the profession of nursing
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The Profession of Nursing
Foundations I Theory
Devin Terry MSN, RN, ACNS-BC
Summer 201
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Objectives
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UAMS Nursing Philosophy
Professionalism- committed to professional practice and collaboration with the interdisciplinaryteam to provide innovative and exceptional patient-and-family-centered care to impact theoverall health of our community.
Accountability- the professional nurse is the foundation of nursing practice . Strong patientadvocates, accepting responsibility for professional practice an willingly commit to strive tocreate optimal outcomes.
Communication- the power to share ideas and concepts as the basis for effective team work.Promotes positive outcomes when executed with enthusiasm and optimism.
Excellence- professional practice model as the basis for delivery on nursing care. Value anenvironment where the scope of practice promotes innovative and compassionate patient caredelivery and encourages continuous improvement. Excellence through aggressive recruitmentand retention of RN staff.
Together- we set the pace3
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Theory in Nursing
Historical perspective
Role in nursing
evidence or science based practice
Interdisciplinary theories
systems, basic human needs, stress andadaptation, developmental etc
Nursing theories
grand, mid-range, descriptive, prescriptive4
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Grand Theory
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Middle-Range
Limited in scope and less abstract
Specific phenomenon
Applicable to administration, clinical,and teaching
Can be applied to variety of nursingsituations (uncertainty, incontinence,social support, quality of life, andcaring)
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Definition of Nursing
Accountable discipline guided by:
science
theory
a code of ethics
the art of care and comfort to treat
human responses to healthand illness
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ANA: Four Essential Features ofContemporary Nursing Practice
1. attention to the fullrange of human
experiences andresponses to healthand illness withoutrestriction to a
problem focusedorientation
2. integration ofobjective data with
knowledge gainedfrom anunderstanding of theclient/groups
subjectiveexperience
Look at the whole person
before we decide what is wrong! 8
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Four Essential features of ContemporaryNursing Practice
application of
scientific knowledgeto the processes ofdiagnoses andtreatment
3. provision of a caringrelationship thatfacilitates health andhealing
4.
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ATI Check your knowledge #1
1. A RN is making the first home visit to a family of anew born for a well-infant check. The family includesthe 17y/o mother of the newborn, her 2 y/o daughter,and the grandmother of the two young children.Which of the following interventions will be the mostbeneficial in establishing a therapeutic relationshipwith this family?
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ATI #1 continued
a) Tell the family members not to worry aboutany concerns they may have.
b) Include all the family members in thediscussion about the infants exam.
c) Present a nonjudgmental attitude.
d) Give written information regarding well-infant checks.
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Nursing Education
Entry level education (all take samelicensing exam)
diploma (3 year, usually hospital affiliated)
associate degree (2 year, focus ontechnical)
baccalaureate degree (4 year universityeducation)
graduate degree (undergraduate degrees inother disciplines, graduate degree innursing)
Thats you!
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Advanced Education
Masters degree programs
nurse practitioners, clinical nurse
specialists, educators, administrators
Doctoral degree programs
PhD vs. DSN, DNP or DNSc
educators, researchers, ethicists,philosophers, theorists, executives, healthpolicy makers
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Continuing Education
Courses that assist in developing andmaintaining expertise and knowledge
Promotes quality of nursing care
Mandatory in some states (Arkansasincluded)
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Professionalism
Professionalism
behavior that upholds the status, methods,
character, and standards of a givenprofession
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Characteristics of aProfession
Extended educationbuilt upon a basicliberal foundation
Theoretical body ofknowledge leading toskills, abilities, andnorms
Provides a specificservice
Autonomy indecision making and
practice Code of ethics
governing practice
Is nursing a true
Profession?
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ATI check your knowledge #2
2. State three ways nurses obtain theirprofessional values?
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Standards of NursingPractice
Nursing actions that are agreed upon bynurses as constituting safe and effective
client care
Establish foundation for professionalpractice
Developed and implemented byprofessional organizations
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Standards of Practice
ANA establishes these writtenstatements defining the acceptable level
of performance in the profession
Provide direction for the provision ofnursing care
Provide set of expectations that can beused to evaluate nursing performance
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ANA Standards of NursingPractice
Standards of Care
Assessment
Diagnosis Outcome Id.
Planning
Implementation
Evaluation
Standards ofProfessionalPerformance
quality of care
performanceappraisal
education
collegiality
ethics
collaboration
research
UAMS uses same guidelines to
Help guide student practice!
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Functions of NursingProfessional Organizations
Establish, maintain, and improve nursingstandards
Hold members accountable for practicing bythe standards
Public education
Public protection Protection of members of the profession
Lobbies at the state and federal level fornurses
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Professional NursingOrganizations
American NursesAssociation (ANA)
members are state nursesassoc. members
publishes American
Journal of Nursing Offers specialty
certification
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ANA:
Advances:
nursing roles
economic interest
Healthcare
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Professional NursingOrganizations
National League of Nursing(NLN)
members are nurses,agencies, non-nurses
promotes improved
development of nursingservices and education
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Professional NursingOrganizations
National Student Nurses Association
American Academy of Nurses
Sigma Theta Tau Specialty nursing organizations
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Professional Nursing Roles
Traditionally, providing care andcomfort to clients and performing
specific nursing functions Expanded to include illness prevention,
health promotion, and concern for
client holistically
What is holistic care?
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Professional Nursing Roles
Caregiver
Comforter Advocate
Teacher
Clinicaldecision maker
Communicator
Case Manager Researcher
Rehabilitator
NURSE!27
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ATI Check your knowledge #3
3. The nursing team is directed by the
a) Assistive personnel (AP)
b) Licensed Practical Nurse/ LicensedVocational Nurse (LPN/LVN)
c) Registered Nurse (RN)
d) Nutrition Aide
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Trends
Toward more holistic care
Increased variety in employmentsettings
Importance of advanced education
Graying of America
Increasing urbanization
Increasing cultural diversity
Communication and travel 29
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Trends
Stagnating/declining wages
Poverty levels (1/7 Americans)
especially high incidence in women,children, the elderly, and minorities
Increasing numbers of uninsured
Access
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Types of law
Statutory law
Americans with Disabilities Act
Nurse Practice Acts
Child and elder abuse reporting laws
Public law
Law applicable to an entire group of people(mandatory annual tb testing of all healthcare workers)
Written law with the intention to clarify
Law governing the relationship between individuals and the state
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Legal Regulation of NursingPractice
Nurse Practice Acts
power granted to individual states
protects the public
defines the nature and scope ofprofessional practice
single most important law affecting nursingpractice
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Features of Nurse PracticeActs
Defines the practice of nursing
Delineates rules and regulations that
govern practice
Outlines relationship of professionalnursing to other health care providers
Establishes licensure requirements
Creation of a State Board of Nursing
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Features of Nurse PracticeActs
Defines professional misconduct
Defines disciplinary actions for
professional misconduct
http://www.arsbn.org/
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Other Laws Affecting NursingPractice
Occupational Safety and Health Act of 1970
Controlled Substance Acts (Comprehensive
Drug Abuse Prevention and Control Act of1970)
Health Care Quality Improvement Act
American with Disabilities Act Good Samaritan Laws
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Professional Regulation ofNursing Practice
Professional Nursing Organizations
Centers for Disease Control and
Prevention (CDC)
Employer policies and procedures
Educational programs
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C l f h P f i f
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Control of the Profession ofNursing
Credentialing
methods by which the profession attempts toensure and maintain practitioner competency
Certification
voluntary process granting recognition formeeting criteria established by a nongovt.assoc.
Accreditation
monitors educational programs ability to meetpredetermined standards for student outcomes
Licensure 37
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Licensure
State function, mandatory
Grants owner formal permission from
the State Board of Nursing to practicenursing
Criteria
educational preparation
passing the NCLEX examination
good moral character
application and registration fee payment
How do they check this??
Fee is a common trend
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Other Legal Issues
Civil vs.. criminal law
criminal prevents harm
civil protects rights
Assault & battery
threat of harmful/offensive contact vs.
intentional touching without consent
Invasion of privacy
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Malpractice and Negligence
Unintentional tort
Negligence
conduct not consistent with what anordinarily prudent person would use insame circumstance
Malpractice professional negligence
nursing care below standard of care
No intent
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Liability
Liability
legal obligation or responsibility to provide
care to a client that meets the acceptedstandard of care
Elements of Liability
dutybreach of duty
causation
damage 41
A f P t ti l Li bilit
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Areas of Potential Liabilityfor Nurses
Failure to monitor and assess
Failure to ensure safety
Medication errors
Improper implementation
of skills or procedures Documentation errors
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L l R ibiliti f
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Legal Responsibilities ofStudent Nurses
Practice nursing as part of the clinicaland academic requirements of the
educational institution and under thesupervision of nursing faculty
Legal protection is not available to
nursing students practicing nursingoutside of their educational programs(i.e., when working as nurse techs or
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Safeguarding Your Practice
Know your obligations andresponsibilities
Practice competently
Know your strengths and limitations
Keep current
Document your care
Professional liability insurance
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Client Rights
Informed consent
Confidentiality
(HIPAA)
Advance directives
Organ transplantation
issues
Right to refuse treatment
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Informed Consent
Legal right of client to receive adequateand accurate information about medical
condition and treatment risks, benefits, alternatives, consequences
of refusal
Physician is responsible for conveyinginformation and obtaining consent forprocedures
Examples?
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Informed Consent
Who can give consent?
adult 18 years or older
mentally/physically competent
parent/guardians for minors and wards
minors
may give consent for child in legal custody may give consent for self if married or a parent
may seek treatment for pregnancy, STDs, andsubstance abuse
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Nurses Role in Informed Consent
Witnessing signature of client
Ensuring consent is voluntary and that the
client understands info imparted Ensuring that client appears competent
Ensuring that the form is signed and on the
chart
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Confidentiality ~ HIPAA
Clients right to privacy in thehealth care system
Ethically obligated to maintainconfidentiality
Additional protection under thelaw for persons receiving
treatment for drug and alcoholabuse, mental health care, sexualassault, HIV, and AIDS
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ATI check your knowledge #4
4. HIPAA provides which client right?a) The right to a consistent determination of death
b) The right to donate all or part of the body for organdonation or medical research after death.
c) The right to refuse treatment and establish advancedirectives.
d) The right for sensitive health information to be keptconfidential.
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Advance Directive / Patient SelfDetermination Act
Written document providing direction forhealth care in the event a person becomes
unable to personally make treatment choices Durable power of attorney appoints an agent
to make health care decisions
Includes living wills
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Organ Transplantation Issues
Right to determine whetherthey want to donate tissuesor organs
Uniform Anatomical GiftAct- law in all statesproviding list of individualswho can provide consent fororgan donation
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Quality of Life Issues
Use to determine benefits of medicalintervention
Difficulty assessingand defining
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Allocation of Scarce
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Allocation of ScarceResources
Organ transplantation UniformAnatomical Gift Act - allows a
competent client to make an informeddecision to donate all part of her bodyfor organ donation or medical researchafter death.
Access to service $$$ spent
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Ethics
Branch of philosophythat attempts to
determine whatconstitutes good, bad,right, and wrong in
human behavior Provides guidelines to
direct human action
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Ethical Principles for the Practice ofProfessional Nursing
Autonomy - respects persons right to selfdetermine
Beneficence care given is in the best interest
Confidentiality
Nonmaleficence - do no harm
Fidelity - honoring agreements
Justice - moral rightness, fairness, or equity
Veracity - adhering to truth
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Ethical Code for Nurses
TheAmerican Nurses Association Codeof Ethics for Nurses (2001) and the
International Council of Nurses Codeof Ethics for Nurses (2000)
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ATI Check your knowledge #5
5. The ANA code of ethics serves which of the followingpurposes?
a) Establishes standardized curricula for nursingeducational programs
b) Sets formal guidelines and standards forprofessional nursing conduct.
c) Ensures that nurses provide client care based onscientific principles.
d) Determines qualifications for advance practicenurses (APNs)
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Accountability and
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Accountability andResponsibility
Responsible for providing care within establishedstandards of the profession
implement care using the nursing process
students responsible for acquiring knowledge andskills needed to become safe practitioner
Accountable/answerable for the outcomes of actionstaken
to yourself, clients, institutions, peers, theprofession, and society
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History of Nursing
&Nursing Leaders
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Nursing in Ancient
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Nursing in AncientCivilization
Women cared for children and the ill
Relationship of illness to religious and mythical
beliefs Recognition that illness was at least partly
caused by physical factors by the Aztecs,Mayans, and Toltec
Nursing roles expanded outside the familyover time
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Influence of Christianity
Educated and wealthy women cared forthe sick and impoverished
New Testament 1st recorded history of nursing
Phoebe
1st deaconess
60 AD - 1st visiting nurse
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Nursing in the Middle Ages
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Nursing in the Middle Ages476-1453
Dark Ages (1st 500 years)
few institutions of higher learning
low level of education except for nobilityand clergy
Bubonic plague
killed 1/3 - 1/2 population of Europe stimulated hospital construction
contributed to the founding of nursing
orders (1st- Augustinian Sisters) 63
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Middle Ages (continued)
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Middle Ages (continued)
Midwifery
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15 to 18th Century
Crusades
Lack of hygiene and sanitation
Poverty in urban centers
Smallpox epidemics
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Colonialism and Revolution
1st colonial hospital in 1658 in what becameNew York
Hospitals only in the largest colonies withuntrained male nurses
Folk remedies the extent of nursing/healthcare
More American Revolutionary soldiers diedfrom disease or complications of care thanfrom wounds sustained in battle
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Industrialization
High incidence of illness, injury and early mortality
Caring for the sick became socially acceptable and theneed for competent nurses was recognized
Nursing textbooks written Nursing training programs
Sisters of Charity, The Kaiserwerth School ofNursing, Nurse Society of Philadelphia
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Crimean War
1854-1856, region now partof Ukraine
Great Britain, Turkey,France, and Sardinia unitedagainst Russia
Florence Nightingaleemerges as a hero (she hasher own slide)
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American Civil War
Clara Barton and the American Red Cross
Women provided care to sick and injuredsoldiers and implemented sanitary conditionsin field hospitals
Value of primary prevention recognized
Post-Civil War first U.S. schools of nursingbased on the Nightingale model (combinationof classroom and clinical experience)
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Spanish-American War
Trained nurses employed in militaryhospitals (not enough to meet all needs)
Military camps shattered by epidemicdiseases such as typhoid and malaria
Army Nursing Service
preferred trained nurses paid $30 per month plus
room and board
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World War I Nurses could not meet civilian and
military needs - again requiringuntrained volunteers
Rockefeller Foundation established a
committee to study nursing education
Goldmark report revealed faults withhospital training programs, identifiedlack of funding as the obstacle to
higher educational standards Funded expansion of nursing
programs at Yale, Vanderbilt, and theUniversity of Toronto
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World War I (continued)
Expansion of hospitals and nursingschools during the 1920s
Apprenticeship method Womens suffrage
Lavinia Dock (nurse activist)
Great Depression
transition from home based nursing care tohospital care
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World War II
Increased demand for QUALIFIED nurses
US Congress passed Lanhan act to fundnursing education and improve existing
facilities (federal subsidization)
GI Bill of Rights
Baby boom and post-war economy stimulated
hospital construction Nursing shortage
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Korean War
Mobile Army Surgical Hospitals (MASH
units)
Paved the way for ICU development andbetter ER and trauma care
Development of associate degree programs(Mildred Montag of Teachers College)
Concept of Nursing Diagnosis
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Vietnam War
1966 -Congressional bill permittedappointment of male nurses to the armed
forces nurse corps resulting in more malenurses
Rapid expansion of civilian hospitals andmedical technology
Increased specialization
Graduate educational and nurseentrepreneurship opportunities
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Contemporary Developments
Financially driven health care system ofthe 1980s (DRG, HMO, emergency care
centers) Focus on cost containment and
efficiency in the 1990s
Increase in jobs in outpatient and homehealth care settings
Managed care
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Contemporary Developments
Nursings Agenda for Health CareReform
primary care, prevention, and communityoutreach
Nursing shortage
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Nursing Leaders: Florence
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Nursing Leaders: FlorenceNightingale
Born in 1820 in England
Founder of modern nursing
Trained at Deaconess Institute in Kaiserwerthand with the Sisters of Charity in Paris
Led a group of 38 nurses in British militaryhospitals in Turkey
The Lady with the Lamp
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Florence Nightingale
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Florence Nightingale(continued)
Established sanitary conditions in British militaryhospitals in Turkey
Organized nursing care around the clock
Reduced mortality from 42.7 to 2.2% in 6 months
Post Crimean War
authored Notes on Nursing andNotes on
Hospitals Nightingale Training School (Nightingale plan)
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Nursing Leaders (late 1800s)
Linda Richards- 1st trained US nurse
Isabel Hampton Robb - 1st principal of JohnsHopkins SON, instrumental in establishingorganizations that became ANA and NLN
Mary Adelaide Nutting - worked for nurses tobe educated in the university setting
Clara Barton - Civil War nurse, developedAmerican Red Cross
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Nursing Leaders (late 1800s)
Mary Mahoney -Americas 1stprofessional black nurse
Lillian Wald opened the Henry StreetSettlement Service in New York andestablished public health nursing
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Nursing Leaders (early
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g ( y1900s)
Margaret Sanger - 1st birth controlclinic in America
Isabel Maitland Stewart - research todifferentiate between nursing and non-nursing tasks, instrumental in
upgrading nursing education Mary Breckinridge - founded Frontier
Nursing Service (1st organized
midwifery service) 83
Nursing Leaders (early
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g ( y1900s)
Lucille Petry - 1stwoman appointed to
position of AssistantSurgeon General ofthe US Public Health
Service