Chapter 1Health Care Delivery and Nursing Practice

Health Care Delivery and Nursing Practice

• Nursing is defined as the “diagnosis and treatment of human responses to health and illness”.

• Health is defined as a “state of complete physical, mental, and social well-being”.

• Wellness “includes a conscious and deliberate approach to an advanced state of physical, psychological, and spiritual health”.

Health Care Delivery Systems

• Managed Care

• Case Management

• Health Maintenance Organizations

• Preferred Provider Organizations

Roles of the Nurse•Practitioner

•Leader

•Research

Models of Nursing• Team Nursing

• Primary Nursing

• Community-Based Nursing and Community Health-Public Health Nursing

Chapter 2

Health Assessment

Role of Nurse• Nurse obtains health history

– Biographical data

– Past health history

– Family history

– Review of systems

– Patient profile

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Physical Assessment–Inspection

–Auscultation

–Palpation

–Percussion

Nutritional Assessment• Body Mass Index• Biochemical Assessment• Clinical Examination• Dietary Data• Conducting the Dietary Interview• Evaluating The dietary Information• Factors Influencing Nutritional Status in Varied

Situations• Analysis of Nutritional Status

Chapter 3Critical Thinking, Ethical

Decision Making, and the Nursing Process

Nhelia B. Perez RN , MSN

Critical Thinking• Critical Thinking is a multidimensional skill involving reasoning and purposeful, systematic, reflective, rational, outcome-directed thinking

ATTITUDES AND CHARACTERISTICS OF A CRITICAL

THINKER• Alert to changes• Analytical• Autonomous• Careful• Committed• Confident• Courageous• Creative• Curious• Emphatic• Fair minded

• Flexible• Genuine• Honest• Humble• Independent• Insightful• Has integrity• Logical• Open-minded• Patient• practical

• Proactive• Prudent• Questioning• Realistic• Reflective• Reflective• Responsible• sensitive

Five Levels of proficiency

• Novice

• Advance beginner

• Competent

• Proficient

• expert

Three Aspects

• Reliance on principles to experience.

• Perception of the situation as component parts to perception of a whole.

• Detached observer to involved performer

ETHICAL NURSING CARE• ETHICS VS MORALITY

Ethics and morality is used to describe between right and wrong and to suggest appropriate guidelines for action.

ETHICS - formal systematic study of moral beliefs.

MORALITY – the adherence to informal personal values.

ETHICS THEORIES• Teleologic Theory /

Consequentialization- focuses on the ends or consequences of action

utilitarianism “the greatest good for the greatest number.”

* Deontologic Theory / Formalist Theory – argues that moral standards or principles exist independently of the ends or consequences.

APPROACHES TO ETHICS• Metaethics - Metaethics is a fundamental study

of ethics without context. It is the study of what in essence ethical values are, how such values are obtained and how moral goods are achieved, in any context. Metaethics is often concerned with logical analyses of what ethical system must be.

• Applied Ethics - is a discipline of philosophy that attempts to apply 'theoretical' ethics, such as utilitarianism, social contract theory, and deontology, to real world dilemmas.

ETHICAL PRINCIPLES• Autonomy - the ability to make a

choice free from external constraints.• Beneficence – the duty to do good.• Confidentiality – relates to the concept

of privacy.• Double effect – Morally justify some

actions that produce both good and evil

Criteria for double effect

• The action itself is good and morally neutral.

• The agent sincerely intends the good and not the evil effect.

• The good effect is not achieved by means of the evil effect.

• There is proportionate or favorable balance of good over evil.

• Fidelity – the duty to be faithful to one’s commitment.

• Justice – Like cases should be treated alike. Criteria

- Equality- Individual Effect- Individual Effort- Societal Contribution- Individual merit- Legal entitlement

• Nonmaleficence – The duty not to inflict harm as well as to prevent and remove harm.

• Paternalism – is the intentional limitation of another’s autonomy, justified by an appeal to beneficence or the welfare or needs of another.

• Respect for person – to treat others in such a way that enables them to make the choice.

• Sanctity of life – Life is the highest good.

• Veracity – the obligation to tell the truth and not to lie or deceive others.

ETHICAL PROBLEMS IN NURSING

• Confidentiality• Restraints• Trust Issues• Refusing to provide care• End of life issues

- Pain control- Do-not-resuscitate Orders- Life Support- Food and Fluid

Preventive Ethics

• Advance Directives

Chapter 4

Complementary & Alternative Therapies

• Complementary, Alternative & Integrative Therapies

• Why do People choose Alternative Therapies

• Role of the Nurse

• Issues Related to discussing complementary and alternative therapies with clients.

Nursing Process

• Nursing Process is a deliberate problem-solving approach for meeting health care and nursing needs

The Chicago Tribune has a story about the suspicious deaths possibly caused by morphine overdose at a nursing home.  McHenry County prosecutors acknowledge the suspicious

deaths at the Woodstock Residence nursing home in Woodstock have been difficult to pursue.  Three bodies

were exhumed last year, and tissue samples were sent to a Pennsylvania lab for analysis. The bodies of three others

whose deaths investigators consider suspicious could not be examined because they were cremated.  Alissa

Nataupsky, administrator of the Woodstock Residence, has denied any wrongdoing at the home and has said the

investigation was triggered by a former employee. When Cole, 78, died in September 2006, the cause of death was

listed as pneumonia. Cole had been living at the Woodstock Residence for two months. If lab results do not

conclusively show that morphine overdoses caused the deaths of the three former residents whose bodies were

exhumed, a grand jury might be used to further investigate the case, a law enforcement source said.