to academic success. 6. Implement personal lifestyle and study strategies to promote success. 7. Use pedagogic features to enhance learning. T he evolution of nursing has been dramatic in recent history.Professional Nurse Interview Questions NUR 3805
While most of the changes in nursing are in response to changes in society and in the healthcare system, there are also changes related to the evolution of the profession. The reciprocal relationships among nursing, medicine, health, and society require that nursing must change as society changes, and as the nursing profession changes, nurses must also transform in response to professional and societal demands. Factors in Society That Promote the Nurse’s Return to School Changes in society place new demands on nurses. An aging population results in older patients with more complex health problems. Changing reimbursement practices result in patients being discharged more quickly from hospitals, even though they still need skilled nursing care either in long-term care facilities or in their homes. With the passage of the Patient Protection and Affordable Care Act of 2010, health care is available to a greater percentage of the population, but there are still those who are uninsured or underinsured. More care is being delivered in community and outpatient settings. A more diverse population requires nurses to be more knowledgeable about cultural and social influences on health. Professional Nurse Interview Questions NUR 3805
New technology and scientific discoveries require nurses to update their knowledge and skills continuously. New diseases 2 CHAPTER 1 • BEGINNING THE JOURNEY related to social and environmental problems require nurses to have a greater, integrated knowledge of the biological, psychological, and social sciences to promote health, to prevent illness or injury, and to care for those who are already ill or injured. Many of these societal changes will be discussed in more detail in later chapters. Changing Trends of Nursing as a Profession Changed views of men’s and women’s roles are at the foundation of some of the profession’s internal changes. Historically, nursing was considered a woman’s occupation; however, that has been changing since the 1980s. In 1980, 2.7% of registered nurses (RNs) were male (U.S. Department of Health and Human Services, 2004); by 2000, the percentage increased to 5.4% (U.S. Department of Health and Human Services, 2004); and in 2013, 7% of RNs were male (Budden, Zhong, Moulton, & Cimiotti, 2013). As more men entered nursing, the image of the profession changed. Use of traditional identifying symbols of nursing, such as nurses’ caps and white uniforms, declined. There also has been less acceptance of the passive behaviors associated with the historical “handmaiden” role, when the nurse was viewed as the submissive and unquestioning assistant to the physician. Professional Nurse Interview Questions NUR 3805
As members of the healthcare team, RNs contribute from their area of expertise and are expected to be accountable and responsible for their work. These expectations require a more assertive and proactive role for the contemporary professional nurse as she or he participates in a more collaborative healthcare system. Other factors have also accounted for changes in the role of the professional nurse. The average age of RNs has increased. In 2000, the average age of RNs was 45.2 years (U.S. Department of Health and Human Services, 2004); in 2013, the average age of RNs had increased to 50 years (Budden et al., 2013). Of concern is the fact that 11% of licensed RNs are retired, and that percentage is expected to increase as the baby boomer nurses approach retirement. Based on data from the Department of Labor, the American Association of Colleges of Nursing (2014) predicts a continuing shortage of RNs. The number of individuals graduating from nursing programs is not keeping up with the number of nurses leaving the profession because of retirement or other personal reasons. However, even as nurses retire, 8% of RNs 65 years of age and older continue to work full or part time in nursing. In the past, a nurse may have been more likely to work until having children and then stop working or work only part time or short term when additional income was needed. Professional Nurse Interview Questions NUR 3805