NUR 302 (Module 1 Sherpath Lessons)

Nursing Ethics

Accountability (accepting responsibility) Advocacy (offering active support) Autonomy (being independent and self-motivated) Beneficence (acting in the best interest of the patient) Confidentiality (protecting disclosure) Fidelity (keeping promises) Justice (relating to others with fairness and equality) Nonmaleficence (doing no harm) Responsibility (being answerable) Veracity (being truthful) Examples of nursing ethics are: The nurse holds in confidence personal information and uses judgment in sharing information about a patient. The nurse acts as an advocate for the patient and has the best interests of the patient in mind at all times. Nurses treat all patients equally regardless of socioeconomic background, religious beliefs, race, religion, or sexual orientation. Nurses recognize nursing as their life's work, being an important component of their lives and clearly defining who they are. Nurses focus on service to their patients and the community.

Linda Richards

first trained nurse, graduated from Boston's Women's Hospital in 1873

Dorothea Dix

headed the U.S. Sanitary Commission (a forerunner of the Army Nurse Corps)

educator

nurse ensures that patients receive sufficient information on which to base consent for care and related treatment. In addition, the nurse assesses the patient's learning needs and determines specific teaching strategies to meet those needs. The nurse then evaluates the effectiveness of patient teaching. Patients need to be informed about their medications, procedures, diagnostics, and health promotion measures. Discharge planning requires extensive education so that patients will be prepared to handle their own needs at home. It is important for the nurse to understand literacy standards and regulatory guidelines related to patient rights, informed consent, educating patients, improving quality care, and meeting patient needs. The Joint Commission, an accrediting organization for health care facilities, publishes standards for patient and family education directed at improving health care outcomes.

Altruism

A profession provides services needed by society. Altruism is public service over personal gain. Nurses recognize nursing as their life's work. It is an important component of their lives and clearly defines who they are. Nurses focus on service to their patients and the community.

novice nurse

A nursing student or nurse with no previous experience.

Socialization

A process that involves learning the theory and skills necessary for the role of nurse. By understanding and adopting the role, nursing students gain the ability to participate as a member of the profession. The nursing student's knowledge base, attitudes, and values toward nursing practice evolve. The student matures professionally and personally as she/he gains a full understanding of the nursing profession. The transformation continues after graduation as the nurse gains experience while working and pursuing further education. Transformation into the nursing role requires students to become response-based practitioners with the ability to recognize the complexity of a situation and *prioritize concerns*

Theoretical Knowledge

A profession develops, evaluates, and uses theory as a basis for practice. To advance knowledge in their field, professionals publish and communicate their knowledge. Nursing has a well-defined, specific, and unique body of theoretical knowledge. Theory in nursing leads to defined skills, abilities, and norms that are enlarged by research.

Higher Education

A profession has clearly defined educational requirements for entry into practice. Nurses must have a diploma, associate's degree, or a bachelor's degree in nursing to be eligible to take the NCLEX-RN examination. Higher education offers nurses greater professional opportunities and the training necessary to extend nursing science through advanced practice and research.

Overview of Criteria for Nursing Profession

A profession is a vocation that requires specialized education related to a specific body of knowledge. Nursing is considered a profession. Professionals have a clear standard of educational preparation and requirements before they can enter into practice. Graduates with associate, diploma, and baccalaureate degrees in nursing are eligible to take the NCLEX-RN examination for state licensure.

Licensure

A profession is committed to competence. Members of a profession have legally recognized licenses that demonstrate basic competency to practice. Professionals are accountable for continuing their education to keep up competencies. Nurses are committed to professional development and are required by most states to take continuing education courses to keep their licenses current and demonstrate competency.

Specific criteria or characteristics possessed by nursing that help to define it as a profession

Altruism Body of knowledge and research Accountability Higher Education Autonomy Code of Ethics Professional organization Cultural diversity Licensure

Evidence-based practice (EBP)

An integration of the best-available research evidence with clinical judgment about a specific patient situation. vidence for nursing practice comes from nursing research. Potential problems are discovered during patient care, and nurse researchers gather and analyze data and report research findings in the literature. The nurse assesses current and past research, clinical guidelines, and other resources to identify relevant literature. Assessing the need for change and identifying a problem. Linking the problem with interventions and outcomes by formulating a well-built question to search the literature: P-population, I-Intervention, C-Compare to another intervention or standard of care, O-outcome. Identifying articles and other evidence-based resources that answer the PICO question. Critically appraising the evidence. Synthesizing the best evidence. Designing a change for practice. Implementing and evaluating the change by applying the synthesized evidence. Integrating and maintaining change while monitoring processes and outcomes by reevaluating the application of evidence and assessing areas for improvement.

the standards of practice, includes six responsibilities for the nursing process:

Assessment Diagnosis Outcomes identification Planning Implementation Evaluation

Lenah Higbee

Born in Canada but completed her nursing training at the New York Postgraduate Hospital. She joined the newly established U.S. Navy Nurse Corps in 1908 as one of its first twenty members who became known as "the Sacred Twenty." She was promoted to superintendent of the U.S. Navy Nurse Corps in 1909. Chief Nurse Higbee led the Nurse Corps through the first World War and was awarded the Navy Cross in 1918. She was the first woman to receive that medal.

Master of Science in Nursing (MSN) degree

Certified nurse midwife (CNM) Nurse practitioner (NP) Clinical nurse specialist (CNS) Certified registered nurse anesthetist (CRNA) Four additional advanced practice roles that may involve direct or indirect patient care roles are: Clinical nurse leader (CNL) Nurse educator Nurse researcher Nurse administrator

Additional Advanced Roles for Nurses

Clinical nurse leader (CNL) is a new role for RNs. Nurses who practice as CNLs oversee integration of care for a specific group of patients. They may use evidence-based practice to provide direct care in complex situations. The CNL is part of a team made up of several professionals, which does not include an administrative or management role. CNLs are leaders in the health care delivery system in all health care settings, not just the acute care setting. Implementation of this role varies across settings. Obtaining a master's degree supports one of the advanced practice roles that have either indirect or no direct patient care as a component. The nurse educator may practice as faculty in university, community college, or diploma based schools of nursing, technical schools, or as staff educators in health care facilities. Nurse educators combine their clinical abilities with their responsibilities for designing curricula, educating and evaluating students, evaluating learning program effectiveness, advising students, and engaging in scholarly work. Additional options for nurses with master's degrees include researcher and nursing administrator. Nurse researchers use statistics to gather and report on data related to health care. They may be involved in clinical trials with patients or other research related to health care. Nurse administrators coordinate the use of human, financial, and technological resources to provide patient care services. Positions for the nurse administrator include facilitator, manager, director, chief nurse executive, and vice president of nursing.

APRN

Designation for an RN who has met advanced educational and clinical practice requirements. They have, at a minimum, a master's degree and provide at least some level of direct care to patients. APRNs have acquired theoretical research-based and practical knowledge as part of the graduate education. They are either certified or approved to practice in their expanded, specialized roles. Advanced practice nurses have a set of core competencies. Direct clinical practice Collaboration Expert coaching and guidance Research Ethical decision making Consultation Leadership

Part 2 focuses on professional performance:

Ethics Education Evidence-based practice and research Quality of practice Communication Leadership Collaboration Professional practice evaluation Resource utilization Environmental health

Researcher

Evaluate research studies and apply research findings to practice. Nurses communicate concerns about nursing practices, and those concerns often become the basis of research. By applying research findings to their practice, nurses are involved in evidence-based practice (EBP).

Nurse Practice Acts (NPAs)

Laws that set the legal limits of nursing practice and define the scope of practice within each state or jurisdiction. These acts are laws, and nurses must be familiar with them when they practice in any state. Nurse practice acts are worded in broad legal terms. These terms must be interpreted so that nurses clearly understand what they mean within the context of their profession. A nursing scope of practice defines the boundaries in which nurses can practice and how those boundaries intersect with other professions or disciplines. In addition to adhering to nurse practice acts and practicing within their scope of practice, nurses must follow the policies and procedures of the institution at which they are employed.

Florence Nightingale

Notes on Nursing (1860) elevated nursing care by including critical thinking and respect for patient needs and rights. Founder of modern nursing and is known for her care of the sick in the Crimean War (1853-1856). Her contributions influenced developments in the field of epidemiology. By collecting data about patient care and using statistical knowledge, she was able to show that more soldiers were dying in war hospitals from poor sanitation due to cholera and dysentery than were dying in the field. Her role included establishing nursing as a respected profession for women that was distinct from the medical profession. She founded a nursing school and stressed the need for university-based and continuing education for nurses.

Professional Organization

Numerous professional organizations support and encourage high standards in nursing. Each nursing organization determines responsibilities and standards of conduct and regulates its members' adherence to its own professional standards. The American Nurses Association (ANA) is an example of a professional organization that provides standards for nursing practice.

Change Agent

Nurse works with patients to address their health concerns. Nurses work with other staff members to address change within an organization or a community. The nurse can be a change agent in a leadership role. The role of change agent requires knowledge of change theory, which encourages change and provides strategies for effecting change. This role can be extended to bringing about legislative change on health policy issues.

ANA Principles for Social Networking

Nurses must not transmit or place online individually identifiable patient information. Nurses must observe ethically prescribed professional patient—nurse boundaries. Nurses should understand that patients, colleagues, institutions, and employers may view postings. Nurses should take advantage of privacy settings and seek to separate personal and professional information online. Nurses should bring content that could harm a patient's privacy, rights, or welfare to the attention of appropriate authorities. Nurses should participate in developing institutional policies governing online conduct.

Diversity

Nurses provide care to patients with many different cultures and backgrounds. According to the ICN, nursing care is respectful of and unrestricted by considerations of age, color, creed, culture, disability or illness, gender, sexual orientation, nationality, politics, race or social status. To respect the diversity of their patients, nurses practice culturally competent care, which means care that is sensitive to the needs of people with varying cultural differences.

Accountability

Nursing accountability is essential for developing trusting relationships with patients and coworkers. Accountability involves accepting responsibility for actions and omissions, as well as legal, ethical, and professional implications.

Professional Organizations

Nursing organizations give nurses access to current information and resources as well as a voice in the profession

Nursing as an Art and Science

Nursing practice requires blending the most current knowledge and practice standards with an insightful and compassionate approach to patient care. Patients' health care needs are multidimensional. The highest level of nursing care reflects the needs and values of society. Professional standards of care and performance meet the needs of each patient and integrate evidence-based findings. In the United States, Nurse Practice Acts (NPA) are governed by each state's Board of Nursing. Nurse Practice Acts regulate the scope of nursing practice and protect public health, safety, and welfare. This protection includes shielding the public from unqualified and unsafe nurses. Although each state defines for itself the scope of nursing practice, most have similar NPAs. The definition of nursing practice published by the American Nurses Association (ANA) is similar to the scope of nursing practice as defined in most states.

Ethics Code

Practice and conduct within a profession is guided by a code of ethics. Ethics is the standards of right and wrong behavior. The International Council of Nurses (ICN) and the ANA each developed a code of ethics for nurses. Public opinion polls consistently show that the nursing profession is viewed as the most honest and ethical of all professions. Review the ANA Nursing Code of Ethics.

Clara Barton

Practiced nursing during the American Civil War and established the American Red Cross. Through her leadership, the American Red Cross became the first medical response team to respond to varying disasters such as floods and earthquakes. Prior to becoming a nurse, Clara Barton was a teacher. She opened a free public school in New Jersey.

Doctor of Philosophy/Nursing Practice

Prepares nurses for leadership roles in research, teaching, and administration. The newer DNP is an academic degree that focuses on the clinical aspects of nursing. DNP specialties include the four advanced practice roles of NP (nurse practitioner), CNS (clinical nurse specialist), CNM (certified nurse midwife), and CRNA (certified registered nurse anesthetist). In addition, some DNPs focus on the CNL (clinical nurse leader) option. Both types of doctoral degrees are essential to advancing nursing as a profession.

Delegator

Process of entrusting or transferring the responsibility for certain tasks to other personnel, including UAP, licensed vocational nurses (LVNs), and LPNs. Because the RN retains ultimate responsibility for patient care, it is imperative that the nurse knows the scope of practice and capabilities of each health care team member. For example, UAP are capable of performing basic care, including bathing, taking vital signs, helping the patient ambulate, and assisting with eating. UAP duties can vary from state to state depending on state practice acts.

Autonomy

Professionals have autonomy in their decision making and practice. Professions tend to be self-regulating. Policies are developed by members of the profession. As with other professionals, nurses make independent decisions within their scope of practice and are responsible for the results and consequences of those decisions.

Leader

Providing direction and purpose to others, building a sense of commitment toward common goals, communicating effectively, and assisting with addressing challenges with patients. Integrity, creativity, interpersonal skills, critical thinking, and the ability to problem-solve are characteristics of effective leaders. Nurse leaders motivate others toward accomplishing common goals.

nursing process

The multistep scientific approach that nurses use to care for their patients. As a care provider, the nurse follows this process to assess patient data, prioritize nursing diagnoses, plan care for patients, implement appropriate interventions, and evaluate care in an ongoing cycle.

Advocate

The nurse interprets information and provides necessary education. The nurse accepts and respects the patient's decisions even if they are different from the nurse's own beliefs and values. The nurse ensures the patient's wishes are communicated to other health care providers. Nurses should always advocate for patients, especially in situations in which they cannot speak for themselves, such as during a severe illness or when under general anesthesia.

Manager

The nurse oversees all of the activities and treatments for patients. Coordination of the health care provider's services must be done efficiently and effectively to promote, restore, or maintain the patients' health. In addition to managing a group of patients, the nurse may also be the manager of a unit in a hospital. A nurse manager in a hospital oversees the staff on a patient care unit while managing the budget and resources required for necessary unit functions.

Nursing American Nurses Association (ANA) (2010)

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.

Nursing Virginia Henderson (1966)

The unique function of the nurse is to assist the individual, sick or well, in the performance of those activities contributing to health or its recovery (or to peaceful death) that he would perform unaided if he had the necessary strength, will or knowledge. And to do this in such a way as to help him gain independence as rapidly as possible.

Licensed Practical or Vocational Nurse

Their education takes 12-18 months to complete and then they are eligible to take the National Council Licensure Examination for Practical Nurses (NCLEX-PN) to practice as an LPN/LVN. In most institutions, they must practice under the supervision of a registered nurse. They can collect data but they cannot perform an assessment that requires decision-making, identify or individualize nursing diagnoses, or initiate a care plan. They may update care plans, and can administer medications with the exception of certain IV medications.They may choose to complete an LPN/LVN to RN program to become an RN.

Advanced beginner nurses

Use more sophisticated rules based on limited experiences.

expert

diverse experience and an intuitive grasp of clinical problems and situations

Nursing The International Council of Nurses (ICN) (2010)

encompasses autonomous and collaborative care of individuals of all ages, families, groups and communities, sick or well and in all settings. Nursing includes the 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.

proficient nurse

same clinical position for longer than 2-3 years and uses experiences when making decisions.

Collaboration

two or more people work together toward a common goal. In the role of collaborator, the nurse works with UAPs, LPNs/LVNs, primary care providers, social workers, clergy, and/or therapists to provide high-quality patient care. The nurse plays an important role in the coordination of this care to ensure all goals are met. The nurse is responsible for ensuring that all patient care orders are carried out and communicated with the entire team. The characteristics necessary for effective collaboration are: Clinical competence and accountability Common purpose Interpersonal competence and effective communication Trust and mutual respect Recognition and valuation of diverse complementary knowledge and skills Humor

competent nurse

working in the same clinical position for 2-3 years.