Chapter 1 Introduction to Nursing

A nurse is practicing as a nurse-midwife in a busy OB-GYN office. Which degree in nursing is necessary to practice at this level? A) LPN B) ADN C) BSN D) MSN

D) A master's degree (MSN) prepares advanced practice nurses. Many master's graduates gain national certification in their specialty area, for example, as family nurse practitioners (FNPs) or nurse midwives.

-Few still exist; none in Georgia -Hospital based training

Diploma in nursing

3 types of registered nursing education

Diploma, associate degree, baccalaureate program

-Established the Nurse Corps of the United States Army (1861-1865) -Not a nurse -Interest was in mental health

Dorothea Dix

-Established to teach graduates to give bedside nursing care to patients -Programs are 1 year in length -Take NCLEX PN exam

Practical and vocational nursing education

Participation in or conduct of research to increase knowledge in nursing and improve patient care

Researcher

STOP Technique used to reduce stress and be able to respond more skillfully during challenging times:

S- stop and take a step back T- take a few breaths O- observe inside yourself P- proceed after you pause

Carrying out complicated technical procedures requiring critical thinking

Science of nursing

A feeling of despair caused by the transfer of emotional distress from a victim to a caregiver, which often develops suddenly

Secondary traumatic stress

-Provided nursing care to soldiers during Civil War -Worked for women's movement

Sojourner Truth

-Organizations that provide information on specific areas of nursing, often have publications in specialty area and may be involved in certification activities

Specialty practice and special interest nursing organizations

-Outlined by ANA -Define activities that are specific and unique to nursing -Nurses use these to guide them in carrying out their nursing roles

Standards of Nursing Practice

Healthy self-care practices include:

Stress reduction training, relaxation techniques, time management, work-life balance practices, mindfulness techniques

-Nursing leader and women's right activist -Instrumental in Constitutional amendment giving women right to vote

Lavinia Dock

Assertive, self-confident practice of nursing when providing care, effecting change, and functioning with groups

Leader

Central focus in all definitions of nursing

Patient (Includes physical, emotional, social, and spiritual dimensions of patient)

QSEN project competencies:

Patient-centered care, teamwork and collaboration, quality improvement, safety, EBP, and informatics

Facilitating coping with disability and death: Nurses role:

-Altered function decreases a person's ability to carry out ADLs and expected roles -Nurses maximize person's strengths and potentials through: patient teaching and referral to community support systems -Providing end-of-life-care through hospice programs

Nurses use four blended competencies to meet 4 aims:

-Cognitive, technical, interpersonal, ethical/legal -Quality and Safety Education for Nurses (QSEN)

Current trends in health care and nursing:

-Continued nursing shortage -Growing population of hospitalized patients who are older and more acutely ill -Increasing healthcare costs -Need to stay current with rapid advances in medical knowledge and technology

-Preventing illness: -Nurse's role in preventing illness: -Other examples:

-Action taken to prevent occurrence of an event or minimize its effects -Nurse does so by teaching and by personal example -Educational programs; community programs and resources encouraging healthy lifestyle; literature, TV, radio, internet information on health diet, exercise, healthy habits; health assessments in institutions, clinics, communities that identify areas of strength and risks for illness

-Restoring health: -Examples of ways to restore health:

-Activities to restore health encompass those traditionally considered to be the nurse's responsibility -Performing assessments that detect illness; referring questions and abnormal findings to other providers; providing direct care to ill person; collaborating with other providers in providing care; planning, teaching, carrying out rehab for illnesses; working in mental health and chemical-dependency programs

Health is influenced by factors such as:

-Genetic inheritance -Cognitive abilities -Educational level -Race and ethnicity -Culture -Age and biological sex -Developmental level -Lifestyle -Environment -Socioeconomic status

Development of nursing from 19th-21st century:

-Hospital schools organized to provide more easily controlled and less expensive staff for the hospital -Female nurses were under control of male administrators and physicians -World War II: large numbers of women worked outside the home and became more independent and assertive; Explosion of medicine and technology broadened the role of nurses; Growth of nursing as professional discipline

Development of nursing during early civilizations:

-Nurse usually was mother who cared for her family during sickness by providing physical care and herbal remedies

Development of nursing during Early Christian period:

-Nursing has formal and more clearly defined role; deaconesses made visits to the sick -Nursing developed purpose, direction, and leadership

Development of nursing from 1950s to present, nursing broadened in all areas:

-Practice in wide variety of healthcare settings -Development of specific body of knowledge -Conduct and publication of nursing research -Recognition of role of nursing in promoting health -Increased emphasis on nursing knowledge as foundation for EBP lead to growth of nursing as professional discipline

Development of nursing during 16th century:

-Shift from a religious orientation to an emphasis on warfare, exploration, and expansion of knowledge -Nursing had a poor reputation; nurses received low pay and worked long hours in unfavorable conditions

Development of nursing during 19th-20th century:

-Social reforms changed the roles of nurses and of women in general -Nursing as we know it began, based on many of the beliefs of Florence Nightingale -Florence Nightingale challenged prejudices against women and elevated the status of all nurses -Florence Nightingale established the first training school for nurses and wrote books about healthcare and nursing education

Guidelines for nursing practice:

-Standards of nursing practice -Nurse practice acts and licensure -Code of ethics and professional values -Nursing process

Development of nursing during Ancient Greek civilizations:

-Temples became center of medical care -Belief that illness was caused by sin and the god's displeasure -Nurses cared for sick in the home and community; practiced as nurse-midwives

Nursing is recognized as profession based on what criteria:

-Well defined body of specific and unique knowledge -Strong service orientation -Recognized authority by professional group -Code of ethics -Professional organization that sets standards -Ongoing research -Autonomy and self-regulation

Four broad aims of nursing practice

1) To promote health 2) To prevent illness 3) To restore health 4) To facilitate the coping with disability or death

Four overarching goals of Healthy People 2020:

1.) Attain high-quality, longer lives free of preventable disease, disability, injury, and premature death. 2.) Achieve health equity, eliminate disparities, and improve the health of all groups. 3.) Create social and physical environments that promote good health for all. 4). Promote quality of life, healthy development, and healthy behaviors across all life stages.

Nurses today work in a wide variety of healthcare settings. What trend occurred during World War II that had a tremendous effect on this development in the nursing profession? A) There was a shortage of nurses and an increased emphasis on education B) Emphasis on the war slowed development of knowledge in medicine and technology C) The role of the nurse focused on acute technical skills used in hospital settings D) nursing was dependent on the medical profession to define it priorities

A) During World War II, large numbers of women worked outside the home. They became more independent and assertive, which led to an increased emphasis on education. The war itself created a need for more nurses and resulted in a knowledge explosion in medicine and technology. This trend broadened the role of nurses to include practicing in a wide variety of health care settings.

Nursing in the United States is regulated by the state nurse practice act. What is a common element of each state's nurse practice act? A) Defining the legal scope of nursing practice B) Providing continuing education programs C) Determining the content covered in the NCLEX examination D) Creating institutional policies for health care practices

A) Nurse practice acts are established in each state to regulate the practice of nursing by defining the legal scope of nursing practice, creating a state board of nursing to make and enforce rules and regulations, define important terms and activities in nursing, and establish criteria for the education and licensure of nurses. The acts do not determine the content covered on the NCLEX, but they do have the legal authority to allow graduates of approved schools of nursing to take the licensing examination. The acts also may determine educational requirements for licensure, but do not provide the education. Institutional policies are created by the institutions themselves.

A nurse working in a rehabilitation facility focuses on the goal of restoring health for patients. Which examples of nursing interventions reflect this goal? Select all that apply. A) A nurse counsels adolescents in a drug rehabilitation program B) A nurse performs range-of-motion exercises for a patient on bedrest C) A nurse shows a diabetic patient how to inject insulin D) A nurse recommends a yoga glass for a busy executive E) A nurse provides hospice care for a patient with end-stage cancer F) A nurse teaches a nutrition class at a local high school

A, B, C) Activities to restore health focus on the person with an illness and range from early detection of a disease to rehabilitation and teaching during recovery. These activities include drug counseling, teaching patients how to administer their medications, and performing range-of-motion exercises for bedridden patients. Recommending a yoga class for stress reduction is a goal of preventing illness, and teaching a nutrition class is a goal of promoting health. A hospice care nurse helps to facilitate coping with disability and death.

Protection of human or legal rights and securing of care for all patients based on the belief that patients have the right to make informed decisions about their own health and lives

Advocate

Five values that epitomize professional nurse:

Altruism, autonomy, human dignity, integrity, social justice

-National voice for baccalaureate and higher-degree nursing education programs -Goals focus on establishing quality educational standards, influencing nursing profession to improve health care, and promoting public support of baccalaureate and graduate education, research, and nursing practice

American Association of Colleges of Nursing (AACN)

-Primary mission is to advance profession of nursing to improve health for all -Advances nursing profession by fostering high standards of nursing practice, promoting safe and ethical work environment, bolstering health and wellness of nurses, and advocating on health care issues that affect nursing and the public

American Nurses Association (ANA)

Being there for patient, holding patient's hand, active listening

Art of nursing

-Community colleges -2 to 3 years in length

Associate degree in nursing

10) According to the National Advisory Council on Nurse Education and Practice, what is a current health care trend contributing to 21st century challenges to nursing practice? A) Decreased numbers of hospitalized patients B) Older and more acutely ill patients C) Decreasing health care costs owing to managed care D) Slowed advances in medical knowledge and technology

B) The National Advisory Council on Nurse Education and Practice identifies the following critical challenges to nursing practice in the 21st century: A growing population of hospitalized patients who are older and more acutely ill, increasing health care costs, and the need to stay current with rapid advances in medical knowledge and technology.

Cumulative state of frustration with the work environment that develops over a long time

Burnout

A nurse is caring for a patient in the ICU who is being monitored for a possible cerebral aneurysm following a loss of consciousness in the emergency department (ED). The nurse anticipates preparing the patient for ordered diagnostic tests. What aspect of nursing does this nurse's knowledge of the diagnostic procedures reflect? A) The art of nursing B) The science of nursing C) The caring aspect of nursing D) The holistic approach to nursing

B) The science of nursing is the knowledge base for care that is provided. In contrast, the skilled application of that knowledge is the art of nursing. Providing holistic care to patients based on the science of nursing is considered the art of nursing.

Nurses' set of vital signs: BP-T-P-R

BP- Being present T- Tracking P- Practicing health and wellness behaviors R- Refueling

-At least 4 years in length -Good underpinning with solid general education background -Courses not found in other two levels of education: research, leadership/management, community nursing

Baccalaureate in nursing

A nurse practicing in a primary care center uses the ANA's Nursing's Social Policy Statement as a guideline for practice. Which purposes of nursing care are outlined in this document? Select all that apply. A) A description of the nurse as a dependent caregiver B) The provision of standards for nursing educational programs C) A definition of the scope of nursing practice D) The establishment of a knowledge base for nursing practice E) A description of nursing's social responsibility F) The regulation of nursing research

C, D, E) The ANA Social Policy Statement (2010) describes the social context of nursing, a definition of nursing, the knowledge base for nursing practice, the scope of nursing practice, standards of professional nursing practice, and the regulation of professional nursing.

A nurse instructor outlines the criteria establishing nursing as a profession. What teaching point correctly describes this criteria? Select all that apply. A) Nursing is composed of a well-defined body of general knowledge B) Nursing interventions are dependent upon medical practice C) Nursing is recognized by authority by a professional group D) Nursing is regulated by the medical industry E) Nursing has a code of ethics F) Nursing is influenced by ongoing research

C, E, F) Nursing is recognized increasingly as a profession based on the following defining criteria: well-defined body of specific and unique knowledge, strong service orientation, recognized authority by a professional group, code of ethics, professional organization that sets standards, ongoing research, and autonomy and self-regulation.

-Provision of care to patients that combines both the art and science of nursing in meeting the physical, emotional, intellectual, sociocultural, and spiritual needs -Integrates roles of communicator, teacher, counselor, leader, researcher, advocate, and collaborator to promote wellness through activities that prevent illness, restore health, and facilitate coping with disability or death -Primary role of the nurse

Caregiver

-Practiced nursing on Civil war battlefields -Founded American Red Cross (1882)

Clara Barton

-Entails five values that epitomize the professional nurses -Outlined by ANA code of Ethics

Code of Ethics and Professional Values

Effective skills in organization, communication, and advocacy to facilitate functions of members of the health care team as they provide patient care

Collaborator

The use of effective interpersonal and therapeutic communication skills to establish and maintain helping relationships with patients of all ages in a wide variety of health care settings

Communicator

Loss of satisfaction from providing good patient care

Compassion fatigue

-Keep knowledge and skills up to date -Concept of lifelong learning

Continuing education

The use of therapeutic interpersonal communication skills to provide information, make appropriate referrals, and facilitate patient's problem-solving and decision-making skills

Counselor

Nurses today complete a nursing education program, and practice nursing that identifies the personal needs of the patient and the role of the nurse in meeting those needs. Which nursing pioneer is MOST instrumental in this birth of modern nursing? A) Clara Barton B) Lilian Wald C) Lavinia Dock D) Florence Nightingale

D) Florence Nightingale elevated the status of nursing to a respected occupation, improved the quality of nursing care, and founded modern nursing education. Clara Barton established the Red Cross in the United States in 1882. Lillian Wald was the founder of public health nursing. Lavinia Dock was a nursing leader and women's rights activist instrumental in establishing women's right to vote.

The role of nurses in today's society was influenced by the nurse's role in early civilization. Which statement best portrays this earlier role? A) Women who committed crimes were recruited into nursing the sick in lieu of serving jail sentences. B) Nurses identified the personal needs of the patient and their role in meeting those needs. C) Women called deaconesses made the first visits to the sick, and male religious orders cared for the sick and buried the dead. D) The nurse was the mother who cared for her family during sickness by using herbal remedies.

D) In early civilizations, the nurse usually was the mother who cared for her family during sickness by providing physical care and herbal remedies. This nurturing and caring role of the nurse has continued to the present. At the beginning of the 16th century, the shortage of nurses led to the recruitment of women who had committed crimes to provide nursing care instead of going to jail. In the early Christian period, women called deaconesses made the first organized visits to sick people, and members of male religious orders gave nursing care and buried the dead. The influences of Florence Nightingale were apparent from the middle of the 19th century to the 20th century; one of her accomplishments was identifying the personal needs of the patient and the nurse's role in meeting those needs

Became well-known for her work in the Crimean War and many contributions that includes: -Identified personal needs of patient and role of nursing in meeting them -Established standards for hospital management -Established nursing education and nursing as a respected occupation for women -Established nursing education -Recognized two component of nursing: health and illness -Believed nursing is separate and distinct from medicine -Recognized nutrition is important to health -Instituted occupational and recreational therapy for sick -Stressed need for continuing education for nurses -Maintained accurate records, recognized as beginnings of nursing research

Florence Nightingale

-Nurse practitioner (NP), clinical nurse specialist, nurse midwife, nurse anesthetist -Doctoral programs PhD and DNP (Doctor of nursing practice)

Graduate Education in nursing

-Nurse and abolitionist -Active in underground railroad movement before joining Union Army during Civil War

Harriet Tubman

State of optimal functioning or well-being

Health

Nurses promote health by:

Identifying, analyzing, and maximizing each patients own individual strengths as components of preventing illness, restoring health and facilitating coping with disability or death

-At place of employment -Usually focus on specific skills and use of new equipment

In-service education

-Leader in nursing and nursing education -Organized nursing school at Johns Hopkins Hospital -Initiated policies that including limiting number of hours in days work -Wrote textbook to help student learning -First president of Nurses Associated Alumnae of US and Canada

Isabel Hampton Robb

-Provided social services within neighborhood setting -Leader for women's rights -Recipient of 1931 Nobel Peace Prize

Jan Addams

-Established neighborhood nursing service for sick in poverty-stricken area of New York City -Founder of public health nursing

Lilian Wald

-Graduated as first trained nurse in United States -Began practice of keeping records and writing orders

Linda Richards

-Nurse during Civil War -Organized New York Charities Aid Association to improve care of sick in Bellevue Hospital -Recommended standards for nursing education

Louise Schuyler

-Opened first birth control clinical in US -Founder of Planned Parenthood Federation

Margaret Sanger

-First professor of nursing in the world -Published History of Nursing

Mary Adelaide Nutting

-Director of nursing school at Toronto General hospital -One of founders of Canadian Nurses Association

Mary Agnes Snively

-Organized diet kitchens, laundries, and ambulance services -Supervised nursing staff during civil war

Mary Ann Bickerdyke

-Established Frontier Nursing Services -Established one of first midwifery schools in US

Mary Breckenridge

-America's first African American nurse

Mary Elizabeth Mahoney

-Open to all people interested in nursing, including nurses, nonnurses, and facilities -Foster development and improvement of all nursing services and nursing education -Conducts professional testing services in US

National League for Nursing (NLN)

-National organization for students enrolled in nursing education programs

National Student Nurses Association (NSNA)

-Established first 3 year training program in North America

Nora Gertrude Livingston

-Broadly worded -Defines legal scope of nursing practice -Create a state board of nursing to make and enforce rules and regulations -Define important terms and activities in nursing, including legal requirements and titles for RNs and LPNs -Establish criteria for the education and licensure of nurses

Nurse Practice Acts and Licensure

-One of major guidelines for nursing practice -Helps nurses implement their roles -Integrates art and science of nursing -Used by nurse to identify patient's health care needs and strengths, to establish and carry out a care plan to meet those needs, and to evaluate effectiveness of plan to meet established outcomes -Allows nurses to use critical thinking and clinical reasoning -Defines areas of care that are within domain of nursing

Nursing process

The use of communication skills to assess, implement, and evaluate individualized teaching plans to meet learning needs of patients and their families

Teacher/educator