5.5 Standards of Care

Standards of care in nursing are guidelines that provide a foundation as to how a nurse should act and what they should and should not do in their professional capacity. These guidelines establish a baseline of quality patient care and provide an objective standard of accountability within the profession. Standards of care are enforced by courts of law and state Boards of Nursing, who evaluate a nurse’s practice against these standards. If a nurse’s actions (or lack of actions) do not meet the accepted standard of care, their conduct may be found to be negligent. Standards for nursing care are set by several organizations, including the American Nurses Association (ANA), states’ Nurse Practice Acts, agency policies and procedures, federal regulators, and professional nursing organizations.

American Nursing Association’s Scope and Standards of Practice

In the United States, the American Nurses Association (ANA) publishes two resources that set standards and guide professional nursing practice: Code of Ethics for Nurses and Nursing: Scope and Standards of Practice. The Code of Ethics for Nurses establishes an ethical framework for nursing practice across all roles, levels, and settings.^[1] It is discussed in greater detail in Chapter 5.2. The Nursing: Scope and Standards of Practice describes a professional nurse’s scope of practice and defines the who, what, where, when, why, and how of nursing. It also sets 18 standards of professional practice that all registered nurses are expected to perform competently.^[2]

The ANA’s Standards of Professional Nursing Practice are “authoritative statements of the actions and behaviors that all registered nurses, regardless of role, population, specialty, and setting, are expected to perform competently.”^[3]:

• Ethics. The registered nurse integrates ethics in all aspects of practice.
• Advocacy. The registered nurse demonstrates advocacy in all roles and settings.
• Respectful and Equitable Practice. The registered nurse practices with cultural humility and inclusiveness.
• Communication. The registered nurse communicates effectively in all areas of professional practice.
• Collaboration. The registered nurse collaborates with the health care consumer and other key stakeholders.
• Leadership. The registered nurse leads within the profession and practice setting.
• Education. The registered nurse seeks knowledge and competence that reflects current nursing practice and promotes futuristic thinking.
• Scholarly Inquiry. The registered nurse integrates scholarship, evidence, and research findings into practice.
• Quality of Practice. The registered nurse contributes to quality nursing practice.
• Professional Practice Evaluation. The registered nurse evaluates one’s own and others’ nursing practice.
• Resource Stewardship. The registered nurse utilizes appropriate resources to plan, provide, and sustain evidence-based nursing services that are safe, effective, financially responsible, and judiciously used.
• Environmental Health. The registered nurse practices in a manner that advances environmental safety and health.

American Psychiatric Nurses Association Standards of Practice

In addition to the ANA Standards of Professional Nursing Practice, the American Psychiatric Nurses Association establishes standards of practice for psychiatric-mental health nurse specialists in Psychiatric-Mental Health Nursing: Scope and Standards of Practice.^[4] These standards are built on the ANA’s Standards of Professional Nursing Practice, with additional activities included under the Intervention standard of care. These interventions are further discussed in the “Applying the Nursing Process” section of Chapter 3.

Nurse Practice Act

In addition to the professional standards of practice, nurses must legally follow regulations set by the Nurse Practice Act and enforced by the Board of Nursing in the state where they are employed. The Board of Nursing is the state-specific licensing and regulatory body that sets standards for safe nursing care and issues nursing licenses to qualified candidates, based on the

active listening

Communicating both verbally and nonverbally that we are interested in what the other person is saying while also actively verifying our understanding with them.

Acute grief

Grief that begins immediately after the death of a loved one and includes the separation response and response to stress.

Adaptive coping strategies

Coping strategies including problem-focused coping and emotion-focused coping.

Addiction

Associated with compulsive or uncontrolled use of one or more substances.

ADOPIE

A mnemonic for the components of the nursing process: Assessment, Diagnosis, Outcomes Identification, Planning, Implementation, and Evaluation.

adrenergic agonists

Mimic the effects of the body’s natural SNS stimulation.

adrenergic antagonists

Block SNS receptors.

Adult day care centers

Care that offers people with dementia and other chronic illnesses the opportunity to be social and to participate in activities in a safe environment, while also giving their caregivers the opportunity to work, run errands, or take a much-needed break.

Adults at risk

Adults who have a physical or mental condition that impairs their ability to care for their own needs.

Advance directives

Legal documents that direct care when the patient can no longer speak from themselves, including the living will and the health care power of attorney.

Adverse childhood experiences (ACE)

Traumatic experiences during childhood such as neglect; abuse; or witnessing violence, substance abuse, mental illness, divorce, or imprisonment of a family member.

adverse childhood experiences (ACEs)

Traumatic circumstances experienced during childhood such as abuse, neglect, or growing up in a household with violence, mental illness, substance use, incarceration, or divorce.

Affect

A client’s expression of emotion.

Ageism

Prejudice or discrimination against people based on their age. Ageism has a negative impact on physical and menatl health.

agoraphobia

Intense fear of two or more of the situations such as use of public transportation, being in open spaces, being in enclosed spaces, standing in line, being in a crows, or being outside their home.

agranulocytosis

Extremely low white blood cell count.

akathisia

Motor restlessness.

alexithymia

The inability to describe emotions with how one is feeling.

Alogia

Reduction or poverty in speech.

Alzheimer's disease

An irreversible, progressive brain disorder that slowly destroys memory and thinking skills and eventually the ability to carry out the simplest tasks. It is the most common cause of dementia.

Anergia

Lack of energy.

anhedonia

The inability to experience or even imagine any pleasant emotion.

Anorexia nervosa

A condition where people avoid food, severely restrict food, or eat very small quantities of only certain foods.

Anosognosia

The inability to recognize that one is ill.

anticholinergics

Drugs that block the effects of PNS receptors.

Anticipatory grief

Grief before a loss, associated with diagnosis of an acute, chronic, and/or terminal illness experienced by the client, family, or caregivers.

Antisocial personality disorder

A pervasive pattern of disregard for and violation of the rights of others since age 15.

Anxiety

A universal human experience that includes feelings of apprehension, uneasiness, uncertainty, or dread resulting from a real or perceived threat.

apathy

A lack of feelings, emotions, interests or concerns.

Apathy

Lack of interest in events that one previously found pleasurable.

Aphasia

A language disorder that affects a person's ability to express and understand written and spoken language

Asociality

Decreased desire for social interaction.

Assault

Intentionally putting another person in reasonable apprehension of an imminent harmful or offensive contact.

Assimilation

The process of adopting or conforming to the practices, habits, and norms of a cultural group.

autonomy

The capacity to determine one’s own actions through independent choice, including demonstration of competence.

Avoidant personality disorder

A pervasive pattern of social inhibition, feelings of inadequacy, and hypersensitivity to negative evaluation.

Avoidant restrictive food intake disorder (ARFID)

A condition where individuals limit the amount or type of food eaten.

Avolition

Reduced motivation or goal-directed behavior.

Battery

Intentional causation of harmful or offensive contact with another person without that person’s consent.

Behavioral prevention

Interventions are implemented to encourage individuals to change habits or behaviors by using health promotion strategies.

Beneficence

The bioethical principle of benefiting others by preventing harm, removing harmful conditions, or affirmatively acting to benefit another or others, often going beyond what is required by law.

Bibliotherapy

A behavioral intervention that uses books to help children express feelings in a supportive environment, gain insight into feelings and behavior, and learn new ways to cope with difficult situations.

Binge drinking

Defined as a pattern of alcohol consumption that brings the blood alcohol concentration level to 0.08% or more.

Binge eating

Eating large amounts of food in a short period of time with a feeling of a loss of control.

Binge eating disorder

A condition where people lose control over their eating and have recurring episodes of eating unusually large amounts of food.

Biological therapies

Any form of treatment for mental disorders that attempts to alter physiological functioning, including drug therapies, electroconvulsive therapy, and psychosurgery.

Bipolar I Disorder

The most severe bipolar disorder with at least one manic episode; most individuals experience additional hypomanic and depressive episodes.

Bipolar II Disorder

A pattern of depressive episodes and hypomanic episodes, but individuals have never experienced a full-blown manic episodes typical of Bipolar I Disorder.

Black Box Warning

A significant warning from the Food and Drug Administration (FDA) that alerts the public and health care providers to serious side effects, such as injury or death.

Black Box Warnings

An FDA warning for prescription drugs that highlights potential life-threatening effects and is used to alert healthcare professionals and the public to risks.

blunted

Diminished range and intensity.

Board of Nursing

A state specific licensing and regulatory body that sets standards for nursing care and issues nursing licenses to qualified candidates.

body illusion

A perception that one's own body is significantly different from its actual configuration.

Body mass index (BMI)

A person’s weight in kilograms divided by the square of height in meters.

Borderline personality disorder

A pervasive pattern of instability of personal relationships, self-image, and affect with significant impulsivity.

Boundaries

Limits that we set as individuals that define our identity and promote a sense of autonomy and feeling in control of what we want and don’t want.

boundary impairment

Impaired ability to sense where one’s influence ends and another person’s begins.

bradykinesia

Slowed movement.

Brief interventions

Quick therapeutic techniques used to initiate change in individuals with unhealthy behaviors.

Bulimia nervosa

A condition where people have recurrent and frequent episodes of binge eating.

Capacity

A functional determination that an individual is or is not capable of making a medical decision within a given situation.

Caregiver

A person who has taken responsibility for all or part of an individual's care.

catatonia

A state of unresponsiveness due to a person’s mental state.

Catecholamines

Substances that include epinephrine, norepinephrine, and dopamine and are responsible for the body's “fight-or-flight” response.

chief complaint

The patient’s primary reasons for seeking care.

cholinergics

Drugs that stimulate nicotinic and muscarinic receptors.

circumstantial

Speaking with many unnecessary or tedious details without getting to the point of the conversation.

Civil law

Rights, responsibilities, and legal relationships between private citizens and involves compensation to the injured party.

Clang associations

Stringing words together that rhyme without logical association and do not convey rational meaning.

Clinical prevention

Interventions are delivered one-on-one to individuals in a direct care setting.

Clouded consciousness

A state of reduced awareness to stimuli.

Cognition

The mental action or process of acquiring knowledge and understanding through thought, experience, and the senses.

Cognitive behavioral therapy (CBT)

A type of psychotherapy that helps a person recognize distorted/negative thinking with the goal of changing thought and behaviors to respond to changes in a more positive manner.

Cognitive impairment

A term used to describe impairment in mental processes that drive how an individual understands and acts in the world, affecting the acquisition of information and knowledge.

Cognitive symptoms

Refers to problems in attention, concentration, and memory.

Coma

A state of unarousable unresponsiveness, where vigorous noxious stimuli may not elicit reflex motor responses.

Comfort care

A term commonly used in the acute care setting to describe the shift in care that occurs when the patients and medical team’s goals shift from curative intervention to symptom control, pain relief, and quality of life. However, there is no formal admission to hospice or palliative care that can impact insurance coverage.

Command hallucination

An auditory hallucination that instructs a patient to act in specific ways from innocuous to life-threatening

community diagnosis

A summary statement resulting from analysis of the data collected from a community health needs assessment.

Community health needs assessment

Systematic process to identify and analyze community health needs and assets in order to prioritize these needs, plan, and act upon significant unmet community health needs.

Compassion fatigue

A state of chronic and continuous self-sacrifice and/or prolonged exposure to difficult situations that affect a health care professional’s physical, emotional, and spiritual well-being

Competency

A legal term related to the degree of cognitive ability an individual has to make decisions or carry out specific acts.

Complicated grief

When interference in the grieving process occurs, leading to a prolonged, more intense grieving. There is often preoccupation with the circumstances of the loss, which may manifest as feelings of guilt regarding the situation around the loss.

Compulsions

Repetitive behaviors that a person with OCD feels the urge to do in response to an obsessive thought.

Conduct disorder (CD)

Ongoing pattern of aggression toward others with serious violations of rules and social norms at home, school, and with peers.

Confidentiality

The right of an individual to have personal, identifiable medical information, referred to as protected health information, kept private.

Congruence

Consistency of verbal and nonverbal communication.

controlled substances

Substances regulated by the U.S. Drug Enforcement Agency.

Coordinated specialty care

Recovery-oriented treatment programs for people with first-episode psychosis, an early stage of schizophrenia.

Coping

Cognitive and behavioral efforts made to master, tolerate, or reduce external and internal demands and conflicts.

Coping strategies

An action, series of actions, or a thought process used in meeting a stressful or unpleasant situation or in modifying one’s reaction to such a situation.

Countertransference

A tendency for the examiner to displace (transfer) their own feelings onto the client and then these feelings may influence the client.

Cravings

Powerful urges to use a substance due to many factors including the substance's association with pleasurable feelings and environmental stimuli that activate the dopamine system.

Criminal law

A system of laws that punishes individuals who commit crimes.

crisis

The inability to cope or adapt to a stressor.

Cultural diversity

The quality of different cultures or traditions in a region.

Cultural humility

A humble and respectful attitude toward individuals of other cultures that pushes one to challenge their own cultural biases, realize they cannot know everything about other cultures, and approach learning about other cultures as a life-long goal and process.

Culture

A set of beliefs, attitudes, and practices shared by a group of people or community that is accepted, followed, and passed down to other members of the group.

Cyclothymia

A disorder defined by periods of hypomanic symptoms and periods of depressive symptoms lasting for at least two years (1 year in children and adolescents).

Defamation of character

When an individual makes negative, malicious, and false remarks about another person to damage their reputation.

defendants

The parties named in the lawsuit.

Defense mechanisms

Reaction patterns used by individuals to protect themselves from anxiety that arises from stress and conflict.

Delirium

An onset of an abnormal mental state, often with fluctuating levels of consciousness, disorientation, irritability, and hallucinations.

Delirium tremens (DTs)

A rapid-onset, fluctuating disturbance of attention and cognition that is sometimes associated with hallucinations.

Delusions

Fixed, false belief not held by cultural peers and persisting in the face of objective contradictory evidence.

Dementia

A group of symptoms that lead to a decline in mental function severe enough to disrupt daily life caused by a group of conditions, such as Alzheimer’s disease, vascular dementia, frontal-temporal dementia, and Lewy body disease.

Dependence

When a person suddenly stops using a drug, their body goes through withdrawal, a group of physical and mental symptoms that can range from mild to life-threatening.

Dependent personality disorder

A pervasive and excessive need to be taken care of that leads to submission and clinging behavior and fears of separation.

depressive episode

An episode where the person experiences a depressed mood (feeling sad, irritable, empty) or a loss of pleasure or interest in activities, for most of the day, nearly every day, for at least two weeks.

Development

Physical, social, and cognitive changes that occur continuously throughout one’s life.

Developmental disabilities

A group of conditions with physical, learning, language, or behavioral impairments.

developmental monitoring

Observing for signs of developmental delays.

developmental screening

Formal questionnaires or checklists based on research that ask questions about a child’s development including language, movement, thinking, behavior, and emotions.

Deviance

Behavior that violates social norms or cultural expectations because one's culture determines what is "normal."

Dialectical behavior therapy (DBT)

A type of cognitive behavioral therapy that provides clients with new skills to manage painful emotions and decrease conflict in relationships.

Disenfranchised grief

Grief over any loss that is not validated or recognized. Those affected by this type of grief do not feel the freedom to openly acknowledge their grief.

disheveled

Hair, clothes, or hygiene appears untidy, disordered, unkempt, or messy.

Dissociation

A break in how a person’s mind handles information, causing disconnection from their thoughts, feelings, memories, and surroundings.

Dissociative symptoms

The experience of detachment or feeling as if one is outside one's body with loss of memory.

distractibility

Referring to the client’s attention being easily drawn to unimportant or irrelevant external stimuli.

Distress

Psychological and/or physical pain.

Do-not-resuscitate (DNR) order

A medical order that instructs health care professionals not to perform cardiopulmonary resuscitation.

Do-not-resuscitate order

A medical order that instructs healthcare personnel not to perform CPR

Drug diversion

When medication is redirected from its intended destination for personal use, sale, or distribution to others.

Dyscalculia

Difficulty with math.

Dysfunction

Disturbances in a person’s thinking, emotional regulation, or behavior that reflects significant dysfunction in psychological, biological, or developmental processes underlying mental functioning.

Dysgraphia

Difficulty with writing.

Dyskinesia

Uncontrolled, involuntary movement.

Dyslexia

Difficulty with reading.

Dysphoria

A state of unease or dissatisfaction.

dysphoric

Exhibiting depression.

dystonia

Involuntary contractions of muscles of the extremities, face, neck, abdomen, pelvis, or larynx in either sustained or intermittent patterns that lead to abnormal movements or postures.

Echolalia

Pathological repetition of another person’s words.

Echopraxia

Mimicking movements of another person.

Electroconvulsive Therapy (ECT)

A medical treatment reserved for patients with severe major depression who have not responded to medications, psychotherapy, or other treatments. It involves a brief electrical stimulation of the brain while the patient is under anesthesia.

Emaciation

Extreme thinness.

emergency admission

Individuals are admitted to psychiatric facilities when they are deemed likely to harm themselves or others.

Emotion-focused coping

Adaptive coping strategies such as mindfulness, meditation, and yoga; using humor and jokes; seeking spiritual or religious pursuits; engaging in physical activity or breathing exercises; and seeking social support.

Emotional abuse

Harm to a child’s psychological or intellectual functioning, which is exhibited by severe anxiety, depression, withdrawal, or aggression.

entitlement

Unreasonable expectations of especially favorable treatment.

Environmental prevention

Interventions are implemented for the entire community when laws, policies, physical environments, or community structures influence a community’s health.

environmental risk assessment

Identification of physical environment features that could be used to attempt suicide in clients identifed as at a high risk for suicide.

euphoric

A pathologically elevated sense of well-being.

euthymic

Normal affect and mood with a wide range of emotion appropriate for the situation.

Exposure and Response Prevention (EX/RP)

Spending time in the very situation that triggers compulsions (for example, touching dirty objects) but then being prevented from undertaking the usual resulting compulsion (handwashing).

Exposure therapy

Confronting the fears underlying an anxiety disorder to help people engage in activities they have been avoiding.

Expressive Language

Difficulty communicating thoughts using language due to not knowing the words to use, not knowing how to put words together, or not being able to express the words.

Extrapyramidal (EPS)

Refers to akathisia (agitation, distress, and restlessness), rigidity, bradykinesia (slowed movement), tremor, and dystonia (involuntary contractions of muscles of the extremities, face, neck, abdomen, pelvis, or larynx in either sustained or intermittent patterns that lead to abnormal movements or postures).

Extrapyramidal (EPS) side effects

Refer to akathisia (agitation, distress, and restlessness), rigidity, bradykinesia (slowed movement), tremor, and dystonia (involuntary contractions of muscles of the extremities, face, neck, abdomen, pelvis, or larynx in either sustained or intermittent patterns that lead to abnormal movements or postures).

extrapyramidal side effects

Involuntary or uncontrollable movements. tremors, and muscle contractions.

False imprisonment

An act of restraining another person and causing that person to be confined in a bounded area.

Family dynamics

Refers to the patterns of interactions among relatives, their roles and relationships, and the various factors that shape their interactions.

Family-based therapy

A type of psychotherapy where parents of adolescents with anorexia nervosa assume responsibility for feeding their child.

family-focused therapy

Psychotherapy that focuses on psychoeducation, communication enhancement training, and problem-solving skills.

Financial abuse

Illegal and unauthorized use of money, benefits, and property that belong to an individual for the use of someone other than the individual.

First-generation antipsychotics

Treat positive symptoms of schizophrenia and have several potential adverse effects due to their tight binding to dopamine receptors.

flat

No emotional expression.

Flight of ideas

A state where the client frequently shifts from one topic to another with rapid speech, making it seem fragmented.

Focus groups

Systematic method of data collection through small-group discussions led by a facilitator.

Fraud

An intentional tort that occurs when an individual is deceived for personal gain.

gender dysphoria

Feelings of unease about their incongruent maleness or femaleness.

Gender expression

How an individual presents one’s gender to the outside world, but it does not necessarily correlate with their gender identity.

Gender identity

An individual's innate sense of being male, female, androgenous, nonbinary, or a preference to reject gender designation.

Gender roles

Social constructs based on masculinity and femininity that embody society's expectations of attitudes, behaviors, and personality traits based on one’s biological sex.

generalized anxiety disorder (GAD)

Excessive anxiety and worry, occurring on more days than not for at least six months, about a number of events or activities.

Grandiose delusions

A state of false attribution to the self of great ability, knowledge, importance or worth, identity, prestige, power, accomplishment.

Grief

An emotional response to loss including feelings of loneliness, sadness, guilt, regret, anger, and peace that affects survivors physically, psychologically, socially, and spiritually.

Group therapy

A type of psychotherapy that brings people with similar disorders together in a supportive environment to learn how others cope in similar situations.

Hallucinations

False sensory perceptions not associated with real external stimuli that can include any of the five senses (auditory, visual, gustatory, olfactory and tactile).

health

A state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity.

Health care power of attorney

A legal document that identifies a trusted individual to serve as a decision maker for health issues when the patient is no longer able to speak for themselves.

Health disparities

Health differences that are linked with social, economic, and/or environmental disadvantages.

Health equity

Everyone has a fair and just opportunity to be as healthy as possible.

health inequities

Avoidable differences in health status seen within and between communities.

Health Insurance Portability and Accountability Act (HIPAA)

Federal regulations to ensure the privacy and protection of personal records and information.

healthy community

Local groups from all parts of the community work together to prevent disease and make healthy living options accessible.

Heavy drinking

A female consuming 8 or more drinks per week and a male consuming 15 or more standard drinks per week, or either gender binge drinking on 5 or more days in the past 30 days.

Histrionic personality disorder

A pervasive pattern of excessive emotionality and attention seeking.

Homicidal ideation

Threats or acts of life-threatening harm towards another person.

Hospice care

Patient- and family-centered care that begins after treatment of disease is stopped because the condition is not survivable. The focus is on symptom management and quality of life.

Human trafficking victims

Individuals who are forced to work or provide commercial sex against their will in legal business settings and underground markets.

Hypertensive crisis

Acute rise and significantly elevated blood pressure, typically over 180/120 mm Hg, that causes acute end-organ damage such as stroke, myocardial infarction, or acute kidney damage.

Hypomanic episodes

Episodes similar to symptoms of a manic episode, but they are less severe and do not cause significant impairment in social or occupational functioning or require hospitalization.

Ideas of reference

False beliefs that coincidental events relate to oneself.

Illusions

Misperceptions of real stimuli.

Impairment

A limited ability to engage in activities of daily living.

Inclusiveness

The practice of providing equal access to opportunities and resources for people who might otherwise be excluded or marginalized, such as those having physical or mental disabilities or belonging to other minority groups.

Incongruency

Lack of alignment between response and actions.

Indicated prevention

Interventions that target individuals who have a high probability of developing disease.

Individual trauma

An event, series of events, or set of circumstances that is experienced by an individual as physically or emotionally harmful or life-threatening and can have lasting adverse effects on their functioning and mental, physical, social, emotional, or spiritual well-being.

Informed consent

The fundamental right of an individual to receive information about the risks, benefits, and alternatives in order to make a healthcare decision.

Insight

The client's ability to identify the existence of a problem and to have an understanding of its nature.

Integrative therapies

Psychotherapy that selects theoretical models or techniques from various therapeutic schools to suit the client’s particular problems.

Intellectual disability

A diagnostic term that describes intellectual and adaptive functioning deficits identified during the developmental period.

Intentional torts

Wrongs that the defendant knew (or should have known) would be caused by their actions.

Interpersonal and Social Rhythm Therapy (IPSRT)

Psychotherapy that emphasizes the importance of establishing stable daily routines such as sleeping, waking up, working, and eating meals.

Intersectionality

The expression of more than one cultural or subcultural identity.

Interviews

Structured conversations with individuals who have experience, knowledge, or understanding about a particular topic or issue.

Intimate partner violence (IPV)

Abuse or aggression that occurs in a romantic relationship.

Intoxication

A disturbance in behavior or mental function during or after the consumption of a substance.

involuntary admission

An individual admitted to a psychiatric facility who is diagnosed with a mental illness, pose a danger to themselves or others, are gravely disabled (e.g., unable to provide themselves basic necessities like food, clothing, and shelter), or are in need of treatment but their mental illness prevents voluntary help-seeking behaviors.

Justice

A moral obligation to act on the basis of equality and equity and a standard linked to fairness for all in society.

Key informant interviews

Interviews conducted with people in key positions in the community and have specific areas of knowledge and experience.

labile

A rapid change in emotional responses, mood, or affect that are inappropriate for the moment or the situation.

lanugo

Growth of fine hair all over the body.

Latency

Delayed response.

learning disorder

Difficulty in one or more areas of learning, even when their overall intelligence or motivation are not affected.

Light therapy

Therapy for seasonal affective disorder (SAD) that involves sitting in front of a light therapy box that emits a very bright light. It usually requires 20 minutes or more per day, typically first thing in the morning, during the winter months.

lithium toxicity

Elevated lithium levels resulting in diarrhea, vomiting, drowsiness, muscular weakness, and lack of coordination.

Living will

A legal document that describes the patient’s wishes if they are no longer able to speak for themselves due to injury, illness, or a persistent vegetative state.

Loose associations

Jumping from one idea to an unrelated idea in the same sentence. For example, the client might state, “I like to dance, my feet are wet.

Loss

The absence of a possession/person or future possession with the response of grief.

Magical thinking

The idea that one can influence the outcome of specific events by doing something that has no bearing on the circumstances.

major life activities

Caring for oneself, performing manual tasks, seeing, hearing, eating, sleeping, walking, standing, lifting, bending, speaking, breathing, learning, reading, concentrating, thinking, communicating, and working.

Maladaptive coping responses

Ineffective responses to stressors such as avoidance of the stressful condition, withdrawal from a stressful environment, disengagement from stressful relationships, and misuse of drugs and/or alcohol.

Malpractice

A specific term used for negligence committed by a health professional with a license.

mandated reporters

Individuals required by state law to report suspected neglect or abuse of children, adults at risk, and the elderly.

manic episode

A persistently elevated or irritable mood with abnormally increased energy lasting at least one week.

Marginalization

The treatment of an individual or group as less significant, or peripheral to the mainstream population

Maslow’s Hierarchy of Needs

Used to prioritize the most urgent patient needs.

Mental health

A state of well-being in which an individual realizes their own abilities, copes with the normal stresses of life, works productively, and contributes to their community.

mental health continuum

A continuum of mental health, ranging from well-being to emotional problems to mental illness.

Mental health disorders among children

Serious changes in the way children typically learn, behave, or handle their emotions, causing distress and problems getting through the day.

mental illness

A health condition involving changes in emotion, thinking, or behavior (or a combination of these) associated with emotional distress and problems functioning in social, work, or family activities.

mental status examination

An assessment of a client’s level of consciousness and orientation, appearance and general behavior, speech, motor activity, affect and mood, thought and perception, attitude and insight, and cognitive abilities.

Metabolic syndrome

A cluster of conditions that occur together, increasing the risk of heart disease, stroke, and type 2 diabetes.

migrant worker

A person who moves within their home country or outside of it to pursue work.

Milieu therapy

Nursing interventions used to assist health care consumers to make positive change and promote recovery in a therapeutic milieu.

Mood

The predominant emotion expressed by an individual.

Motivational interviewing (MI)

A communication skill used to elicit and emphasize a client’s personal motivation for modifying behavior to promote health.

Motor tics

Movements of the body such as blinking, shrugging the shoulders, or jerking an arm.

Mourning

The outward expression of loss based on cultural norms, customs, and practices.

Music therapy

An evidence-based approach to improve an individual’s physical, psychological, cognitive, behavioral, and social functioning when listening to music, singing, or moving to music.

Narcissistic personality disorder

A pervasive pattern of grandiosity (in fantasy or behavior), need for attention, and lack of empathy.

Negative symptoms

Refers to loss of motivation, disinterest or lack of enjoyment in daily activities, social withdrawal, difficulty showing emotions, and difficulty functioning normally.

Neglect

When a parent or caretaker fails, refuses, or is unable, for reasons other than poverty, to provide the necessary care, food, clothing, or medical or dental care, which seriously endangers the physical health of the child.

Negligence

The failure to exercise the ordinary care a reasonable person would use in similar circumstances.

Neologisms

A newly coined word that has meaning only to the person using it.

neuroadaptations

Progressive changes in the structure or function of the brain due to misue of alcohol or other substances.

Neuroleptic malignant syndrome (NMS)

A rare but fatal adverse effect that can occur at any time during treatment with antipsychotics. Signs include increased temperature, severe muscular rigidity, confusion, agitation, hyperreflexia, elevation in white blood cell count, elevate creatinine phosphokinase, elevated liver enzymes, myoglobinuria, and acute renal failure.

Neurotransmitters

Chemical substances released at the end of a neuron by the arrival of an electrical impulse.

Non-suicidal self-injury (NSSI)

Intentional self-inflicted destruction of body tissue without suicidal intention and for purposes not socially sanctioned.

Nonmaleficence

The bioethical principle that specifies a duty to do no harm and balances avoidable harm with benefits of good achieved.

Nonsubstance related disorders

Excessive behaviors related to gambling, viewing pornography, compulsive sexual activity, Internet gaming, overeating, shopping, overexercising, and overusing mobile phone technologies.

Nurse Practice Act

A legislative act that establishes regulations for nursing practice within that state and defines the scope of nursing practice.

nurse-client relationship

A relationship that establishes trust and rapport with a specific purpose of facilitating therapeutic communication and engaging the client in decision-making regarding their plan of care.

nursing process

A critical thinking model based on a systematic approach to patient-centered care.

Obsessions

Persistent thoughts, ideas, images, or impulses that are experienced as intrusive or inappropriate and result in anxiety, distress, or discomfort.

Obsessive-compulsive disorder (OCD)

A common chronic disorder in which a person has uncontrollable, reoccurring thoughts (obsessions) and/or behaviors (compulsions) they feel the urge to repeat over and over.

Obsessive-compulsive personality disorder

A pervasive pattern or preoccupation with orderliness, perfectionism, and mental and interpersonal control at the expense of flexibility, openness, and efficiency.

Obtundation

A moderate reduction in the client's level of awareness so that mild to moderate stimuli do not awaken the client. When arousal does occur, the patient is slow to respond.

Opiates

Powerful analgesics (such as morphine and oxycodone) prescribed to treat moderate to severe pain, as well as illicit drugs (such as heroin).

opioid receptors

The mu, delta, and kappa receptors.

oppositional defiant disorder (ODD)

Act out persistently causing serious problems at home, in school, or with peers.

outcome

Measurable behavior demonstrated by the patient who is responsive to nursing interventions.

Overdose

The biological response of the human body when too much of a substance is ingested.

Palliative care

Patient- and family-centered care that optimizes quality of life, anticipating, preventing, and treating suffering.

Panic

The most extreme level of anxiety that results in significantly dysregulated behavior.

Panic attacks

Sudden periods of intense fear that come on quickly and reach their peak within minutes.

Paranoia

A condition characterized by delusions of persecution.

Paranoid personality disorder

A pervasive distrust and suspiciousness of others such that their motives are interpreted as malevolent.

Parish nurses

Nurses who use their skills for church or parish members in paid or volunteer positions.

perinatal depression

Depressive disorder that occurs during pregnancy.

personality

A relatively stable pattern of thinking, feeling, and behaving that evolves over a person’s lifetime and is unique to each individual.

personality disorder

An enduring pattern of inner experience and behavior that deviates significantly from the expectations of one’s culture.

Personality traits

Characteristics, whether considered good or bad, that make up one’s personality.

phobia

Intense fear or aversion to specific objects or situations.

Physical abuse

Defined as injury inflicted on a child by other than accidental means.

Pica

Type of eating disorder in which an individual repeatedly eats things that are not considered food and have no nutritional value, such as paper, dirt, soap, hair, glue, or chalk.

plaintiff

A person bringing the lawsuit.

Play therapy

Encourages children to express feelings such as anxiety, self-doubt, and fear through their natural play.

PNS receptors

Nicotinic and muscarinic receptors that are stimulated by acetylcholine (ACh).

Post-traumatic stress disorder (PTSD)

Can develop in some people who have experienced a shocking, frightening, or dangerous event. It is natural to feel afraid during and after a traumatic situation, and the “fight-or-flight” stress response is a physiological reaction intended to protect a person from harm.

Postpartum depression

Feelings of extreme sadness, anxiety, and exhaustion that may make it difficult for mothers of newborns to complete daily care activities for themselves and/or for their babies.

postpartum psychosis

Severe postpartum depression can cause delusions (thoughts or beliefs that are not true), hallucinations (seeing, hearing, or smelling things that are not there), mania (a high, elated mood that often seems out of touch with reality), paranoia, and confusion.

poverty of content

A conversation in which the client talks without stating anything related to the question or their speech in general is vague and meaningless.

Primary data collection

Data collection that occurs through public forums, focus groups, interviews, windshield surveys, surveys, and participant observation.

Primary prevention

Interventions aimed at susceptible populations or individuals to prevent disease from occurring.

Primordial prevention

Risk factor reduction strategies focused on social and environmental conditions that affect vulnerable populations.

Problem-focused coping

Adaptive coping strategies that typically focus on seeking treatment such as counseling or cognitive behavioral therapy.

Protected Health Information (PHI)

Individually identifiable health information, including demographic data, that relates to the individual’s past, present, or future physical or mental health or condition; the provision of health care to the individual; and the past, present, or future payment for the provision of health care to the individual.

Protective factors

Factors that help prevent substance use disorders from developing despite the risk factors that are present.

Psychiatric Advance Directive (PAD)

A legal document that describes a person’s preferences for future mental health treatment or names an individual to make treatment decisions for them if they are in a crisis and unable to make decisions.

Psychiatric-mental health nursing

A nursing speciality in which registered nurses with a bachelor’s degree, two years of full-time work, and 30 hours of continuing education can receive board certification.

psychomotor agitation

A condition of purposeless, non goal-directed activity.

psychomotor retardation

A condition of extremely slow physical movements, slumped posture, or slow speech patterns.

psychosis

Conditions where there is a loss of contact with reality.

psychosocial assessment

A component of the nursing assessment process that obtains additional subjective data to detect risks and identify treatment opportunities and resources.

Psychotherapy

A variety of treatment techniques that help an individual identify and change troubling emotions, thoughts, and behaviors.

Psychotherapy interventions

All generally accepted and evidence-based methods of brief or long-term therapy, including individual therapy, group therapy, marital or couple therapy, and family therapy.

Psychotic symptom

Include hallucinations, delusions, thought disorders, disorganized speech, and alterations in behaviors.

Psychotropic medications

Medications that affect the mind, emotions, and behavior.

Public forums

Gatherings where large groups of citizens discuss important issues at well-publicized locations and times.

Public health nurses

Nurses who work across various settings in the community such as government agencies, community-based centers, shelters, and vaccine distribution sites.

Purging episodes

Eating large amounts of food in a short time followed by vomiting or using laxatives or diuretics to eliminate what was consumed.

Quaternary prevention

Actions taken to protect individuals from medical interventions that are likely to cause more harm than good and to suggest interventions that are ethically acceptable.

Racing thoughts

Fast moving and often repetitive thought patterns that can be overwhelming.

Rapid cycling

At least four mood episodes associated with bipolar disorder occurring in a 12-month period.

Receptive Language

Difficulty understanding what others say due to not hearing the words (hearing loss) or not understanding the meaning of the words.

Recovery

A process of change through which individuals improve their health and wellness, live a self-directed life, and strive to reach their full potential.

refeeding syndrome

A syndrome in which individuals exhibit hypophosphatemia, sodium and fluid imbalances; changes in glucose, protein, and fat metabolism; thiamine deficiency; hypokalemia; and hypomagnesaemia.

Relapse

The return to substance use after a significant period of abstinence.

remission

Individuals with severe substance use disorders can overcome their disorder with effective treatment and regain health and social function.

Repetitive Transcranial Magnetic Stimulation (rTMS)

Uses a magnet to activate the brain.

resilience

The ability to rise above circumstances or meet challenges with fortitude.

Resilience factors

Supports that lessen the risk for traumatic stress disorders, such as supportive family and friends, support groups, and strong coping skills.

Resiliency

The ability to cope with adversity and recover emotionally from a traumatic event.

Resilient zone

Healthy balance of SNS and PNS stimulation.

Respite care

Care provided at home (by a volunteer or paid service) or in a care setting, such as adult day care or residential facility, that allows the caregiver to take a much-needed break.

Restraints

Devices used in health care settings to prevent patients from causing harm to themselves or others when alternative interventions are not effective.

Role fidelity

Being responsible for providing competent nursing care.

Rumination

Obsessional thinking involving excessive, repetitive thoughts that interfere with other forms of mental activity.

Safety plan

A set of actions that can help lower the risk of being hurt by an abusive partner.

Schizoid personality disorder

A pervasive pattern of detachment from social relationships and a restricted range of expression of emotions in interpersonal settings.

Schizophrenia

Mental illness characterized by periods of psychosis for at least six months.

Schizotypal personality disorder

A pervasive pattern of social and interpersonal deficits marked by acute discomfort with and reduced capacity for close relationships, as well as by cognitive or perceptual distortions and eccentricities of behavior.

School nurses

Nurses who provide direct care for children with chronic health problems and administer medications prescribed during school hours.

Seasonal affective disorder (SAD)

A type of depression causing symptoms during the fall and winter months when there is less sunlight and usually improves with the arrival of spring.

Seclusion

The confinement of a patient in a locked room or an area from which they cannot exit on their own.

Second-generation antipsychotics

Treat both positive and negative symptoms of schizophrenia.

Secondary analysis

Analyzing previously collected data to determine community needs.

Secondary prevention

The early detection of disease and targets healthy-appearing individuals with subclinical forms of disease.

Selected prevention

Interventions that target individuals or groups with greater risk factors (and perhaps fewer protective factors) than the broader population.

Selective mutism

People fail to speak in specific social situations despite having normal language skills.

separation anxiety

Being very afraid when away from parents or caregivers.

separation anxiety disorder

Fears about being separated from people to whom they are attached.

serious mental illness

Mental illness that causes disabling functional impairment that substantially interferes with one or more major life activities.

Serotonin Syndrome

A medical emergency that can occur in clients taking medications that affect serotonin levels.

Sexual abuse

Sexual intercourse or sexual touching of a child; sexual exploitation; sex trafficking of a child; forced viewing of sexual activity; or permitting, allowing, or encouraging a child to engage in prostitution.

sexual identity

Individual's assessment of their sexual orientation.

Sexual orientation

Individual's pattern of physical, emotional, and romantic arousal (including fantasies, activities, and behaviors) and the gender(s) of persons to whom an individual is physically or sexually attracted.

SLUDGE

A mnemonic for anticholinergic side effects.

SNS receptors

Alpha-1, Alpha-2, Beta-1, and Beta-2 receptors.

social anxiety disorder

Marked fear or anxiety about one or more social situations in which the individual is exposed to possible scrutiny by others.

Social determinants of health (SDOH)

Conditions in which people are born, grow, work, live, and age.

Social norms

Stated and unstated rules of their society.

Social vulnerability

The characteristics of a person or a community that affect their capacity to anticipate, confront, repair, and recover from the effects of a disaster.

SOLER

A mnemonic for effective nonverbal communication.

somatization

Psychological stress is expressed through physical concerns such as headaches and stomachaches.

Spirituality

A sense of connection to something larger than oneself and typically involves a search for meaning and purpose in life.

splitting

A pattern of unstable and intense personal relationships characterized by alternating between extremes of idealization and devaluation.

standard drink

Defined as 14 grams (0.6 ounces) of pure alcohol.

Standards of Professional Nursing Practice

Authoritative statements of the actions and behaviors that all registered nurses, regardless of role, population, specialty, and setting, are expected to perform competently.

Standards of Professional Performance

12 additional standards that describe a nurse’s professional behavior, including activities related to ethics, advocacy, respectful and equitable practice, communication, collaboration, leadership, education, scholarly inquiry, quality of practice, professional practice evaluation, resource stewardship, and environmental health.

Stigma

A cluster of negative attitudes and beliefs that motivates the general public to fear, reject, avoid, and discriminate against people with conditions like mental illness.

stress response

The body’s physiological response to a real or perceived stressor.

Stressors

Any internal or external event, force, or condition that results in physical or emotional stress.

Stupor

A state of unresponsiveness unless a vigorous stimulus is applied, such as a sternal rub.

substance

A psychoactive compound with the potential to cause health and social problems, including substance use disorder.

Substance misuse

The use of alcohol or drugs in a manner, situation, amount, or frequency that could cause harm to the user or to those around them.

Substance use

The use of any of the psychoactive substances.

substance use disorder (SUD)

An illness caused by repeated misuse of substances such as alcohol, caffeine, cannabis, hallucinogens, inhalants, opioids, sedatives, hypnotics, anxiolytics, stimulants (amphetamines, cocaine, and other stimulants), and tobacco.

Substance use disorders

Recurrent use of alcohol and/or drugs causes clinically significant impairment, including health problems, disability, and failure to meet major responsibilities at work, school, or home.

suicidal ideation

Thoughts of killing oneself.

Suicide

Death caused by injuring oneself or ingesting substances with the intent to die

Suicide attempt

A term used to describe an individual who harms themselves with intent to end their life but does not die as a result of their actions.

Suicide plan

An individual who has a plan for suicide, has the means to injury oneself, and has the intent to die.

suicide risk assessment

Identifying the risk of a client committing suicide by assessing suicidal ideation, plan, intent, suicidal or self-harm behaviors, risk factors, and protective factors.

Sundowning

A period of increased confusion, anxiety, agitation, pacing, and disorientation in patients with dementia that often begins at dusk and continues throughout the night. The cause is unknown.

Surveys

Standardized questions that are relatively easy to analyze.

Sympathetic nervous system (SNS)

Part of the autonomic nervous system that activates the 'fight or flight' responses such as increases in heart rate and respiratory rate.

Tangential speech

Speech with a wandering train of thought that never returns to the main point of a conversation

tardive dyskinesia

A syndrome of movement disorders that persists for at least one month and can last up to several years despite discontinuation of the medications.

Tardive dyskinesia (TD)

A syndrome of movement disorders that can occur in clients taking first-generation antipsychotics.

Teen dating violence (TDV)

Intimate partner violence (IPV) that occurs during adolescence.

Telehealth

The use of digital technologies to deliver medical care, health education, and public health services by connecting multiple users in separate locations.

Teletherapy

Mental health counseling over the phone or online with videoconferencing tools.

Temperament

An individual's natural, biologically based behavioral tendencies and emotional reactions, present from birth

Tertiary prevention

Implemented for symptomatic clients to reduce the severity of the disease and potential long-term complications.

Therapeutic communication

A type of professional communication defined as the purposeful, interpersonal, information-transmitting process that leads to client understanding and participation.

therapeutic milieu

A safe, welcoming, supportive, and functional physical treatment environment.

Third-generation antipsychotics

Newer antipsychotic medications that have partial D2 agonism, as opposed to D2 blockade, resulting in less adverse effects such as weight gain.

Tics

Sudden twitches, movements, or sounds that people do repeatedly with the inability to stop their body from doing these action.

Time-out

An age-appropriate removal from an activity for a child or adolescent for a set period of time to promote self-control and self-reflection.

Tolerance

A need for progressively increased amounts of a substance to achieve the desired effect or a diminished effect with continued use of the same amount of a substance.

tort

An act of commission or omission that gives rise to injury or harm to another and amounts to a civil wrong for which courts impose liability.

Transcranial Magnetic Stimulation (TMS)

A noninvasive procedure that uses magnetic fields to stimulate nerve cells in the brain to improve symptoms of depression.

Transference

When the client projects (i.e., transfers) their feelings to the nurse.

Transgender

A gender identity or gender expression that differs from the sex they were assigned at birth.

Trauma

An event, series of events, or set of circumstances that is experienced by an individual as physically or emotionally harmful and can have lasting adverse effects on the individual’s functioning and physical, social, emotional, or spiritual well-being.

Trauma-informed care (TIC)

A strengths-based approach to providing client care that is grounded in an understanding of the impact of trauma. It emphasizes physical, psychological, and emotional safety for both providers and survivors and creates opportunities for survivors to rebuild a sense of control and empowerment referred to as resilience.

Unintentional torts

Occur when the defendant’s actions or inactions were unreasonably unsafe.

Universal prevention

Interventions designed to reach entire groups, such as those in schools, workplaces, or entire communities.

Veracity

Telling the truth.

Vocal tics

Sounds that a person makes with his or her voice such as grunting, humming, clearing the throat, or yelling out a word or phrase.

voluntary admissions

Individuals over age 16 who present to a psychiatric facility and request hospitalization.

vulnerable population

A group of individuals who are at increased risk for health problems and health disparities.

Well being

The “healthy” range of the mental health continuum where individuals are experiencing a state of good mental and emotional health

Well-being

The “healthy” range of the mental health continuum where individuals are experiencing a state of good mental and emotional health.

WHODAS

A generic assessment instrument that provides a standardized method for measuring health and disability across cultures.

windshield survey

Type of direct observation of community needs while driving and literally looking through the windshield.

withdrawal

A group of physical and mental symptoms that can range from mild to life-threatening.

Withdrawal management

Interventions aimed at managing the physical and emotional symptoms that occur after a person suddenly stops using a psychoactive substance.

word salad

Severely disorganized and virtually incomprehensible speech or writing, marked by severe loosening of associations.

Workplace violence

The act or threat of violence, ranging from verbal abuse to physical assaults directed toward persons at work or on duty.

Nurse Practice Act [/pb_glossary]enacted by that state’s legislature. The Nurse Practice Act establishes regulations for nursing practice within that state and defines the scope of nursing practice. If nurses do not follow the standards and scope of practice set forth by the Nurse Practice Act, they can have their nursing license revoked by the Board of Nursing.

Nursing students are legally accountable for the quality of care they provide to patients just as nurses are accountable. Students are expected to recognize the limits of their knowledge and experience and appropriately alert individuals in authority regarding situations that are beyond their competency. A violation of the standards of practice constitutes unprofessional conduct and can result in the Board of Nursing denying a license to a nursing graduate.

Employer Policies, Procedures, and Protocols

In addition to following professional nursing standards and the state Nurse Practice Act, nurses and nursing students must also practice according to agency policies, procedures, and protocols. For example, each agency has specific policies regarding the use of restraints. If a nurse did not follow this policy and a patient was injured or died, the nurse could be held liable in a court of law.

Agencies also have their own sets of procedures and protocols. For example, each agency has specific procedural steps for performing nursing skills, such as inserting urinary catheters. Agencies also have protocols that are precisely written plans for a regimen of therapy. For example, agencies typically have a hypoglycemia protocol that nurses automatically implement when a patient’s blood sugar falls below a specific number and includes actions such as providing orange juice and rechecking the blood sugar. These agency-specific policies, procedures, and protocols supersede the information taught in nursing school, and nurses and nursing students can be held legally liable if they don’t follow them. Therefore, it is vital for nurses and nursing students to review and follow current agency-specific procedures, policies, and protocols when providing patient care.

Federal Regulations

In addition to professional standards, state Nurse Practice Acts, and employer policies, procedures, and protocols, nursing practice is also influenced by federal regulations enacted by government agencies such as The Joint Commission and the Centers for Medicare and Medicaid.

The Joint Commission (TJC) is a national organization that accredits and certifies over 20,000 health care organizations in the United States. The mission of The Joint Commission is to continuously improve health care by setting standards for providing safe, high-quality health care. The Centers for Medicare & Medicaid Services (CMS) enforces quality standards in health care organizations that receive Medicare and Medicaid funding. Nurses must follow standards set by these agencies and implemented by their employers. For example, the expectation that a nurse checks medication rights three times before administering medication to a patient is based on a federal regulation.