Ming is particularly drawn to the idea of becoming an advanced practice registered nurse (aprn)

Presentation on theme: "Chapter 1 Nursing Today Nursing is both an art and a science."— Presentation transcript:

1 Chapter 1 Nursing Today Nursing is both an art and a science.
The science is based on a body of knowledge that is constantly changing and evolving. The art is based on the practice of compassion, respect, and dignity rendered to the patient and family members alike. Remember, even though the patient is the center of your care, the family, significant others, and community will have needs. When rendering care, you will be guided by a code of ethics developed by the American Nurses Association and practiced by nurses. As you begin your practice, you will incorporate ANA standards, evidence-based practice, and critical thinking skills. As the weeks unfold, you will read further on these topic areas in: Chapter 5: Evidence-Based Practice Chapter 15: Critical Thinking in Nursing Practice

2 Historical Perspective Highlights
Nurses: Respond to needs of patients Actively participate in policy Respond and adapt to challenges Make clinical judgments and decisions about patients’ health care needs based on knowledge, experience, and standards of care Nursing: Care is provided according to standards of practice and a code of ethics. •Nursing responds to the health care needs of society, which are influenced by economic, social, and cultural variables of a specific era. Nurses exert great influence in social policy and political arenas. We have a strong organization (American Nurses Association) and strong lobbyists who propose legislation to care for our patients. Through nursing research and evidenced-based practice (see Chapter 5), nurses have been able to carry on the traditions that Florence Nightingale began in the Crimean War. Florence dealt with battlefield conditions that gave rise to infection, illness, and mortality. The twenty-first century nurse deals with pain management, nutrition management, care of the elder population, and care of the infant and the underserved child. As the health care system changes, the art, science, and practice of nursing continues to evolve. Nursing draws not only from science, but also from the humanities and social sciences. As nurses use and adapt this body of knowledge, nursing practice grows and evolves. •Nursing definitions reflect changes in the practice of nursing and help bring about changes by identifying the domain of nursing practice and guiding research, practice, and education.

3 Florence Nightingale First practicing epidemiologist
Organized first school of nursing Improved sanitation in battlefield hospitals Her practices remain a basic part of nursing today. Florence Nightingale believed that the role of nurses was to help the body recover, and then remain free, from disease. Nightingale was the first practicing epidemiologist. She used her keen mind and statistical analysis to show the connection between poor sanitation and diseases like cholera and dysentery. In 1860, Florence organized the first school of nursing, the Nightingale Training School for Nurses, at St. Thomas’ Hospital in London. Known as the Lady with the Lamp, Nightingale crossed the battlefields of the Crimean War with her lantern. By improving sanitation in battlefield hospitals, she showed how effective fresh air, hygiene, and nutrition were in the treatment of wounded soldiers. The practices she advocated remain a basic part of nursing care in the twenty-first century.

4 Civil War to the Beginning of the Twentieth Century
The growth of nursing in the United States: Clara Barton founded the American Red Cross. Dorothea Lynde Dix Mother Bickerdyke Harriet Tubman Mary Mahoney Isabel Hampton Robb Lillian Wald and Mary Brewster: Henry Street Settlement The Civil War, fought from 1861 to 1865, made nursing a necessity. Clara Barton tended to soldiers on the battlefield. Dorothea Lynde Dix was the supervisor of female nurses in the Union Army. Mother Bickerdyke organized ambulance service, supervised nurses, and searched for abandoned, wounded soldiers on the battlefield. Harriet Tubman was a prominent female in the Underground Railroad movement to free slaves. Mary Mahoney was the first professionally educated African-American. She may be one of the first proponents of better relationships between cultures and races and respect for individuals regardless of background, race, color, or religion. Isabel Hampton Robb helped found the American Nurses Association in She was an influential author with the following titles: Nursing: Its Principles and Practice for Hospital and Private Use; Nursing Ethics; and Educational Standards for Nurses. She was one of the original founders of the American Journal of Nursing. In 1893, nursing expanded in the community owing to the influence of Lillian Wald and Mary Brewster. Nurses working in the settlement they established were some of the first to demonstrate autonomy in practice because they frequently encountered situations that required quick and innovative problem solving and critical thinking without the supervision or direction of a health care provider.

5 The Twentieth Century Movement toward scientific, research-based practice and defined body of knowledge 1901: Army Nurse Corps established 1906: Mary Adelaide Nutting, first professor of nursing at Columbia University 1908: Navy Nurse Corps established : Study of nursing education 1940s and 1950s: Associations emerged 1970: Emergency Room Nurses Organization A number of events began to shape nursing education in the twentieth century. In 1901, the Army Nurse Corps was established, followed by the Navy Nurse Corps in 1908. Under the influence of Mary Adelaide Nutting, nursing education moved into U.S. universities in the early twentieth century. In 1906, Nutting became the first professor of nursing at Columbia University Teachers College. Another important development in nursing history occurred when the Rockefeller Foundation approached Nutting, along with Lillian Wald and Annie Goodrich, to study nursing education. Their study, conducted in 1920 and published in 1923, concluded that nursing education needed financial support and should be centered in university schools of nursing. In the 1920s, nursing education continued to develop as specialty areas of nursing began to emerge. However, organizations supporting these areas would not develop until the 1940s and 1950s. These organizations include the Association of Operating Room Nurses, The American Association of Critical Care Nurses, and the Oncology Nursing Society. In 1970, the Emergency Room Nurses Organization was formed, which changed its name to Emergency Nurses Association in 1995.

6 The Twenty-First Century
Nursing code of ethics Changes in curriculum Nursing in multiple care settings Advances in technology and informatics End-of-life care The American Nurses Association established the Center for Ethics and Human Rights in the 1990s. This center helps nurses at large address complex ethical and human rights issues. In 2001, the code of ethics was revised to reflect current ethical issues that affect nursing practice. (See also Chapter 22, Ethics and Values.) The nursing curriculum has continued to change to meet changing societal needs. Issues such as bioterrorism, emerging infections, disaster management, and technology advances were not included in the curriculum as late as 10 years ago. Today, nurses work in multiple settings. Nurses also work in non–patient care environments to support the needs of nursing, nursing education, and patient care. [Ask students in what other areas nurses can work and still support nursing, nursing education, and the patient? Answer: politics, lobbying groups, not-for-profit agencies] The End-of-Life Nursing Education Consortium (ELNEC), offered collaboratively by the American Association of Colleges of Nursing (AACN) and the City of Hope Medical Center, has brought end-of-life care and practices into nursing curricula and professional continuing education programs for practicing nurses.

7 Influences on Nursing Changes in society lead to changes in nursing:
Health care reform Demographic changes Medically underserved Threat of bioterrorism Rising health care costs Nursing shortage [Demographics: What types of changes affect health care? Answers: people moving from rural to urban centers, increased life span, increase in patients living with chronic illnesses (we have better drugs and therapy available), increases in alcoholism and lung cancer (and other cancers)] Nurses have always cared for patients inside and outside of the medical system. We promote the rights of minorities, immigrants, the underinsured, and the uninsured to receive high-quality health care. The rising rates of unemployment, mental illness, and homelessness make our advocacy more important than ever. Nurses can be proud that they created bills of rights for dying, hospitalized, and pregnant patients. To prepare for the threat of terrorism, the nursing curriculum and health care agencies are training future and practicing nurses to deal with nuclear, chemical, and biological events. As a nurse, you are responsible for providing the patient with the best-quality care in an efficient and economically sound manner. The nursing shortage affects all aspects of nursing such as patient care, administration, and nursing education, but it also presents challenges and opportunities for the profession. [What other factors have influenced nursing? Discuss technology, consumerism, health promotion, and the effects of the women’s and human rights movements on nursing.]

8 Nursing as a Profession
A profession has characteristics: Requires an extended education Requires a body of knowledge Provides a specific service Has autonomy Incorporates a code of ethics No one factor absolutely differentiates a job from a profession, but the difference is important in terms of how you practice. To act professionally, you administer quality patient-centered care in a safe, conscientious, and knowledgeable manner. Nursing is a profession because we share the characteristics of a profession. You will be educated and trained to care for others. You will be required to take college/university courses to complete general education requirements. You will use a theoretical body of knowledge that guides you to develop skills and define your abilities and practice according to a clear set of norms. You will be providing a service to others. You will have autonomy in decision making and practice. A code of ethics will guide your practice. Your skills, the body of knowledge you will have mastered, the norms you will adhere to, and the service you provide will make you a member of a profession.

9 Scope and Standards of Practice
Nursing: Scope and Standards of Practice 1960: Documentation began Standards of Practice Standards of Professional Performance Goal To improve the health and well-being of all individuals, communities, and populations through the significant and visible contributions of registered nursing using standards-based practice Since 1960, the ANA has been documenting the scope of nursing and developing Standards of Practice. [Discuss Box 1-1, ANA Standards of Nursing Practice (p. 4 of the text).] Within this document are the Standards of Practice and the Standards of Professional Performance.

10 Standards of Practice Nursing standards provide the guidelines for implementing and evaluating nursing care. Six standards of practice: Assessment Diagnosis Outcomes identification Planning Implementation Evaluation These Standards of Practice are also referred to as nursing process, and are discussed further in Chapters 16 through 20. [Discuss each.] [Refer students to Box 1-1 for more info (p. 4 of the text).] These Standards of Care, the nursing process, will guide the care you render to your patients in all health care facilities. Implementation includes coordination of care, health teaching and health promotion, consultation, and prescriptive authority and treatment.

11 Standards of Professional Performance
Ethics Quality of Practice Professional Practice Evaluation Education Communication Resources Evidence-Based Practice and Research Leadership Environmental Health Collaboration The ANA has identified 10 Standards of Professional Performance. [Refer students to Box 1-2 (on p. 5 of the text).] These standards serve as objective guidelines for nurses to follow. They help nurses be accountable for their actions, their patients, and their peers.

12 Code of Ethics A code of ethics is the philosophical ideals of right and wrong that define principles used to provide care. It is important for you to incorporate your own values and ethics into your practice. Ask yourself: How do your ethics, values, and practice compare with established standards? The last component of what makes nursing a profession is our code of ethics. It will be important to incorporate the ANA code of ethics, as well as your personal values and ethics, into your nursing practice. [Advise students that this topic is discussed further in Chapter 22, Ethics and Values.]

13 Quick Quiz! 1. Nursing is defined as a profession because nurses A. Perform specific skills. B. Practice autonomy. C. Utilize knowledge from the medical discipline. D. Charge a fee for services rendered. Answer: B

14 Nursing Education Professional registered nurse education
2-year associate’s degree 4-year baccalaureate degree Graduate education Master’s degree, advanced practice RN Doctoral degrees Continuing and in-service education Members of a profession require an extended education, as well as a basic foundation in the liberal arts. To become a nurse, you must enroll in a school, college, or university. A long-standing debate has focused on what should be required for entry into practice. Should a registered nurse study at a diploma, 2-year, or 4-year program? All students who graduate from schools of nursing are eligible to take the National Council Licensure Examination for Registered Nurses (NCLEX-RN). Two-year college: Focuses on basic sciences and theoretical/clinical courses related to practice of nursing. Four-year college/university: Focuses on basic sciences and theoretical/clinical courses, as well as social sciences, arts, and humanities, to support nursing theory. National League for Nursing Accreditation Council (NLNAC), which schools voluntarily join, publishes interpretive guidelines that identify core competencies for the professional nurse as well. NLNAC also supports the Pew Health Commission and the Institute of Medicine's Competencies for Health Professionals. A master’s degree in nursing is important for the roles of nurse educator and nurse administrator, and it is required for an advanced practice registered nurse (APRN). Expanding clinical roles and continuing demand for well-educated nursing faculty, nurse administrators, and APRNs in clinical settings and new nursing specialties such as nursing informatics are just a few reasons for increasing the number of doctorally prepared nurses. Continuing and in-service education are ways to continue your education. You will continue to develop or learn additional knowledge, skills, and competencies necessary for the practicing registered nurse.

15 Case Study Ming graduated with an associate’s degree in nursing last year and currently works in a long-term care facility. Although Ming enjoys his work and has been promoted to shift supervisor on his unit, he finds that he’d like to pursue a nursing career that offers a regular schedule and more autonomy than he currently experiences at the long-term care facility. Ming considers returning to school for an advanced degree. [Ask the class: What are some options open to Ming?] Ming’s research indicates that accelerated RN to MSN programs are available, where he may obtain a master’s degree.

16 Nursing Practice Nurses practice in a variety of settings. Nurses:
Protect, promote, and optimize our patients’ health Prevent illness and injury Alleviate suffering through the diagnosis and treatment of human responses Advocate for the care of our patients Various state and provincial Nurse Practice Acts establish legal regulations for practice in a specified area, and professional organizations establish Standards of Practice. The American Nurses Association is concerned with legal aspects of nursing practice, public recognition of the significance of nursing practice to health care, and implications for nursing practice generated by trends in health care. (The ANA definition of nursing is summarized on the slide.) Compare and discuss the ANA and ICN definitions of nursing: The American Nurses Association (ANA) definition of nursing: The protection, promotion, and optimization of health and abilities; prevention of illness and injury; alleviation of suffering through the diagnosis and treatment of human response; and advocacy in the care of individuals, families, communities, and populations. The International Council of Nurses (ICN) definition: Nursing encompasses autonomous and collaborative care of individuals of all ages, families, groups, and communities, sick or well and in all settings. Nursing includes promotion of health; prevention of illness; and the care of ill, disabled, and dying people. Advocacy, promotion of a safe environment, research, participation in shaping health policy and in patient and health systems management, and education are also key nursing roles.

17 Nursing Practice Nurse Practice Acts Licensure and certification
Science and art of nursing practice Benner’s stages of nursing proficiency: Novice Advanced beginner Competent Proficient Expert In the United States, individual State Boards of Nursing oversee Nurse Practice Acts. The Nurse Practice Acts regulate the scope of nursing practice and protect public health, safety, and welfare. They also specify the training needed for nurse practitioners and other advanced practice professionals. Licensure: RN candidates must pass the NCLEX-RN, a standardized examination for all candidates. Certification: Minimal practice requirements are set, based on the certification the nurse is seeking. Common certification is for medical-surgical nurse, diabetic nurse educator, gerontological nurse, and many more. You will begin to learn how to develop your critical thinking abilities and your ability to practice autonomously. You will gradually acquire clinical expertise. Patricia Benner has done extensive work on the development of proficiency of nurses. (See Box 1-3 on p. 6 of the text.) Novice: Beginning nursing student or any nurse entering a situation in which there is no previous level of experience. Advanced Beginner: A nurse who has had some level of experience with the situation. Competent: A nurse who has been in the same clinical position for 2 to 3 years. Proficient: A nurse with more than 2 to 3 years of experience in the same clinical position. Expert: A nurse with diverse experience who has an intuitive grasp of an existing or potential clinical problem.

18 Professional Responsibilities
Nurses are responsible for obtaining and maintaining specific knowledge and skills. In the past: To provide care and comfort Now: To provide care and comfort and to emphasize health promotion and illness prevention As health care changes, the nursing profession must also change to meet the needs of an increasingly complex patient population. To meet these needs, nurses must demonstrate their ability to be autonomous and accountable.

19 Autonomy and Accountability
Professional Roles Autonomy and Accountability Caregiver Advocate Educator Communicator Manager Autonomy is an essential element of professional nursing that involves the initiation of independent nursing interventions without medical orders. Caregiver: Nurses help their patients regain health and find their maximum level of independent function through the healing process. Healing involves the body, mind, and spirit. [See Chapter 35 for more information on spiritual health.] Advocate: Nurses protect the human and legal rights of their patients and help patients assert those rights when needed. [See Chapter 9 for more information on cultural and ethnic issues.] Educator: Your teaching can be formal or informal and will involve the patient, family, significant other, or other support systems. [Chapter 25 reviews Patient Education.] Communicator: [See Chapter 24.] You know that communication is central to the nurse-patient relationship. Again, it is important to develop a communication style for use with patients and members of their support system, as well as a style for communicating with other members of the health care team. Manager: As a manager, you will collaborate with others to help your patients meet their established outcomes and will evaluate the manner in which care is administered. As a manager of care, you will evaluate staff nurses to determine whether they meet professional and health care facility standards.

20 Career Development Nursing provides an opportunity for you to commit to lifelong learning and career development. {Fig 1-2 here} Ask students to discuss career opportunities available to them. Some answers may include: •Staff nurse in med-surg, OR, PACU, ED, Short Stay unit, ICU, CCU, TCU, OB, PEDS, or L&D, or in an outpatient setting. •Advanced practice nurse: Requires additional education and experience. APNs can be nurse practitioners, clinical nurse specialists, certified registered nurse anesthetists, or nurse midwives. •Nurse educator: Requires additional education and experience. •Nurse administrator: Requires additional education and experience. •Nurse researcher [Photo is on p. 8 of the text.]

21 Case Study (cont’d) Ming is particularly drawn to the idea of becoming an advanced practice registered nurse (APRN). Ming’s career options for becoming an APRN include which of the following? (Select all that apply.) A. Physician assistant (PA) B. Clinical nurse specialist (CNS) C. Certified nurse midwife (CNM) D. Certified RN anesthetist (CRNA) [Discuss areas of specialization for the APRN. Answers: B, C, D] Rationale: The four core roles for APRNs include clinical nurse specialist (CNS), certified nurse midwife (CNM), certified RN anesthetist (CRNA), and certified nurse practitioner (CNP). Physician assistant (PA) is not a nursing role.

22 Professional Nursing Organizations
National League for Nursing (NLN) American Nurses Association (ANA) International Council of Nursing (ICN) National Student Nurses Association (NSNA) or Canadian Student Nurses Association (CSNA) Other professional organizations focus on specific areas. Professional nursing organizations deal with issues of concern to specialist groups within the nursing profession. The NLN sets standards for excellence and innovation in nursing education. The purpose of the ANA is to improve standards of health and the availability of health care to foster high standards for nursing and to improve the professional development and general and economic welfare of nurses. The ANA is part of the ICN. The objectives of the ICN are parallel to those of the ANA: To promote national association of nurses, improve standards of nursing practice, and seek a higher status for nurses by providing an international power base for nurses. The NSNA considers issues of importance to nursing students, such as career development and preparation for licensure. Some professional organizations focus on specific areas such as critical care, nursing administration, nursing research, or nurse midwifery.

23 Quick Quiz! 2. The NLN and the ANA are professional organizations that deal with A. Nursing issues of concern. B. Political and professional issues affecting health care. C. Financial issues affecting health care. D. All of the above issues. Answer: D

24 Case Study (cont’d) If Ming decides to pursue a career as an APRN, which patient populations may he serve? (Select all that apply.) A. Adult-gerontology B. Prison inmates C. Neonatology D. Psychiatric mental health Answers: A, C, D Rationale: APRNs serve six patient populations: adult-gerontology, pediatrics, neonatology, women’s health/gender related, family, and psychiatric mental health. Although APRNs may care for prison inmates, this group is not a separate patient population, but rather falls into the other six categories based on age, gender, and medical condition.

25 Quality and Safety Education for Nurses (QSEN)
Competency: Patient-Centered Care Teamwork and Collaboration Evidence-Based Practice Quality Improvement Safety Informatics One trend in nursing, QSEN, addresses the challenge to prepare nurses with the competencies needed to continuously improve the quality of care in their work environments. See Table 1-1, Quality and Safety Education for Nurses (on p. 9 of the text), for examples of each QSEN competency. Definitions follow: Patient-Centered Care: Recognize the patient or designee as the source of control and a full partner in providing compassionate and coordinated care based on respect for patient’s preferences, values, and needs. Teamwork and Collaboration: Function effectively within nursing and interprofessional teams, fostering open communication, mutual respect, and shared decision making to achieve quality patient care. Evidence-Based Practice: Integrate best current evidence with clinical expertise and patient/family preferences and values for delivery of optimal health care. [See also Box 1-4, Evidence-Based Practice: Safety Competencies and Patient-Centered Care, on p. 10 of the text.] Quality Improvement: Use data to monitor the outcomes of care processes and use improvement methods to design and test changes to continuously improve the quality and safety of health care systems. Safety: Minimize risk of harm to patients and providers through both system effectiveness and individual performance. Informatics: Use information and technology to communicate, manage knowledge, mitigate error, and support decision making.

26 Case Study (cont’d) If Ming decides to choose a career as a critical care CNS, then his specialty is identified by which means? A. Population B. Setting C. Disease specialty D. Type of care E. Type of problem Answer: B Rationale: The CNS specialty may be identified by a population (e.g., geriatrics), a setting (e.g., critical care), a disease specialty (e.g., diabetes), a type of care (e.g., rehabilitation), or a type of problem (e.g., pain).

27 Additional Nursing Trends
Genomics Public perception of nursing Impact of nursing on politics and health policy Future trends The nursing profession will continue to evolve and grow, and so must individual nurses. How has genomics affected nursing? [Discuss the impact of gene research on nursing practice.] Today great emphasis is placed on nurses and nursing. We are highlighted, as in TV ads by the Johnson and Johnson Foundation campaign to draw individuals into the profession. [Ask students: How will this publicity affect your role?] Nurses are becoming more politically sophisticated and, as a result, are able to increase the influence of nursing on health care policy and practice. What other trends do you anticipate? [Discuss.]