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B.Sc. NURSING [Post Basic (1st, year)], NURSING FOUNDATION, June-20009, , Time: 3 hrs., Note:, , M.M.: 35, , Attempt all questions., , Q.1. (a) Describe the, development of, , nursing education in India., , (b) Explain the role of clinical nurse, , specialist., Q.2. (a) Explain the theory of, adaptation given by Calista, (b) Explain the needs and, problems of elderly., Or, , Write the, , Q.3., , (5), (5), , Roy., (5), (5), , nursing care plan utilizing the nursing process, , framework for any patient from your, speciality., Write, short notes, , on, , any Three of the, , (a) Nursing Audit., (b) Total quality management., (c) Tools of evaluation., (d) Team nursing., , (10), , following: (3x5=15)
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47, , Nursing Foundetion (June-2009), , SOLVED PAPER, , QUESTION-1, (a) Describe the development of nursing education in India., b) Explain the role of clinical nurse specialist., , ANSWER-1(a), Development of Nursing Education in India, 18o0:, , 1891:, , Florence nightingale is the founder of and nursing profession., She established hightingale training school for nurses at, London., School of nursing, , was, , established in "Cama, , hospital, , for, , women and children.", GNM training was 2 years until 2009 and duration was, increased to 3 years., , 1908:, , 1909:, , TNAI was established, Bombay presidency Nursing Association granted the nursing, diploma to students., , 1926: First Nurses Registration Act was enacted., 1939: Nursing councils in all states except Assam., 1941: First text book for nurses in india., 1942: The auxillary nursing services was started., , 1946:, , B.Sc. nursing program, , was, , started in CMC vellore and RAK, , Delhi., , 1952:, 1954:, , Ten months, , course, , in public health nursing, , out, , 63:, , Syllabi for men-could take 2, of nursing of women., subject (3 months) in place, , of 6, , course., , M.Sc. nursing started., program throughout, Uniform standard of nursing training, , india., , 1965: GNM syllabus revised., , 1977: ANM syllabus revised., , 1981:, , started., , INC integrated public health nursing in Basic Nursing, curriculum of GNM, , 1960:, , was, , B.Sc. Nursing syllabus revised,
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SES Post Basic B.Sc., , 48, , 1986:, 2002:, , Nursing (1st Yean, , GNM syllabus revised., INC revised GNM syllabus and extended its duration to 3%, years., , 2006:, 2006:, , B.Sc. nursing syllabus revised., PhD in nursing strated by INC., , ANSWER-1 (b), Role of Clinical Nurse Specialist: The clinical nurse specialist is a, , advanced practice nurse with nursing expertise in a specialized area, of practice setting. She may specialize in a specific disease, such as, cancer, or cardiac problems or in a specific field, such as pediatrics, or gerontology., The nurse practitioner provides health care to clients, usually in, , outpatient, ambulatory care, or community based setting., She provides care for the clients with complex problems and, , provides a more holistic approach, attending to symptoms of, , nonpathological conditions comfort, and comprehensiveness of care., She works, , as an, , expert clinician, educator, , ,case, , manager,, , consultant, and researcher to plan or improve the quality of care, provided to the client and family., As clinical nurse specialist have, experience in clinical practice., She has practical skills and theoretical, knowledge. the nurse educator, teach ill or disabled clients and their families how to, provide care in, the home., The, 1., , 2., , 3., , major, , clinical nurse practitioner, categories are:, Adult Nurse Practitioner, provides primary, ambulatory care to, adults with a non emergent acute or chronic, illness and in some, , setting tertiary care., Family Nurse Practitioner provides primary, ambulatory care for, family. She meets the family's general health care needs,, some illnesses by, providing direct care, and guides or manages, counsels, the family as needed., Pediatric Nurse Practitioner provides, health care to infants, children., and
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Nursing Foundation (June-2009), , 4., 4, , 49, , Women s Health Nurse Practitioner provides primary ambulatory, care to women secking obstetrical or gynecological health care., , 5., , Acute Care Nurse Practitioner is a generalist, functions in, , 6., , collaboration with physician in an acute care settingg, Geriatic Nurse Practitioner is trained in the special needs ofaging, adult with emphasis on health promotion, health maintenance,, and functional status., , In general she functions as:, , Obey the order given by doctor., Provide basic care to the patient., , Administer prescribed medication to the patient, , Provide health education to patient and family regarding, prevention of disease and promotion of health., Attend the in service education program to improve the, , knowledge., Maintain nurse-patient relationship., Observe patient's illness and prevent any complications., and health., , Participate in research activities related to nursing, Supervise the ward and junior stafit., illness., Rehabilitate the client suffering from chronic, QUESTION-2, , Calista Roy., (a) Explain the theory of adaptation given by, of, (b) Explain the needs and problems elderly., , Or, , nursing process, speciality., for any patient from your, , Write the nursing, framework, , care, , plan utilizing, , the, , ANSWER-2 (a), heory of adaptatior given by Roy, (1979) has developed adaptation, , Oy, , physiologi, , model which is based, , on, , the, , sociological and dependence-, , S1logical, psychological, focuses on the individual as a, dependence adaptive modes. Roy, feedback cycle of, that employs a, system, opsychosocia adaptive
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SES Post, , 50, , Basic B.Sc. Nursing, , (1st, , Year, input (stimuli), throughput (control processès) and output (behaviors, or adaptive responses)., , Concepts:, Person is a Bio-psycho-social being in constant interaction with a, , changing environment. He uses innate and acquired mechanisms to, adapt. He functions as a unity for some purpose., , Environment:, Focal-internal or external and immediately confronting the person, Contextual-all stimuli present in the situation that contribute to, effect of focal stimulus, Residual-a factor whose effects in the current situation are unclear, All conditions, circumstances, and influences surrounding and, affecting the development and behavior of persons and groups, with particular consideration of mutuality of person and earth, resources, including focal, contextual and residual stimuli, , Health: It is Inevitable dimension of person's life. It is represented, by a health-illness continuum, Nursing is:, , To promote adaptation in the four adaptive models., To promote adaptation for individuals and groups in the four, adaptive modes, thus contributing to health, quality of life, and, dying with dignity by assessing behaviors and factors that influence, adaptive abilities and by intervening to enhance environmental, interactions., , Subsystems:, Cognator subsystem: A major coping process involving 4, , cognitive-emotive channels: perceptual and information, processing, learning, judgment and emotion., Regulator subsystem: A basic type of adaptive process that, , responds automatically through neural, chemical, and endocrine, coping channels., Characteristics of the theory:, Theories can interrelates concepts in such a way as to present a, new, , view of looking at, , a, , particular phenomenon.
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Nursing Foundation (June-2009), , Theories must, , 51, , be, , logical in nature., Theories should be, relatively simple yet generalizable., , Theories can be the bsis for the hypotheses that can be tested., Theories contribute to and assist in, increasing the general body, of knowledge of a, discipline through the research implemented, to validate them., Theories can be utilized by the, practitioners to guide and improve, their practice., Theories must be consistent with other validated theories, laws, and principles but will leave open unanswered questions that, , need, , to, , be, , investigated., , Usefulness of Adaptation Model:, It, , provides scientific knowledge, , It, , helps to guide nursing practice., , for practice., It helps in clinical assessment and intervention., It helps to organize nursing education., It provides curricular frame work for various nursing colleges., Middle range theories have been derived from Roy Adapatation, Model., Roy Adaptation Model offers guidelines to nurse in developing, the nursing process. The elements of nursing process are: First, level assessment, Second level assessment, Diagnosis, Goal, , setting, Intervention and, , evaluation., , ANSWER-2 (b), Needs and Problems of elderly: elderly is the developmental stage, Occurring from age 65 and beyond. In this stage, following things, , have happen:, , Physiological changes and alterations in health status., Retirement and altered income., , Death of spouse., Develop afiliation with one's age group., Meet civic and social responsibilities., , Establish satisfactory living arrangements.
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SES Post Basic B.Sc. Nursing (1st Yea), , 52, , Older adults have several, , Developing a, , sense, , psychosocial tasks to accom-plish, such, , that one has lived, of satisfaction with the life, , (to find meaning in one's life), Establishing meaningful roles, , Adjusting to infirmities (if any exist), Coping, , with losses and, , changes, , Preparing for death, Needs and problems of elderly:, , Physical impairment, Feeling of loneliness, Chronic illness, , Feeling of helplessness, Dependency on offspring, Fear of death, , Difficulty in walking, Difficulty in vision, Difficulty in hearing, Difficulty in eating, Difficulty in comprehending, Functional impairment client suffering from, , OR, , ANSWER-2 (b), Nursing Care Plan, Paper NA-2008 Ans., , of Chronic Renal Failure: Refer to Solved, 2 (b) Page No. 37 to 42., , QUESTION-3, Write short notes on any Three of the following:, (a), , Nursing Audit, , (b) Total quality management, (c) Tools of evaluation, (d) Team nursing
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53, , Nursing Foundation (June-2009), , ANSWER-3(a), documentation, Nursing Audit: Nursing audit is a method for assuring, of the, of nursing care in keeping with the standards, the, quality, of, and the professional, governméntal, agency, the nursing department,, , and accrediting groups., , Nursing Audit:, care provided, Necessitating adequate documentation of nursing, , Purposes of, ., , 2, , through the entire nursing process., record., and utility ofthe charting, the, attention, to, design, Directing, , ., , Encouraging the, , to, , the client, , use, , of the problem oriented nursing system., , Supporting and becoming an integral part ofnursing, , 44., , program, , and, , by objective, , delivery of client care, , Facilitating the co-operative planning, employees., evaluation, by physicians and nursing, oriented performance, results, for, Increasing the priority, service employees., program for nursing, education effects., , 5., 6., , Enriching and providing, , 7., , Providing, , 8., , evaluation, , a, , specific, , direction to, , management, , in service, , technique in carrying, , out, , function., and control, , patient care., members, nursing staff, , 9, 10., , to improve, ldentifying ways, ways for, Providing a meaningful, , participate and, , achieve, , Concept of Nursing, Nursing, , career, , growth., , Audit:, , comprises of, Audit mainly, , Types of Nursing, The nursing, , audits, , Concurrent, , care., , It, , is, , Debit and Credit., , Audit:, are, , mainly of two types:, , Audit:The, , the open chart, , to, , concurrent, , been called, audit has also, , as, , the patient is receiving, the quality of ongoing, , it is done while, audit because, , a process, , being received, , audit that, , by, , clients, , evaluates, , by looking, , at the, , nursing process., , assessment, , of the, , to an in-depth, client, Audit: Refers, having the, 4Retrospective, 2., discharged,, has been, on two, the client, after, audit focuses, quality,, care, , Chart, , as, , factors:, , a, , source, , of data., , Retrospective
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SES Post Besic B. Sc. Nursing (1st Yea, , 54, Discharge status, , Complications, Advantages of Nursing Audit:, Method of measurement., Functions are easily understood., , Scoring system is fairly simple., Results are easily understood., , Assess the work of all those involved in recording case., May be useful tool as part of a quality assurance program in area, where accurate records of case are kept., Disadvantages of Nursing Audit:, It is not so useful in areas where the, been implemented., , nursing process, , has not, , Many compc.ients overlap making analysis difficult, It is time, , consuming., , Requires a team of trained auditors., Deals with a large amount of information., , Only evaluates record keeping., , ANSWER-3 (b), Total Quality, Total Quality, , Management (TQM):, Management (TQM) is the method of management and, system operation used to achieve Continous, Quality Improvement, (CQI). TQM, an, promotes, , organization culture that supports customer, , need, empowers employees, , to, , work, , as, , teams,, , development, and requires a new leadership style in emphasizes, which, are, , cQl, , viewed, , as, , is the, , resources., , TQM, , is, , a, , self-, , employees, system of operation, whereas, , desired outcome of a quality, management program. It is, difficult to achieve performance, improvement without a TQM culture., TQM is an integrative, of, , philosophy management for continuously, the, improving quality of products and, the premise that the, processes., on, quality of the products andTQM functions, of, processes is the, everyone who is involved, with the creation or, consumption of the products or services, offered by the, , responsibility, , organization.
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55, , Nursing Foundation (June-2009), , ln other words, TQM capitalizes on the involvement of management,, workforce, supplierS and even customers, in order to meet or exceed, , customer expectations., , Goal of a Quality Management Program:, 1., 1., , To focus on process, , improvement, which will ultimately improve, , the quality of care., 2, , To retain or regain competitiveness in order to achieve customer, satisfaction, , Practices of Total Quality Management:, common Total, Cua, Mckone and Schroeder (2001) identified the nine, , Quality Management practices:, 1., , Cross-functional product design, , 2., , Process management, , 3., 4., , Supplier quality management, Customer involvement, , 5., , Information and feedback, , 6., , Committed leadership, , 7, , Strategic planning, , 8., , Cross-functional training, , 8, , Employee involvement, , ANSWER-3 (), Care:, , Tool and Techniques for Evaluating Nursing, In nursing,, to evaluate the care provided., used, instrument, an, is, Tool, the nursing care:, tools are used for evaluating, , commonly following, , .Observation checklist, , 2., , Rating scale, , 3, , Likert scale, , 4, , Nursing round, , 5., , Incidental reporting, , 6., , Case study/presentation, , 7., , Client's satisfaction scale
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SES Post Basic B.Sc. Nursing (1st Yean, , 56, , ANSWER-3 (d), Team, , Nursing: A decentralized system, , in which the care of a patient, , of a group working in coordinated, is distributed among the members, conference, nursing care, effort. Basic to team nursing are the team, , plan, and leadershipskills, Objective of Team Nursing: To give the best, , possible quality, , of, , of the staff to, patient care by utilizing the abilities of every member, , the fullest extent and by providing close supervision both of patient, , care and of the individual who give it., , Functioning of Team Nursing:, The two important points of functioning are:, , 1. The head nurse must know at all times the condition ofthe patients, and the plan for their care and must be assured that assignments, , 22., , and workmanship contribute to quality nursing, The team leader must have freedom to use her initiative and the, opportunity to nurse, supervise, and teach unencumbered by the, , responsibility for administrative detail., In the team nursing RN functions as a team leader and, coordinates, the small grcup (no more than four or five) of, ancillary personnel, to, , provide care to a, , small group of patients., , The team leader is also responsible for, encouraging a, environment and maintaining clear communication, , cooperative, , giving, teaching and coordinating patient activities., , patient care,, , among all team, members., The team leader's duties include, planning care, assigning duties,, and, directing assisting team members,, direct, The team leader, , assigns each member specific, , dependent on the role., The members of the team, report, then, , reports, , to the, , responsibilities, , directly to the team leader, who, , charge nurse or unit manager., , Communication is enhanced through the use of, , assignments, the development of nursing care written patient, of regularly scheduled, plans, and the use, team, conferences, to, status and formulate, revisions to the plan of discuss the patient, care.
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Nursing Foundation (June-2009), , 57, , However, for team nursing to succeed, the team leader must, have strong clinical skills, good communication skills, delegation, , ability, decision-making ability and the ability to create a, , cooperative working environment., Channels of Communication in Team Nursing:, , 1., , Reports, Work or assignment conference, , 3, , 4., , Patient care conference, Written nursing care plan, , The greatest single distinguishing feature ofteam nursing is the team, conference. In general, there are three parts to the conference:, , 1., , Report by each team member on her patients., Planning for new patients and changing plans as needed for others., , 3. Planning the next day's assessment., , Advantages:, 1., 2., , High quality comprehensive care can be provided despite a, relatively high proportion of ancillary staff., Each member of the team is able to participate in decision making, , 3., , and problem solving., Each team member is able to contribute his or her own special, , expertise or skills in caring for the patient., , 4. Improved patient satisfaction., 5 Organisational decision making occurring at the iower level., 6., , Cost-effective system because it works with expected ratio of, , unlicensed to licensed personnel., , .Team nursing is an effective method of patienbcare delivery and, has been used in most inpatient and outpatient health care settings., , Disadvantages:, Establishing a, personnel., , 2., , team, , concept takes time,, , effort and, , constancy of, , Unstable staffing pattern make team nursing difficult., , All personnel must be client centred., 4. There is less individual responsibility and independence regarding, nursing functions.
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58, , SES Post Basic B.Sc. Nursing (1st Yean, , 5., , Continuity of care may suffer if the daily team assignments vary, , and the patient is confronted with many different caregivers., , 6, 7., , The team leader may not have the leadership skills required to, effectively direct the team and create a "team spirit"., Insufficient time for care planning and communication may lead, to, Therefore responsibilities and care may become, , uncleargoals., , fragmented.
