Slide 1

Chapter I

Nursing Today: A Time of Transformation Status of Nursing in the United StatesNational surveys of actively licensed nurses conducted approximately every 4 yearsConducted by federal government Latest: March 2012; data available in 2014 Comprehensive appraisal through National Sample Survey of Registered Nurses (NSSRN)Published by U.S. Department of Health and Human Services, Division of NursingCopyright 2014, 2011, 2007, 2005, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.2NumbersNurses are the largest group of health care providers in the United States. Three million held licenses in 2008.There was a 5.3% increase from 2004. Of those with licenses, 85% actively work in nursing.63% work full time.12% of full-time nurses hold two nursing positions.14% of part-time nurses hold two nursing positions.

Copyright 2014, 2011, 2007, 2005, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.3Gender92.9% women7.1% menThe proportion of men in nursing has increased by 50% since 2000.Of nurses licensed since 2000, men constitute a larger proportion: 9.6%.A higher proportion of male registered nurses (RNs) work in hospitals than female RNs (76% to 62%).Men over-represent certified registered nurse anesthetists (CRNAs) at 41%. Copyright 2014, 2011, 2007, 2005, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.4Age The rate of working nurses' aging has slowed.Due to rise in number of nurses under age 30Due to increased numbers of nurses aged 60 and older who continue to work in this economyAverage age of graduates from all nursing programs is 31.Bachelors of science in nursing (BSN) mean age: 28Associate and diploma degree mean age: 33Median age has risen from 38 years in 1988 to 46 years in 2004, reflecting the economic downturn in which older nurses remain in the workforce. Copyright 2014, 2011, 2007, 2005, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.5Race, Ethnicity 16.8% of the U.S. RN population, compared to 34.4% of the general U.S. population, constitutes ethnic minorities. Improvement from 2004, when 12.2% RNs constituted ethnic minoritiesThe percentage of minorities currently enrolled as students is increasing, at 26.8%.The percentage of RNs practicing in the United States who were educated in India or the Philippines is over-represented compared to general population. Copyright 2014, 2011, 2007, 2005, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.6Education Three mechanisms of nursing education: 4-year BSNSlightly over 50% of nurses2-year associate degree in nursing (ADN)Majority of nurses receive initial education through ADN programsDiploma in nursing, typically 3 years of hospital education earned by only 3.1% of nurses since 2004 5.6% of U.S. RNs are educated internationally. Recruitment of foreign-educated RNs is a controversial strategy to expand the workforce in response to the nursing shortage.Copyright 2014, 2011, 2007, 2005, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.7Employment Opportunities for NursesPractice in wide variety of settingsHospitals remain primary work site: 62.2%Ambulatory care: 10.5%Community health/public health: 7.8%Extended care and nursing homes: 5.3%Remainder: nursing organizations, schools of nursing, government agencies, insurance companiesCopyright 2014, 2011, 2007, 2005, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.88Hospital-Based NursingNurses work in a variety of roles; most provide direct patient care.Clinical ladder programs allow nurses to progress upward through direct-care roles.Clinical nurse specialists (CNSs) are at the top of most clinical ladders. Nurse managers fulfill nonclinical roles.Assume 24-hour accountability for their units Flexible staffing has relaxed formerly rigid work schedules. Educational credentials of hospital RNs range from ADN to doctorate (PhD).

Copyright 2014, 2011, 2007, 2005, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.9Community Health NursingCommunity health nursing is increasing as more nursing care is delivered outside hospitals. Work settings include public health or private agencies.Deliver care for chronic health problemsImprove overall community health through programs in prevention, nutrition, child care, health maintenanceThere has been tremendous increase in home health nursing services, with predictions that most future health care will take place in patients' homes.

Copyright 2014, 2011, 2007, 2005, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.10Background

The changing demographics (the aging population) along with a place of service shift from inpatient to outpatient will require more nurses in the community to meet the population needs.

The current average age of the nursing workforce is 44.6 nationally and 54 years of age in the State of New Jersey

Unlike hospitals where 42% surveyed reported a nurse residency program, only 2.2% of home health care agencies reported that they offer this program

Home health care agencies will experience a deficient in trained staff to meet the needs of New Jersey residents during a time when the number of homebound patients is expected to increase by more than 50% (Pittman, Horton, Terry & Bass, 2014).

A lack of data to accurately project needs along with a lack of existing residency programs to benchmark from, have created an environment where the gap between what is known and what is needed is widening.

11Nurse Practice OpportunitiesNurse entrepreneurOffice-based nursingOccupational and environmental health Military nursingSchool nursingHospice and palliative careTelehealth nursingFaith community nursingNursing informaticsCopyright 2014, 2011, 2007, 2005, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.12Nurse Practice Opportunities Requiring Higher Degrees Nurse educatorsAdvanced practice nursing (APN)Certified nurse practitioner (CNP)CNS Certified nurse-midwife (CNM)CRNAClinical nurse leader (CNL)Copyright 2014, 2011, 2007, 2005, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.13Issues in Advanced Practice NursingAPNs have worked to change laws to increase their scope of practice.The need for increased roles for APNs has been validated by research establishing Safety Cost-efficiencyHigh level of patient acceptanceAPNs have increased efficiency and availability of primary health care delivery in the United States while reducing costs.

Copyright 2014, 2011, 2007, 2005, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.14Employment Outlook in NursingNurses can expect employment opportunities to grow "much faster than average": around 22% through 2016. Home health care positions are expected to increase fastest. Several factors contribute: technological advances, increase in primary care, aging of nation's population, and increased percentage of medical procedures performed in outpatient settings. Copyright 2014, 2011, 2007, 2005, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.15Nursing SalariesNurses' salaries vary widely according to:Practice settingLevel of education/preparationExperienceRegion of the countryMedian salary: $62,450Lowest 10%: less than $43,410In nursing care facilitiesHighest 10%: $92,240In employment services, general medical/surgical hospitals21% of RNs are members of unions or are covered by union contracts.

Copyright 2014, 2011, 2007, 2005, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.16Question 1What percentage of licensed RNs work full time?1. About 95%2. About 85%3. About 65% 4. About 25% Copyright 2014, 2011, 2007, 2005, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.17About 65%: "More than 2.9 million individuals held licenses as registered nurses in 2004, but only 2.4 million (83.2%) of these individuals were actively working in nursing. The remainder of the registered nurse population (16.8%) were either not working at all or working in fields other than nursing Elsevier items and derived items 2009, 2005, 2001 by Saunders, an imprint of Elsevier Inc.17 Question 2Currently, which is the primary worksite for RNs? Ambulatory care Home health care Education Extended care Hospital

Copyright 2014, 2011, 2007, 2005, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.185. Hospital: "In 2004 hospitals remained the primary worksite for registered nurses (reported by 56.2% of those employed, down from 59.1% in 2000). Elsevier items and derived items 2009, 2005, 2001 by Saunders, an imprint of Elsevier Inc.18ANSWER AND RATIONALE:Question 3Which will provide the most opportunity for employment, because most future health care services will take place in this setting? Ambulatory care Home health care Education Extended care Hospital

Copyright 2014, 2011, 2007, 2005, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.192. Home Health: "Opportunities in hospitals, traditionally the largest employers of nurses, will grow more slowly than those in community-based sectors. "Home health care positions are expected to increase the fastest of all. This is in response to the expanding elderly population's needs and the preference for and cost-effectiveness of home care. Furthermore, technological advances are making it possible to bring increasingly complex treatments into the home. Elsevier items and derived items 2009, 2005, 2001 by Saunders, an imprint of Elsevier Inc.19 Status of Nursing in the United StatesNational surveys of actively licensed nurses conducted approximately every 4 yearsConducted by federal government Latest: March 2012; data available in 2014 Comprehensive appraisal through National Sample Survey of Registered Nurses (NSSRN)Published by U.S. Department of Health and Human Services, Division of NursingCopyright 2014, 2011, 2007, 2005, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.20

Chapter 2The History and Social Context of NursingCopyright 2014, 2011, 2007, 2005, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.MidNineteenth-Century Nursing in England: The Influence of Florence NightingaleShe was the founder of modern nursing.She lived in Britain from 1820 to 1910.She was the daughter of a privileged, aristocratic family.Stifled by her social position, she entered nurses' training at age 30.She spurred reform of the British Army medical system based on her efforts during Crimean War.She wrote Notes on Nursing: What It Is and What It Is Not to establish nursing's unique body of knowledge. She founded first training school for nurses in London (1860).Copyright 2014, 2011, 2007, 2005, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.221861-1873: The American Civil War: An Impetus for Training for NursingAt start, no nurses were available to serveAs war continued, women responded to needs of sick and wounded by volunteering as nursesLeaders emerged: Dorothea Dix: Union Superintendent of Women Nurses, champion for mental healthSojourner Truth: famous abolitionistHarriet Tubman: leader of "underground railroad"Mary Ann "Mother" Bickerdyke: lay nurseClara Barton: founded American Red CrossPhoebe Pember: Confederate hospital matronCopyright 2014, 2011, 2007, 2005, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.23After the Civil War: Moving Toward Education and Licensure Under the Challenges of SegregationThe Civil War prompted a move toward formal education of nurses.Three American schools were modeled after Nightingale's school and opened in 1873: Bellevue Training School for Nurses (New York City) Connecticut Training School for Nurses (New Haven)Boston Training School for Nurses at Massachusetts General Hospital

Copyright 2014, 2011, 2007, 2005, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.24The Feminization of NursingRequirements for early nursing school applicants were based on Victorian stereotypes of female qualities."Good breeding" and "ladylike behavior"Submission to authoritySensitivityIntelligence

Copyright 2014, 2011, 2007, 2005, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.25Discrimination in Early TrainingDiscrimination against male, African-American, and Jewish applicants First school exclusively for men: School for Male Nurses at the New York City Training School (1986) First school exclusively for African Americans:Atlanta Baptist Female Seminary (later Spelman College) 1886

Copyright 2014, 2011, 2007, 2005, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.26Professionalization Through OrganizationChicago World's Fair (1893)Several nursing leaders emerged after gathering there to share ideas.Isabel Hampton RobbLavinia Lloyd DockBedford FenwickPaper by Florence NightingaleWhat became the National League for Nursing (NLN; with its early name) was formed at this meeting.Copyright 2014, 2011, 2007, 2005, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.27Professionalization Through Organization (cont.)1896: American Nurses Association (ANA)Founded by Isabel Hampton RobbName changed to ANA in 19111899: International Council of Nurses (ICN)1908: National Association for Colored Graduate Nurses1916: African-American students admitted to ANA through constituent states in the North

Copyright 2014, 2011, 2007, 2005, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.28Nursing's Focus on Social Justice: The Henry Street SettlementHenry Street SettlementEstablished in New York City in 1893 Founded by Lillian WaldPurpose: address serious health conditions of immigrantsService: visiting nurses, well-baby clinics, disease prevention, health education, minor illness treatmentStill functions today to fight urban povertyCopyright 2014, 2011, 2007, 2005, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.29Nursing's Focus on Social Justice: The Henry Street Settlement (cont.)Margaret SangerHenry Street SettlementAddressed plight of immigrant women in New YorkFought for safe contraception and family planningDangerous, controversial workRenowned for preserving reproductive and contraceptive rights for womenCopyright 2014, 2011, 2007, 2005, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.30

A Common Cause but Still Segregated

Jessie Sleet Scales served the African-American community to treat tuberculosis patients. Elizabeth Tyler worked with African-American patients at the Henry Street Settlement. Together they established Stillman House.It was a branch of the Henry Street Settlement.It served "colored people" through community health nursing programs.Their courageous activism broke through racial barriers.Copyright 2014, 2011, 2007, 2005, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.31War Again Creates the Need for Nurses: Spanish-American War1898 war triggered epidemic of typhoid fever Generated great need for professional nursesNot enough to supply needAnita M. McGee, MD appointed head of Hospital Corps to recruit nurses. Nursing school graduates supplemented by untrained women Set the stage for developing:Army Nurse Corps (1901)Navy Nurse Corps (1908)

Copyright 2014, 2011, 2007, 2005, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.32Professionalism and Standardization of Nursing Through Licensure1903: Four states created permissive licensure.Established "title protection" for nurses in these states1923: All states require examinations for "title protection," though not standardized.1947: Fully mandated licensure, as started in New York in 1930, became the norm.1950: NLN administered the first nationwide State Board Test Pool Examination. Copyright 2014, 2011, 2007, 2005, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.331917-1930: The Challenges of the Flu Epidemic, World War I, and the Early Depression Era1917: Influenza epidemic swept the United States and the United States entered World War I.Nurses demonstrated the ability to respond effectively to both needs.1920: Mary Adelaide Nutting chaired the National Committee on Nursing to:Supply trained nurses for the U.S. Army hospitalsFound the Army School of Nursing 1920: Congress approved military rank for nurses.Copyright 2014, 2011, 2007, 2005, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.341917-1930: The Challenges of the Flu Epidemic, World War I, andthe Early Depression Era (cont.)1925: Mary Breckinridge established the Frontier Nursing Service (FNS). Breckinridge provided the first organized midwifery program in the United States.Nurses worked in rural Appalachian Mountains to serve needs of poverty-stricken residents.They traveled by horseback to deliver babies, educate families, and care for the sick. FNS became one of the first demonstrations of nurses providing primary health care.Copyright 2014, 2011, 2007, 2005, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.35

1931-1945: Challenges of the Great Depression and World War II

1933: The Civil Works Administration (CWA) nurses provided rural and school health services for families who could no long afford nursing services.1935: Social Security Act enhanced public health nursing.World War IIThe inadequate supply of nurses prompted Congress to budget for nursing education. 124,000 volunteer student nurses were certified by the Cadet Nurse Corps.

Copyright 2014, 2011, 2007, 2005, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.36

1945-1960: The Rise of Hospitals: Bureaucracy, Science, and Shortages

The Hill-Burton Act (1946) provided funds to construct hospitals.Rapid expansion of facilities resulted in an acute shortage of nurses.Result: "Team nursing" was introduced.Group of patients cared for by group of caregiversRemoved RN from bedsideResulted in efficient but fragmented careThe nursing shortage prompted the creation of associate degree in nursing (ADN) programs. Copyright 2014, 2011, 2007, 2005, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.371961-1982: The Great Society, Vietnam, and the Changes in Roles for Women1965: Medicare and Medicaid ensured access to health care for the elderly, poor, and disabled.There was increased employment and specialization for nurses in hospitals.Intensive care, cardiology, psychiatry, additional responsibilities due to shortage of primary care physiciansGreat Society reforms of President Lyndon B. Johnson fostered the certified nurse practitioner (CNP) role.Copyright 2014, 2011, 2007, 2005, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.381961-1982: The Great Society, Vietnam, and the Changes in Roles for Women (cont.)The Vietnam War impacted nursing through: Stretching boundaries of nursing practice in jungle mobile hospital unitsResponsibility for performance of emergency proceduresNurses suffered posttraumatic stress disorder (PTSD) due to traumas of battlefield roles.1993: Vietnam Women's Memorial statue was dedicated in Washington, DC.Copyright 2014, 2011, 2007, 2005, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.391983-2000: Challenges for Nursing: HIV/AIDS and Life Support TechnologiesThe early 1980s marked the recognition and spread of the human immunodeficiency virus (HIV).The epidemic globally changed the landscape of health care very quickly.Global initiatives included research for treatment, prevention, and services in resource-poor nations, especially Africa.Preventive measures included massive changes in the daily routines of nurses: Needle/intravenous use and disposal, routine glove use, strict protocols for handling blood products.Copyright 2014, 2011, 2007, 2005, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.401983-2000: Challenges for Nursing: HIV/AIDS and Life Support Technologies (cont.)There was an enormous increase in the use of medical technologies. Technical life support first became widely used during this time.This raised important ethical questions about when and how to use life support appropriately.Prominent medical/legal cases prompted consideration of patients' "right to die" and treatment of "persistent vegetative states." Copyright 2014, 2011, 2007, 2005, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.412001-2015: The Post 9/11 Era and Natural Disasters2001 World Trade Center attacks and 2005 Hurricane Katrina in New Orleans resulted in important challenges to disaster relief. Nurses were called to act in conditions previously unimaginable and unaddressed. The ANA cited "unfamiliar and unusual conditions that may necessitate adaptations . . . to recognized standards of nursing practice."Nursing responded by increasing preparedness for natural and man-made disasters.Copyright 2014, 2011, 2007, 2005, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.42Health Care Reform2010: Affordable Care Act (ACA) was signed by President Barack Obama.It provides implementation of health insurance coverage changes to improve access and affordability. The ACA includes: Banning lifetime coverage limits for extreme medical conditionsYoung adult coverage to age 26Prevention of coverage denial to children under 19 with preexisting conditionsCoverage of preventive servicesRight to appeal coverage decisionsChoice of primary care providersCopyright 2014, 2011, 2007, 2005, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.43Information Medical TechnologiesThere is rapid development of information technologies in health care.The goals are to improve recording, transmission, access, and continuity of medical information, with the goal to "go paperless.Technologies include electronic medical records, bedside computer systems, nurses' personal information systems, and online reference tools for nurses. Shared experiences of particular illnesses creates subgroups of patients who can communicate via global, online technologies.Copyright 2014, 2011, 2007, 2005, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.44War in Iraq and Afghanistan Many soldiers return to the United States from two war fronts with significant injuries.Improved initial care in the field prevents more deaths but also increases the number of live solders with serious injuries.These serious injuries require long-term rehabilitation and nursing care, with needs including: lower extremity injuries, missing limbs, PTSD, neurologic deficits, etc.

Copyright 2014, 2011, 2007, 2005, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.45Social Context of Nursing: GenderGender role stereotyping starts early after (or even before) birth.It affects who traditionally enters nursing: "respectable" women who care for others.Only 8% of enrolled students are men, and in earlier eras, they were recruited for their strength.Today, men's motivations to enter nursing are similar to women's.Economic and job security have improved the appeal of nursing for both women and men.

Copyright 2014, 2011, 2007, 2005, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.46Social Context of Nursing: Image of NursingSociety's image of nurses varies.They are often presented as sexualized and less intelligent than physicians, with relatively simple responsibilities.There is also a very positive public image: They are highest in honesty and ethics. (Gallup poll, 1999-2010) The identifiable uniform has disappeared, making it difficult to discern RN from other staff. Woodhull Study on Nursing and the Media (1977) concluded that nurses are invisible to the media and to the public.Copyright 2014, 2011, 2007, 2005, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.47Social Context of Nursing: Image of Nursing (cont.)Johnson & Johnson launched a campaign (2002) to enhance nursing's image and improve recruitment.The Truth About Nursing (2001) is a nonprofit organization with goal to "change how world thinks about nursing." Uses a variety of social media to shape public imageIt is important for individual nurses to take responsibility for public image and to be cognizant of portrayals in the media.Copyright 2014, 2011, 2007, 2005, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.48National Population TrendsAging of AmericaLonger life expectanciesHigher proportion of older versus young U.S. citizens New disproportion will create stress on U.S. economic and social systemsProfound impact on health care systems, including access, delivery, and staffingDiversityPopulation of most minority ethnic/racial groups is growing in United States, including Hispanic, Asian, and Native-American peopleNursing must change through education and experience to meet differing cultural needs of patients.Copyright 2014, 2011, 2007, 2005, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.49Technological DevelopmentsFour types: genetics, biomedical, information, and knowledgeGenetics: Genonomics, epigenetics, and pharmacogenetics will shape the foreseeable future of health care and nursing practice.Biomedical: Nurses take responsibility for monitoring and responding to data generated by complex machines or implantable devices.Copyright 2014, 2011, 2007, 2005, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.50Technological Developments (cont.)Information: Nurses assume responsibility for data entry and retrieval using computer-based applications on the unit, at the bedside, or hand-held, which communicate, store, manage, retrieve, and process information. Knowledge: "technology of the mind; involves use of computer systems to transform information into knowledge and generate new knowledge; called "expert systems."Copyright 2014, 2011, 2007, 2005, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.51Nursing ShortageOvertime, frequent imbalances in nursing supply lead to "nursing shortages."These are usually confined to hospitals and nursing homes. Internal causes: salary issues, long hours, increased responsibility for unlicensed workers, too little authority for RNsExternal causes: changes in demand for nurses, increasing age of population and of nurses, alternative career options for womenThe key factor is the shortage of nursing faculty.Copyright 2014, 2011, 2007, 2005, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.52Initiatives to Provide a Stable Supply of RNSFour major initiativesAmerican Recovery and Reinvestment Act, 2009To stimulate U.S. economy, with provision for $500 million to strengthen U.S. health care work forceRobert Wood Johnson FoundationHas committed tens of millions of dollars to create regional workforce development systems in health careJohnson & Johnson Campaign for Nursing's FutureIn partnership with National Student Nurses Association (NSNA), NLN, ANA, Sigma Theta Tau International (STTI) American Nurses Credentialing Center (ANCC) Magnet Recognition ProgramTo attract and retain nurses in acute hospital settingsCopyright 2014, 2011, 2007, 2005, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.53Question 1 Who published Notes on Nursing: What It Is and What It Is Not? 1. Clara Barton2. Florence Nightingale 3. Lillian Wald4. Nurse Ratched

Copyright 2014, 2011, 2007, 2005, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.542. Florence Nightingale: Perhaps her most famous publication is the 1859 Notes on Nursing: What It Is and What It Is Not. In this document Nightingale stated clearly for the first time that mastering a unique body of knowledge was required of those wishing to practice professional nursing.Elsevier items and derived items 2009, 2005, 2001 by Saunders, an imprint of Elsevier Inc.54Clara Barton established the Red Cross. Lillian Wald began the Henry Street Settlement and public health nursing. And Nurse Ratched is a fictional character and one of the most damaging images of nursing, portrayed as a cold, sadistic, and controlling psychiatric nurse. Question 2Before Florence Nightingale, men provided most of the nursing care.True FalseCopyright 2014, 2011, 2007, 2005, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.551. True: Men are not new to the profession of nursing. During the eleventh, twelfth, and thirteenth centuries in Europe they supplied much of the nursing care, often within the authority of military or religious orders. Florence Nightingale worked hard to establish nursing as a worthy career for respectable women, largely ignoring the historical contributions of men. The male role as she saw it was confined to supplying physical strength, such as lifting, moving, or controlling patients, when needed. Elsevier items and derived items 2009, 2005, 2001 by Saunders, an imprint of Elsevier Inc.55 Question 3According to the text, what is the fourth technological development? Genetics, biomedical, information, andComputersEquipmentKnowledge Laser

Copyright 2014, 2011, 2007, 2005, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.563. Knowledge: The word "technology" seems to be everywhere today and has a place in many domains in health care. For purposes of this basic introduction, four types of technological developments will be discussed: genetic, biomedical, information, and knowledge. Elsevier items and derived items 2009, 2005, 2001 by Saunders, an imprint of Elsevier Inc.56