Nursing A ConceptBased Approach to Learning VOLUME TWO

Nursing: A Concept-Based Approach to Learning VOLUME TWO EDITION VOLUME TWO || SECOND EDITION MODULE 42 Accountability Nursing: A Concept-Based Approach to Learning Volume Two, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved

The Concept of Accountability Nursing: A Concept-Based Approach to Learning Volume Two, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved

The Concept of Accountability • Accountability § Answerable for the outcomes of a task or assignment § Nurses are accountable for their own actions; may also be accountable for the actions of their subordinates or trainees • Responsibility § Specific accountability or liability § Associated with performance of duties of particular role Nursing: A Concept-Based Approach to Learning Volume Two, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved

The Concept of Accountability, continued • Standards of Practice § Description of responsibilities § Minimal level to ensure safe, effective care • Acknowledging accountability for both successes and errors helps professional culture remain positive Nursing: A Concept-Based Approach to Learning Volume Two, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved

Criteria of a Profession • Occupation that requires extensive education • Calling that requires special knowledge, skill, preparation • Differs from other occupations Nursing: A Concept-Based Approach to Learning Volume Two, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved

Criteria of a Profession, continued • Specialized education § Trending toward colleges, universities § Entry into registered nursing • • • Hospital diploma Associate degree Baccalaureate degree Master's degree Doctoral degree Nursing: A Concept-Based Approach to Learning Volume Two, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved

Criteria of a Profession, continued • Body of knowledge § Well-defined § Conceptual frameworks • Service orientation § Differentiates nursing from occupations pursued primarily for profit § Guided by rules, policies, code of ethics • Ongoing research § Evidence-based practice Nursing: A Concept-Based Approach to Learning Volume Two, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved

Criteria of a Profession, continued • Code of ethics § Integrity of nursing profession • Autonomy § Legal authority to define scope of practice § Independence at work, responsibility, accountability for one's actions • Professional organization § Governance of nursing profession Nursing: A Concept-Based Approach to Learning Volume Two, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved

Concepts Related to Accountability • • Violence Comfort Teaching and Learning Evidence-Based Practice Nursing: A Concept-Based Approach to Learning Volume Two, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved

Socialization to Nursing • Process of socialization § Learn to become member of groups, society § Learn social rules defining relationships § Professional socialization is complex • Critical values of nursing § Develop, clarify, internalize professional values § National Student Nurses Association code Nursing: A Concept-Based Approach to Learning Volume Two, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved

Economics • Greater financial support increased demand • Cost of care increased sicker clients • Challenges to nursing § Inpatient to outpatient care § Community-based health settings § Changes in employment have implications Nursing: A Concept-Based Approach to Learning Volume Two, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved

Consumer Demands • • Consumers better educated More knowledgeable about health, illness Aware of other's needs for care Public's concepts of health and nursing § Health is a right § Individual must assume responsibility for health • Consumer as active participant Nursing: A Concept-Based Approach to Learning Volume Two, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved

Science and Technology • Advances affect nursing practice, competence, accountability • Innovations have changed nursing education § Clinical training Nursing: A Concept-Based Approach to Learning Volume Two, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved

Information and Telecommunications • Internet affecting health care • Telecommunication § Transmission of information from one site to another • Telehealth § Long-distance health care • Telenursing § Delivering care through telecommunication • Vo. IP to assess client living in rural area Nursing: A Concept-Based Approach to Learning Volume Two, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved

Legislation • Changes relating to health affect nursing • Patient Self-Determination Act (PSDA) § All competent adults informed in writing at time of admission of rights to accept, refuse medical care Nursing: A Concept-Based Approach to Learning Volume Two, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved

Demography • Needs of population for nursing services § § Population of North America increasing Proportion of elderly increasing Population shifting from rural to urban Mortality and morbidity studies reveal risk factors Nursing: A Concept-Based Approach to Learning Volume Two, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved

The Current Nursing Shortage • Factors affecting shortage: § § § Enrollment in nurse training is too low Aging nurse workforce Shortage of nursing faculty Aging population Increased demand for nurses Workplace issues • Collaboration among many stakeholders is needed to address shortage Nursing: A Concept-Based Approach to Learning Volume Two, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved

Nursing Practice • Accountability § Influenced by individual values, beliefs § Values, ethics inherent to profession as whole § Social factors § Supported or undermined by individual RN § Development of the nursing profession itself Nursing: A Concept-Based Approach to Learning Volume Two, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved

Exemplar 42. 1 Competence Nursing: A Concept-Based Approach to Learning Volume Two, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved

Overview • Possessing knowledge, skills necessary to perform one's job appropriately and safely • High standards of competence in today's world Nursing: A Concept-Based Approach to Learning Volume Two, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved

Areas of Competence • Health and wellness promotion § Enabling individuals, communities to increase control over determinants of health • Illness prevention § Immunizations, prevention of STD • Health restoration § Extends from early detection of disease to recovery period • Caring for the dying Nursing: A Concept-Based Approach to Learning Volume Two, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved

Promoting Lifelong Competence • • Client safety benefits Maintaining and increasing competence Specialist or generalist Nurse is accountable for own choices Nursing: A Concept-Based Approach to Learning Volume Two, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved

Benner's Stages of Nursing Expertise • • • Stage Stage I, Novice II, Advanced beginner III, Competent IV, Proficient V, Expert Nursing: A Concept-Based Approach to Learning Volume Two, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved

Nursing Process • Nurses hold themselves accountable § Weighing, assessing own competence § Honorable to say "I don't know" • Ask for help when uncertain of safety in any action Nursing: A Concept-Based Approach to Learning Volume Two, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved

Exemplar 42. 2 Professional Development Nursing: A Concept-Based Approach to Learning Volume Two, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved

Overview • Different meanings § § Advanced education Experience or seniority Involvement or membership in organization Continuing education classes or offerings Nursing: A Concept-Based Approach to Learning Volume Two, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved

Historical Perspectives • Struggle for autonomy, professionalization • Recent renewed interest producing related literature Nursing: A Concept-Based Approach to Learning Volume Two, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved

Women's Roles • Traditional female roles include care of others. § Roots "in the home" § Subservient, dependent roles • Traditional nursing role § § Humanistic caring Nurturing Comforting Supporting Nursing: A Concept-Based Approach to Learning Volume Two, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved

Religion • Christian values impacted Western nursing • Deaconess groups • Early religious values dominated nursing § § Self-denial Spiritual calling Devotion to duty Hard work Nursing: A Concept-Based Approach to Learning Volume Two, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved

War • Accentuates need for nurses • Crusades § Orders of knights to care for sick/injured • Crimean War § Nightingale asked to recruit female nurses • American Civil War § Harriet Tubman § Sojourner Truth § Dorothea Dix Nursing: A Concept-Based Approach to Learning Volume Two, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved

War, continued • WWI § Progress in health care • WWII § Acute shortage of caregivers • Vietnam War § Youngest group of medical personnel ever Nursing: A Concept-Based Approach to Learning Volume Two, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved

Societal Attitudes • Before mid-1800 s § No respectable woman should have a career • Late 1800 s § Guardian angel image § Image as doctor's handmaiden Nursing: A Concept-Based Approach to Learning Volume Two, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved

Societal Attitudes, continued • Mid-1900 s § Heroine (WW II) • Early 1990 s § Tri-Council for Nursing: A Concept-Based Approach to Learning Volume Two, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved

Nursing Leaders • Nightingale (1820– 1910) § Improved standards for care of war wounded § "Lady with the lamp" § Political pressure on government • Barton (1812– 1912) § Schoolteacher who volunteered as nurse § Organized nursing service Civil War § Established American Red Cross Nursing: A Concept-Based Approach to Learning Volume Two, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved

Nursing Leaders, continued • Richards (1841– 1930) § America's first trained nurse 1873 § Introduced nurse's notes and doctor's orders § Initiated practice of wearing uniforms • Mahoney (1845– 1926) § First African American professional nurse § Worked for acceptance of African Americans § Promotion of equal opportunities Nursing: A Concept-Based Approach to Learning Volume Two, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved

Nursing Leaders, continued • Wald (1867– 1940) § Founder of public health nursing § First to offer trained nursing service to poor § New York slums Nursing: A Concept-Based Approach to Learning Volume Two, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved

Nursing Leaders, continued • Dock (1858– 1956) § Feminist, writer, political activist, suffragette § Campaigned for nurses to control profession § Founded precursor to National League of Nurses Nursing: A Concept-Based Approach to Learning Volume Two, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved

Nursing Leaders, continued • Sanger (1879– 1966) § Public health nurse in New York § Imprisoned for opening first birth control clinic § Considered founder of Planned Parenthood Nursing: A Concept-Based Approach to Learning Volume Two, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved

Nursing Leaders, continued • Breckinridge (1881– 1965) § Established Frontier Nursing Service after WWI § Brought health care to rural U. S. § Started midwifery training schools Nursing: A Concept-Based Approach to Learning Volume Two, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved

Definitions of Nursing • Early definitions § Florence Nightingale § Virginia Henderson § 20 th-century theorists • Common themes § Caring, art, science, client-centered, holistic, adaptive, helping profession • American Nurses Association (ANA) definitions of nursing Nursing: A Concept-Based Approach to Learning Volume Two, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved

Recipients of Nursing • Consumer • Patient § Individual waiting for, undergoing medical treatment and care • Client § Individual engaging the advice, services of another individual who is qualified to provide this service Nursing: A Concept-Based Approach to Learning Volume Two, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved

Settings for Nursing • • Acute care hospital Clients' homes Community agencies Ambulatory clinics Long-term care facilities Health maintenance organizations (HMOs) Nursing practice centers Nursing: A Concept-Based Approach to Learning Volume Two, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved

Nurse Practice Acts • Legal acts for professional nursing practice • Each state has own act • Common purpose § Protect the public Nursing: A Concept-Based Approach to Learning Volume Two, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved

Standards of Nursing Practice • Standards of Practice § Description of responsibilities for which American nurses are accountable • Standards of Professional Performance § Description of behaviors expected in professional nursing role • Principles published in 2011 for social networking in nursing Nursing: A Concept-Based Approach to Learning Volume Two, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved

ANA Standards of Practice • • • Assessment Diagnosis Outcome identification Planning Implementation Integration of ethics in all areas of practice Nursing: A Concept-Based Approach to Learning Volume Two, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved

ANA Standards of Professional Performance • • Enhance general practice Ensure appropriate education level Maintain collegiality with peers Collaborate with entire care team Nursing: A Concept-Based Approach to Learning Volume Two, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved

Chain of Command • Hierarchy within an organization • Types of authority § Line § Staff • Purpose of chain of command § Provides structure § Instructor first link for students § Unprofessional not to follow Nursing: A Concept-Based Approach to Learning Volume Two, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved

Chain of Command, continued • Organizational chart § Visual presentation of: • Chain of command • Organizational hierarchy • Flow of responsibility § Does not reflect informal structure Nursing: A Concept-Based Approach to Learning Volume Two, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved

Roles and Functions of the Nurse • Multiple roles simultaneously § Counselor while providing physical care § Teaching aspects of that care • Increased autonomy expanded roles • Variety of roles, functions within nursing Nursing: A Concept-Based Approach to Learning Volume Two, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved

Roles and Functions of the Nurse, continued • Work in various organizations • All required to maintain competence § Seek professional development as necessary § Provide appropriate and safe client care Nursing: A Concept-Based Approach to Learning Volume Two, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved

Roles and Functions of the Nurse, continued • Expanded career roles § § § Nurse practitioner Clinical nurse specialist Nurse anesthetist Nurse-midwife Nurse researcher Nursing: A Concept-Based Approach to Learning Volume Two, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved

Roles and Functions of the Nurse, continued • Expanded career roles § § Nurse administrator Nurse educator Nurse entrepreneur Clinical nurse leader Nursing: A Concept-Based Approach to Learning Volume Two, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved