Introduction to Nursing Chapter 1 Fundamental of Nursing

Introduction to Nursing Chapter 1 Fundamental of Nursing The Art and Science of Person-Centered Care Ninth Edition Carol Taylor, Pamela Lynn, Jennifer L. Barlett

Learning Objectives: Describe the historical background of nursing, definitions of nursing and the status of nursing as a profession and as a discipline. Explain the aims of nursing as they interrelate to facilitate maximal health and quality of life for patients. Explain how nursing qualifies as a profession. Describe the various levels of educational preparation in nursing. Discuss the effects on nursing practice of nursing organizations, standards of nursing practice, nurse practice acts, and the nursing process. Identify current trends in nursing. Discuss the importance of self-care in relations to the demands of the nursing profession.

Historical Background of nursing Historical background Early civilizations believed that illness had supernatural causes. This theory was based on the belief that everything in nature was alive with invisible forces and endowed with power. Good spirits brought health Evil spirits brought sickness and death The health care provider was the medicine man who treated disease by chanting, inspiring fear, or opening skull to release evil spirits (Dolan, Fitzpatrick, & Herrmann, 1983) Health care was provided by the mother providing physical care and herbal remedies. This nurturing and caring has continued to present. Ancient Greek civilizations The centers of medical care because of the belief that illness was caused by sin and the gods’ displeasure.

Historical background of nursing (cont. ) Ancient Greek Temples became centers of medical care Mosaic Health Code- for ethical human relationships, mental health, and disease control Beliefs that illness was caused by sin and the gods’ displeasure Early Christian period Women called “deaconesses” made first organized visit to sick people Hospitals were built for the people needing health care Beginning 16 th Century Western societies shifted from religious orientation to warfare, exploration and knowledge expansion. Monasteries and convents closed leaving shortage of people to care for sick Women convicted of crimes recruited into caring for the sick instead of jail. They received low pay, worked long hours, had a poor reputation

Birth of modern Nursing! Nursing as we know it began middle of 19 th century Social reforms changes roles of nurses and women in general FLORENCE NIGHTINGALE Born 1820 in a wealthy family, well educated, traveled extensively Began training as a nurse age 31 Challenged prejudices against women and elevated the status of all nurses. Florence Nightingale contributions: Identifying personal needs of patient and the role nurses had in meeting needs Establishing standards for hospital management Establishing a respected occupation for women Recognized two components; Health and Illness Nursing is separate and distinct from medicine Nutrition is important to health Occupational and recreational therapy Need for continuing education for nurses Maintaining accurate records began nursing research

Definitions of Nursing Word “nurse” originated from the Latin word nutrix, meaning “to nourish” “nursing describe the nurse as a person who nourishes, foster, and protects and who is prepared to take care of sick, injured, aged, and dying people” American Nurses Association (ANA) “the protection, promotion, and optimization of health and abilities, prevention of illness and injury, facilitations of healing, alleviation of suffering through the diagnosis and treatment of human response, and advocacy in the care of individuals, families, groups, communities, and populations. ” (ANA, 2015 c)

Nursing’s Aims and Competencies 1. To promote health 2. To prevent illness 3. To restore health 4. To facilitate coping with disability or death To meet these aims-use of blended competencies Cognitive Technical Interpersonal Ethical/legal

Quality and Safety Education for Nurses QSEN Patient centered care Teamwork Collaboration Quality improvement Safety Evidence-based practice Informatics

Nursing Roles in all settings Caregiver Communicator Teacher/educator Counselor Leader Researcher Advocate Collaborator

Nursing as a profession and a discipline Profession 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 Autonomy and self-regulation Discipline Specialized skills and application of knowledge based on education with both theoretical and clinical practice components. Guided by standards set by professional organizations and established code of ethics Evolution of nursing Evolved through history from technical service to person-centered maximizing potential in all human dimensions Active development process, using lessons from past to gain knowledge for practice in the present and in the future.

Educational Preparation of Nurses Education preparation for practice programs lead to licensure or legal authority to practice as a nursing professional Options: Licensed practical nurse (LPN) Registered nurse (RN) Associate degree Bachelors degree (BSN) Advanced degrees RN to master’s degree (MSN) RN to doctor of nursing practice (DNP) RN to doctor of philosophy (Ph. D) RN to advanced practice nurses (APRNs) RN as family nurse practitioners (FNPs) RN as clinical nurse leader (CNL)

Educational Preparation of Nurses (cont. ) Practical and Vocational Nursing (LPN) Education Established to teach nurses bedside nursing care- 1 year program NCLEX-PN licensure test LPN’s work under direction of health care provider or RN to give direct patient care. Meets health care needs in hospitals, long-term care facilities, home health. Registered Nursing Education (RN) Diploma, Associate degree, Baccalaureate programs (varies in length of program) NCLEX-RN licensure test Graduate Education Advanced practice nurses (APRNs)- function in education, managerial, clinical specialist, various advance practice areas Masters prepared nurses (MSN)- function in education, leadership, research Doctor of nursing practice (DNP)- terminal degree in nursing practice, alternative approach to research-focused Doctor of philosophy (Ph. D)- education, research, science development RN to advanced practice nurses (APRNs) RN as family nurse practitioners (FNPs) RN as clinical nurse leader (CNL)

Continuing Education “…successful nurses are lifeline learners!” (Fundamental of nursing 9 th edition) ANA defines continuing education: Options of continuing education “…as those professional development experiences designed to enrich the nurse’s contribution to health. ” Courses, seminars, workshops, on site in-services. Mandatory continuing education for licensure Some states require continuing education to maintain licensure. State of Utah requires: 30 contact hours OR 200 practice hours 15 contact hours OR 400 practice hours

Nursing Organizations: Effects on Nursing Practice Professional organization are a criteria of a profession Professional organizations sets standards for practice and education Focus: Current issues in nursing and health care Influence on health care policy and legislation Benefits of belonging to nursing organizations Networking with colleagues Having a voice in legislation affecting nursing Staying current with trends and issues in nursing

National Nursing Organizations in the USA American Nurses Association (ANA) National League for nurses (NLN) American Association of Colleges of Nursing (AACN) National Student Nurses Association (NSNA) Specialty Practice and Special –Interest Nursing Organizations (examples): American Academy of Nurse Practioners American Assembly for Men in Nursing American Association of Critical Care Nurses Hospice Nurses Association

Standards of Nursing Practice Nursing controls and guarantees it’s practice through standards of practice, nurse practice acts and licensure. ANA Code of Ethics for Nurses includes professional values, and the use of the nursing process Each of these guide your nursing education as a student AND YOUR PRACTICE AFTER GRADUATION!

Standards (cont. ) Standards allow nurses to Carry out professional roles Serving as protection for the nurse, patient and the health care where it is provided. Each nurse is accountable for: His or her own quality of practice Is responsible for the use of these standards Ensure knowledgeable, safe, and comprehensive nursing care.

Nurse Practice Acts and Licensure Nurse practice acts are laws established in each state in the US, they REGULATE the practice of nursing. Each state set the standards for that state however there is commonality in all state standards including: Protect the public by defining legal scope of nursing practice, excluding untrained or unlicensed people from practicing nursing. Create a state board of nursing or regulatory body having the authority to make and enforce rules and regulations concerning the nursing profession. 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. Each state has legal authority to allow graduates from approved schools of nursing to take the licensing exam. The license in that state is valid during the life the holder (renewals required) License can be denied, revoked or suspended for professional misconduct.

Nursing Process Nursing process is a major guideline for nursing practice- integrates both the art and science of nursing. The standard activities involved in the nursing process are Assessing Diagnosing Planning Implementing Evaluating Nursing process is used to: Identify the patient’s health care needs and strengths Establish and carry out a plan to meet those needs Evaluate the effectiveness of the plan to meet established outcomes Nursing skills used in the nursing process Critical thinking Clinical reasoning Defining areas of care that are within the domain of nursing

Current Trends in Nursing American Nurses Association identified 4 trends that will affect American nurses. Nursing shortages will offer unique opportunities Job opportunities are expanding outside the hospital and nurses will play a much bigger role in communities Technology will play a larger role in nursing practice Nurses will collaborate more with other health care providers.

Nursing trends (cont. ) In 2011 Institute of Medicine (IOM) study on the future of nursing; Nurses should practice to the full extent of their education and training. Nurses should achieve higher levels of education and training through an improved education system that promotes seamless academic progression. Nurses should be full partners, with health care providers and other health professionals in redesigning health care in the United States. Effective workforce planning and policy making require better data collection and improved information infrastructures Campaign for Action …aims everyone in America can live a healthier life…nurses are essential partners in providing care and promoting health. Campaign for Action working in every state to mobilize nurses, health providers, consumes, educators, and businesses to strengthen nursing on multiple fronts.

Self-care ANA Code of Ethics for Nurses reminds us that our primary duty is to the patient, however… “…the nurse owes the same duties to self as the others, including the responsibility to promote health and safety, preserve wholeness of character and integrity, maintain competence, and continue personal and professional growth. ” ANA defines a healthy nurse… “as one who actively focuses on creating and maintaining a balance and synergy of physical, intellectual, emotional, social, spiritual, personal and professional well-being. ”

Nurse fatigue…. Signs of fatigue Compassion fatigue: Loss of satisfaction from providing good patient care Burnout: Cumulative state of frustration with the work environment that develops over a long time Secondary traumatic stress: A feeling of despair cause by the transfer of emotion distress from a victim to a caregiver, which often develops suddenly Healthy self-care practices Stress reduction training Use of relaxation techniques Time management Assertiveness training Work-life balance Meditation or mindfulness-based practices

Mindfulness “capacity to intentionally bring awareness to present-moment experience with an attitude of openness and curiosity. ” Promotes healing as you pause, focus on the present, and listen. S—Stop and take a step back T—Take a few breaths O—Observe inside yourself P—Proceed after you pause -Ponte and Koppel (2015)