nursing today
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Chapter 1 Nursing TodayMosby items and derived items © 2009, 2005
by Mosby, Inc., an affiliate of Elsevier Inc.
Chapter 1
Nursing Today
Nursing is both an art and science.
The science is based on a body of knowledge that is constantly changing and evolving.
The art is based on the practice of compassion, respect, and dignity rendered to the client and family members alike.
Remember, even though the client is the center of your care, the family, significant others, and community will have needs.
When rendering care, you will be guided by a code of ethics developed by the American Nurses Association and practiced by nurses.
As you begin your practice, you will incorporate ANA standards, evidence-based practice, and critical thinking skills.
As the weeks unfold, you will read further on these topic areas in:
Chapter 5: Evidence-Based Practice
*
Mosby items and derived items © 2009, 2005 by Mosby, Inc., an affiliate of Elsevier Inc.
Historical Perspective Highlights
Actively participate in policy
Respond and adapt to challenges
Since the days of Florence Nightingale, nurses have responded to the need of their clients. We do this in many ways.
Nurses exert great influence in social policy and political arenas. We have a strong organization (American Nurses Association) and strong lobbyists who propose legislation to care for our clients. At times, the proposed legislation at improving access and quality of care for the indigent and underserved.
Through nursing research and evidenced-based practice (chapter 5), nurses have been able to carry on the traditions that Florence Nightingale began in the Crimean War. Florence dealt with battlefield conditions that gave rise to infection, illness, and mortality. The 21st century nurse is deals with pain management, nutrition management, care of the elder population, and care of the infant and underserved child.
As the health care system changes, the art, science, and practice of nursing continues to evolve. Nursing draws not only from science, but also the humanities and social sciences. As nurses use and adapt this body of knowledge, nursing practice grows and evolves.
*
Mosby items and derived items © 2009, 2005 by Mosby, Inc., an affiliate of Elsevier Inc.
Florence Nightingale
No discussion of nursing can be complete without a section on Florence Nightingale.
She believed that the role of nurses was to help the body recover, and then remain free, from disease.
In 1860 Florence organized the first school of nursing, the Nightingale Training School for Nurses, at St. Thomas’ Hospital in London.
Nightingale was the first practicing epidemiologist. She used her keen mind and statistical analysis to show the connection between poor sanitation and diseases like cholera and dysentery.
Known as the Lady with the Lamp, Nightingale crossed the battlefields of the Crimean War with her lantern. By improving sanitation in battlefield hospitals, she showed how effective fresh air, hygiene, and nutrition were in the treatment of wounded soldiers.
*
Mosby items and derived items © 2009, 2005 by Mosby, Inc., an affiliate of Elsevier Inc.
Civil War to the Beginning
of the Twentieth Century
Clara Barton, Dorothea Lynde Dix, Mother Bickerdyke, Harriet Tubman
Mary Mahoney
Isabel Hampton Robb
The Civil War, fought from 1861 to 1865, made nursing necessity. Clara Barton, who tended to soldiers, who tended to soldiers on the battlefield, has been compared to Florence Nightingale. She was the founder of the American Red Cross. The other prominent women mentioned on this slide also contributed greatly to the practice of nursing.
Dorothea Lynde Dix was the supervisor of female nurses in the Union army.
Mother Bickerdyke organized ambulance service, supervised nurses, and searched for abandoned, wounded soldiers on the battlefield.
Harriet Tubman was a prominent female in the Underground Railroad movement to free slaves.
Mary Mahoney was the first professionally educated African-American. She may be one of the first proponents of better relationships between cultures and races, respect for individuals regardless of background, race, color or religion.
Isabel Hampton Robb helped found the American Nurses Association in 1911. She was an influential author with the following titles:
Nursing: Its Principles and Practice for Hospital and Private Use, Nursing Ethics, and Educational Standards for Nurses. She was one of the original founders of the American Journal of Nursing.
*
Mosby items and derived items © 2009, 2005 by Mosby, Inc., an affiliate of Elsevier Inc.
The Twentieth Century
1901, 1906, 1908
1940s
1950s
1990s
A number of events began to shape nursing education in the twentieth century.
In 1901 the Army Nurse corps was established, followed by the Navy Nurse corps in 1908.
Under the influence of Mary Adelaide Nutting, nursing education moved into U.S. universities in the early twentieth century. In 1906 Nutting became the first professor of nursing at Columbia University Teachers College.
Another important development in nursing history occurred when the Rockefeller Foundation approached Nutting, along with Lillian Wald and Annie Goodrich, to study nursing education. Their study, conducted in 1920 and published in 1923, concluded that nursing education needed financial support and should be centered in university schools of nursing.
*
Mosby items and derived items © 2009, 2005 by Mosby, Inc., an affiliate of Elsevier Inc.
The 21st Century
Nursing in multiple care settings
The American Nurses Association established the Center for Ethics and Human Rights in the 1990s. This center helps nurses at large address complex ethical and human rights issues. In 2001 the code of ethics was revised to reflect current ethical issues which affect nursing practice. We will learn more about this in Chapter 22: Legal implications.
The nursing curriculum has continued to change to meet changing social needs. Issues such as bioterrorism, emerging infections, disaster management, and technology advances were not included in the curriculum as late as 10 years ago.
As patient care needs change, nurses and nursing education will follow suit. Today, nurses work in multiple settings. Nurses also work in non–patient care environments to support the needs of nursing, nursing education, and patient care.
You might want to ask students what other areas nurses can work in and still support nursing, nursing education, and the patient?
Answer: politics, lobbying groups, not-for-profit agencies
*
Mosby items and derived items © 2009, 2005 by Mosby, Inc., an affiliate of Elsevier Inc.
Societal Influences on Nursing
Human rights
Medically underserved
Demographics
You can ask students what types of changes affect health care?
Answers: people moving from rural to urban centers, increased lifespan, increase in patients living with chronic illnesses (we have better drugs and therapy available), increases in alcoholism, lung cancer (and other cancers)
Woman’s Health Issues
Women are demanding equality, especially in the areas of economic, political, occupational, and educational needs. Because women are demanding that they receive better care, new advances are continually being made in obstetrics, oncology, and research.
Human Rights
Nurses have always placed patients at the center of care and been strong advocates for patient care needs. Therefore, it is not surprising that nurses are among the strongest advocates of recognizing patients needs, special and normal. Nurses can be proud that they created bills of rights for dying, hospitalized, and pregnant clients.
Medically Underserved
Nurses have always cared for patients inside and outside of the medical system. We promote the rights of minorities, immigrants, the underinsured, and the uninsured to receive high-quality health care. The rising rates of unemployment, mental illness, and homelessness makes our advocacy more important than ever.
Threat of Bioterrorism
*
Mosby items and derived items © 2009, 2005 by Mosby, Inc., an affiliate of Elsevier Inc.
Needs of the Consumer
Health promotion and wellness
The health care delivery system is constantly changing to meet the needs of the health care consumer. More information can be found in Chapter 2: Health Care Delivery System.
Many consumers are savvy about their illnesses due to media and the Internet. Clients expect to be cared for in a culturally competent manner. More can be seen in Chapter 9: Culture and Ethnicity. Healthy People 2010 also outlines health care goals for the public.
No one would argue that one of our main goals as nurses is to keep our clients safe and inflict no harm! Throughout the nursing program you will continue to hear information about the Joint Commission.
Ask students if they can identify areas in which safety has been an issue?
Answers: medication errors, abbreviation list, injures due to transfers and falls, wrong surgery on patients (more in chapter 50: Care of Surgical Clients)
*
Mosby items and derived items © 2009, 2005 by Mosby, Inc., an affiliate of Elsevier Inc.
Influence of Today’s Health Care Delivery System
Rising health care costs
Nursing shortage
We will hear more about the Health Care Delivery System in Chapter 2.
The cost of health care is rising for multiple reasons. As a future health care provider, you are charged with the responsibility to practice safe nursing care as well as stay fiscally sound. One way you can help is to serve on the New Product Committee so you can have a say about the types of products that best meet your patients’ needs.
In chapter 5, we are going to discuss evidence-based practice. We know that nursing research is not new, since Florence Nightingale did research and altered her nursing care as a result of her findings. Through research, nursing knowledge advances and nurses become better able to provide up-to-date, higher-quality nursing care.
*
Mosby items and derived items © 2009, 2005 by Mosby, Inc., an affiliate of Elsevier Inc.
Nursing as a Profession
A profession has characteristics:
Requires an extended education
Provides a specific service
Incorporates a code of ethics
A nurse is not just a person who performs tasks and skills. Nursing is a profession because we share the characteristics of a profession.
You will be educated and trained to care for others. You will be required to take college/university courses to complete general education requirements. You will use a theoretical body of knowledge that guides you to develop skills and define your abilities and practice according to a clear set of norms. You will be providing a service to others, You will have autonomy as you provide care and have code of ethics to guide your practice.
*
Mosby items and derived items © 2009, 2005 by Mosby, Inc., an affiliate of Elsevier Inc.
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)
*
Mosby items and derived items © 2009, 2005 by Mosby, Inc., an affiliate of Elsevier Inc.
Standards of Practice
Please refer to Box 1-2
*
Mosby items and derived items © 2009, 2005 by Mosby, Inc., an affiliate of Elsevier Inc.
Standards of Professional Performance
The ANA has identified nine standards of professional performance.
*
Mosby items and derived items © 2009, 2005 by Mosby, Inc., an affiliate of Elsevier Inc.
Code of Ethics
Philosophical ideals of right and wrong that define principles
As we have just discussed, to be a profession, nurses need a scope of practice, standards of practice, and standards of professional performance.
*
Mosby items and derived items © 2009, 2005 by Mosby, Inc., an affiliate of Elsevier Inc.
Nursing Education
Continuing and in-service education
We just said that members of a profession require an extended education, as well as a basic foundation in the liberal arts. To become a nurse, you must enroll in a school, college, or university. There has been a long-standing debate over what should be required for entry into practice. Should a registered nurse study at a diploma, two-year, or four-year program?
All students who graduate from schools of nursing are eligible to take the National Council Licensure Examination for Registered Nurses (NCLEX-RN).
Two-year college: focuses on basic sciences and theoretical/clinical courses related to practice of nursing.
Four-year college/university focuses on basic sciences and on theoretical/clinical courses, as well as social sciences, arts, and humanities to support nursing theory.
National League for Nursing Accreditation Council (NLNAC), which schools voluntarily join, publishes interpretive guidelines that identify core competencies for the professional nurse as well. NLNAC also supports the Pew Health Commission and the Institute of Medicine's Competencies for Health Professionals.
If you elect to continue your education, after receiving a baccalaureate degree in nursing you can pursue an Master’s or doctoral degree in nursing or other related fields.
Master Degree education: provides you with advanced clinical skills in nursing science and theory. A master’s degree in nursing is valuable and many times is necessary to pursue a role as nurse educator, nurse administrator, advanced practice nurse, or nursing faculty.
Doctoral Preparation: a DSN or DSC prepares you to apply research findings to clinical nursing. A PhD emphasizes basic research and theory .
The need for doctoral-prepared nurses is on the rise. These nurses are needed to educate beginning nurses and those seeking advanced academic and clinical preparation.
*
Mosby items and derived items © 2009, 2005 by Mosby, Inc., an affiliate of Elsevier Inc.
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 is practiced in a variety of settings. Various state and provincial nurse practice acts establish legal regulations for practice in a specified area and professional organizations establish standards of practice.
*
Mosby items and derived items © 2009, 2005 by Mosby, Inc., an affiliate of Elsevier Inc.
Nursing Practice
Science and art of nursing practice
In the United States individual State Boards of Nursing oversee nurse practice acts. The nurse practice acts regulate the scope of nursing practice and protect public health, safety, and welfare. They also specify the training needed for nurse practitioners and other forms of advanced practice.
If you are set up with classroom technology, you might want to direct students to your state board of registered nursing website.
Licensure:
RN candidates must pass the NCLEX-RN, a standardized exam for all candidates.
Certification:
Minimal practice requirements are set and based on the certification the nurse is seeking. Common certification is for medical surgical nurse, diabetic nurse educator, gerontological nurse, and many more.
We discussed earlier that nursing is both an art and science. You will learn the essentials and basics. However, as knowledge and standards change, you will continue to enhance your education by formal training or in-service and continuing education programs.
You will also begin to learn how to develop your critical thinking abilities and your ability to practice autonomously. You will also be required to go through a period of socialization into the profession.
Patricia Benner has done extensive work on the socialization of nurses into the profession.
See box 1-4 for information on the 5 stages of socialization
Novice
*
Mosby items and derived items © 2009, 2005 by Mosby, Inc., an affiliate of Elsevier Inc.
Professional Responsibilities
Nurses are responsible for obtaining and maintaining specific knowledge and skills.
In the past:
Now:
To provide care and comfort and to emphasize health promotion and illness prevention
*
Mosby items and derived items © 2009, 2005 by Mosby, Inc., an affiliate of Elsevier Inc.
Professional Roles
Caregiver
Educator
Manager
Advocate
Communicator
Caregiver:
Nurses help their clients regain health and find their maximum level of independent function through the healing process. Healing involves the body, mind, and spirit. We will look more at spiritual health in Chapter 29.
Advocate:
Nurses protect the human and legal rights of their clients and help clients assert those rights when needed. In Chapter 9 we will discuss cultural and ethnic issues that can create barriers to access to the health care system.
Educator:
In Chapter 25 we will be looking at client education. Your teaching can be formal or informal and will involve the client, family, significant other, or other support systems.
Communicator:
In Chapter 24, we will look at communication and styles. You know that communication is central to the nurse-client relationship. Again, it is important to develop a communication style to use with clients and members of their support system, as well as a style for communicating with other members of the health care team.
Manager:
*
Mosby items and derived items © 2009, 2005 by Mosby, Inc., an affiliate of Elsevier Inc.
Career Development
Nursing provides an opportunity for you to commit to lifelong learning and career development.
Ask students to discuss career opportunities available to them.
Some answers may include:
Staff nurse
Staff nurse in med-surg, OR, PACU, ED, Short Stay unit, ICU, CCU, TCU, OB, PEDS, L&D
Staff nurse in outpatient setting
Advanced practice nurse
APNs can be nurse practitioners, clinical nurse specialists, certified registered nurse anesthetists, nurse midwives
Nurse educator
Nurse administrator
*
Mosby items and derived items © 2009, 2005 by Mosby, Inc., an affiliate of Elsevier Inc.
Professional Nursing Organizations
NLN
The NLN sets standards for excellence and innovation in nursing education.
ANA
The ANA’s purpose is to improve standards of health and the availability of health care to foster high standards for nursing, to improve the professional development and general and economic welfare of nurses.
ICN
The ANA is part of the ICN. The objectives of the ICN are parallel to those of the ANA: to promote national association of nurses, improve standards of nursing practice, seek a higher status for nurses by providing an international power base for nurses.
NSNA
*
Mosby items and derived items © 2009, 2005 by Mosby, Inc., an affiliate of Elsevier Inc.
Future Trends in Nursing
Nursing is ever changing.
We have been talking about nursing today.
We have taken the opportunity to explore the early days of nursing (Florence Nightingale) and discussed the evolution of nursing from the 1900s to the twenty-first century.
The nursing profession will continue to evolve and grow, and so must individual nurses.
There is great emphasis on nurses and nursing today. We are highlighted, we are on TV, we are the emphasis of Johnson and Johnson Foundation campaign to draw individuals into the profession.
Chapter 1
Nursing Today
Nursing is both an art and science.
The science is based on a body of knowledge that is constantly changing and evolving.
The art is based on the practice of compassion, respect, and dignity rendered to the client and family members alike.
Remember, even though the client is the center of your care, the family, significant others, and community will have needs.
When rendering care, you will be guided by a code of ethics developed by the American Nurses Association and practiced by nurses.
As you begin your practice, you will incorporate ANA standards, evidence-based practice, and critical thinking skills.
As the weeks unfold, you will read further on these topic areas in:
Chapter 5: Evidence-Based Practice
*
Mosby items and derived items © 2009, 2005 by Mosby, Inc., an affiliate of Elsevier Inc.
Historical Perspective Highlights
Actively participate in policy
Respond and adapt to challenges
Since the days of Florence Nightingale, nurses have responded to the need of their clients. We do this in many ways.
Nurses exert great influence in social policy and political arenas. We have a strong organization (American Nurses Association) and strong lobbyists who propose legislation to care for our clients. At times, the proposed legislation at improving access and quality of care for the indigent and underserved.
Through nursing research and evidenced-based practice (chapter 5), nurses have been able to carry on the traditions that Florence Nightingale began in the Crimean War. Florence dealt with battlefield conditions that gave rise to infection, illness, and mortality. The 21st century nurse is deals with pain management, nutrition management, care of the elder population, and care of the infant and underserved child.
As the health care system changes, the art, science, and practice of nursing continues to evolve. Nursing draws not only from science, but also the humanities and social sciences. As nurses use and adapt this body of knowledge, nursing practice grows and evolves.
*
Mosby items and derived items © 2009, 2005 by Mosby, Inc., an affiliate of Elsevier Inc.
Florence Nightingale
No discussion of nursing can be complete without a section on Florence Nightingale.
She believed that the role of nurses was to help the body recover, and then remain free, from disease.
In 1860 Florence organized the first school of nursing, the Nightingale Training School for Nurses, at St. Thomas’ Hospital in London.
Nightingale was the first practicing epidemiologist. She used her keen mind and statistical analysis to show the connection between poor sanitation and diseases like cholera and dysentery.
Known as the Lady with the Lamp, Nightingale crossed the battlefields of the Crimean War with her lantern. By improving sanitation in battlefield hospitals, she showed how effective fresh air, hygiene, and nutrition were in the treatment of wounded soldiers.
*
Mosby items and derived items © 2009, 2005 by Mosby, Inc., an affiliate of Elsevier Inc.
Civil War to the Beginning
of the Twentieth Century
Clara Barton, Dorothea Lynde Dix, Mother Bickerdyke, Harriet Tubman
Mary Mahoney
Isabel Hampton Robb
The Civil War, fought from 1861 to 1865, made nursing necessity. Clara Barton, who tended to soldiers, who tended to soldiers on the battlefield, has been compared to Florence Nightingale. She was the founder of the American Red Cross. The other prominent women mentioned on this slide also contributed greatly to the practice of nursing.
Dorothea Lynde Dix was the supervisor of female nurses in the Union army.
Mother Bickerdyke organized ambulance service, supervised nurses, and searched for abandoned, wounded soldiers on the battlefield.
Harriet Tubman was a prominent female in the Underground Railroad movement to free slaves.
Mary Mahoney was the first professionally educated African-American. She may be one of the first proponents of better relationships between cultures and races, respect for individuals regardless of background, race, color or religion.
Isabel Hampton Robb helped found the American Nurses Association in 1911. She was an influential author with the following titles:
Nursing: Its Principles and Practice for Hospital and Private Use, Nursing Ethics, and Educational Standards for Nurses. She was one of the original founders of the American Journal of Nursing.
*
Mosby items and derived items © 2009, 2005 by Mosby, Inc., an affiliate of Elsevier Inc.
The Twentieth Century
1901, 1906, 1908
1940s
1950s
1990s
A number of events began to shape nursing education in the twentieth century.
In 1901 the Army Nurse corps was established, followed by the Navy Nurse corps in 1908.
Under the influence of Mary Adelaide Nutting, nursing education moved into U.S. universities in the early twentieth century. In 1906 Nutting became the first professor of nursing at Columbia University Teachers College.
Another important development in nursing history occurred when the Rockefeller Foundation approached Nutting, along with Lillian Wald and Annie Goodrich, to study nursing education. Their study, conducted in 1920 and published in 1923, concluded that nursing education needed financial support and should be centered in university schools of nursing.
*
Mosby items and derived items © 2009, 2005 by Mosby, Inc., an affiliate of Elsevier Inc.
The 21st Century
Nursing in multiple care settings
The American Nurses Association established the Center for Ethics and Human Rights in the 1990s. This center helps nurses at large address complex ethical and human rights issues. In 2001 the code of ethics was revised to reflect current ethical issues which affect nursing practice. We will learn more about this in Chapter 22: Legal implications.
The nursing curriculum has continued to change to meet changing social needs. Issues such as bioterrorism, emerging infections, disaster management, and technology advances were not included in the curriculum as late as 10 years ago.
As patient care needs change, nurses and nursing education will follow suit. Today, nurses work in multiple settings. Nurses also work in non–patient care environments to support the needs of nursing, nursing education, and patient care.
You might want to ask students what other areas nurses can work in and still support nursing, nursing education, and the patient?
Answer: politics, lobbying groups, not-for-profit agencies
*
Mosby items and derived items © 2009, 2005 by Mosby, Inc., an affiliate of Elsevier Inc.
Societal Influences on Nursing
Human rights
Medically underserved
Demographics
You can ask students what types of changes affect health care?
Answers: people moving from rural to urban centers, increased lifespan, increase in patients living with chronic illnesses (we have better drugs and therapy available), increases in alcoholism, lung cancer (and other cancers)
Woman’s Health Issues
Women are demanding equality, especially in the areas of economic, political, occupational, and educational needs. Because women are demanding that they receive better care, new advances are continually being made in obstetrics, oncology, and research.
Human Rights
Nurses have always placed patients at the center of care and been strong advocates for patient care needs. Therefore, it is not surprising that nurses are among the strongest advocates of recognizing patients needs, special and normal. Nurses can be proud that they created bills of rights for dying, hospitalized, and pregnant clients.
Medically Underserved
Nurses have always cared for patients inside and outside of the medical system. We promote the rights of minorities, immigrants, the underinsured, and the uninsured to receive high-quality health care. The rising rates of unemployment, mental illness, and homelessness makes our advocacy more important than ever.
Threat of Bioterrorism
*
Mosby items and derived items © 2009, 2005 by Mosby, Inc., an affiliate of Elsevier Inc.
Needs of the Consumer
Health promotion and wellness
The health care delivery system is constantly changing to meet the needs of the health care consumer. More information can be found in Chapter 2: Health Care Delivery System.
Many consumers are savvy about their illnesses due to media and the Internet. Clients expect to be cared for in a culturally competent manner. More can be seen in Chapter 9: Culture and Ethnicity. Healthy People 2010 also outlines health care goals for the public.
No one would argue that one of our main goals as nurses is to keep our clients safe and inflict no harm! Throughout the nursing program you will continue to hear information about the Joint Commission.
Ask students if they can identify areas in which safety has been an issue?
Answers: medication errors, abbreviation list, injures due to transfers and falls, wrong surgery on patients (more in chapter 50: Care of Surgical Clients)
*
Mosby items and derived items © 2009, 2005 by Mosby, Inc., an affiliate of Elsevier Inc.
Influence of Today’s Health Care Delivery System
Rising health care costs
Nursing shortage
We will hear more about the Health Care Delivery System in Chapter 2.
The cost of health care is rising for multiple reasons. As a future health care provider, you are charged with the responsibility to practice safe nursing care as well as stay fiscally sound. One way you can help is to serve on the New Product Committee so you can have a say about the types of products that best meet your patients’ needs.
In chapter 5, we are going to discuss evidence-based practice. We know that nursing research is not new, since Florence Nightingale did research and altered her nursing care as a result of her findings. Through research, nursing knowledge advances and nurses become better able to provide up-to-date, higher-quality nursing care.
*
Mosby items and derived items © 2009, 2005 by Mosby, Inc., an affiliate of Elsevier Inc.
Nursing as a Profession
A profession has characteristics:
Requires an extended education
Provides a specific service
Incorporates a code of ethics
A nurse is not just a person who performs tasks and skills. Nursing is a profession because we share the characteristics of a profession.
You will be educated and trained to care for others. You will be required to take college/university courses to complete general education requirements. You will use a theoretical body of knowledge that guides you to develop skills and define your abilities and practice according to a clear set of norms. You will be providing a service to others, You will have autonomy as you provide care and have code of ethics to guide your practice.
*
Mosby items and derived items © 2009, 2005 by Mosby, Inc., an affiliate of Elsevier Inc.
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)
*
Mosby items and derived items © 2009, 2005 by Mosby, Inc., an affiliate of Elsevier Inc.
Standards of Practice
Please refer to Box 1-2
*
Mosby items and derived items © 2009, 2005 by Mosby, Inc., an affiliate of Elsevier Inc.
Standards of Professional Performance
The ANA has identified nine standards of professional performance.
*
Mosby items and derived items © 2009, 2005 by Mosby, Inc., an affiliate of Elsevier Inc.
Code of Ethics
Philosophical ideals of right and wrong that define principles
As we have just discussed, to be a profession, nurses need a scope of practice, standards of practice, and standards of professional performance.
*
Mosby items and derived items © 2009, 2005 by Mosby, Inc., an affiliate of Elsevier Inc.
Nursing Education
Continuing and in-service education
We just said that members of a profession require an extended education, as well as a basic foundation in the liberal arts. To become a nurse, you must enroll in a school, college, or university. There has been a long-standing debate over what should be required for entry into practice. Should a registered nurse study at a diploma, two-year, or four-year program?
All students who graduate from schools of nursing are eligible to take the National Council Licensure Examination for Registered Nurses (NCLEX-RN).
Two-year college: focuses on basic sciences and theoretical/clinical courses related to practice of nursing.
Four-year college/university focuses on basic sciences and on theoretical/clinical courses, as well as social sciences, arts, and humanities to support nursing theory.
National League for Nursing Accreditation Council (NLNAC), which schools voluntarily join, publishes interpretive guidelines that identify core competencies for the professional nurse as well. NLNAC also supports the Pew Health Commission and the Institute of Medicine's Competencies for Health Professionals.
If you elect to continue your education, after receiving a baccalaureate degree in nursing you can pursue an Master’s or doctoral degree in nursing or other related fields.
Master Degree education: provides you with advanced clinical skills in nursing science and theory. A master’s degree in nursing is valuable and many times is necessary to pursue a role as nurse educator, nurse administrator, advanced practice nurse, or nursing faculty.
Doctoral Preparation: a DSN or DSC prepares you to apply research findings to clinical nursing. A PhD emphasizes basic research and theory .
The need for doctoral-prepared nurses is on the rise. These nurses are needed to educate beginning nurses and those seeking advanced academic and clinical preparation.
*
Mosby items and derived items © 2009, 2005 by Mosby, Inc., an affiliate of Elsevier Inc.
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 is practiced in a variety of settings. Various state and provincial nurse practice acts establish legal regulations for practice in a specified area and professional organizations establish standards of practice.
*
Mosby items and derived items © 2009, 2005 by Mosby, Inc., an affiliate of Elsevier Inc.
Nursing Practice
Science and art of nursing practice
In the United States individual State Boards of Nursing oversee nurse practice acts. The nurse practice acts regulate the scope of nursing practice and protect public health, safety, and welfare. They also specify the training needed for nurse practitioners and other forms of advanced practice.
If you are set up with classroom technology, you might want to direct students to your state board of registered nursing website.
Licensure:
RN candidates must pass the NCLEX-RN, a standardized exam for all candidates.
Certification:
Minimal practice requirements are set and based on the certification the nurse is seeking. Common certification is for medical surgical nurse, diabetic nurse educator, gerontological nurse, and many more.
We discussed earlier that nursing is both an art and science. You will learn the essentials and basics. However, as knowledge and standards change, you will continue to enhance your education by formal training or in-service and continuing education programs.
You will also begin to learn how to develop your critical thinking abilities and your ability to practice autonomously. You will also be required to go through a period of socialization into the profession.
Patricia Benner has done extensive work on the socialization of nurses into the profession.
See box 1-4 for information on the 5 stages of socialization
Novice
*
Mosby items and derived items © 2009, 2005 by Mosby, Inc., an affiliate of Elsevier Inc.
Professional Responsibilities
Nurses are responsible for obtaining and maintaining specific knowledge and skills.
In the past:
Now:
To provide care and comfort and to emphasize health promotion and illness prevention
*
Mosby items and derived items © 2009, 2005 by Mosby, Inc., an affiliate of Elsevier Inc.
Professional Roles
Caregiver
Educator
Manager
Advocate
Communicator
Caregiver:
Nurses help their clients regain health and find their maximum level of independent function through the healing process. Healing involves the body, mind, and spirit. We will look more at spiritual health in Chapter 29.
Advocate:
Nurses protect the human and legal rights of their clients and help clients assert those rights when needed. In Chapter 9 we will discuss cultural and ethnic issues that can create barriers to access to the health care system.
Educator:
In Chapter 25 we will be looking at client education. Your teaching can be formal or informal and will involve the client, family, significant other, or other support systems.
Communicator:
In Chapter 24, we will look at communication and styles. You know that communication is central to the nurse-client relationship. Again, it is important to develop a communication style to use with clients and members of their support system, as well as a style for communicating with other members of the health care team.
Manager:
*
Mosby items and derived items © 2009, 2005 by Mosby, Inc., an affiliate of Elsevier Inc.
Career Development
Nursing provides an opportunity for you to commit to lifelong learning and career development.
Ask students to discuss career opportunities available to them.
Some answers may include:
Staff nurse
Staff nurse in med-surg, OR, PACU, ED, Short Stay unit, ICU, CCU, TCU, OB, PEDS, L&D
Staff nurse in outpatient setting
Advanced practice nurse
APNs can be nurse practitioners, clinical nurse specialists, certified registered nurse anesthetists, nurse midwives
Nurse educator
Nurse administrator
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Mosby items and derived items © 2009, 2005 by Mosby, Inc., an affiliate of Elsevier Inc.
Professional Nursing Organizations
NLN
The NLN sets standards for excellence and innovation in nursing education.
ANA
The ANA’s purpose is to improve standards of health and the availability of health care to foster high standards for nursing, to improve the professional development and general and economic welfare of nurses.
ICN
The ANA is part of the ICN. The objectives of the ICN are parallel to those of the ANA: to promote national association of nurses, improve standards of nursing practice, seek a higher status for nurses by providing an international power base for nurses.
NSNA
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Mosby items and derived items © 2009, 2005 by Mosby, Inc., an affiliate of Elsevier Inc.
Future Trends in Nursing
Nursing is ever changing.
We have been talking about nursing today.
We have taken the opportunity to explore the early days of nursing (Florence Nightingale) and discussed the evolution of nursing from the 1900s to the twenty-first century.
The nursing profession will continue to evolve and grow, and so must individual nurses.
There is great emphasis on nurses and nursing today. We are highlighted, we are on TV, we are the emphasis of Johnson and Johnson Foundation campaign to draw individuals into the profession.