Lewis et al: Medical-Surgical Nursing: Assessment and Management of Clinical

Problems, 7th edition

Key Points

Chapter 1: Nursing Practice Today

• Nursing involves the (1) protection, promotion, and optimization of health and abilities; (2) prevention
of illness and injury; (3) alleviation of suffering through the diagnosis and treatment of human response;
and (4) advocacy in the care of individuals, families, communities, and populations.

• Nurses offer skilled care to those recuperating from illness or injury, advocate for patients’ rights, teach
patients so that they can make informed decisions, support patients at critical times, and help them
navigate the increasingly complex health care system.

• Certification in nursing specialties (e.g., ambulatory care, critical care, gerontologic, pediatric,
psychiatric and mental health, and community health nursing) is offered through a variety of nursing
organizations.

• Entry-level nurses with an associate or baccalaureate degree in nursing are prepared to function
as generalists. With additional preparation, nurses can assume roles such as clinical nurse specialist and
nurse practitioner.

• The exact roles (i.e., independent, dependent, collaborative) of the nurse are often determined by
state and agency policies. In most cases, the nurse’s role is one of “interdependence and co-
participation” with the patient and other health team members.

• Delegation of nursing interventions to licensed practical nurses/licensed vocational nurses

(LPNs/LVNs) and unlicensed assistive personnel (UAP) is an important function of the professional
nurse.

• Healthy People 2010 is a broad-based program that involves government, private, public, and nonprofit
organizations in preventing disease and promoting health.

• Evidence-based practice (EBP) is the conscientious use of the best evidence (e.g., findings from
research) in combination with clinician expertise and patient preferences and values in clinical decision-
making.

• Nursing informatics is a specialty that integrates nursing science, computer science, and information
science in identifying, collecting, processing, and managing data and information to support nursing
practice, administration, education, and research.

• The five elements of the nursing process are assessment, diagnosis, planning, implementation,
and evaluation. Once begun, the nursing process is not only continuous but it is also cyclic in nature.
Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier Inc.
Key Points 1-2

• Standardized nursing terminologies can promote continuity of patient care and provide data that can
support the credibility of the profession.

• Nursing diagnoses describe health states that nurses can legally diagnose and treat. A three-part nursing
diagnosis statement includes the problem, etiology, and signs and symptoms.

• Collaborative problems are potential or actual complications of disease or treatment that nurses treat
with other health care providers, most frequently physicians.

• The Nursing Outcomes Classification (NOC) is a research-based, standardized language for nursing
outcomes. It is used to evaluate the effects of nursing interventions. NOC is a list of measures that
describes patient outcomes influenced by nursing interventions.

• The Nursing Interventions Classification (NIC) includes independent and collaborative interventions
that nurses carry out, or direct others to carry out, on behalf of patients.

• A nursing intervention is any treatment based on clinical judgment and knowledge that a nurse
performs to enhance patient outcomes.

• The setting of specific outcomes with outcome indicators is necessary for systematic
measurement of the patient’s progress.

• Outcomes may be developed by writing specific outcome statements or choosing outcomes from
the Nursing Outcomes Classification (NOC).

• The Nursing Interventions Classification (NIC) includes treatments (both physiologic and
psychosocial) that nurses perform in all settings and specialties.

• NIC and NOC provide a common language for communication among nurses and facilitate
computer collection of standardized nursing data.

• During the evaluation phase, the nurse determines whether the patient outcomes and nursing
interventions were realistic, measurable, and achievable.

• Assessment, diagnosis, outcomes, interventions, and evaluation of the patient’s response to care are a
critical part of the patient’s record.

• When nursing terminologies are used in information systems for documentation of nursing
practice, nurses can track and report on the benefits of nursing care.

Chapter 2: Health Disparities

• Determinants of health are those factors that influence the health of individuals.

Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

Key Points 1-3

• Health disparities refer to differences in measures in the health status among groups of people in a
community, a state, or the entire nation.

• Racial, ethnic, and cultural differences exist in the health screening behaviors, treatments provided, and
access to health care providers.

• Factors such as stereotyping and prejudice can affect health care seeking behavior in minority
populations.

• Discrimination and bias occur when negative treatment occurs based on race, ethnicity, gender, aging,
and sexual orientation.

• Use of standardized evidence-based guidelines can reduce health disparities in diagnosis and treatment.

• Interpersonal skills such as active listening, relationship building, and effective communication are basic
to the delivery of high quality and equitable health care.

Chapter 3: Culturally Competent Care

• Culture encompasses the knowledge, values, beliefs, art, morals, law, customs, and habits of the
members of a society, including the systems of technology, education, social structures, and political
practices.

• The demographics and cultural composition of the United States are diverse. Therefore it is important
for nurses to be aware of cultural differences of patients in health care settings.

• Recent immigrants may be at risk for physical and mental health problems. This may be related to their
country of origin or exposure to various factors in their new area.

• Cultural competence is a multiple-step process that involves the integration of knowledge, attitudes,
and skills to enhance a working relationship with an individual who is from a different culture.

• Certain culture-related factors that must be considered in health care settings include the use of folk
healers, spirituality, communication styles, familial roles, personal space, touch, nutrition, disease
susceptibility, immigration, medication interactions, and psychologic factors.

• Verbal and non-verbal communication should be culturally assessed.

• A medical translator should be used when a nurse does not speak the patient’s primary language.

Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier Inc.