LSUHSC-SON Intro. to Nursing [Exam 1 Content]
WHO (2010): Interprofessionality
"It is no longer enough for health workers to be professional. They also need to be interprofessional." Definition: Inter-professionality is a process by which professionals reflect on and develop ways of practicing that provides an integrated and cohesive answer to the needs of the client/family/population.
Shaw's Textbook of Nursing (1907)
"It properly includes, as well as the execution of specific orders, the administration of food and medicine, the personal care of the patient"
Harmer and Henderson (1939)
"Nursing may be defined as that service to an individual that helps him to attain or maintain a healthy state of mind or body"
Harmer's Textbook of the Principles and Practice of Nursing (1922)
"The object of nursing is not only to cure the sick ... but to bring health and ease, rest and comfort to mind and body. Its object is to prevent disease and to preserve health"
3 Early Training Schools for Nurses in the U.S.
- Based on Nightingale's model at St. Thomas Hospital - Had to be female to train - Northern schools admitted African American women - One Jewish and one African American each class
Advanced Degrees: Doctoral Education
- Doctoral programs prepare nurses to become faculty members in universities, administrators in schools of nursing or large medical centers, researchers, theorists, and advanced practitioners. - Research-focused degree—doctor of philosophy (PhD): Research focused doctorate - Practice-focused degree—doctor of nursing practice (DNP): doctor of nursing science
Mary Seacole (1805-1881): Herbalist
- Jamaican nurse and businesswoman. Voted greatest black Briton. - Did not work with Nightingale during the Crimean War. She was rejected by Nightingale. - Expert on cholera— managed the care of the soldiers of Crimea.
1965: Social Security Act Amended
- Medicare and Medicaid - Hospital as preferred care (and work) setting - Idaho first state to recognize diagnosis and treatment as legal scope of practice for NPs
Vietnam War (1968-1973)
- Mobile hospitals and nurses - Beyond the roles and responsibilities - PTSD among nurses and soldiers - 1933 Vietnam Women's Memorial statue
Novice Thinking
- Organize knowledge as separate facts - Rely heavily on resources - Lack knowledge gained from actually doing - Focus on actions and may not fully assess before acting uNeed and follow clear-cut rules
Critical Thinking
- Reflective thinking is an active process valuable in learning and changing behaviors, perspectives, or practices. - Critical thinking in nursing is undergirded by the standards and ethics of the profession. - Nurses who think critically are engaged in a process of constant evaluation, redirection, improvement, and increased efficiency.
The Civil War (1861-1873)
- Set stage to advance professional nursing practice - Demonstrated dramatic improvements in care - Moved toward formal education and training - Reform in military hospitals serves as model for civilan hospitals nation wide
Expert Thinking
- Store knowledge in highly organized and structured manner - Assess and consider different options for intervening before acting - Know which rules are flexible and when it is appropriate to bend the rules - Are aware of resources and how to use them
Goals and Outcomes
- The goal begins with the words "the patient will" or "the patient will be able to." - The goal sets a general direction, includes an action verb, and should be both attainable and realistic for the patient. - Outcome criteria define the terms under which the goal is said to be met, partially met, or unmet. - Short-term goals and long-term goals - Cultural congruent intervention - is developed within the broad social, cultural, and demographic context of the patient's life.
Florence Nightingale (1820-1910)
- Training: Kaiserswerth, Germany and Sisters of Charity, Paris - Crimean War (1854-1856)—hospital setup in Scutari, Turkey - Data collection on morbidity and mortality helped reform the British medical system. - 1859: Notes on Nursing: What it is and what it is not—a body of nursing knowledge and professional nursing - 1860: Established first training school for nurses at St. Thomas' Hospital in London
1983-2000: HIV/AIDS and Life Support Technologies
- Universal precautions - Changes in equipment—needles, IV catheters, gloves
Strategies to Reduce "Reality Shock"
-Seek practical experiences outside of school -Balance work with academic responsibilities -"Shadowing" programs -Take initiative to form group for mutual support -Mentors and preceptors -Care for self
Nursing in Hospitals
-direct patient care (staff nurses, clinical nurse specialist, charge nurses) -educators -managers -administrators
Culture of Civility
-respecting one another -honoring differences -listening and seeking common ground -engaging in social discourse
Why Define Nursing?
1. Establishes the parameters (or boundaries) of the profession and clarifies the purposes and functions of the work of nursing. 2. Guides the educational preparation of aspiring practitioners and guides nursing research and theory development. 3. Makes the work of nursing visible and valuable to the public and to policymakers who determine when, where, and how nurses can practice.
The Future of Nursing: Leading Change, Advancing Health
1. Nurses must practice to the fullest extent of their education and training. 2. Nurses should attain higher education levels through a system of improved education with seamless progression across degrees. 3. As health care in the United States is being transformed, nurses should be full partners with other health care professionals in this effort. 4. Improved data collection and information infrastructure can result in more effective workforce planning and policy development.
Recommendations of Early Studies of Nursing Education
1. Nursing education programs should be established within the system of higher education. 2. Nurses should be highly educated. 3. Students should not be used to staff hospitals. 4. Standards should be established for nursing practice. 5. All students should meet certain minimum qualifications on graduation.
Setting Priorities
1. Urgent & Important- Focus on these first. 2. Important by not urgent- Prioritize and prepare to work on these next. 3. Urgent but not important- Theses are distractions; ignore them. 4. Not urgent or important-Why waste your time?
Four Domains of Interprofessional Collaborative Practice Competency
1. Values/ethics for interprofessional practice 2. Roles/responsibilities 3. Interprofessional communication 4. Teams and teamwork
What statement best supports nursing as a profession? 1.Code of ethics 2.Collective bargaining 3.College education 4.Multiple entries to practice
1.Code of ethics
Paans and colleagues (2011) found four domains of factors that affect nurses' accurate documentation of diagnoses:
1.Nurses themselves as effective diagnosticians 2.How nurses are educated about nursing diagnoses 3.Complexity of a patient's situation 4.Degree to which a hospital's policy and environment supports the use of nursing diagnosis
The Process of Professionalism (Carr-Saunders & Wilson, 1933)
1.Practitioners performed full-time work in the discipline. 2.They determined work standards, identified a body of knowledge, and established educational programs in institutions of higher learning. 3.They promoted organization into effective occupational associations, and then worked to establish legal protection that limited practice of their unique skills by outsiders. 4.Finally, they established codes of ethics.
Nine Key Questions of Clinical Judgment
1.What major outcomes (observable beneficial results) do we expect to see in this particular patient, family, or group when the plan of care is terminated? 2.What problems or issues must be addressed to achieve the major outcomes? 3.What are the circumstances? Who is involved? How urgent are the problems? What are the factors influencing their presentation? What are the patient's values, beliefs, and cultural influences? 4.What knowledge is required? 5.How much room is there for error? 6.How much time do I have? 7.What resources can help me? 8.Whose perspectives must be considered? 9.What is influencing my thinking?
Early Studies of Quality of Nursing Education
1900's: Concerned more with poor quality of former nursing training programs. Isabel Hampton Robb investigated ways to prepare nurses better for leadership in schools of nursing. Mary Adelaide Nutting attended Teachers College in 1907 as first nursing professor in history and became pioneer in nursing education. 1923: Major study- The study of Nursing and Nursing Education in the U.S. (known as Goldmark Report) 1924: Yale opened School of Nursing Annie W. Goodrich- Dean Funded by Rockefeller Foundation
1917-1930: The Challenges of WWI
1917- United States entered World War I - National Committee on Nursing • Charged with supplying nurses • Army School of Nursing
Henderson
1960 definition of nursing adopted by ICN
Characteristics of Pre-licensure Baccalaureate Programs
4-year program. General education + nursing courses. Faculty qualifications - minimum of master's degree BSN graduates are eligible to take licensure exams, assume beginning practice and obtaining leadership positions in any health care setting, prepare to move into graduate programs and advanced practice certification programs. 2008 AACN. The Essentials of Baccalaureate Education for Professional Nursing Practice
What is an accurate statement regarding nurse certification? 1. Certification is required at the entry point to practice. 2. Certification is the government's way of ensuring currency in practice. 3. Certification refers to agency efforts to maintain competence. 4. Certification validates knowledge, skills, and abilities.
4. Certification validates knowledge, skills, and abilities.
A Novice Nurse Would Most Likely: 1.Anticipate medical management based on assessments 2.Have multiple ways of initiating IV therapy 3.Teach patient while performing a dressing change 4.Use a checklist when inserting a nasogastric tube
4.Use a checklist when inserting a nasogastric tube
Nursing Diagnoses
A nursing diagnosis is "a clinical judgment about individual, family or community responses to actual or potential health problems or life processes. - It provides the basis for selection of nursing interventions to achieve outcomes for which the nurse has accountability" (NANDA-I, 2012).
Accreditation: Ensuring Quality Education
Accreditation - voluntary review process of educational programs by a professional organization The accrediting agency compares the educational quality of the program with established standards and criteria. It derives authority from the US Department of Education. Two agencies accredits nursing education programs: Accreditation Commission for Education in Nursing (ACEN) Commission on Collegiate Nursing Education (CCNE)
Prioritization
After diagnoses identified, must be prioritized - Relative danger to the patient - Life-threatening versus overall general health Maslow's Hierarchy of Needs - High priority needs - basic physiological needs - Nurses should involve patients in identifying priority diagnoses. - Socio-cultural factors must be considered in planning care.
Mary Mahoney (1845-1926)
America's 1st African-American professionally educated nurse Worked for acceptance of African Americans in nursing & for promotion of equal opportunities Knew the importance of nurses working together to improve the role - Mary Mahoney Award established by National Association of Colored Graduate Nurses - NACGN later combined with the ANA
Accreditation of Nursing Schools
An accredited program voluntarily adheres to standards that protect the quality of education, safety, and the profession itself. Accrediting agencies establish standards by which program effectiveness is measured. Self-study and site visits Continued accreditation Deficiencies Implications on prospective students and graduates
Affordable Care Act
An expansion of medicaid, most of employers must provide health insurance, have insurance or face surtax, prevents rejection based on pre-existing condition. Also referred to as "Obamacare", signed into law in 2010. • The patient protection and affordable care act • The healthcare and education affordability reconciliation act
Diagnosis
Analysis and identification of the problem
The Goldmark Report
Another major and important study of nursing education was published in 1923. Title: The study of Nursing and Nursing Education in the United States The study focused on: 1. Clinical learning experiences of students 2. Hospital control of the schools 3. Desirability of establishing university schools of nursing 4. Lack of funds specifically for nursing education 5. Lack of prepared teachers Note: It is notable that some of the findings of the Goldmark Report in terms of funding and faculty shortages remain applicable to nursing today.
The nursing process is a systematic, problem-solving approach that provides the framework for nursing practice in the United States and Canada. Put the five steps of the nursing process in order
Assessment Diagnosis Planning Intervention Evaluation
1918-1919: Influenza Epidemic
Beginning of influenza pandemic -Red Cross Nursing: widespread public education in-home care & hygiene • 1920: Congress passed a bill that provided nurses with military rank. • 1920 notable for increased use of hospitals and acceptance of scientific basis of medicine by public
Articulated Programs
Definition: Mobility between programs Purpose: Facilitate opportunities to move up the educational ladder. Multiple-entry and multiple exit programs Articulation agreements facilitate student movement between programs and accept transfer credit between institutions. These result in acceleration or advanced placement.
Diploma Nursing Programs
Diploma programs provided formal education and jobs to women. •Modified apprenticeship model •Demanding schedule Duration: 3 years (current programs: 24 months) : Most colleges and universities did not recognize diploma programs. Current practice: Diploma programs establish agreements with colleges and universities. Decline in Mid 1960s caused by: 1. Growth of ADN and BSN programs, a move to the mainstream of higher education 2. Inability of hospitals to continue to finance nursing education 3. Accreditation standards have made it difficult for diploma programs to attract qualified faculty 4. Increasing complexity of health care has required nurses to have greater academic preparation
Bloom's Taxonomy
Domains of Learning: Cognitive:uInvolves knowledge and intellectual skills. Cognitive skills range from simple recall to complex tasks such as synthesis and evaluation. Psychomotor: Involves physical movement and increasingly complex activities in the motor-skill arena. Learning in this domain can be assessed by measures such as distance, time, and speed. Affective Domains: Involves the emotions, such as feelings, values, and attitudes.
Standardization of Nursing Through Licensure
Early 20th century—early efforts at licensure • ICN resolution: Each country and state to provide for licensure of the nurses - 1903: Permissive licensure laws: Nurses did not have to be registered to practice but could not use the title of registered nurse (RN) unless registered. - 1923: All states required permissive licensure - 1947: New York fully mandated licensure - 1950: NLN and first nationwide State Board Test Pool Examination
Miller (1985): The Wheel of Professionalism
Education in university setting and scientific background in nursing • Theory: Development; use; evaluation • Community service orietation • Continuing education; competence • Research: Development; use; evaluation • Self-regulatory; autonomy • Professional organization participation • Publication & Communication • Adherence to Code for Nurses
Intervention
Effective interventions depend on an accurate diagnosis.
Continuing Education: Maintaining Expertise and Staying Current
Ensuring that nurses remain up to date in knowledge Lifelong learning Versus: Staff development Role of ANCC Contact hours Mandatory continuing education
Advanced Degrees in Nursing: Master's Education
Entrance requirements •BSN •RN License •3.0 GPA Duration of the program Curriculum Major areas of role preparation: •Administration, case management, informatics, health policy/health care systems, teacher education, clinical nurse specialist, NP, nurse-midwifery, nurse anesthesia, and other clinical and nonclinical areas of study •Example: Nurse practitioners are prepared to manage patients with chronic illness and perform health screenings in a primary care Common graduate degrees
Extended Degree Programs
Excelsior College in New York Students don't attend classes Learning is independent Assessed through highly standardized and validated competency-based outcomes assessments Virtual university Students arrange their own clinical experience Verify accreditation specific each state nursing education
Kelly's Criteria: Eight Characteristics of a Profession (Continued..)
FIFTH: Practitioners are relatively independent and control their own policies and activities (autonomy). •Autonomy - control over one's practice. •Licensure and autonomous practice •"Doctor's orders" connotation •Groups that control nursing practice •Organized nursing •Organized medicine •Health service administration •Magnet Recognition program and survey of nurses SIXTH: Practitioners are motivated by service (altruism) and consider their work an important component of their lives. •Altruism - ideal of service to others •Nurses' altruism is sometimes questioned when they demand higher compensation and better working conditions. •Collective bargaining •Nursing as "simply a job" SEVENTH: There is a code of ethics to guide the decisions and conduct of practitioners. •International Council of Nurses (ICN) and ANA established a Code of Ethics •1893: Nightingale Pledge (BOX 3-1) •Functioned as nursing's first code of ethics; established roots for current codes EIGHTH: There is an organization (association) that encourages and supports high standards of practice. •American Nurses Association (ANA) - official voice of nursing. •Primary advocate for nursing interests •Purposes •Relatively low percentage of nurses who belong to ANA and the constituent state nurses association A significant political influence is unrealized for the profession.
Challenges within Nursing
Faculty and other resources shortages: - Average age of professors: 62years - Average age of associate professors: 58 years - Trends Quality and safety education for nurses (QSEN) IOM (2003) identified five problems in professional health education.
Socialization Specific to Work Setting Obstacles
Feelings of being unprepared and overwhelmed Ideals taught in school are difficult to achieve in practice Establishing positive relationships with colleagues Speed of functioning and time management Sheer physical fatigue Mental and emotional stress of decision making
Linda Richards (1841-1930)
First trained nurse in America. Responsible for the development of the first nursing and hospital records. Credited with the development of our present-day documentation system.
New England Hospital
First training school for nurses in the US (1872)
Kelly's Criteria: Eight Characteristics of a Profession (pg. 61)
First: The services provided are vital to humanity and the welfare of society. •Why do students want to become a nurse? "To help people" •Services versus caring •Caring is the core of professional nursing through which nurses intervene for their patients. SECOND: There is a special body of knowledge that is continually enlarged through research. •Research nursing degrees •Nursing is no longer based on simple problem solving but increasingly relies on theory and research as a basis for practice. •Example: Evidence-based practice THIRD: The services involve intellectual activities; individual responsibility (accountability) is a strong feature. •Critical and creative thinking serves as basis for providing nursing care. Example: Nursing process FOURTH: Practitioners are educated in institutions of higher learning. •1909: University of Minnesota - first university-based nursing •1965: ANA Position Paper - All nursing education should take place in institutions of higher education. •Debate: Entry level into Practice
Development of Nursing Education in the United States
Florence Nightingale and formal nursing preparation 1860: St. Thomas Hospital in London Belief: Nursing schools should be financially and administratively separated from hospitals. 1872: Establishment of the first U.S. training schools 1873: first trained nurse Melinda Ann Richards 1879: 11 nursing training schools 1900: 432 hospital-owned and hospital-operated nursing programs.
Facilitating the Transition From Student to Nurse
Formal socialization: Nursing faculty as the first mentor Orderly, building-block fashion Informal socialization - incidental lessons Professional socialization: Absorbing the culture of nursing - rites, rituals, and valued behaviors Learning vocabulary Learning new roles and anxiety, disappointments and frustrations, and disillusionment
Mildred Montag
Founded ADN education in 1952 Short duration to prepare nurse technicians Nurse technicians' function under supervision of professional nurses Routine care in acute and long-term settings Intended for end-point degree and not an incremental step to BSN
Initiatives to Provide Stable Workforce of Registered Nurses
Four Major Initiatives: - American Recovery and Reinvestment Act of 2009 - Robert Wood Foundation - Johnson & Johnson's Campaign for Nursing's Future - ANCC Magnet Recognition Program
Practice Setting for Professional Nurses
Hospitals- 63.2% Ambulatory Care- 10.5% Public and Community Health- 7.8% Home Health- 6.4% Extended Care Facilities- 5.3% Other- 6.8%
Technological Developments
IT—Information Technology—computer-based applications used to communicate, store, manage, retrieve, and process information - Meaningful use - Centers for Medicare and Medicaid Services - Paperless - Access and confidentiality • Knowledge technology • Telehealth • Intentional caring and technology
Houle (1980)
Identified characteristics that indicate that an occupation moves along the continuum toward professional status. •Step 1: Defining the group's mission and foundations of practice •Step 2: Mastery of theoretical knowledge, development of the capacity to solve problems, use of practical knowledge, and self-enhancement (continued learning and development) •Step 3: Development of a collective identity as an occupation evolves into a profession
Ariza-Montes and colleagues (2013) described issues facing nurses in terms of incivility:
Includes bullying Organizational structures that are hierarchical, are downsizing, or whose employees do not feel empowered contribute to incivility Conduct is form of workplace violence Most often occurs with new and inexperienced nurses
Online and Distance Learning Programs
It allows access to adult learners who are geographically unable to participate in a traditional classroom setting Intended to improve access for rural areas Flexibility Distance learning and issues of adequate and properly supervised clinical experiences Fraudulent programs Before committing to an online program
ANA Position Paper
It concluded that baccalaureate education should become the foundation for professional practice.
Lysaught Report
It made recommendations concerning supply and demand for nurses, nursing roles and functions, and nursing education. Priorities identified by the study: The need for increased research into both practice and education of nurses The report made recommendations in increased research in practice and curriculum development
Florence Nightingale—Notes on Nursing: What It Is and What It Is Not (originally published 1859).
It ought to signify the proper use of fresh air, light, warmth, cleanliness, quiet, and the proper selection and administration of diet—all at the least expense of vital power to the patient (Nightingale, 1946, p. 6).
Reality Shock: When Ideals and Reality Collide Drop out
Kramer (1974) described ways nurses "drop-out" rather than take steps to resolve reality shock. 1. Disengaging mentally and emotionally 2. Driving oneself and others to the breaking point by trying to do it all 3. "Job hopping" - looking for the perfect, non-stressful job that is completely compatible with professional values Prematurely returning to school (seeking the routine and known expectations of a student) Burning out— a condition of unresolved reality shock with subsequent emotional exhaustion Leaving the nursing profession entirely, which neither nursing nor society can afford
Becoming Certified: Validating Knowledge & Proficiency
Licensure: Granted by the State Board of Nursing Certification: Benefits of being a certified nurse ANCC and standardized certification Requirements
LACE
Licensure: The granting of authority to practice Accreditation: Formal review and approval by a recognized agency of educational degree or certification programs in nursing or nursing related programs Certification: The formal recognition of knowledge, skills, and experience demonstrated by the achievement of standards identified by the profession Education: The formal preparation of RNs in bachelor's degree programs
1980-1990: Medical Technology & Life Support
Mechanical ventilation, vegetative state terminology, and advanced directives were becoming more prominent during this time frame - Advance directives
NANDA
Mission: To "facilitate the development, refinement, dissemination and use of standardized nursing diagnostic terminology" with the goal to "improve the health care of all people" - 235 diagnoses approved for clinical testing - 25 new diagnoses; 13 revised diagnoses - Diagnoses are retired if usefulness is limited or outdated Example: "Disturbed thought processes."
Strategies to decrease stress associated with return to school:
Never forget your reason for returning to school. Be actively involved in your studies, including being proactive on your own behalf. You may be troubled by others' opinions of your return to school; however, set aside their ideas for your own. Advanced education requires thinking conceptually. Become an excellent time manager and be disciplined about how you spend your study time. A mentor—another nurse, more advanced student, or faculty member—is an invaluable source of support. Trust your faculty to help you and ask for their help and guidance.
Principles of Florence Nightingale
Nurse should be trained in an educational institution supported b public funds and associated with a medical school Nursing school should be affiliated with a teaching hospital but also be independent of it. Curriculum should include both theory and practical experience. Professional nurse should be in charge of administration and instruction and should be paid for their instruction. Students should be carefully selected and should reside in nurses' houses that form discipline and character Students should be required to attend lectures take quizzes, write papers, and keep diaries. Student records should be maintained.
Baccalaurate Programs
Nurses need at least bachelor's degree in nursing to qualify as a recognized profession and to provide leadership in administration, teaching, and public health. Mary Adelaide Nutting came to Teachers College in 1907 as the first nursing professor in history and became a pioneer in nursing education. 1909 First BSN program in University of Minnesota 1919 Seven BSN programs. Most BSN programs were 5 years in duration. Growth of BSN was slow because of: •The reluctance of universities to accept nursing as an academic discipline •The power of the hospital-based diploma programs
What is Nursing?
Nursing can be described as both an art and a science (heart and a mind) Key Responsibilities: • Perform physical exams and health histories before making critical decisions • Provide health promotion, counseling and education • Administer medications and other personalized interventions • Coordinate care, in collaboration with a wide array of health care professionals
History of Nursing
Nursing leaders work to evolve nursing education in response changing landscape of healthcare delivery Nursing education must have the standards Public recognize nursing role to achieve optimal outcomes for patients and to practice safely 2009 call for bachelor of science in nursing as entry level for RN practice. Masters of science in nursing obtained within 10 years of licensure. Note: Shift was in question due to nurses being undereducated to meet demands of current practice.
Implementation of Planned Interventions
Occurs when nursing orders are actually carried out - As the nurse carries out planned interventions, they are continually assessing the patient, noting responses to interventions, and modifying the care plan. - Documentation
Writing Nursing Diagnosis
P = Problem (NANDA-I diagnostic label) E = Etiology (causal factors) S = Signs and symptoms (defining characteristics)
National Population Trends: Aging of America & Diversity
People are living longer. • The number of elderly people is increasing as the number of adults in early midlife is decreasing. • Current nursing strategies: - Care of elderly in nursing programs - Gerontology courses • Gerontological clinical nurse specialists and NPs • Nurses need to be educated to be aware and respectful of culture differences. • Cultural competence, cultural sensitivity, and cultural humility
Associate Degree Programs
Popularity of ADN is due to: 1. Accessibility of community colleges 2. Low tuition costs 3. Part-time and evening study opportunities 4. Shorter duration of programs 5. Graduates' eligibility to take the RN licensure exam Based on a model developed by Mildred Montag.
National League for Nursing (NLN)
Position Statement on Nursing Roles: Scope and Preparation - affirmed BSN as minimum educational level for professional nursing practice and ADN or diploma as the preparation for technical nursing practice.
Can Professional Socialization be Achieved Through Distance Education?
Puterbaugh, Shannon, and Gorton (2010) suggested that distance learning may be used successfully and with adequate socialization. Loisier (2014) the findings suggested that despite the support of the idea of collaborative learning and socialization via distance education, socialization does not occur automatically online in collaborative work and may conflict with distance students' desire for flexible and individual learning.
Alternate Paths in Nursing Education: Baccalaureate Programs for Registered Nurses
RN-to-BSN Education: • Diploma and ADN nurses are given credits to meet certain BSN requirements. • Transfer of general education courses • Options for advanced placement Programs for Second-degree Students: • Accelerated or fast-track sequence to award a second bachelor's degree or in some cases MSN
Nursing in the United States
RNs are largest group of health care providers. • 2020 National Nursing Workforce Survey • Over 4.1 million active licensed RNs • 84.1% actively working • 64.9% work full time • 49% not employed (caring for home) • 14.6% difficulty finding work • 32.1% other, not specified
Martha Rogers
Scope of nursing goals included nursing process maintenance and promotion of health prevention of disease nursing diagnosis intervention rehabilitation
11th, 12th, and 13th centuries: men as nurses under military and religious orders
Stereotype: Men supply strength or control of patients when needed (psychiatric nursing).
Women's Social Roles
Stereotype: Women were intellectually inferior to men, and hence women were not called on to make decisions or think for themselves.
Collaboration in Health Care Education: Interprofessional Education
Students in various disciplines take courses and have clinical experiences together. Involves structural changes in health care education to think beyond traditional model in which HCP are educated differently Enhances development of respect across disciplines Increases understanding of roles of other disciplines Facilitates better communication among practitioners
Dorothea Dix (1802-1887)
Superintendent of Women Nurses by by the Union Army(passion to help the mentally ill) - Month long training program for women who wished to serve at two hospitals in New York - African American women could train also
Overriding Goal of Nursing Education
Teach students to think like a nurse. See health care through the lens of nursing. Respond to your educational and clinical experiences with the development of professionalism.
Clara Barton (1821-1912)
Tended to Union Soldiers "Angel of the Battlefield" - Instrumental in acquiring needed supplies - Later founded the American Red Cross
Factors Influencing Socialization
The Code of Ethics for Nurses requires that nurses work with all patients regardless of their beliefs. Personal feelings can be shaped by significant adults and peers. Negative health behaviors can influence personal feelings. Unexamined biases are more likely to influence behavior than examined one. (EVERYONE have BIASES) Becoming a professional nurse requires learning how to deal with values conflicts while respecting patients' differing viewpoints. KEY point: Identify and reflect on hot button issues that affect you negatively so that you can understand your responses and know how to set aside negative feelings to provide excellent care to patients
1931-1945: Challenges of the Great Depression & WWII
The Great Depression: Many families could no longer afford private duty nurses, forcing many nurses into unemployment. • 1933: President Franklin D. Roosevelt and Civil Works Administration • Social Security Act of 1935 enhanced the practice of public health nursing. - Purpose: Strengthen public health services and provide medical care for children with disability and blind persons.
AACN Position Statement
The baccalaureate Degree in Nursing as the Minimal Preparation for Professional Practice. It supports articulated programs which enable ADN nurse to attain BSN.
Clinical Ladder
The clinical ladder concept benefits nurses by allowing them to advance skills while still working directly with patients.
National Commission on Nursing
The major block to the advancement of nursing was the ongoing conflict about educational preparation for nurses. Recommendation: Establish a clear system of nursing education including pathways for educational mobility and development of additional graduate education programs (DeBlack, 1991)
World War II (1939-1945)
The most destructive war in human history; America entered the war in 1941 after the Japanese attack on Pearl Harbor on December 7, 1941. • Military shortage • Cade Nurse Corps • 1943-1948 179,000 women volunteered • 124,000 graduated and certified for military service in Army and Navy Nurse Corps • Black nurses could provide nursing services to soldiers overseas
Developing a Plan of Care
The nurse creates and develops plans of care for each patient Standardized plans of care are based on common and recurring problems - RN then individualizes these standard plans of care Critical pathways - multidisciplinary plans of care - Facilitates communication among all members of the health care team
Evaluation
The nurse examines the patient's progress in relation to the goals and outcome criteria to determine whether a problem is resolved, is in the process of being resolved, or unresolved. Evaluation may reveal data, diagnosis, goals, and nursing interventions all on target and problem is resolved - Evaluation may indicate a need for change in care plan
The Nursing Process
The nursing process is "a conceptual framework that enables the student or the practicing nurse to think systematically and process pertinent information about the patient" (Huckabay, 2009, p. 72). It combines the "art of nursing" (creativity) with systems theory and the scientific method to produce high level care for your patients that is both interpersonal and interactive (Doenges, Moorhouse, and Murr, 2013).
Superintendent Sally Tompkins
The only woman in the Confederacy to hold military rank
Solutions to Nursing Shortage
The origin and resolution of nursing shortages are complex • Increase supply of nurses • Create a role requiring less training to supplement the number of nurse - Shorter training/education
Hildegard Peplau
Theory of Interpersonal Relations: pioneer among contemporary nursing theorists
Barriers to Professionalism in Nursing
Varying levels of education for entry into practice •Nursing's lack of a standardized requirement for a minimum of a BSN, and preferably a master's degree, stands in sharp contrast with other health care professions requiring more education to practice (David, 2000). Gender issues •The persistent devaluing of women's work in our society has created an ongoing struggle for professions such as nursing and teaching to increase the status, increase the compensation, and •Improve the working conditions. Historical influences •Religious and military background and obedience •Florence Nightingale •Isabelle Hampton Robb External conflicts •Tension between medicine and nursing •Lobby for protection of nursing practice Internal conflicts •Fragmented power and influence in professional nursing
Dealing with Incivility
Ways to turn incivility into a culture of civility: • Recognize incivility issue • Develop a framework at the institutional level • Set and operationalize behavioral standards Nurses have the responsibility to intervene on behalf of their colleagues who are being harassed or bullied; silence from the other nurses is a form of acquiescence to bullying (Houck and Colbert, 2017).
Landmarks in History of Nursing Education
[table 4.1]:
Nursing in Communities
ambulatory clinics health departments hospices homes community based settings
What are correct statements regarding the nursing workforce? (Select all that apply.) a. Asian nurses are underrepresented in nursing. b. Economic downturn influences median age of nurses. c. Foreign-educated nurses readily adapt to care settings. d. Male nurses are more likely to have higher degrees. e. Women are overrepresented as nurse anesthetists.
b. Economic downturn influences median age of nurses. c. Foreign-educated nurses readily adapt to care settings. d. Male nurses are more likely to have higher degrees. e. Women are overrepresented as nurse anesthetists. Note: Asian nurses are overrepresented among the different racial and ethnic groups in nursing. Men are overrepresented as nurse anesthetists
During flu season, a nurse encourages, educates, and administers vaccines to health care workers. These roles best describe which of the following choices? a. Community health nurse b. Military nurse c. Occupational health nurse d. Parish nurse
c. Occupational health nurse Note: These are roles of an occupational health nurse.
What is a correct statement regarding Florence Nightingale's contribution to professional nursing? a. She advocated for nursing licensure. b. She encouraged gender equality in nursing practice. c. She established training schools for nurses. d. She promoted inclusion of colored nurses
c. She established training schools for nurses. Note: 1859 Notes on Nursing stated clearly the need for hospital reform and mastering a unique body knowledge. She helped establish training schools for nurses. With regard to colored nurses and men, she excluded them—Mary Seacole.
Clinical Judgement
consists of informed opinions and decisions based on empirical knowledge and experience. Knowing the limitations of your expertise is an important aspect of clinical judgment. - Know when approaching the limits of expertise and consult additional professionals as needed
What are internal causes of nursing shortages? a. Aging of the population b. Greater patient acuity c. Multiple options for women d. Salary issues
d. Salary issues Note: Internal causes include salary issues, long hours, increased responsibility for unlicensed workers, and significant responsibility with little authority. The other options are listed as external causes of nursing shortage.
Hall
described a professional model with 5 attributes of professions. (pg. 58)
Bandura (1977)
described a type of socialization, modeling, which is useful when learning any new behavior.
Cohen (1981) & Hinshaw (1976)
described developmental models appropriate for beginning nursing students. • Stage I: Unilateral dependence. Students unlikely to question or analyze the concepts nursing faculty present critically because they possess limited questioning or critical analysis (i.e., beginning nursing student) • Stage II: Negativity/independence (cognitive rebellion). Students' critical thinking abilities and knowledge bases expand. They begin to question authority figures. • Stage III: Dependence and mutuality. Reasoned appraisal; begins integration of facts and opinions following objective testing. • Stage IV: Interdependence. Collaborative decision-making; commitment to a professional role. Commitment to role
Namahyoke Curtis
first black contract nurse • 1901- Founding of Army Nurse Corps • 1908- Navy Nurse Corps
Covid-19 Pandemic
first emerged in late 2019 • By late 2021: - 246 million cases reported - At least 5 million deaths • Long COVID: ongoing health problems and symptoms • Tremendous stress on healthcare providers • Exposed huge disparities in health, standards of health care, access to health care
Pharmacy Profession Task Force
found that members of a profession share 10 characteristics (pg. 58)
1946: Hill-Burton Act
funds to construct new hospitals, led to acute shortage of nurses, difficult working conditions
Assessment
gather information or data about the individual, family, or community.
Benner (1984)
identified five stages nurses pass through in the transition from novice to expert. 1. Novice - Has little background and limited practice skills. First enroll in nursing school 2. Advanced beginner - Marginally competent skills and uses theory and principles much of the time.. 3. Competent practitioner - Feels competent, organized, plans and sets goals. 2-3 years of experience. 4. Proficient practitioner - Views patient holistically, sets priorities, focuses on long-term goals... 3-5 years of experience 5. Expert practitioner - Performs fluidly, grasps patient needs automatically, expertise comes naturally. Extensive experience
Professional Socialization
process of internalization and development or modification of an occupational identity that "begins when the students are in formal nursing program and continues as they practice in the real world." Structural: Professional role is shaped by rules. Cultural: Traditions, symbols, language, idea systems in society shape how one becomes a nurse.
Lucille Brown
recommended that schools of nursing must be placed in colleges to recruit men and minorities
Dorothy Orem
self care theory, emphasizing the patient reaching their own potential for self care needs
Causes of Reality Shock
the feelings of powerlessness and ineffectiveness experienced by new graduates Psychological stress generated by reality shock decrease the ability of individuals to cope effectively with the demands of the new role. Lack of support, such as the availability of faculty that students have Absence of positive reinforcement (such as one gets from clinical faculty) and lack of frequent communication The gap between the ideals taught in school and the actual work setting The inability to provide nursing care effectively because of circumstances such as a heavy case load or time constraints
Roy Bixler and Genevieve Bixler
were advocates and supporters of nursing. They were not nurses. •Used seven criteria •1959: Re-appraised nursing and noted progress in nursing's professional development
Race & Ethnicity
• 19% are of ethnic minorities. • Largest disparity b/t U.S. population and RN population is with Hispanics/Latinos • Other disparities is with Blacks/African Americans and non-Hispanics • Asians makes up 5.9% population and 7.2% RN population an overrepresentation
Nursing Shortage
• Causes of nursing shortage - Internal causes - External causes • Shortage of nursing faculty - Doctoral-prepared and master's prepared are more than 50 years of age. - Nurses with advanced degreed are hired in more lucrative private sector. - Not enough doctoral- or master's-prepared nurses are produced to meet demands for education.
Nursing in Today's Evolving Healthcare Environment
• Comprise largest segment of healthcare workforce in US • Increasing opportunities to practice in variety of settings
Education
• Entry level - basic education to become a nurse • Graduating from nursing school qualifies you to take the NCLEX! Must be state approved! • NCLEX - National Council Licensure Examination for Registered Nurses! Passing makes you an RN! • Four Mechanisms to get basic nursing education: 4 year education - bachelor of science in nursing (BSN) 2 year accelerated programs (prior bachelor degree) (BSN) 2 year education - associate degree in nursing (ADN) 3 year education - diploma in nursing - hospital based
Formal Education & Training (1869-1900)
• Freedman Hospital trained black nurses and physicians for 79 years • Howard opened in 1969 graduating its first class in 1973. • 1886 first Male Nursing School in New York City • 1898 the Alexian Brothers Hospital in Chicago established training school for men.
Nursing in the Workforce
• Gender • Age • Race & Ethnicity • Education • Practice Setting for Professional Nurses
Employment Outlook in Nursing
• Growing opportunities for nurses - Technological advancements - Increasing emphasis on primary care - Aging population • Hospital care to cost-effective home care • Long-term care • Nursing salaries including advanced practice nurses - Wage compression—flattening of salaries for experienced nurses
The American Civil War (1861-1873)
• No professional nurses to tend the wounded • No organized system of medical care in either the Union or Confederacy A call for nurses- Roman Catholic orders (Sisters of Charity, Mercy, and Holy Cross)
Nursing Opportunities Requiring Advanced Degrees
• Nurse Educators • Clinical Nurse Leaders • Nurse Practitioner • Clinical Nurse Specialist • Certified Nurse - Mid-wife • Certified Registered Nurse Anesthetist
Opportunities in Nursing
• Nursing in Medical Offices • Nursing in the Workplace - occupational nursing • Nursing in the Armed Forces • Nursing in Schools • Nursing in Palliative Care and End - of - life settings • Nursing from a Distance: Telehealth • Managing Information in Nursing: Informatics • Nursing Faith Community • Nursing in Business: Entrepreneurs
Gender
• Nursing remains a profession dominated by women • NCSBN survey 9.4% of nurses are men substantially larger than the 2% male workforce documented in 1970
Influences of the Nursing Shortage
• Social Context - who chooses to be a nurse. Why did you choose nursing? • The image of nursing - sexy, mean, or caring • Gender - thank goodness more and more men are joining for forces! • National population trends - professionalism • Technology - we actually lose nurses due to technology • Aging of America and Nursing - we live longer in the US and our nurses are aging. We are counting on you!
The Aging of Nursing
• The future of nursing depends on the infusion of youth. • The steady increase in the age of nurses in the workforce is a major concern ! • 22.1% plan to retire in next 5 years • 19% equal or older than 65 • 12.2% 60 to 64 years of age • 31.2% (1/3) of the current nursing workforce older than age 60 - 2020 could be an issue! • Recruiting, educating, and retaining younger nurses!!! Note: In the next 10-15 years, 1 million nurses will retire!
The Spanish American War (1898)
• U.S. declared war on Spain • Hospital Corps formed • Typhoid fever epidemic
Effects of Evolving Healthcare Environment
• U.S. delivery of healthcare - Patients as consumers - Cost control while optimizing outcomes • COVID -19 - Long term health - Socioeconomic effects - Mandates - Healthcare workforce • Issues in Healthcare - Access to adequate health care - Morality rates
Flexner Report
•1910: Flexner Report called for medical schools to implement high standards for admission and graduation. •1915: Flexner published a list of criteria that he believed to be characteristic of a profession: •Is basically intellectual (as opposed to physical) and is accompanied by a high degree of individual responsibility •Is based on a body of knowledge that can be learned and is developed and refined through research •Is practical, in addition to being theoretical
Characteristics of a Profession
•Can be taught through a process of highly specialized professional education •Has strong internal organization of members and a well-developed group consciousness •Has practitioners who are motivated by altruism (the desire to help others) and who are responsive to public interests
Profession
•Education takes place in a college or university. •Education is prolonged. •Work involves mental creativity. •Decision making is based largely on science or theoretical constructs (evidence-based practice). •Values, beliefs, and ethics are an integral part of preparation. •Commitment and personal identification are strong. •Workers are autonomous. •People are unlikely to change professions. •Commitment transcends material reward. •Accountability rests with individual.
Collegiality
•Essence of Collegiality - promotion of a supportive and healthy work environment, cooperation, and recognition of interdependence among members of the nursing profession •Professional nurses demonstrate collegiality by sharing with, supporting, assisting, and counseling other nurses and nursing students. •Collegial Behaviors
Documents that Guide All Nurses in Their Professional Commitment
•Nursing's Social Policy Statement: The Essence of the Profession - A Contract with Society •Nursing: Scope and Standards of Practice •Code of Ethics for Nurses Purpose: •It is a statement of ethical values, obligations, duties, and professional ideals of nurses individually and collectively. •It is nursing's non-negotiable ethical standard. •It expresses nursing's own understanding of its commitment to society.
Professional Commitment
•Personal identification is derived from the profession. •Profession as a "calling" •Commitment transcends expectation of material reward. •Strong professional identity - it is less common to change careers than an occupation.
Occupation
•Training may occur on the job. •Length of training varies. Work is largely manual. •Decision making is guided largely by experience or by trial and error. •Values, beliefs, and ethics are not prominent features of preparation. •Commitment and personal identification vary. •Workers are supervised. People often change jobs. •Material reward is main motivation. •Accountability rests primarily with employer.
Professional Preparation
•Typically in a college or university. It requires instruction in the specialized body of knowledge and techniques of the profession. •It includes orientation to the beliefs, values, and attitudes expected of the members of the profession, and the standards of practice and ethical considerations (socialization). •Intense preparation enables practitioners to act in a logical, rational manner using scientific knowledge and prescribed ways of thinking through problems rather than relying on simple problem solving, custom, intuition, or trial and error. •Example: nursing process