NUR 205 Objectives
Describe the historical background of nursing
Renaissance and the reformation period there were major advancements in medicine (pharmacology, chemistry, and medical knowledge), but it was known as the dark ages of nursing because there were crude methods of doctors and nursing no longer appealed to women of higher status; nursing became an undesirable job. Nursing orders were established by the Sisters of Charity- recruited young women for nurse training, developed educational programs and cared for abandoned children. St. Vincent de Paul established the hospital to care for orphaned and abandoned children. Colonial america: -health care was deficient, life expectancy was low; plagues such as yellow fever and smallpox were a threat; physicians were poorly trained. Pennsylvania hospital was the first hospital established by Benjamin Franklin.
Dorothea dix
Served as superintendent of the Female Nurses of the Army during the Civil War; was given the authority and the responsibility for recruiting and equipping a corps of army nurses; was a pioneering crusader for the reform of the treatment of the mentally ill
identify the 8 parameters of a symptom or client health complaint
Location Character Quantity/Severity Timing Setting Aggravating or relieving factor Associated factors Patients perception
Margaret Sanger
Opened the first birth control clinic in the US; founder of planner parenthood federation
describe what kind of data base needs to be collected based on the clinical situation
1. Initial assessment/complete database: complete health history and a full physical exam 2. Focused/problem centered: concerns mainly assessment on one problem or one body system 3. Ongoing/follow up databases: to assess identified problems at regular/appropriate intervals (on return visits/during hospital stay) in order to evaluate change 4. Emergency database: key data/assessment to immediate problem done in an emergency situation
Explain the elements of the communication process
1. Stimulus • What is bringing on this conversation? (having surgery tomorrow) 2. Sender/Encoder • (starts talking about issue) 3. Message • Tell me about the procedure/surgery 4. Medium/Channel of Communication • Auditory • Visual • Kinesthetic (touch/demonstrate) 5. Receiver • Receiving information
Explain the aims of nursing as they interrelate to facilitate maximal health and quality of life for patients.
1. to promote health: increase a persons well being and health potential 2. To prevent illness: avoid illness; achieve early detection; or maintain function within the constraints of an illness 3. To restore health: direct care for diagnosis or treatment of disease 4. To facilitate coping with disability or death-to facilitate an optimal level of functioning; provide quality end of life care
Understand how the varying phases of the therapeutic relationship and interview utilize communication techniques
3 phases of a therapeutic relationship 1. Orientation phase -establish tone and guidelines for the relationships -identify each other by name (Mr., Mrs., Ms., Dr.) -clarify roles of both people -establish an agreement about the relationship and mutual understanding of what will occur in the relationship (trust) -goals of the relationship -when, where, and for how long each meeting will be -duration of the relationship -provide patient with an orientation to the healthcare system 2. Working phase (longest phase): Nurse-patient interactions are designed to ensure achievement of health goals or objectives that were mutually agreed upon -work together to meet the clients needs -provide whatever assistance is needed to achieve each goal or outcome (example: feeding, hygiene and counseling) -patient centered approach -evaluate the nursing interventions and modify as needed -motivating patients to learn and implement health promotion activities and to facilitate the patients ability to execute the nursing plan and to express feelings about any health problems 3. Termination phase -end of the relationship -should not be abrupt or unexpected -termination expectations should occur from the beginning of the relationship -reactions vary depending on: meaning assigned to it, length of the relationship, extent to which the outcomes were reached Interview 1. Introduction phase -set the stage: welcome the patient and use his/her name, introduce yourself and explain your role, indicate how long interview will take and if there will be a subsequent psychical exam, remove internal/external potential factors that could be barriers to communication, ensure comfort and put client at ease, describe the purpose and expectations of the interview, describe confidentiality, do not use diminutives during interaction 2. Working phase: -Open-ended questions: allow the patient a wide range of possible responses (encourages free verbalization)-beginning, to introduce a new section of questions, whenever the person introduces a new topic, tell me how i can help you, what brings you here today, tell me about your symptoms -Close-ended questions: limit answers, for specific information, fill in any details that the client left out -Validating questions: nurse restates what she/he heard or observed -Clarifying question: allows nurse to gain an understanding of patient comments -Reflective question: repeating what the patent said or describing the persons feelings -Sequencing questions: place events in chronological order -Directing question: used to obtain more information about a topic or to introduce a new aspect of a current topic 3. Conclusion: end gracefully; summarize what you, the nurse, have learned about the patients health history during the interview; thank the client for their time and cooperation
Isabel Hampton Robb
A leader in nursing and nursing education; organized the nursing school at Johns Hopkins Hospital; initiated policies that included limiting the number of hours in a days work and wrote a textbook to help student learning; the first president of the Nurses Associated Alumnae of the United States and Canada (now American Nurses Association).
Elizabeth Smellie
A member of the original Victorian Order of Nurses for Canada (a group that provided public health nursing); organized the Canadian Women's Army Corps during World War II
Harriet tubman
A nurse and an abolitionist; active in the underground railroad movement before joining the Union Army during the Civil War
Louise Schuyler
A nurse during the Civil War; returned to New York and organized the New York Charities Aid Association to improve care of the sick in Bellevue Hospital; recommended standards for nursing education
Lavina dock
A nursing leader and women's rights activist; instrumental in the Constitutional amendment giving women the right to vote
Discuss the contents of the ANA standards of practice and code of ethics
ANA: -defines the activities of nurses that are specific and unique to nursing -allows nurses to carry out professional roles, serving as protection for the nurse, the patient and the healthcare institution -each nurse is accountable for his or her own quality of practice and is responsible for the use of these standards to ensure knowledgebale, safe. and comprehensive nursing care Code of ethics:-the nurse practices with compassion and respect for inherent dignity, worth, and uniqueness of every individual, unrestricted by consideration of social or economic status, personal attributes, or nature of health problems -nurses primary commitment is to the patient-nurse promotes, advocates for and strives to protect the health, safety and rights of the patient -nurse is responsible and accountable for individual nursing practice and determines the appropriate delegation of tasks consistent with the nurse obligation to provide optimum patient care -the nurse owes the same duties to self as to others -nurse participates in establishing, maintaining, and improving health care environments and conditions of employment conductive to the provision of quality health care and consistent with the values of the profession - nurse participates in advancement of the profession through contributions to practice, education, administration and knowledge development -collaboration -articulating nursing values and maintaining integrity of the profession and its practice
Describe the ethical principles as they relate to nursing
Autonomy-respect autonomy of others Nonmaleficence-doesn't harm Beneficence-benefits others Justice-treat others fairly Fidelity-faithful to promises we make to others Accountability Veracity-accuracy Privacy Confidentiality
Mary Adelaide Nutting
Became the first professor of nursing in the world as a faculty member of Teachers' College, Columbia University; with Lavinia Dock, published the four-volume History of Nursing
Describe the status of nursing today
Challenges facing professional nurses -changing duties and responsibilities -severe nursing shortage -patient safety, accountability, and quality of care Core competencies required by professional nurses: critical thinking, communication, inter-professional collaboration, assessment, leadership, technical skills Knowledge required by professional nurses: -health promotion/disease prevention, information technology, public policy Consumer issues in health care -Access, quality, cost, accountability Changes in society: -aging population, intercultural population, generational differences in an aging workforce, high acuity and short staffing, need for a well-trained work force, average age of full time faculty 54 years of age, Nurse Reinvestment Act signed into bill August 2002 to provide funds for nursing education, recruitment and retention Affordable Care Act: -provide insurance to over 32 million previously uninsured Americans Robert Wood Johnson Foundation -nurses should practice to full extent of training -nurses should achieve higher levels of education -nurses should be full partners with physicians and other health care professionals to re-design health care in the US -improve health care workforce data collection to better assess and project workforce requirements Opportunities for professional nurses -opportunities to increase knowledge -evidence based practice -united effort to shape health care; influence policy -united effort to address the nursing shortage
begin to utilize strategies for documentation of health history
Collecting data -active processing -observing and listening to the client (also SO and family member): help clarify, elaborate, and give additional pertinent information; systematic series of mental actions to analyze and interpret the information -Learning to listen 1. listen with the intent to understand-keep an open mind, put aside your own paradigms 2. develop skill of emphatic listening; take time to understand the other persons frame of reference (values and beliefs) so that you can define the true meaning of the message 3. recognize your use of the following: ignoring, pretending to listen, selective listening; listening attentively to the specific words but not the meaning Active processing -translation-clear, succint, meaningful statements -reasoning: make mental connections of the data to diseases, health patters or the current situation. Inferences-attach meaning to data or reach a conclusion about the data; intuition and validation
Differentiate between intentional torts and unintentional torts
Crime: a wrong against a person or his/her property (considered to be against the public as well, punishable by state)-misdemeanor and felony Tort: a wrong committed by a person against another person or his/her property (subject to action in civil court) 1. intentional: fraud, defamation, assault and battery, false imprisonment, and invasion of privacy 2. unintentional: -negligence: occurs when harm or injury is caused by an act of either omission or commission by a layperson -malpractice: an act of negligence by a professional person as compared to the actions of another professional person in a similar circumstance. 4 elements that must be established to prove malpractice are: duty (an obligation to use due care), breech of duty (failure to meet a standard of care), causation (failure to meet standard of care resulted in injury), and damage (actual harm or injury)
discuss factors that influence communication and interviewing skills
Developmental level Gender Sociocultural differences Roles and responsibilities Space and Territory Physical, mental and emotional state Values Environment: comfort zone
Mary Agnes Snively
Director of the nursing school at Toronto General Hospital and one of the founders of the Canadian Nurses Association
Lilian ward
Established a neighborhood nursing service for the sick poor of the Lower East Side in New York City; the founder of public health nursing
Nora Gertrude Livingston
Established a training program for nurses at the Montreal General Hospital (the first 3-year program in North America)
Mary Breckinridge
Established the FNS/Frontier Nursing Services in 1925, health care services for rural Kentucky, The FNS is still in operation today and provides vital service to the rural communities of Kentucky.Breckenridge collected data that clearly documented a significant decrease in mortality with the nursing services provided by the FNS
describe internal and external factors that impact the interview process
External: Physical setting -privacy, interruptions, environment -dress: client should remain in street clothes during the interview; nurse should meet the standards for the setting for professional appearance -documentation: note-taking (some is unavoidable but beware of focusing on paperwork but not patient), tape recording and picture taking is not allowed -noise Factors that promote effective communication -warmth and friendliness, openness and respect, empathy, honest, authenticity, trust, caring, competence -rapport builders: a feeling of mutual trust experienced by people in a satisfactory relationship-specific objectives for the purpose of interaction, comfortable environment, privacy, confidentiality, patient vs task focus, utilization of nursing observations, optimal pacing, respecting personal space
Discuss nursing leaders who influenced the development of nursing
Florence Nightingale: -founder of professional nursing -demonstrated the value of aseptic technique and infection control procedures -honored for her contributions to nursing research - demonstrated the value of political activism to affect health care reform -established the first nursing school in england -honored as the founder of professional nursing services, initiated social services spent up to 20 hours each day providing nursing care -introduced principles of asepsis and infection control, a system for transcribing physicians orders and a system to maintain patient records -kept careful statistics-documented a decrease in the death rate of soldiers from 42% to 2% as a result of health care reforms that emphasized sanitary conditions Mary Seacole: Jamaican nurse who played a major role in the Crimean war; was denied the opportunity to join Nightingales nursing brigade because she was African american. Opened a lodging house with her won money to care for the sick and wounded soldiers. Contributed to control of the cholera epidemic through extensive knowledge in tropical medicine Dorothea Dix: Appointed to organize military hospitals, provide trained nurses, and disperse supplies; she received no official status or salary Harriet Tubman: worked as a nurse, scout, and spy for the union army. Conducted an "underground railroad" to lead slaves to freedom Sojourner Truth: abolitionist and nurse, advocate of clean and sanitary conditions so patients could heal Suzie King Taylor: worked as a full time nurse on the battlefront Clara Barton: American Red Cross Lillain Wald: public health nursing Mildreg montag: philosophical developer of ADN
Mary Elizabeth Mahoney
Graduated from the New England Hospital for Women and Children in 1879 as America's first African American nurse
Linda richards
Graduated in 1873 from the New England Hospital for Women and Children in Boston, Massachusetts, as the first trained nurse in the United States; became the night superintendent of Bellevue Hospital in 1874 and began the practice of keeping records and writing orders
Identify and explain the components of a nursing health history and mental status assessment
Health history: -Start with biographical data (name, age, birth date, address, phone, gender, religion, race, occupation, marital status) -Occupational history: where have they worked and what did that job entail -Financial status: are health care costs a financial burden -Past history: hospitalizations, surgeries, injuries, illnesses, immunizations -Family profile -Relationships and environment -Teaching/learning/education -Socialization and leisure -Current health state -Psychological profile: self concept, stress factors, coping mechanisms -Spiritual beliefs -Self care/ rest and sleep -Sexuality -diet recall Mental status: Appearance, behavior, cognitive, and thought processes and perceptions
Discuss the concept of nursing advocacy, accountability and responsibility
It is the nurses responsibility to provide care that is established by standards of the profession Being accountable means that the nurse is answerable for the outcomes of action taken To advocate for someone means to speak for that person when the person is unable to speak for themselves
Describe the mechanisms that influence the professional and legal regulation of nursing practice
Legal regulations 1. Credentialing: refers to ways in which professional competence is ensured and maintained 2. Accreditation: mandatory and voluntary; process by which an educational program is evaluated and recognized as having met certain standards 3. Licensure: National Council Licensure Examination (NCLEX-RN) for entry level competence (moving to another state you do not have to retake the NCLEX) 4. Certification: validates specialty knowledge, experience, and clinical judgement Professional Regulations -CDC -employer policy and procedures -educational programs -the nursing process
Discuss the MSU CON mission and vision
Mission: The mission of MSU CON is to enhance the health of the community by providing excellence in nursing education, nursing research and nursing practice. We will advance the profession of nursing and serve as an advocate for optimal healthcare for all people Vision: The MSU CON is a leader in creating positive change in healthcare outcomes locally, nationally, and globally through excellence in nursing education, research and practice
Describe how nonverbal communication can impact the communication process
Nonverbal set of behaviors that conveys messages without words-body language -touch, eye contact, facial expressions, body posture, gait, use of gestures, general physical appearance, mode of dress and grooming, sounds and silence often help nurses understand subtle, hidden messages in what the patient is saying verbally. Nurses must be aware of the nonverbal messages they send as well
Discuss the effects on nursing practice of nursing organizations, standards of nursing practice, nurse practice acts, and the nursing process
Nurse practice acts: laws established in each state in the US to regulate the practice of nursing. They differ from state to state but all have certain elements in common -Define the legal scope of nursing practice excluding unlicensed or untrained people -Establishes criteria for education and licensure of nurses -Identify violations that can result in disciplinary actions against the nurse -Exclude untrained or unlicensed people from practicing nursing -Create a state board of nursing -Make and enforce rules an regulations -Define important terms and activities in nursing -Provide legal requirements and titles for RNs and LPNs Profession and Legal requirements of nursing practice -CDC -Employer policy and procedures -educational programs -the nursing process Professional and legal regulation of nursing practice: defines the activities of nurses that are specific and unique to nursing. Allows nurses to carry out professional roles, serving as protection for the nurse, the patient and the healthcare institutions. Each nurse is held accountable for his/her own quality of practice
describe and utilize appropriate interviewing techniques
Obtain accurate and thorough information -gather data Utilize therapeutic communication QUESTIONS TO ASK -Open-ended questions: allow the patient a wide range of possible responses (encourages free verbalization)-beginning, to introduce a new section of questions, whenever the person introduces a new topic, tell me how i can help you, what brings you here today, tell me about your symptoms -Close-ended questions: limit answers, for specific information, fill in any details that the client left out -Validating questions: nurse restates what she/he heard or observed -Clarifying question: allows nurse to gain an understanding of patient comments -Reflective question: repeating what the patent said or describing the persons feelings -Sequencing questions: place events in chronological order -Directing question: used to obtain more information about a topic or to introduce a new aspect of a current topic
Mary Ann Bickerdyke
Organized diet kitchens, laundries, and an ambulance service, and supervised nursing staff during the Civil War
Discuss the clients rights and their influence on nursing practice
Patients have the following rights - see and copy their health record -update their health record -request corrections of any mistakes -get a list of disclosures a health care institution has made independent of disclosures made for the purposes of treatment, payment, and health care operations -request a restriction in certain uses or disclosures -to choose how to receive health maintenance -patient has the right to not be legally forced to remain in a health facility -every patient has the right to be free from invasion of his or her person
Describe the various levels of educational preparation in nursing
Practical and Vocational Nursing Education -established to teach graduates to give bedside nursing care to patients. Most programs are 1 year in length divided into 1/3 classroom hours and 2/3 clinical/lab. Take NCLEX-PN for licensure Registered Nursing Education -Diploma: first schools established to educate nurses-3 years -Associates degree: 2 year educational program -Baccalaureate: 4 year; built on general education base with concentration on nursing at upper levels Graduate education in nursing Continuing education: professional development expereinces designed to enrich the nurses contributions to health; CE are required for RN to maintain licensure In-service education: designed to increase knowledge and skills of the nursing staff
Sojourner Truth
Provided nursing care to soldiers during the Civil War and worked for the women's movement
Jane adams
Provided social services within a neighborhood setting; a leader for womens rights; recipient of Nobel Peach prize in 1931
Describe the discuss the importance and purpose of a complete and holistic health history in nursing practice
Purpose of collecting a health history is to establish a database and to identify actual and potential problems. Need to be able to recognize objective and subjective data Purpose of an assessment -establish a database -identify actual and potential problems -focus on a specific problem -determine immediate needs and priorities -determine related or contributing factors -identify strengths as a basis for changing behavior -identify the risk for complications -recognize complications
Describe how organized nursing arrived in the United states
The Civil War -no army nurses and no organized medical corps when the war began-call for volunteers -Post civil war: hospitals increased rapidly, became the traditional setting for women to legitimately work outside of the home; number of nurse training schools increased after the war (offered little classroom education, on-the-job training occurred in hospital wards)
Identify historical factors that influenced the development of nursing
The Harley Street Experience -Position of Superintendent for 14 months between August, 1853 and October 1854 -Importance of egalitarian and competent caring-no religious means test -Excelled as an effective nursing administrator -Understood the importance of the environment in healthcare -Early documented example of women working for a woman The Crimean war -Florence Nightingale -Bad conditions-she was called in and at first denied but then accepted -purchased medical supplies, food and linens; set up a kitchen; instituted laundry services; instituted social services; spent up to 20 hours each day providing nursing care The Civil War -no army nurses and no organized medical corps when the war began so there was a call for nurses to volunteer -dorothea dix -post civil war clara barton with american red cross -hospitals developed rapidly, nursing increased WW1: -advances in medicine -nurses served honorably -Mary breckenridge -shepard towner act: first legislation to assist special populations and provide public health nurses with resources to promote health and well-being of women, infants and children The Great Depression -american economy was disintegrated and nurses were forced to join the ranks of unemployed -New deal: enacted to rescue the country and provide medical care and other services for the large numbers of indigent people -social security act of 1935 affected health care and provided avenues for public health nursing. Social security act was for federal grants to states for maternal and child welfare services. Vocational rehabilitation services for the handicapped, medical care for crippled children and blind people to strengthen public health services WW2: -legislation: programs enacted to expand nursing education and increase the number of nurses in the military branch -nursing became an essential part of the military service; nurses recognized as integral part of the military and attained officer rank Post WW2: -unemployment dropped -nurses demonstrated value to the armed services during the Korean war; emerged as a true profession with minimum national standards for nursing education; BSN grew and ADN grew too -legislation: nurse training act of 1943 was the first instance of federal funding to support nurse training; hill-burton act provided funds to construct hospitals; created a hospital construction boom that increased the demand for professional nurses Nursing in 1960s -Legislation: community mental health centers act, medicaid, medicare -impact on medicare reimbursement: hospital occupancy increased, resulting in an increased need for hospital nurses; nursing embraced the hospital setting Nursing in the 1970s -influenced by the womens movement -hospitals continued to be focus of nursing education and practice -nurses were instrumental in developing community programs, including hospice programs, birthing centers and adult day care centers Nursing in 1980s -increasing number of homless and indigent; emergence of AIDs -spiraling health care costs became an issue. DRG system for reiumbursement was instituted; hospitals were forced to enhance efficiencies and reduce patients length of stay; medical care continued to advance Nursing in 1990s -growing concern about health of the nation -exposure to hazardous materials -focus moved from acute care to prevention and primary care; emphasis on outpatient, ambulatory, and home services
Describe the relationship between nursing education and practice
The knowledge base for nursing practice includes diagnosis, interventions and evaluation of outcomes from an established care plan. In addition, the nurse integrates objective data with knowledge gained from an understanding of the patients or groups subjective experience, applies scientific knowledge in the nursing process, and provides a caring relationship that facilitates health and healing
explain therapeutic and nontherapeutic communication techniques
Therapeutic techniques 1. Developing conversational skills -control the tone of your voice -be knowledgeable about the topic of conversation -be flexible (based on patients needs) -be clear and concise (one subject at a time) -avoid confusing words that might have different interpretations -be truthful -keep an open mind -take advantage of available opportunities (use all patient interactions to the fullest) 2. Developing listening skills -sit when communicating with a patient -be alert and relaxed and take your time -keep the conversation as natural as possible -indicate you are paying attention (maintain eye contact if appropriate) -use appropriate facial expressions and body gestures -think before responding to the patient -do not pretend to listen -listen for themes in the patients comments Nontherapeutic techniques -failure to perceive patient as a human being -failure to listen -using cliches -using questions requiring only yes or no answers -asking why -probing questions -leading questions -giving advice -being judgmental -changing the subject -giving false assurance -gossip and rumor -incivility -bullying
List the forms of communication
Verbal and Nonverbal
Clara barton
Volunteered to care for wounds and feed Union soldiers during the Civil War; served as the supervisor of nurses for the Army of the James, organizing hospitals and nurses; established the Red Cross in the United States in 1882