The Profession of Nursing

Foundations I Theory Devin Terry MSN, RN, ACNS-BC Summer 201

1

Objectives

UAMS Nursing Philosophy

P
rofessionalism- committed to professional practice and collaboration with the interdisciplinary team to provide innovative and exceptional patient-and-family-centered care to impact the overall health of our community.

A C

ccountability- the professional nurse is the foundation of nursing practice . Strong patient

advocates, accepting responsibility for professional practice an willingly commit to strive to create optimal outcomes. ommunication- the power to share ideas and concepts as the basis for effective team work.

Promotes positive outcomes when executed with enthusiasm and optimism.

xcellence- professional practice model as the basis for delivery on nursing care. Value an

environment where the scope of practice promotes innovative and compassionate patient care delivery and encourages continuous improvement. Excellence through aggressive recruitment and retention of RN staff.

Together- we set the pace

3

Theory in Nursing
Historical perspective Role in nursing
evidence or science based practice

Interdisciplinary theories
systems, basic human needs, stress and adaptation, developmental etc

Nursing theories
grand, mid-range, descriptive, prescriptive
4

Grand Theory

Middle-Range
Limited in scope and less abstract Specific phenomenon Applicable to administration, clinical, and teaching Can be applied to variety of nursing situations (uncertainty, incontinence, social support, quality of life, and caring)
6

Definition of Nursing
Accountable discipline guided by:
science theory a code of ethics the art of care and comfort to treat human responses to health and illness

ANA: Four Essential Features of Contemporary Nursing Practice

1. attention to the full range of human experiences and responses to health and illness without restriction to a problem focused orientation
Look at the whole person before we decide what is wrong!
8

2. integration of objective data with knowledge gained from an understanding of the client/groups subjective experience

Four Essential features of Contemporary Nursing Practice

3. provision of a caring relationship that facilitates health and healing 4.

application of scientific knowledge to the processes of diagnoses and treatment

9

ATI Check your knowledge #1

1. A RN is making the first home visit to a family of a new born for a well-infant check. The family includes the 17y/o mother of the newborn, her 2 y/o daughter, and the grandmother of the two young children. Which of the following interventions will be the most beneficial in establishing a therapeutic relationship with this family?

10

ATI #1 continued
a) Tell the family members not to worry about any concerns they may have. b) Include all the family members in the discussion about the infants exam. c) Present a nonjudgmental attitude. d) Give written information regarding wellinfant checks.

11

Nursing Education
Entry level education (all take same licensing exam)
diploma (3 year, usually hospital affiliated) associate degree (2 year, focus on technical) baccalaureate degree (4 year university Thats you! education) graduate degree (undergraduate degrees in other disciplines, graduate degree in 12 nursing)

Advanced Education
Masters degree programs
nurse practitioners, clinical nurse specialists, educators, administrators

Doctoral degree programs

PhD vs. DSN, DNP or DNSc educators, researchers, ethicists, philosophers, theorists, executives, health policy makers
13

Continuing Education
Courses that assist in developing and maintaining expertise and knowledge Promotes quality of nursing care Mandatory in some states (Arkansas included)

14

Professionalism
Professionalism
behavior that upholds the status, methods, character, and standards of a given profession

15

Characteristics of a Profession
Extended education built upon a basic liberal foundation Theoretical body of knowledge leading to skills, abilities, and norms Provides a specific service

Autonomy in decision making and practice Code of ethics governing practice

Is nursing a true Profession?

16

ATI check your knowledge #2

2. State three ways nurses obtain their professional values?

17

Standards of Nursing Practice

Nursing actions that are agreed upon by nurses as constituting safe and effective client care Establish foundation for professional practice Developed and implemented by professional organizations
18

Standards of Practice
ANA establishes these written statements defining the acceptable level of performance in the profession Provide direction for the provision of nursing care Provide set of expectations that can be used to evaluate nursing performance
19

ANA Standards of Nursing Practice

Standards of Care
Assessment Diagnosis Outcome Id. Planning Implementation Evaluation UAMS uses same guidelines to Help guide student practice!

Standards of Professional Performance

quality of care performance appraisal education collegiality ethics collaboration research

20

Functions of Nursing Professional Organizations

Establish, maintain, and improve nursing standards Hold members accountable for practicing by the standards Public education Public protection Protection of members of the profession Lobbies at the state and federal level for nurses
21

Professional Nursing Organizations

American Nurses Association (ANA)
members are state nurses assoc. members publishes American Journal of Nursing Offers specialty certification
22

ANA:
Advances:
nursing roles economic interest Healthcare

23

Professional Nursing Organizations

National League of Nursing (NLN) members are nurses, agencies, non-nurses promotes improved development of nursing services and education

24

Professional Nursing Organizations

National Student Nurses Association American Academy of Nurses Sigma Theta Tau Specialty nursing organizations

25

Professional Nursing Roles

Traditionally, providing care and comfort to clients and performing specific nursing functions Expanded to include illness prevention, health promotion, and concern for client holistically
What is holistic care?
26

Professional Nursing Roles

Caregiver Communicator Comforter Case Manager Advocate Researcher Teacher Rehabilitator Clinical decision maker
NURSE! 27

ATI Check your knowledge #3

3. The nursing team is directed by the
a) Assistive personnel (AP) b) Licensed Practical Nurse/ Licensed Vocational Nurse (LPN/LVN) c) Registered Nurse (RN) d) Nutrition Aide

28

Trends
Toward more holistic care Increased variety in employment settings Importance of advanced education Graying of America Increasing urbanization Increasing cultural diversity Communication and travel

29

Trends
Stagnating/declining wages Poverty levels (1/7 Americans)
especially high incidence in women, children, the elderly, and minorities

Increasing numbers of uninsured Access

30

Types of law
Statutory law
Written law with the intention to clarify

Americans with Disabilities Act Nurse Practice Acts Child and elder abuse reporting laws

Public law

Law governing the relationship between individuals and the state

Law applicable to an entire group of people (mandatory annual tb testing of all health care workers)
31

Legal Regulation of Nursing Practice

Nurse Practice Acts
power granted to individual states protects the public defines the nature and scope of professional practice single most important law affecting nursing practice

32

Features of Nurse Practice Acts

Defines the practice of nursing Delineates rules and regulations that govern practice Outlines relationship of professional nursing to other health care providers Establishes licensure requirements Creation of a State Board of Nursing
33

Features of Nurse Practice Acts

Defines professional misconduct Defines disciplinary actions for professional misconduct

http://www.arsbn.org/
34

Other Laws Affecting Nursing Practice

Occupational Safety and Health Act of 1970 Controlled Substance Acts (Comprehensive Drug Abuse Prevention and Control Act of 1970) Health Care Quality Improvement Act American with Disabilities Act Good Samaritan Laws

35

Professional Regulation of Nursing Practice

Professional Nursing Organizations Centers for Disease Control and Prevention (CDC) Employer policies and procedures Educational programs

36

Control of the Profession of Nursing

Credentialing methods by which the profession attempts to ensure and maintain practitioner competency Certification voluntary process granting recognition for meeting criteria established by a nongovt. assoc. Accreditation monitors educational programs ability to meet predetermined standards for student outcomes Licensure 37

Licensure
State function, mandatory Grants owner formal permission from the State Board of Nursing to practice nursing How do they check this?? Criteria
educational preparation passing the NCLEX examination good moral characterFee is a common trend application and registration fee payment 38

Other Legal Issues

Civil vs.. criminal law
criminal prevents harm civil protects rights

Assault & battery

threat of harmful/offensive contact vs. intentional touching without consent

Invasion of privacy
39

Malpractice and Negligence

Unintentional tort Negligence
No intent

conduct not consistent with what an ordinarily prudent person would use in same circumstance

Malpractice
professional negligence nursing care below standard of care
40

Liability
Liability
legal obligation or responsibility to provide care to a client that meets the accepted standard of care

Elements of Liability
duty breach of duty causation damage

41

Areas of Potential Liability for Nurses

Failure to monitor and assess Failure to ensure safety Medication errors Improper implementation of skills or procedures Documentation errors
42

Legal Responsibilities of Student Nurses

Practice nursing as part of the clinical and academic requirements of the educational institution and under the supervision of nursing faculty Legal protection is not available to nursing students practicing nursing outside of their educational programs (i.e., when working as nurse techs or assistants)

43

Safeguarding Your Practice

Know your obligations and responsibilities Practice competently Know your strengths and limitations Keep current Document your care Professional liability insurance
44

Client Rights
Informed consent Confidentiality (HIPAA) Advance directives

Organ transplantation issues Right to refuse treatment

45

Informed Consent
Legal right of client to receive adequate and accurate information about medical condition and treatment
risks, benefits, alternatives, consequences of refusal Examples?

Physician is responsible for conveying information and obtaining consent for procedures
46

Informed Consent
Who can give consent?
adult 18 years or older mentally/physically competent parent/guardians for minors and wards minors
may give consent for child in legal custody may give consent for self if married or a parent may seek treatment for pregnancy, STDs, and substance abuse
47

Nurses Role in Informed Consent

Witnessing signature of client Ensuring consent is voluntary and that the client understands info imparted Ensuring that client appears competent Ensuring that the form is signed and on the chart

48

Confidentiality ~ HIPAA
Clients right to privacy in the health care system Ethically obligated to maintain confidentiality Additional protection under the law for persons receiving treatment for drug and alcohol abuse, mental health care, sexual assault, HIV, and AIDS
49

ATI check your knowledge #4

4.
HIPAA provides which client right?

a) The right to a consistent determination of death b) The right to donate all or part of the body for organ donation or medical research after death. c) The right to refuse treatment and establish advance directives. d) The right for sensitive health information to be kept confidential.

50

Advance Directive / Patient Self Determination Act

Written document providing direction for health care in the event a person becomes unable to personally make treatment choices Durable power of attorney appoints an agent to make health care decisions Includes living wills

51

Organ Transplantation Issues

Right to determine whether they want to donate tissues or organs Uniform Anatomical Gift Act- law in all states providing list of individuals who can provide consent for organ donation
52

Quality of Life Issues

Use to determine benefits of medical intervention Difficulty assessing and defining

53

Allocation of Scarce Resources

Organ transplantation Uniform Anatomical Gift Act - allows a competent client to make an informed decision to donate all part of her body for organ donation or medical research after death. Access to service $$$ spent
54

Ethics
Branch of philosophy that attempts to determine what constitutes good, bad, right, and wrong in human behavior Provides guidelines to direct human action
55

Ethical Principles for the Practice of Professional Nursing

Autonomy - respects persons right to self determine Beneficence care given is in the best interest Confidentiality Nonmaleficence - do no harm Fidelity - honoring agreements Justice - moral rightness, fairness, or equity Veracity - adhering to truth
56

Ethical Code for Nurses

The American Nurses Association Code of Ethics for Nurses (2001) and the International Council of Nurses Code of Ethics for Nurses (2000)

57

ATI Check your knowledge #5

5. The ANA code of ethics serves which of the following purposes? a) Establishes standardized curricula for nursing educational programs b) Sets formal guidelines and standards for professional nursing conduct. c) Ensures that nurses provide client care based on scientific principles. d) Determines qualifications for advance practice nurses (APNs)
58

Accountability and Responsibility

Responsible for providing care within established standards of the profession implement care using the nursing process students responsible for acquiring knowledge and skills needed to become safe practitioner Accountable/answerable for the outcomes of actions taken to yourself, clients, institutions, peers, the profession, and society

59

History of Nursing & Nursing Leaders

60

Nursing in Ancient Civilization

Women cared for children and the ill Relationship of illness to religious and mythical beliefs Recognition that illness was at least partly caused by physical factors by the Aztecs, Mayans, and Toltec Nursing roles expanded outside the family over time
61

Influence of Christianity
Educated and wealthy women cared for the sick and impoverished New Testament
1st recorded history of nursing

Phoebe 1st deaconess

60 AD - 1st visiting nurse
62

Nursing in the Middle Ages 476-1453

Dark Ages (1st 500 years)
few institutions of higher learning low level of education except for nobility and clergy

Bubonic plague
killed 1/3 - 1/2 population of Europe stimulated hospital construction contributed to the founding of nursing orders (1st- Augustinian Sisters)

63

Middle Ages (continued)

64

Middle Ages (continued)

Midwifery

65

15 to 18th Century
Crusades Lack of hygiene and sanitation Poverty in urban centers Smallpox epidemics

66

Colonialism and Revolution

1st colonial hospital in 1658 in what became New York Hospitals only in the largest colonies with untrained male nurses Folk remedies the extent of nursing/health care More American Revolutionary soldiers died from disease or complications of care than from wounds sustained in battle
67

Industrialization
High incidence of illness, injury and early mortality Caring for the sick became socially acceptable and the need for competent nurses was recognized Nursing textbooks written Nursing training programs Sisters of Charity, The Kaiserwerth School of Nursing, Nurse Society of Philadelphia

68

Crimean War
1854-1856, region now part of Ukraine Great Britain, Turkey, France, and Sardinia united against Russia Florence Nightingale emerges as a hero (she has her own slide)
69

American Civil War

Clara Barton and the American Red Cross Women provided care to sick and injured soldiers and implemented sanitary conditions in field hospitals Value of primary prevention recognized Post-Civil War first U.S. schools of nursing based on the Nightingale model (combination of classroom and clinical experience)
70

Spanish-American War
Trained nurses employed in military hospitals (not enough to meet all needs) Military camps shattered by epidemic diseases such as typhoid and malaria Army Nursing Service
preferred trained nurses paid $30 per month plus room and board
71

World War I
Nurses could not meet civilian and military needs - again requiring untrained volunteers Rockefeller Foundation established a committee to study nursing education Goldmark report revealed faults with hospital training programs, identified lack of funding as the obstacle to higher educational standards Funded expansion of nursing programs at Yale, Vanderbilt, and the University of Toronto
72

World War I (continued)

Expansion of hospitals and nursing schools during the 1920s Apprenticeship method Womens suffrage
Lavinia Dock (nurse activist)

Great Depression
transition from home based nursing care to hospital care
73

World War II
Increased demand for QUALIFIED nurses US Congress passed Lanhan act to fund nursing education and improve existing facilities (federal subsidization) GI Bill of Rights Baby boom and post-war economy stimulated hospital construction Nursing shortage
74

Korean War
Mobile Army Surgical Hospitals (MASH units) Paved the way for ICU development and better ER and trauma care Development of associate degree programs (Mildred Montag of Teachers College) Concept of Nursing Diagnosis
75

Vietnam War
1966 -Congressional bill permitted appointment of male nurses to the armed forces nurse corps resulting in more male nurses Rapid expansion of civilian hospitals and medical technology Increased specialization Graduate educational and nurse entrepreneurship opportunities
76

Contemporary Developments
Financially driven health care system of the 1980s (DRG, HMO, emergency care centers) Focus on cost containment and efficiency in the 1990s Increase in jobs in outpatient and home health care settings Managed care
77

Contemporary Developments
Nursings Agenda for Health Care Reform
primary care, prevention, and community outreach

Nursing shortage

78

Nursing Leaders: Florence Nightingale

Born in 1820 in England Founder of modern nursing Trained at Deaconess Institute in Kaiserwerth and with the Sisters of Charity in Paris Led a group of 38 nurses in British military hospitals in Turkey The Lady with the Lamp

79

Florence Nightingale (continued)

Established sanitary conditions in British military hospitals in Turkey Organized nursing care around the clock Reduced mortality from 42.7 to 2.2% in 6 months Post Crimean War authored Notes on Nursing and Notes on Hospitals Nightingale Training School (Nightingale plan)

80

Nursing Leaders (late 1800s)

Linda Richards- 1st trained US nurse Isabel Hampton Robb - 1st principal of Johns Hopkins SON, instrumental in establishing organizations that became ANA and NLN Mary Adelaide Nutting - worked for nurses to be educated in the university setting Clara Barton - Civil War nurse, developed American Red Cross
81

Nursing Leaders (late 1800s)

Mary Mahoney - Americas 1st professional black nurse Lillian Wald opened the Henry Street Settlement Service in New York and established public health nursing

82

Nursing Leaders (early 1900s)

Margaret Sanger - 1st birth control clinic in America Isabel Maitland Stewart - research to differentiate between nursing and nonnursing tasks, instrumental in upgrading nursing education Mary Breckinridge - founded Frontier Nursing Service (1st organized midwifery service) 83

Nursing Leaders (early 1900s)

Lucille Petry - 1st woman appointed to position of Assistant Surgeon General of the US Public Health Service

84