Module 1 Theoretical foundations Of nursing REFERENCE POTTER

Module 1 Theoretical foundations Of nursing REFERENCE: POTTER & PERRY: FUNDAMENTALS OF NURSING 7 T H EDITION

Chapter 1 Nursing Today

Historical Perspective Highlights

Historical Perspective Highlights • Nurses: • Respond to requirements of clients • Actively take part in policy • Respond adapt to challenges

Florence Nightingale Introduction of Health Maintenance & Restoration www. internet-encyclopedia. org

The Civil War to the Beginning of the Twentieth Century • The growth of nursing in the US • Clara Barton, Dorothea Lynde Dix, Mother Bickerdyke, Harriet Tubman • Mary Mahoney • Isabel Hampton Robb

Twentieth Century Movement toward scientific, research-based practice and defined body of knowledge 1901, 1906, 1908 1940 s 1950 s 1990 s

Twenty-First Century • Nursing Code of Ethics • Changes in curriculum • Nursing in multiple care settings

Societal Influences on Nursing Demographic changes Woman’s health care issues Human rights Medically underserved Threat of bioterrorism

Needs of the Consumer • Cultural diversity • Safety • Health promotion and wellness

Influence of Today’s Health Care Delivery System • Rising health care costs • Evidence-based practice • Nursing and biomedical research • Nursing shortage

Introduction to Professional Nursing

Nursing as a Profession • What characteristics does a profession have? • • • Requires an extensive education Requires a body of knowledge Provides a specific service Has autonomy Incorporates a code of ethics

Nursing as a Profession (cont) • Scope and Standards of Practice • Nursing: Scope and Standards of Practice • 1960 • 2004 • Goal • 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 (ANA, 2004)

Nursing as a Profession (cont) • Standards of Practice • Six standards of practice • • • Assessment Diagnosis Outcomes identification Planning Implementation Evaluation

Nursing as a Profession (cont) � Standards of Professional Performance � Quality of Practice � Education � Professional Practice Evaluation � Collegiality � Collaboration � Ethics � Decisions & actions of behalf of clients are determined in an ethical manner: � ALWAYS SERVE AS A CLIENT ADVOCATE � Research � Resources Utilization � Leadership

Nursing as a Profession (cont) • Code of Ethics • Philosophical ideals of right and wrong that define principles

Nursing Education • Professional registered nurse education • Graduate education • Doctoral preparation • Continuing and in-service education • In-service: program on new medications or equipment

Nursing Practice • Nurses practice in a variety of settings. • Nursing protects, promotes, and optimizes our clients’ health, prevents illness and injury, alleviates suffering through the diagnosis and treatment of human responses, and advocates for the care of our clients (ANA, 2003).

Nursing Practice (cont) • Nurse practice acts • Licensure and certification • Science and art of nursing practice

Nurse Practice Act • State Boards of Nursing oversee the Nurse Practice Act for each state. This act helps to shield the public from unqualified and unsafe nurses. • Georgia Board of Nursing • Each state defines its Nurse Practice Act and as a nurse one should be familiar with it in which ever state that they work. 21

Professional Roles, Responsibilities, & Organizations

Professional Responsibilities • Nurses are responsible for obtaining and maintaining specific knowledge and skills. • In the past: • To provide care and comfort • Now: • To provide care and comfort and to emphasize health promotion and illness prevention

Professional Roles • Caregiver • Advocate • Educator • Communicator • Manager

Career Development • Nursing provides an opportunity for you to commit to lifelong learning and career development.

Professional Nursing Organizations • National League for Nursing • American Nurses Association • International Council of Nursing • National Student Nurses Association

Future Trends in Nursing • Nursing is ever changing. • Nursing will continue to grow. • Nursing will continue to evolve.

Philosophy & Nursing 28

Lesson Objectives • • Define philosophy, its purpose in nursing Define and describe three major branches of philosophy Analyze the contributions of one major philosophers in Nursing Identify and discuss philosophical issues expressed in current events and literature Be able to compare and contrast: SWGTC A. D. N Programs Nursing Philosophy with one other A. D. N Programs Philosophy Discuss nursing philosophy Develop and defend a personal philosophy Analyze how your personal philosophy effects you as a nursing student. 29

What is Philosophy? • Philosophy is the investigation of truth, existence, knowledge, and conduct through logic and reason. It is an attempt to study the nature of existence, validity, justice, beauty, mind, and language 30

Defining Philosophy • Examination of basic concepts • School of thought • Guiding or underlying principles • Set of beliefs or aims • Calm Resignation 31

Branches of Philosophy Affecting Nursing • Epistemology • Ethics (pg 314 -315) • Autonomy • Beneficence • Nonmaleficence • Justice • Fidelity • Advocacy • Responsibility • Confidentiality • Values • Logic or Critical Thinking 32

Philosophy 0 f Nursing • Profession • Promoting optimal health in a safe, holistic, effective, caring and culturally competent approach. • Includes the Health care provider, Manger of Care and Members within the Discipline of Nursing. • (pg 5 A. D. N. Handbook) 33

Philosophy 0 f Nursing • Evidence –Based Practice – Competencies including • • Professional Behaviors Communication Collaboration Assessment Clinical Decision Making Teaching and Learning Caring Providing & Managing Care 34

Your Philosophy • How To Develop Your Own Philosophy • Incorporating what we have discussed related to: • the nursing profession, • standards of practice, • theories, • Standards of Professional Performance Describe YOUR attitude/belief towards: • Nursing as a profession • How you would deal or work with people • Provision of healthcare • Environment 35

The Health Care Delivery System

Health Care Regulation and Competition • Regulatory and competitive approaches • Utilization review committees • Diagnosis-related groups • Capitation • Resource utilization groups • Managed care

Emphasis on Population-Wellness • Health care system is faced with: • Rising costs, increased access to services, growing population, improved quality outcomes, threats of bioterrorism • Health Services Pyramid • Includes primary, secondary, • and tertiary care

Health Care Settings and Services 1. Preventive 2. Primary 3. Secondary 4. Tertiary 5. Restorative 6. Continuing

Preventive and Primary Health Care • Stresses health promotion as the key to quality health • 1. Preventive care • Primary • Secondary • Ex of Secondary Prevention: paraplegic admitted for electrolyte imbalance • Tertiary • 2. Primary care • Keeps people healthy

3. Secondary and 4. Tertiary Care • Focuses on diagnosis and treatment of disease • Secondary • Settings for secondary and tertiary care • Secondary • Hospitals (ER/MS Unit) Ø Tertiary: Ø Intensive Care Units Ø Subacute facilities

Restorative Care • Serves clients recovering from an acute or chronic illness/disability • Helps individuals regain maximal function and enhance quality of life • Promotes patient independence and self-care abilities • Requires multidisciplinary approach • Includes Home Health, Rehabilitation, Extended Care Facilities

Home Care • Involves coordination of services and equipment for health maintenance, education, illness prevention, diagnosis and treatment of disease, palliative care, and rehabilitation • Focuses on client and family independence

Rehabilitation • Attempts to restore clients to their fullest physical, mental, social, vocational, and economic potential • Includes physical, occupational, and speech therapy, as well as social services • Occurs in many health care settings

Extended Care Facility • Extended care facility • Provides intermediate medical, nursing, or custodial care for clients recovering from acute illness or disabilities • Skilled nursing facility (intermediate care) • Provides care for clients until they can return to their community or residential care. Offers Skilled Care from a licensed nursing staff.

Continuing Care • For people who are disabled, functionally dependent, or suffering a terminal disease • Available within institutional settings or in the home

Nursing Centers or Facilities • Provides 24 -hour intermediate and custodial care • Nursing, rehabilitation, dietary, recreational, social, and religious services • Regulated by standards • Omnibus Budget Reconciliation Act of 1987

Assisted Living • Offers a long-term care setting with a home environment and greater resident autonomy • Provides services such as laundry, assistance with meals, personal care, housekeeping, and 24 -hour oversight • Allows residents to live in their own units

Respite Care • The service provides short term relief or time off for persons providing home care to an ill, disabled, or frail older adult. • Trained volunteers allow family caregivers to leave the home for errands or social time.

Adult Day Care Centers • May be associated with a hospital or nursing home or operate independently • Offer services to patients in need of daily physical rehabilitation, counseling for emotional, drug, alcohol addiction

Hospice • Family-centered care that allows clients to live and remain at home • Focuses on comfort, independence, and dignity • Provides client and family support during terminal phase and time of death

Issues in Health Care Delivery • 21 Competencies • Evidence-based practice • Quality health care • CMS • NCQA: HEDIS & Quality • Nursing-sensitive outcomes • NOC • Client satisfaction • Caring nursing staff is an area of primary focus • Technology in health care: E. H. R. • Globalization of health care

Chapter 3 Community-Based Nursing Practice

Community-Based Health Care • A model of care • Occurs outside of traditional health care facilities • Challenges include: • Social lifestyles, political policy, economic initiatives

Achieving Healthy Populations and Communities • Healthy People Initiative • Establishes ongoing health care goals • Healthy People 2010 Goals are to increase life expectancy and quality of life through improved delivery of health care services Overarching Goal for Healthy People 2010 is the elimination of health disparities • Health People 2020 • Healthy People 2020

Community Health Nursing • Nursing practice in the community • Primary goal focuses on health care of individuals, families, and groups • Similar to public health nursing

Community-Based Nursing • Involves acute and chronic care • Involves vulnerable populations • • • Immigrants Poor and homeless Abused Substance abusers Mentally ill Older adults

Competency in Community-Based Nursing • Nurses utilize a variety of skills and talents • • Caregiver Case manager Change agent Client advocate Collaborator Counselor Educator Epidemiologist

Community Assessment • Assesses the community at large • Examines • structure, • population, and • social system

Changing Clients’ Health • Nurses care for clients from diverse backgrounds and settings. • Nurses need an accurate assessment of clients to design interventions that promote health and prevent disease.

Chapter 4 Theoretical Foundations of Nursing Practice

The Domain of Nursing • Domain • Is the perspective of a profession • Provides practical and theoretical orientations for a discipline • Paradigm • Links science, philosophy, and theories

Theory • Explains a phenomenon • Nursing theory • Is a conceptualization of some aspect of nursing • Communicates the purpose of describing, explaining, predicting, and/or prescribing nursing care

Components of a Theory • Phenomenon • Concepts • Definitions • Assumptions

Relationship of Theory to Nursing Practice • Theories • Generate nursing knowledge for use in practice • Can direct how to use nursing process • Are adaptable to different clients and all care settings

Interdisciplinary Theories • Systems • Basic human needs • Developmental • Psychosocial

Developmental theories • Theory is a set of interrelated concepts, definitions, and propositions that present an organized view for the purpose of explaining and making predictions about the subject. • Biophysical theories describe the process of biological maturation, that define the aging process. • A. Gessell’s Theory – pattern of growth r/t to gene activity 67

Theories Continued • I. Psychoanalytic/Psychosocial Theory • describe how men develop from the perspective of personality, thinking, and behavior. Ex. Sigmund Freud, Erikson. • II. Cognitive Developmental Theory- focus on an individual's unconscious thoughts, emotions, and stress on how people learn to think and make sense of the world. ( ex- Piaget, and Kohlberg) 68

Selected Nursing Theories Nightingale Peplau Henderson Orem Leininger Health Maintenance & Restoration Rogers Transcultural perspectives King Roy Watson Benner and Wrubel

The Link Between Theory and Knowledge Development • Nursing knowledge is theoretical and practical. • Theories provide direction to nursing research. • Nursing theory and nursing research build nursing’s knowledge base.

Evidence-Based Practice

A Case for Evidence • A response to societal forces • A problem-solving approach to practice

Steps of Evidence-Based Practice • Five steps: • • • Ask the clinical question. Collect the best evidence. Critique the evidence. Integrate the evidence. Evaluate the practice decision or change.

Nursing Research • A way to identify new knowledge, improve professional education and practice, and use resources effectively • ANA revised Standards of Nursing Practice in 2003 • Includes the Standards of Professional Performance • Chapter 1 • Research in used in nursing practice • Specialty Organizations • American Association of Critical Care Nurses, Oncology Nursing Society, and Sigma Theta Tau International support nursing research.

Outcomes Management Research • Created to assess and document the effectiveness of health care services and interventions • A response of the health care industry to demands from policy makers, insurers, and public

Scientific Method • The foundation of research • The most reliable and objective means of acquiring and conducting research

Nursing and the Scientific Approach • Nursing research provides a way for nursing questions and problems to be studied in broader context. • Quantitative • Qualitative

Research Process • An orderly series of steps that allows a researcher to find the answer to a question • Consists of five steps: • • • Identify problem. Design study. Conduct study. Analyze data. Use the findings.

Quality and Performance Improvement • Every health care organization gathers data on health outcome measures as a way to gauge their quality of care. • Quality Improvement • Performance Management • Organized Quality Programs • JCAHO National Patient Safety Goals • QI/PI Model: • Plan, Do, Check, ACT

DUE NEXT CLASS • -WORK ETHICS PAPER • Nursing Philosophy

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