Nursing 2371 Exam 1 (Ch. 3 & 11)
WHO (2010) statement on professionalism
"It is no longer enough for health workers to be professional. They also need to be interprofessional."
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 - Nursing practice act, health agency policies, school of nursing policies, and profession's standards of practice all provide guidance in making decision about nursing actions within your scope of practice
Dynamic Nature of the Nursing Process
- Nurses are continuously moving from one phase to another and then beginning the process again. - Often a nurse performs two or more phases at the same time
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
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 - Need and follow clear-cut rules
Professional Commitment
- Personal identification is derived from the profession. - Profession as a "calling" - Commitment transcends expectation of material reward
Historical influences
- Religious and military background and obedience - Florence Nightingale - Isabelle Hampton Robb
Writing a Plan of Care
- Standardized plan of care are based on common and recurring problems. - Critical pathways - multidisciplinary plans of care - Facilitates communication among all members of the health care team
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
External conflicts
- Tension between medicine and nursing - Lobby for protection of nursing practice
Professional Preparation
- Typically in a college or university; requires instruction in the specialized body of knowledge and techniques - includes orientation to the beliefs, values, and attitudes; 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
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
Collegial Behaviors
- share knowledge with colleges and students - take part in professional organizations - mentor less experienced nurses
Implementation
- 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 - need to be documented
What are some other SNL?
-Clinical Care Classification -Nursing Interventions Classification -Nursing Outcomes Classifications -Peri-operative Nursing Data Set -Omaha System-Community Health Classifications
What is the power of the board?
-approve schools of nursing -establish standards for nursing practice -examine, approve, renew and reinstate licenses -establish procedures for disciplinary process -maintain records of all Board proceedings
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 -values, beliefs, and ethics are integral part of preparation -accountability rest with individual
What are the 3 purposes of ANA?
-foster high standards of nursing -work for the improvement of health standards and availability of health care services of all people -stimulate and promote the professional development of nurses and advance their economic general welfare
What are some methods collecting data?
-interview -physical examinations -consultation
occupation
-material reward is main motivation -accountability rest primarily with employer -training may occurs on the job -work is largely manual -decision making is guided largely by experience -values, beliefs, and ethics are not prominent features of preparation
What 4 domains of factors that affect nurses' accurate documentation of diagnoses according to Paans?
-nurses themselves as effective diagnosticians -how nurses are educated about nursing diagnoses -complexity of a patient's situation -degree to which a hospital's policy and environment supports the use of nursing diagnosis
What was the Powers of the Board?
-publish an annual report -maintain a roster of licenses -adopt rules and regulations enforcing NPA -appoint an attorney -employ an executive director -obtain criminal record of applicants -regulate student nurses
Kelly's Criteria: 8 Characteristics of a Profession
-services provided are vital to humanity and the welfare of society -there is a special body of knowledge that is continually enlarged through research -service involves intellectual activities -practitioners are educated in institutions of higher learning -practitioners are relatively independent and control their own policies and activities -practitioners are motivated by service and consider their work an important component of their lives -code of ethics to guide the decisions and conduct of practitioners -there is an organization that encourages and support high standards of practice
What was Halls 5 attributes to a professional model?
-uses profession organization as primary point of reference -belief i n value of public service -belief in self regulation -commitment to a profession that goes beyond economic incentives -sense of autonomy in practice
4 domains of Interprofessional Collaborative practice Competency
-values/ethics for interprofessional practice -roles/responsibilities -interprofessional communication -teams and teamwork
The Process of Professionalism (professionalization)
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.
Purpose of Code of Ethics for Nurses:
1. Succinct statement of ethical obligations & duties of every individual who enters the nursing profession. 2. The profession's non-negotiable ethical standard. 3. Expression of nursing's own understanding of its commitment to society.
Clinical Judgment: Nine Key Questions
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?
What are the 3 characteristics Houle identified that occupation moves along a professional status?
1. defining group's mission and foundations of practice 2. mastery of theoretical knowledge, development of the capacity to solve problems, use of practical knowledge, and self-enhancement 3. development of a collective identity
Nursing's Social Policy Statement: The Essence of the Profession
A contract with society-framework for understanding professional nurses relationship with society
Steps of the Nursing Process
Assessment Diagnosis Planning Implementation Evaluation
beneficence
Doing good or causing good to be done; kindly action
What report called for medical schools to implement high standards for admission and graduation?
Flexner Report
Internal conflicts
Fragmented power and influence in professional nursing
Who identified characteristics that indicate that an occupation moves along the continuum toward professional status?
Houle
psychomotor domain
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.
LSBN Purpose
LSBN is an agency of the state charged with the responsibility to protect the public healthy, safety and welfare of the citizens of LA by regulating the practice of nursing by RN and advanced practiced RN
standardized nursing language (SNL)
Language readily understood by all nurses to describe care in order to provide a common means of communication.
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).
Nursing: Scope and Standards of Practice
Outlines the expectations of the professional role within which all RNs must practice and delineates the standards of care and associated competencies for professional nursing
How do you write a nursing diagnosis?
P-problem E-etiology S-signs/symptoms
What task force found that members of a profession share 10 characteristics?
Pharmacy Profession Task Force
Planning
The nurse develops a plan of care that prescribes interventions to attain expected outcomes
Gender issues
The persistent devaluing of women's work in our society has created an ongoing struggle for the nursing profession to increase the status, increase the compensation, and improve the working conditions
True/False Every goal has specific intervention, which may be carried out by a RN or delegated to other members of the nursing staff
True
True/False Nursing process is dynamic
True
nursing diagnosis
a clinical judgment about individual, family or community responses to actual or potential health problems or life processes; identifies the problems the patient is experiencing as a result of the disease process
nursing process
a conceptual framework that enables the student or the practicing nurse to think systematically and process pertinent information about the patient; combines "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
inter-professionality
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
Roy Bixler and Genevieve Bixler
advocates and supporters of nursing even though they were not nurses themselves
ANA Position Paper
all nursing education should take place in institutions of higher education
reflective thinking
an active process valuable in learning and changing behaviors, perspectives, or practices
collective identity
collection of similarities that a group feels with one another
clinical judgement
consists of informed opinions and decisions based on empirical knowledge and experience
autonomy
control over one's practice
caring
core of professional nursing through which nurses intervene for their patients
Nurses who think _____________ are engaged in a process of constant evaluation, redirection, improvement, and increased efficiency.
critically
cultural congruent intervention
developed within the broad social, cultural, and demographic context of the patient's life
Cultural congruent intervention
developed within the broad social, cultural, and demographic context of the patient's life.
fidelity
faithfulness; loyalty
accountability
firmly rooted in the ethical principles of fidelity, loyalty, veracity, beneficence, and respect for the dignity, and self-determination of patients
Nightingale Pledge
first code of ethics; established roots for current code
University of Minnesota
first university-based nursing
Assessment
gather information or data about the individual, family, or community
altruism
ideal of service to others
independent interventions
innervation that requires no supervision or direction by others
cognitive domian
involved knowledge and intellectual skills; can range from simple recall to complex tasks
Affective Domain
involves the emotions
Strong professional identity makes it
less common to change careers than an occupation.
Outcome criteria define the terms under which the goal is said to be
met, partially met, or unmet
Goals should be agreed on by both
nurse and patient
What are the three things that make up the foundation of nursing?
person health environment
Maslow's Hierarchy of Needs
physiological, safety, love/belonging, esteem, self-actualization
Socio-cultural factors must be considered in
planning care
American Nurses Association (ANA)
primary advocate for nursing interests
Essence of Collegiality
promotion of a supportive and healthy work environment, cooperation, and recognition of interdependence among members of the nursing profession
Dependent interventions
require instructions, written prescriptions, or supervision of another health professional with prescriptive authority
goal
sets a general direction, includes an action verb, and should be both attainable and realistic for patient
What types of data is subjective and objective?
symptoms (subjective) objective (signs)
collegiality
the promotion of a supportive and healthy work environment, cooperation, and recognition of interdependence among members of the nursing profession
North American Nursing Diagnosis Association (NANDA) mission:
to facilitate the development, refinement, dissemination, and use of standard nursing diagnostic terminology with the goal to improve health care of all people
Code of Ethics for Nurses
tool that guides a group towards professional definition and provides evidence of professional legitimacy
veracity
truthfulness, honesty
Interdependent interventions
when a nurse has to collaborate with other health professionals before you can carry out the actions
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