Nursing Foundations Carolyne RichardsonPhillips MS RN PNU 145

Nursing Foundations Carolyne Richardson-Phillips, MS, RN PNU 145 Fall 2015

Learning Outcomes By the end of the section, the PN Students will be able to: • Discuss Florence Nightingale’s reformation and contributions to nursing • Discuss the historical progress of Nursing in the United States • Discuss the components of nursing theory • Compare the similarities and differences of 4 nursing theories and the applications to nursing • Discuss Nursing’s educational ladder, approval, accreditation, and practical nurse education • State the rationales for acquiring Continuing Education • Describe the levels of responsibilities that Licensed Practical Nurses perform using nursing process • Identify current and future trends of health care affecting nursing, the client and family • Discuss proactive nursing strategies • Discuss unique nursing skills nurses use in clinical practice

Nursing Historical Origins • Nursing: youngest profession but Oldest art (assisting people) • Evolved from roles of nurturing & caretaking • Women-Early responsibilities-helping out with childbirth, feeding newborns, attending to the ill, aged, the helpless within homes & community settings • Origin stood for Caring more than Curing • Roman Empire-First hospital established • Middle ages- religious groups (Catholic) performed nursing care. Priests regarded as physicians • Christian values of “love thy neighbor as thyself” • Nursing care changed D/T a feud between King Henry VIII & Catholic Church • England took over nursing care of the sick • Hospitals became poor houses • Workers were: criminals, orphans, widows • Workers paid back the Crown for their food, shelter, by tending to the sick

History Of Men in Nursing • • • First nurses throughout the world First nursing school was in India 250 BC Only men were felt to be pure enough to be nurses Military, religious & lay orders of men continued to provide nsg care during the Middle Ages; some of the most famous: the Knights Hospitals, the Teutonic Knights, the Tertiaries, the Knights of St. Lazarus, the Order of the Holy Spirit & the Hosp Brothers of St. Anthony St Camillus (25 May 1550 – 14 July 1614) invented the symbol of the red cross and created the first ambulance service (was an Italian priest who founded a religious Order dedicated to the care of the sick) Crusades saw formation of knights-provided nursing care-built hospitals During the Black Plague, a group of men formed one of the first hospitals to care for the victims In 1783 James Durham, a slave from New Orleans, earned his freedom by working as a nurse; later became one of the first black MD in the US Walt Whitman (1819 -1892), a poet and a writer, volunteered as a hospital nurse in Washington, DC during the Civil War.

History of Male Nurses Cont. • First American Nurse • Friar Juan de Mena----first identified nurse in what was to become the U. S. (Seventy years before the Pilgrims landed on Plymouth Rock; Mena-was shipwrecked off the coast of Texas) • First Massachusetts nurse: Frank Bertram in 1896 • In the early 1900's- Men were excluded from nursing in the military- did not resume this function until the early 1950's, after the Korean War • Nursing Schools For Men - Mills School for Nursing and St. Vincent's Hospital School for Men- founded in New York in 1888 • Pennsylvania Hospital opened a school for female nurses in 1914 and simultaneously opened a separate men’s nursing school

Nightingale Reformation • Florence Nightingale • Founder of Modern Nursing • Crimean War 1854 -1856 • British casualties high, Arrived at hospital with 38 Nurses, cleaned up filth, improved environment • Helped control infection & reduced death rate from 60% to 1% 1820 -1910

Florence Nightingale (cont’d) • Called “Lady with the Lamp” • Acted as a banker, sending men's wages home to families, wrote home on behalf of soldiers • Introduced reading rooms to hospital • When returned to England received money and started the first NURSING SCHOOLS

Florence Nightingale’s Contributions to Nursing • Changed negative image of Nursing to a positive one • Contributions • Trained women for future work • Selective- only those with upstanding characteristics for a potential nurse • Identifying client’s needs and how nurses could meet them • Improving sanitation conditions for sick & injured in the filed and hospitals • Reduced death rate of British soldiers • Establishing nursing education-Provided classroom & clinical (skills) teaching • Advocated for life-long nursing education • Good documentation •

Nursing in the United States • Civil War: around the same time as Nightingale’s reformation • United States- No organized or trained nursing staff • Military relied on untrained corpsmen, civilian volunteers • Nursing Leader-Dorothea Dixnoted social reformer of the mentally ill • Volunteered to form an Army Nursing Corps • Convinced skeptical Military officials, that women could perform the work acceptably D. Dix-1802 -87

Nursing in United States (cont’d) • In 1862, Dorothea followed Nightingale’s advice; established a selection criteria for potential nurses • Dix’s requirements • Not be flighty and marriage-minded young women • Only accepted applicants who were matronly, plain looking • Ages 30 to 50 • Needed to be educated, neat, orderly, sober, have a serious disposition • Be industrious-Applicants-needed 2 letters of recommendation attesting to their moral character, integrity, and capacity to care for the sick • Had to agree to serve for at least 6 months • Dress code of modest black or brown or gray skirts and forbade hoops or jewelry.

Nursing in the United States (cont’d) • Nursing Leader • Civil War nurse • Establish hospitals • Cared for soldiers on both sides of the battle field • Known as “Angel of the Battlefield” • Founder of American Red Cross in 1882 Clara Barton-1821 -1912

U. S. Nursing Schools • After Civil War-established training schools for nurses • Standards deviated from Nightingale’s which were planned, consistent, formal education • U. S. training- unsubsidized apprenticeship • Later, U. S. curricula & content training improved became more organized & uniform • Longer training time established • Graduate nurses-received diplomas

Nursing in the United States Cont. • Lillian Wald (1867 -1940) • Nursing Leader • Established/Opened a neighborhood service for the poor sick - Henry Street Settlement in New York City • First community health nurse in US • Considered the founder of Public Health Nursing (VNA today)

Contemporary Nursing: Combining Nsg Art w/ Science • Beginning of nursing education consisted of learning the ART – ability to perform an act skillfully • Learned by watching & imitating the techniques performed • Mentors passing nursing skills to students • Contemporary Nursing added another dimension: Science-body of knowledge unique to a particular subject • Science: develops from observing & studying the relation of one phenomenon to another • Developing a unique body of knowledge, now possible to predict which nursing interventions that may produce the desired outcomes

Integrating Nursing Theory • Theory: opinion, belief, or view that explains a process (provides an orderly way) • Nightingale & others-examined relationships among humans, health, the environment & nursing-outcomes of this analysis becomes basis for Nursing theory • Nursing theory – proposed ideas about what is involved in process identified as nursing • Purposes of nursing theory: define nursing, describe what nurses do and provide goals or outcomes of care • Components: • Nursing: • Patient/Client: • Health: • Environment:

Integrating Nursing Theory (cont’d) • Nursing programs adopt-theory: • serves as conceptual framework or model for philosophy, curriculum, and importantly nursing approach to clients • Some of the many theories: 1. Environmental theory -Nightingale 2. Basic Needs theory -Henderson 3. Self-Care theory -Orem 4. Adaptation theory -Roy

Nursing Model: Nightingale • What is Florence Nightingale’s contribution to nursing theory? • Recognized as the first nurse Theorist • Described nursing as both an art and a science • Environmental Theory • Recommended adjusting the environment to improve the person’s health • Application to Nursing Practice NURSING- modify unhealthy environment to put client in best condition for nature to act

Nursing Model: Virginia Henderson • Basic Needs Theory • Definition of Nursing-adopted by International Council of Nurses • Included health promotion-not just illness care • Application to Nursing Practice • Nurses- assist in performing activities that client would perform if had strength, will, knowledge • Do this in such a way as to help them gain independence as soon as possible 1897 -1996

Nursing Model: Dorothea Orem • Self-Care Theory • Focuses on each individual’s ability to perform self-care (Optimal level of selfcare) • Defined as 'the practice of activities that individuals have learned -initiate and perform on their own behalf in maintaining life, health, and well-being • Person (client/patient) external elements that man interacts on the struggle to maintain self-care environmental situations 1914 -2007

Dorothea Orem (cont’d) Areas Applicable to Self-Care Theory • Direct nursing care (nurse has direct contact with client/family • Providing care or teaching in the following areas • Nutrition and weight control • Hygiene • Mobility –exercise & physical fitness • Medications • Behavior - stress management • Maintenance of social support systems • Environmental control • Application to Nursing Practice Nurses-assist clients with self-care to improve or to maintain health

Nursing Model: Sr. Callista Roy • Adaptation Theory: • Model provides a way of thinking about people & their environment that is useful in any setting • Helps one prioritize care and challenges the nurse to move the patient from survival to transformation • Major Concepts: • Person or group as an adaptive system to changes in environment • Environment as internal and external stimuliin continuous state of change • Application to Nursing Practice • Nurses assess biologic, psychological, & social factors interfering w/ health; help w/ altering the stimuli causing the maladaptation • Then evaluate the effectiveness of the action taken 1939 to present

Psychosocial Development Theorists • Research related to human motivation Abraham Maslow (1954) A hierarchy of human needs • Based on two groupings: • deficiency needs • growth needs • Within the deficiency needs, each lower need must be met before moving to the next higher level

Maslow (cont’d) 1. 2. 3. 4. 5. Physiological: hunger, thirst, bodily comforts, etc. Safety/security: out of danger; Belonging and Love: affiliate with others, be accepted; and loved Esteem: to achieve, be competent, gain approval and recognition Cognitive: to know, to understand, and explore; and Aesthetic: symmetry, order, and beauty 6. Self-actualization: to find self-fulfillment and realize one's potential; and 7. Self-transcendence: to connect to something beyond the ego or to help others find self-fulfillment and realize their potential

Psychosocial Development Theorists • 8 stages of Psychosocial Development • Expanded Freud’s theory of development to include entire life span • Believed people continue to Develop • Nurses: be aware of positive & negative resolutions for each stage • Developmental stage • Help client develop coping skills • Strengthen client’s attitude by providing encouragement ** Environment- highly influential in development Erikson

Erickson’s Stages • • Stage 1 - Hope -Infant stage - Basic Trust vs. Mistrust Stage 2 -Toddler stage -Will - Autonomy vs. Shame and Doubt Stage 3 - Kindergarten- Purpose - Initiative vs. Guilt Stage 4 - Around age 6 to puberty- Competence - Industry vs. Inferiority Stage 5 - Teenager- Fidelity - Identity vs. Role Confusion Stage 6 - Young adult-Love -Intimacy vs. Isolation Stage 7 - Mid-life crisis-Caring - Generativity vs. Stagnation Stage 8 - Old age wisdom - Ego Integrity vs. Despair

Defining Nursing • Nightingale-earliest definition--“putting individuals in the best possible condition for nature to restore and preserve health” • Henderson-definition adopted by The International Council of Nurses---Nursing involves a special relationship and service between the nurse and client • Nursing’s Social Policy Statement 3 rd ed. (2010) American Nurses Association (ANA) defines nursing as • Protection, promotion, optimization of health & abilities • Prevention of illness & injury • Alleviate suffering through diagnosis & treatment of human response • Advocate the care of individuals, families, communities & populations

Defining Nursing (cont’d) • ANA (2010) –Six essential features added – 1. Provision of a caring relationship that facilitates health and healing – 2. Attention to the range of human experiences and responses to health and illness within the physical and social environments – 3. integration of objective data with knowledge gained from an appreciation of the client’s or group’s subjective experience – 4. Application of scientific knowledge to the processes of diagnosis and treatment through the use of judgment and critical thinking – 5. Advancement of professional nursing knowledge through scholarly inquiry – 6. Influence on social and public policy to promote social justice • ANA: nursing has an independent area of practice in addition to traditional dependent & interdependent functions involving MDs

The Educational Ladder • Lavinia L. Dock Established the National League for Nurses (NLN)– NLN -Responsible for accreditation of nursing schools • Education – Practical (Vocational) Nursing – Registered Nursing • Each program provides knowledge and skills for a particular entry level of practice

Practical/Vocational Nursing • Abbreviated nursing program created during WWII • 1892 -First training for LPNs (YWCA) • 1893 - Ballard School -First school for LPNs • Program was 3 months long • Goal: prepare graduates to care for health needs of infants, children, & adults -mildly or chronically ill or convalescing • 1941 -Formed the National Association for Practical Nurse Education and Service, Inc. (NAPES) • Worked to standardize the program & to facilitate licensure of graduates

Practical/Vocational Nursing (cont’d) • Once education completed-qualified to take licensing examination. NCLEX-PN National Council Licensure Examination for Practical Nurses (NCLEX-PN)) • LPNs – Scope of Practice under the Nurse Practice Act of the state they are working in • Performing skills may differ from state to state • LPN/LVN-work under supervision of a RN, physician, dentist, NP • May supervise unlicensed and or licensed assistive personnel • Career mobility-offer path to RN via Associate or Baccalaureate degrees

Registered Nurse • Students can choose one of 3 paths 1. Hospital-based diploma 2. Associate degree 3. Baccalaureate * Once educated- may take NCLEX-RN National Licensing Examination • Work under supervision of a physician, NP, or dentist in various settings-preventative to acute – Educate clients and public – May work directly at bedside or supervise others (delegate care to others)

Hospital-Based Diploma Programs • Diploma programs –traditional route- thru middle of 20 th century – 1873 Linda Richards first nurse to be given a diploma from the New England Hospital for Women and Children. She is identified as "the first trained nurse" in the U. S. – Programs have become less – Reasons – movement to increase professionalismcolleges/universities, hospitals can no longer support nursing programs – Diploma nurses: well trained, vast clinical experience – Hospital-based program-last 3 years – Can transfer credits-science & Humanities courses to Pursue associate and or baccalaureate degrees

Associate Degree Program • Mildred Montag- advocated the creation of an associate degree in nursing – 2 year program • Nurse –referred to as a technical nurse – would not be working in a management Position * * Once educated-may take NCLEX-RN National Licensing Examination

Baccalaureate Program • ANA & National League for Nursing pushing for this program to be entry level for all nurses • Longest program & most expensive • Nurses have greater flexibility qualifying for jobs-staff & managerial * These nurses are preferred in areas where need for independent decision making

Graduate Nursing Programs • Master’s and Doctoral levels • Master’s prepared-clinical specialists nurse practitioners, administrators, educators • Doctoral prepared-conduct research and advise, administer, & instruct nurses pursuing undergraduate and graduate degrees

Delegation-LPN/LVN -RN • Delegation-Six guidelines 1. Right task: matching the client’s needs with the caregiver’s skills 2. Right circumstance: ensuring that the situation is appropriate 3. Right person: knowing the unique competencies of the caregiver 4. Right direction (communication): providing sufficient information 5. Right supervision: being available for assistance 6. Right follow-up: validating that the task was completed, obtaining the results, and analyzing if further actions are necessary

Continuing Education (cont’d) • Any planned learning experience that takes place beyond basic nursing program – 1. No program provides all the knowledge or skills needed for this lifetime career – 2. New advances in technology better than old ones – 3. Assuming responsibility for self-learning shows personal accountability – 4. Nurses need to demonstrate evidence of competence to maintain consumer’s confidence – 5. Practicing nursing care according the current nursing standards helps to ensure care is legally safe – 6. Many states require nurses to show proof of continuing education to renew their nursing license • Learning- lifelong process

Future Trends • Two major issues: – 1. Elimination of shortage of nurses – 2. Strategies for responding to a growing aging population with chronic health problems • Shortage-retirement, attrition of aging faculty, disappointing salaries, job dissatisfaction • Client-to-nurse ratios • More high-acuity clients, heavier work loads, • mandatory overtime, • Downsizing nursing staff • Continuous health care costs & reimbursements • Information & Telecommunications

Government Responses • Federal Gov-tried to help with the shortage – Passed-American Recovery & Reinvestment Act: 1. Loan repayment programs & scholarships 2. Funding public service announcements to encourage people to enroll into nursing 3. Career ladder programs 4. Establishment of nurse retention & client safety enhancement grants 5. Grants to incorporate gerontology into curricula of nursing programs 6. Loan repayment program for nursing students who agree to teach following graduation

Proactive Strategies • Nurses are taking up the challenge: – Switching from part-time to full-time – Delaying retirement – Pursuing post-licensure education - Training for advanced practice - Becoming cross-trained - Learning more about multi-cultural diversity - Supporting legislative efforts - Promoting wellness programs - Helping clients with chronic diseases - Referring clients with health problems for treatment - Discharge planning- clinical pathways - Participating in quality assurance - Concentrating on continuing knowledge and skills

Levels of Responsibilities for Nursing Process • Assessing-gathers data • Diagnosing • Planning-Setting realistic goals - Suggests interventions - Assists in writing plan of care • Implementing- Performs basic nursing care • Evaluating-shares observations on how well or not –client is doing and adjusts plan of care as needed

Unique Nursing Skills • Assessment skills –need to determine client’s needs & problems – Involves collecting data-Interviewing, observing, & examiningclient and or family or both – Review medical record, talk with other health care workers

Unique Nursing Skills (cont’d) • Comforting Skills- illness causes feelings of insecurity • Insecurity may threatened client and or family’ ability to cope • Nurse uses comforting skillsinterventions that provide stability and security during a healthrelated crisis • Nurse becomes-guide, companion, interpreter • Nurse helps to reduce fear, worry and instills trust

Standards of Care • Nurse Practice Act -Legal acts-laws established in each state and province to define scope of nursing practice and regulate/govern the profession in the United States – Practice acts differ from state to state, but have a common purpose, to protect the public • Standards of Nursing Practice: allow nurses to carry out professional roles and serves as protection for nurses, patients and institutions – Purpose- describe the responsibilities for which nurses are accountable

Standards of Care (cont’d). . • The National Federation of Licensed Professional Nurses (NFLPN)is the professional organization for licensed practical nurses and licensed vocational students/nurses in the United States: • National Federation of Licensed Practical Nurses, Inc, have identified standards: - Education - Legal / Ethical status - Practice - Continuing education - Specialized nursing practice

Professional Organizations-LPN • American Licensed Practical Nurses Association • National Association for Practical Nurse Education and Service • The National Federation of Licensed Professional Nurses (NFLPN)

References • Civil War Nurses Retrieved May 1, 2014 from web site: http: //www. topics. nurse. com/civilwar * Dorothea Dix Bibliography Retrieved May 1, 2014 from web site: http: //www 2. webster. edu/~woolflm/dorotheadix. html * Erikson Retrieved on 5/1/14 from web site: http: //www. simplypsychology. org/Erik-Erikson. html * Florence Nightingale Retrieved 2007 from web site: http: //nursing-theory. org/nursing-theorists/Florence-Nightingale. php Dorothea Orem. Retrieved 5/1/14 from web site: http: //nursingtheory. org/nursing-theorists/Dorothea-E-Orem. php • LPN history Retrieved on 5/1/14 from web site: http: //www. ehow. com/about_5452553_history-licensed-practicalnurses. html • Men in nursing Retrieved 8/21/14 from web site: http: //allnurses. com/men-in-nursing/men-nursing-historical-96326. html. • Timby, B. K. , (2013) (10 th ed). Fundamental Nursing Skills and Concepts. Philadelphia: Lippincott Williams & Wilkins

Historical Pictures of Nursing Nurses in Uniform Nursing at Bedside Student Nurses

Graduating Nurses VNA Nurses 1930

Community Health Nurses

Visiting Nurses

Korean War Nurse

Female & Male Nurses in Iraq

History Male Nurses

Syringe & Needle Medicines

Maternity Instruments Breast Pump

Surgical Instruments 1800 eye surgery

Hearing aid Leeches

Stethoscopes Orthopedic Hammer Vaccination needle

Bedpans & Utensils

Surgical Instruments 1800 - 1855 Dental drill

Civil War Instruments Ancient Roman Surgical Instruments

Surgeon's chest on board Mayflower.