History of NP Role
Ford and SIlver in CO in 1965
state legislative statutes
grant legal authority, the nurse practice act, may require collaborative agreement
collaborative agreement
what types of drugs may be prescribed and of some oversight board
statutory law
rules differ for each state, further define scope of practice
licensure
agency of state grants permission to individuals accountable for the practice of a profession
credentialing
protect the pubic by ensuring minimum level of competence
certification
determines scope of practice, certifies that an individual has met certain standards
scope of practice
defines NP roles and action, varies from state to state
standards of practice
regarding the quality and type of practice, a way to judge the nature of care given
confidentiality
information is not disclosed, protected by Medical Record Confidentiality Act of 1996
HIPAA
health care privacy act: educated about HIPAA, have access to medical records, request amendments, require their permission for disclosure
Tarasoff principle
1976 – duty to warn victims of potential harm from client
Justice
doing what is fair, fairness in care
Beneficence
promoting well being and doing good
nonmalfeasance
doing no harm
fidelity
being true and loyal
autonomy
doing for self
veracity
telling the truth
respect
treating everyone with equal respect
deontological theory
action is judged based on the act itself
teleological theory
action is judged based on the consequences
virtue ethics
actions are chosen based on moral virtues of the person
Four elements of malpractice
duty, breach of duty, proximate cause, damages
competency
legal, not medical concept – determination that client can make reasonable judgments and decisions regarding treatment and health concerns
primary prevention
decreasing the incidence of mental disorders
ex. stress management classes, smoking prevention, DARE
secondary prevention
aimed at decreasing prevalence
ex. telephone hotlines, crisis intervention, disaster response
tertiary prevention
aimed at decreasing the disability and severity of mental disorder
ex. day programs, housing, social skills training
biological risk factors
hx of mental illness, poor nutrition, poor health
psychological risk factors
poor self concept, external locus of control, poor ego defenses
social risk factors
stressful occupation, low socioeconomic status, poor level of social integration
research utilization
synthesizing, disseminating, and using research generated knowledge to make a change in practice
evidence based practice
integration of best research evidence with clinical expertise and patient values and needs
evidence based practice model
P – patient, population, problem
I – intervention
C- comparison treatment or placebo
O – outcome
internal validity
the treatment caused a change in the outcome
external validity
the outcome is generalizable to the population
IRB
protects rights of participants in studies – the belmont report
Trust v Mistrust
0-1 year
ability to form relationships, hope, trust in others
Autonomy v Shame and doubt
1-3 years
self control, self esteem, will power
Initiative v guilt
3-6 years
self directed behavior, goal formation, sense of purpose
Industry v inferiority
6-12 years
ability to work, sense of competency and achievement
Identity v role confusion
12-20 years
personal sense of identity
Intimacy v isolation
20-35 years
committed relationships, capacity to love
generativity v self absorption or stagnation
35-65 years
ability to give time and talent to others, ability to grow and change
integrity v despair
65 years
fulfillment and comfort with life, willingness to face death, insight
Psychodynamic theory
Freud
intrapsychic conflict among structures of mind
Id (I want), ego (I think, I evaluate), superego (I should or ought)
all behavior is purposeful and meaningful
oral stage
0-18 months
sucking, chewing, feeding
linked to schizophrenia, substance abuse, paranoia
anal stage
18 – 3 years
sphincter control, expulsions, retentions
linked to depressive disorders
phallic stage
3-6 years
exhibitionism, masturbation
linked to sexual identity issues
latency stage
6-puberty
peer relationships, learning, socialization
linked to issues forming relationships
genital stage
puberty and on
integration and synthesis of behaviors from early stages, genital based sexuality
linked to sexual perversion disorders
Denial
avoidance of unpleasant realities but ignoring them
projection
unconscious rejection of unacceptable personal beliefs or feelings by attributing them to others
regression
return to more comfortable thoughts, behaviors, or feelings in earlier stages of development
repression
unconscious exclusion of unwanted emotions or thoughts
reaction formation
overcompensation; opposite feeling is acted on
rationalization
justification of illogical ideas, feelings or actions by developing an acceptable explanation
undoing
attempting to make up for or undo an unacceptable behavior
intellectualization
attempts to master current stressor or conflict by expansion of knowledge
suppression
conscious analog of repression
sublimination
unconscious process of substitution of socially acceptable constructive activity for strong unacceptable impulse
altruism
meeting the needs of others in order to discharge drives
cognitive theory
piaget
human development evolves through cognition, learning, and comprehending
stages of development
Sensorimotor
birth – 2 years
object permanence – objects have existence regardless of child’s involvement