Chapter 1 Nursing Today Copyright 2017 Elsevier Inc

Chapter 1 Nursing Today Copyright © 2017, Elsevier Inc. All Rights Reserved.

Giddens Concepts Professional Identity: a sense of oneself that is influenced by characteristics, norms, and values of the nursing discipline, resulting in an individual thinking, acting, and feeling like a nurse. Institutional Roles Behavioral Competencies Emerging Identities Copyright © 2017, Elsevier Inc. All Rights Reserved. 2

Nursing as a Profession Patient-centered care Professionalism Administer quality care Ø Be responsible and accountable Ø Health care advocacy groups Ø Institute of Medicine (IOM) publication on The Future of Nursing Copyright © 2017, Elsevier Inc. All Rights Reserved. 3

Stairstep Model of Professional Transformation From Crigger N, Godfrey N: The making of nurse professionals: A transformational, ethical approach, Sudbury, MA, 2011, Jones & Bartlett. Copyright © 2017, Elsevier Inc. All rights reserved. 4

Science and Art of Nursing Practice Nursing requires Current knowledge and practice standards Ø Insightful and compassionate approach Ø Critical thinking Ø Benner’s stages of nursing proficiency: Novice Ø Advanced beginner Ø Competent Ø Proficient Ø Expert Ø Copyright © 2017, Elsevier Inc. All Rights Reserved. 5

Benner’s Stages of Nursing Expertise Stage V, Expert Stage IV, Proficient Stage III, Competent 2 -3 years as a nurse Stage II, Advanced beginner Stage I, Novice Beginning nursing student or a new situation

The ANA Definition of Nursing is the protection, promotion, and optimization of health and abilities; prevention of illness and injury; alleviation of suffering through the diagnosis and treatment of human response; and advocacy in the care of individuals, families, communities, and populations. Copyright © 2017, Elsevier Inc. All Rights Reserved. 7

Scope and Standards of Practice Nursing definitions Nursing: Scope and Standards of Practice 1960: Documentation began Ø Standards of Practice Ø Standards of Professional Performance Ø Goal Ø To improve the health and well-being of all individuals, communities, and populations through the significant and visible contributions of registered nursing using standards-based practice Copyright © 2017, Elsevier Inc. All Rights Reserved. 8

Standards of Practice Six standards of practice: Assessment Ø Diagnosis Ø Outcomes identification Ø Planning Ø Implementation Ø Evaluation Ø The nursing process is the foundation of clinical decision making: a competent level of nursing. Copyright © 2017, Elsevier Inc. All Rights Reserved. 9

Standards of Professional Performance: Guidelines to Follow Ethics Education Evidence-Based Practice and Research Quality of Practice Professional Practice Evaluation Communication Resources Leadership Environmental Health Collaboration Copyright © 2017, Elsevier Inc. All Rights Reserved. 10

Code of Ethics A code of ethics is the philosophical ideals of right and wrong that define principles used to provide care. Ask yourself: How do your ethics, values, and practice compare with established standards? Copyright © 2017, Elsevier Inc. All Rights Reserved. 11

The ANA Code of Ethics Provision 1 The nurse practices with compassion and respect for the inherent dignity, worth, and unique attributes of every person. Provision 2 The nurse’s primary commitment is to the patient, whether an individual, family, group, community, or population. Provision 3 The nurse promotes, advocates for, and protects the rights, health, and safety of the patient. Provision 4 The nurse has authority, accountability, and responsibility for nursing practice; makes decisions; and takes action consistent with the obligation to promote health and to provide optimal care. Provision 5 The nurse owes the same duties to self as to others, including the responsibility to promote health and safety, preserve wholeness of character and integrity, maintain competence, and continue personal and professional growth. Provision 6 The nurse, through individual and collective effort, establishes, maintains, and improves the ethical environment of the work setting and conditions of employment that are conducive to safe, quality health care. Provision 7 The nurse, in all roles and settings, advances the profession through research and scholarly inquiry, professional standards development, and the generation of both nursing and health policy. Provision 8 The nurse collaborates with other health professionals and the public to protect human rights, promote health diplomacy, and reduce health disparities. Provision 9 The profession of nursing, collectively through its professional organizations, must articulate nursing values, maintain the integrity of the profession, and integrate principle of social justice into nursing and health policy. To access the ANA Code of Ethics with Interpretive Statements: http: //nursingworld. org/Main. Menu. Categories/Ethics. Standards/Codeof. Ethicsfor. Nurses/Code-of-Ethics-For-Nurses. html American Nurses Association, Code of Ethics for Nurses with Interpretive Statements, Washington, D. C. : American Nurses Publishing, 2015

Professional Roles Autonomy and Accountability Caregiver Advocate Educator Communicator Manager Copyright © 2017, Elsevier Inc. All Rights Reserved. 13

Professional Identity Term Meaning Doing Being Acting Ethically Flourishing Changing Identities Copyright © 2017, Elsevier Inc. All rights reserved. 14

Building a Professional Identity Hearing expectations clearly Value debriefing and feedback from role models Engage in reflection Actively adopt a professional identity Understand your own responsibilities for learning and be accountable for them Build relationships with those around you Develop personal self care habits Embrace any opportunity or experiences with patients 15

EXAMPLES OF PROFESSIONAL IDENTITY Copyright © 2017, Elsevier Inc. All rights reserved. 16

Example #1 Integrity Follow through with pain medication Ø Calling the physician when the patient asks you to Ø Checking the Code Cart by the prescribed time Ø Giving medications within the 30 -minute window Ø Copyright © 2017, Elsevier Inc. All rights reserved. 17

Example #2 Compassion Taking time to talk with a troubled family member Ø Responding to a patient’s call light with genuine interest Ø Comforting a colleague who has just had a death in her family Ø Using eye contact to apologize for a misstep with a colleague Ø Copyright © 2017, Elsevier Inc. All rights reserved. 18

Example #3 Courage Speaking up when a colleague didn’t wash his hands before entering a patient room Ø Conveying the details of the conversation a dying patient had with you to other members of the health care team Ø Taking practice issues to the practice council to positively change practice on your nursing unit Ø Speaking out about bullying occurring on the nursing unit Ø Copyright © 2017, Elsevier Inc. All rights reserved. 19

Example #4 Humility Realistically viewing family members’ ability to cope with a crisis Ø Being nonjudgmental as staff deal with a unitbased crisis Ø Clearly identifying your part in an error and not accepting more blame than is yours Ø Seeing the larger picture when issues arise with patients, families, and co-workers Ø Copyright © 2017, Elsevier Inc. All rights reserved. 20

Example #5 Advocacy Sharing with family members the details of a conversation you had with their loved one this a. m. Ø Listening carefully to help family members carry out their wishes, and working with the hospital to do what you can to help that happen Ø Communicating with the family about their loved one’s surgery schedule, course of events, and expected finish time Ø Copyright © 2017, Elsevier Inc. All rights reserved. 21

Example #6 Human Flourishing Encouraging patients in their difficult times Ø Seeking additional resources for patients with limited discharge planning issues Ø Encouraging co-workers to seek employee assistance options for difficulties they are having Ø Create a positive, encouraging environment for patients and families Ø Copyright © 2017, Elsevier Inc. All rights reserved. 22

Career Development Nursing provides an opportunity for you to commit to lifelong learning and career development. Copyright © 2017, Elsevier Inc. All Rights Reserved. 23

Career Development (Cont. ) Provider of care Advanced practice registered nurses Clinical nurse specialist Ø Certified nurse practitioner Ø Certified nurse midwife Ø Certified registered nurse anesthetist Ø Nurse educator Nurse administrator Nurse researcher Copyright © 2017, Elsevier Inc. All Rights Reserved. 24

Nursing Shortage With fewer available nurses, it is important for you to learn to use your patient contact time efficiently and professionally. Essential skills include: Time management Ø Therapeutic communication Ø Patient education Ø Compassionate implementation of bedside skills Ø Copyright © 2017, Elsevier Inc. All Rights Reserved. 25

History of Nursing Video Click here to view a video on the history of nursing.

Historical Influences Nurses: Respond to needs of patients Ø Actively participate in determining best practices Ø Knowledge of the history of the nursing profession increases your ability to understand the social and intellectual origins of the discipline. Copyright © 2017, Elsevier Inc. All Rights Reserved. 27

Florence Nightingale First practicing epidemiologist Organized first school of nursing Improved sanitation in battlefield hospitals Practices remain a basic part of nursing today Copyright © 2017, Elsevier Inc. All Rights Reserved. 28

Civil War to the Beginning of the Twentieth Century Clara Barton Mother Bickerdyke Harriet Tubman Mary Mahoney Lillian Wald and Mary Brewster Copyright © 2017, Elsevier Inc. All Rights Reserved. 29

The Twentieth Century Movement toward scientific, research-based practice and defined body of knowledge Nurses assumed expanded and advanced practice roles 1906: Mary Adelaide Nutting, first nursing professor at Columbia Teacher’s College Ø Army and Navy Nurse Corps established Ø 1920 s: Nursing specialization began Ø Copyright © 2017, Elsevier Inc. All Rights Reserved. 30

Twenty-First Century Changes in curriculum Advances in technology and informatics New programs address current health concerns Leadership role in developing standards and policies Copyright © 2017, Elsevier Inc. All Rights Reserved. 31

Contemporary Influences Importance of nurses’ self-care Changes in society lead to changes in nursing: Affordable Care Act (ACA) Ø Rising health care costs Ø Demographic changes Ø Medically underserved Ø Copyright © 2017, Elsevier Inc. All Rights Reserved. 32

Trends in Nursing Evidence-based practice Quality and Safety Education for Nurses (QSEN) Impact of emerging technologies Genomics Public perception of nursing Impact of nursing on politics and health policy Copyright © 2017, Elsevier Inc. All Rights Reserved. 33

Professional Registered Nurse Education Registered nurse education 2 -year associate’s degree Ø 4 -year baccalaureate degree Ø Graduate education Master’s degree, advanced practice RN Ø Doctoral degrees Ø Continuing and in-service education Copyright © 2017, Elsevier Inc. All Rights Reserved. 34

Nursing Practice Nurse Practice Acts (NPAs) Overseen by State Boards of Nursing Ø Regulate scope of nursing practice Ø Protect public health, safety, and welfare Ø Licensure and certification Licensure: NCLEX-RN® examination Ø Certification: requirements vary Ø Copyright © 2017, Elsevier Inc. All Rights Reserved. 35

Professional Nursing Organizations Address member concerns Present educational programs Publish journals Student organizations Ø National Student Nurses Association (NSNA) Copyright © 2017, Elsevier Inc. All Rights Reserved. 36