The Profession of Nursing

7/28/2019 The Profession of Nursing

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The Profession of Nursing

Foundations I Theory

Devin Terry MSN, RN, ACNS-BC

Summer 201

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Objectives

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UAMS Nursing Philosophy

Professionalism- committed to professional practice and collaboration with the interdisciplinaryteam to provide innovative and exceptional patient-and-family-centered care to impact theoverall health of our community.

Accountability- the professional nurse is the foundation of nursing practice . Strong patientadvocates, accepting responsibility for professional practice an willingly commit to strive tocreate optimal outcomes.

Communication- the power to share ideas and concepts as the basis for effective team work.Promotes positive outcomes when executed with enthusiasm and optimism.

Excellence- professional practice model as the basis for delivery on nursing care. Value anenvironment where the scope of practice promotes innovative and compassionate patient caredelivery and encourages continuous improvement. Excellence through aggressive recruitmentand retention of RN staff.

Together- we set the pace3


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Theory in Nursing

Historical perspective

Role in nursing

evidence or science based practice

Interdisciplinary theories

systems, basic human needs, stress andadaptation, developmental etc

Nursing theories

grand, mid-range, descriptive, prescriptive4


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Grand Theory

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Middle-Range

Limited in scope and less abstract

Specific phenomenon

Applicable to administration, clinical,and teaching

Can be applied to variety of nursingsituations (uncertainty, incontinence,social support, quality of life, andcaring)

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Definition of Nursing

Accountable discipline guided by:

science

theory

a code of ethics

the art of care and comfort to treat

human responses to healthand illness

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ANA: Four Essential Features ofContemporary Nursing Practice

1. attention to the fullrange of human

experiences andresponses to healthand illness withoutrestriction to a

problem focusedorientation

2. integration ofobjective data with

knowledge gainedfrom anunderstanding of theclient/groups

subjectiveexperience

Look at the whole person

before we decide what is wrong! 8


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Four Essential features of ContemporaryNursing Practice

application of

scientific knowledgeto the processes ofdiagnoses andtreatment

3. provision of a caringrelationship thatfacilitates health andhealing

4.

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ATI Check your knowledge #1

1. A RN is making the first home visit to a family of anew born for a well-infant check. The family includesthe 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 mostbeneficial in establishing a therapeutic relationshipwith this family?

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ATI #1 continued

a) Tell the family members not to worry aboutany concerns they may have.

b) Include all the family members in thediscussion about the infants exam.

c) Present a nonjudgmental attitude.

d) Give written information regarding well-infant checks.

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Nursing Education

Entry level education (all take samelicensing exam)

diploma (3 year, usually hospital affiliated)

associate degree (2 year, focus ontechnical)

baccalaureate degree (4 year universityeducation)

graduate degree (undergraduate degrees inother disciplines, graduate degree innursing)

Thats you!

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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, healthpolicy makers

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Continuing Education

Courses that assist in developing andmaintaining expertise and knowledge

Promotes quality of nursing care

Mandatory in some states (Arkansasincluded)

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Professionalism

Professionalism

behavior that upholds the status, methods,

character, and standards of a givenprofession

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Characteristics of aProfession

Extended educationbuilt upon a basicliberal foundation

Theoretical body ofknowledge leading toskills, abilities, andnorms

Provides a specificservice

Autonomy indecision making and

practice Code of ethics

governing practice

Is nursing a true

Profession?

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ATI check your knowledge #2

2. State three ways nurses obtain theirprofessional values?

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Standards of NursingPractice

Nursing actions that are agreed upon bynurses as constituting safe and effective

client care

Establish foundation for professionalpractice

Developed and implemented byprofessional organizations

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Standards of Practice

ANA establishes these writtenstatements defining the acceptable level

of performance in the profession

Provide direction for the provision ofnursing care

Provide set of expectations that can beused to evaluate nursing performance

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ANA Standards of NursingPractice

Standards of Care

Assessment

Diagnosis Outcome Id.

Planning

Implementation

Evaluation

Standards ofProfessionalPerformance

quality of care

performanceappraisal

education

collegiality

ethics

collaboration

research

UAMS uses same guidelines to

Help guide student practice!

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Functions of NursingProfessional Organizations

Establish, maintain, and improve nursingstandards

Hold members accountable for practicing bythe standards

Public education

Public protection Protection of members of the profession

Lobbies at the state and federal level fornurses

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Professional NursingOrganizations

American NursesAssociation (ANA)

members are state nursesassoc. members

publishes American

Journal of Nursing Offers specialty

certification

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ANA:

Advances:

nursing roles

economic interest

Healthcare

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National League of Nursing(NLN)

members are nurses,agencies, non-nurses

promotes improved

development of nursingservices and education

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http://www.nlnfoundation.org/


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National Student Nurses Association

American Academy of Nurses

Sigma Theta Tau Specialty nursing organizations

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Professional Nursing Roles

Traditionally, providing care andcomfort to clients and performing

specific nursing functions Expanded to include illness prevention,

health promotion, and concern for

client holistically

What is holistic care?

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Professional Nursing Roles

Caregiver

Comforter Advocate

Teacher

Clinicaldecision maker

Communicator

Case Manager Researcher

Rehabilitator

NURSE!27
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3. The nursing team is directed by the

a) Assistive personnel (AP)

b) Licensed Practical Nurse/ LicensedVocational Nurse (LPN/LVN)

c) Registered Nurse (RN)

d) Nutrition Aide

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Trends

Toward more holistic care

Increased variety in employmentsettings

Importance of advanced education

Graying of America

Increasing urbanization

Increasing cultural diversity

Communication and travel 29


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Trends

Stagnating/declining wages

Poverty levels (1/7 Americans)

especially high incidence in women,children, the elderly, and minorities

Increasing numbers of uninsured

Access

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Types of law

Statutory law

Americans with Disabilities Act

Nurse Practice Acts

Child and elder abuse reporting laws

Public law

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

Written law with the intention to clarify

Law governing the relationship between individuals and the state

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Legal Regulation of NursingPractice

Nurse Practice Acts

power granted to individual states

protects the public

defines the nature and scope ofprofessional practice

single most important law affecting nursingpractice

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Features of Nurse PracticeActs

Defines the practice of nursing

Delineates rules and regulations that

govern practice

Outlines relationship of professionalnursing to other health care providers

Establishes licensure requirements

Creation of a State Board of Nursing

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Features of Nurse PracticeActs

Defines professional misconduct

Defines disciplinary actions for

professional misconduct

http://www.arsbn.org/

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Other Laws Affecting NursingPractice

Occupational Safety and Health Act of 1970

Controlled Substance Acts (Comprehensive

Drug Abuse Prevention and Control Act of1970)

Health Care Quality Improvement Act

American with Disabilities Act Good Samaritan Laws

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f i l l i f


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Professional Regulation ofNursing Practice

Professional Nursing Organizations

Centers for Disease Control and

Prevention (CDC)

Employer policies and procedures

Educational programs

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C l f h P f i f


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Control of the Profession ofNursing

Credentialing

methods by which the profession attempts toensure and maintain practitioner competency

Certification

voluntary process granting recognition formeeting criteria established by a nongovt.assoc.

Accreditation

monitors educational programs ability to meetpredetermined standards for student outcomes

Licensure 37


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Licensure

State function, mandatory

Grants owner formal permission from

the State Board of Nursing to practicenursing

Criteria

educational preparation

passing the NCLEX examination

good moral character

application and registration fee payment

How do they check this??

Fee is a common trend

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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

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Malpractice and Negligence

Unintentional tort

Negligence

conduct not consistent with what anordinarily prudent person would use insame circumstance

Malpractice professional negligence

nursing care below standard of care

No intent

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Liability

Liability

legal obligation or responsibility to provide

care to a client that meets the acceptedstandard of care

Elements of Liability

dutybreach of duty

causation

damage 41

A f P t ti l Li bilit
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Areas of Potential Liabilityfor Nurses

Failure to monitor and assess

Failure to ensure safety

Medication errors

Improper implementation

of skills or procedures Documentation errors

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L l R ibiliti f


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Legal Responsibilities ofStudent Nurses

Practice nursing as part of the clinicaland academic requirements of the

educational institution and under thesupervision of nursing faculty

Legal protection is not available to

nursing students practicing nursingoutside of their educational programs(i.e., when working as nurse techs or

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Safeguarding Your Practice

Know your obligations andresponsibilities

Practice competently

Know your strengths and limitations

Keep current

Document your care

Professional liability insurance

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Client Rights

Informed consent

Confidentiality

(HIPAA)

Advance directives

Organ transplantation

issues

Right to refuse treatment

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Informed Consent

Legal right of client to receive adequateand accurate information about medical

condition and treatment risks, benefits, alternatives, consequences

of refusal

Physician is responsible for conveyinginformation and obtaining consent forprocedures

Examples?

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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, andsubstance abuse

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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

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Confidentiality ~ HIPAA

Clients right to privacy in thehealth care system

Ethically obligated to maintainconfidentiality

Additional protection under thelaw for persons receiving

treatment for drug and alcoholabuse, mental health care, sexualassault, HIV, and AIDS

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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 organdonation or medical research after death.

c) The right to refuse treatment and establish advancedirectives.

d) The right for sensitive health information to be keptconfidential.

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Advance Directive / Patient SelfDetermination Act

Written document providing direction forhealth 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

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Organ Transplantation Issues

Right to determine whetherthey want to donate tissuesor organs

Uniform Anatomical GiftAct- law in all statesproviding list of individualswho can provide consent fororgan donation

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Quality of Life Issues

Use to determine benefits of medicalintervention

Difficulty assessingand defining

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Allocation of Scarce


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Allocation of ScarceResources

Organ transplantation UniformAnatomical Gift Act - allows a

competent client to make an informeddecision to donate all part of her bodyfor organ donation or medical researchafter death.

Access to service $$$ spent

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Ethics

Branch of philosophythat attempts to

determine whatconstitutes good, bad,right, and wrong in

human behavior Provides guidelines to

direct human action

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Ethical Principles for the Practice ofProfessional Nursing

Autonomy - respects persons right to selfdetermine

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

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Ethical Code for Nurses

TheAmerican Nurses Association Codeof Ethics for Nurses (2001) and the

International Council of Nurses Codeof Ethics for Nurses (2000)

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5. The ANA code of ethics serves which of the followingpurposes?

a) Establishes standardized curricula for nursingeducational programs

b) Sets formal guidelines and standards forprofessional nursing conduct.

c) Ensures that nurses provide client care based onscientific principles.

d) Determines qualifications for advance practicenurses (APNs)

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Accountability and


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Accountability andResponsibility

Responsible for providing care within establishedstandards of the profession

implement care using the nursing process

students responsible for acquiring knowledge andskills needed to become safe practitioner

Accountable/answerable for the outcomes of actionstaken

to yourself, clients, institutions, peers, theprofession, and society

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History of Nursing

&Nursing Leaders

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Nursing in Ancient


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Nursing in AncientCivilization

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 familyover time

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Influence of Christianity

Educated and wealthy women cared forthe sick and impoverished

New Testament 1st recorded history of nursing

Phoebe

1st deaconess

60 AD - 1st visiting nurse

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Nursing in the Middle Ages


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Nursing in the Middle Ages476-1453

Dark Ages (1st 500 years)

few institutions of higher learning

low level of education except for nobilityand 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


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Middle Ages (continued)

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Middle Ages (continued)

Midwifery

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15 to 18th Century

Crusades

Lack of hygiene and sanitation

Poverty in urban centers

Smallpox epidemics

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Colonialism and Revolution

1st colonial hospital in 1658 in what becameNew York

Hospitals only in the largest colonies withuntrained male nurses

Folk remedies the extent of nursing/healthcare

More American Revolutionary soldiers diedfrom disease or complications of care thanfrom wounds sustained in battle

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Industrialization

High incidence of illness, injury and early mortality

Caring for the sick became socially acceptable and theneed for competent nurses was recognized

Nursing textbooks written Nursing training programs

Sisters of Charity, The Kaiserwerth School ofNursing, Nurse Society of Philadelphia

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Crimean War

1854-1856, region now partof Ukraine

Great Britain, Turkey,France, and Sardinia unitedagainst Russia

Florence Nightingaleemerges as a hero (she hasher own slide)

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American Civil War

Clara Barton and the American Red Cross

Women provided care to sick and injuredsoldiers and implemented sanitary conditionsin field hospitals

Value of primary prevention recognized

Post-Civil War first U.S. schools of nursingbased on the Nightingale model (combinationof classroom and clinical experience)

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Spanish-American War

Trained nurses employed in militaryhospitals (not enough to meet all needs)

Military camps shattered by epidemicdiseases such as typhoid and malaria

Army Nursing Service

preferred trained nurses paid $30 per month plus

room and board

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World War I Nurses could not meet civilian and

military needs - again requiringuntrained volunteers

Rockefeller Foundation established a

committee to study nursing education

Goldmark report revealed faults withhospital training programs, identifiedlack of funding as the obstacle to

higher educational standards Funded expansion of nursing

programs at Yale, Vanderbilt, and theUniversity of Toronto

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World War I (continued)

Expansion of hospitals and nursingschools during the 1920s

Apprenticeship method Womens suffrage

Lavinia Dock (nurse activist)

Great Depression

transition from home based nursing care tohospital care

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World War II

Increased demand for QUALIFIED nurses

US Congress passed Lanhan act to fundnursing education and improve existing

facilities (federal subsidization)

GI Bill of Rights

Baby boom and post-war economy stimulated

hospital construction Nursing shortage

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Korean War

Mobile Army Surgical Hospitals (MASH

units)

Paved the way for ICU development andbetter ER and trauma care

Development of associate degree programs(Mildred Montag of Teachers College)

Concept of Nursing Diagnosis

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Vietnam War

1966 -Congressional bill permittedappointment of male nurses to the armed

forces nurse corps resulting in more malenurses

Rapid expansion of civilian hospitals andmedical technology

Increased specialization

Graduate educational and nurseentrepreneurship opportunities

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Contemporary Developments

Financially driven health care system ofthe 1980s (DRG, HMO, emergency care

centers) Focus on cost containment and

efficiency in the 1990s

Increase in jobs in outpatient and homehealth care settings

Managed care

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Contemporary Developments

Nursings Agenda for Health CareReform

primary care, prevention, and communityoutreach

Nursing shortage

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Nursing Leaders: Florence


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Nursing Leaders: FlorenceNightingale

Born in 1820 in England

Founder of modern nursing

Trained at Deaconess Institute in Kaiserwerthand with the Sisters of Charity in Paris

Led a group of 38 nurses in British militaryhospitals in Turkey

The Lady with the Lamp

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Florence Nightingale


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Florence Nightingale(continued)

Established sanitary conditions in British militaryhospitals 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 andNotes on

Hospitals Nightingale Training School (Nightingale plan)

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Nursing Leaders (late 1800s)

Linda Richards- 1st trained US nurse

Isabel Hampton Robb - 1st principal of JohnsHopkins SON, instrumental in establishingorganizations that became ANA and NLN

Mary Adelaide Nutting - worked for nurses tobe educated in the university setting

Clara Barton - Civil War nurse, developedAmerican Red Cross

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Nursing Leaders (late 1800s)

Mary Mahoney -Americas 1stprofessional black nurse

Lillian Wald opened the Henry StreetSettlement Service in New York andestablished public health nursing

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Nursing Leaders (early


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g ( y1900s)

Margaret Sanger - 1st birth controlclinic in America

Isabel Maitland Stewart - research todifferentiate between nursing and non-nursing tasks, instrumental in

upgrading nursing education Mary Breckinridge - founded Frontier

Nursing Service (1st organized

midwifery service) 83

Nursing Leaders (early


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g ( y1900s)

Lucille Petry - 1stwoman appointed to

position of AssistantSurgeon General ofthe US Public Health

Service

Documents

The Profession of Nursing