NURS100 ch. 1-5

prehistoric civilization health beliefs

all illnesses were the work of gods

prehistoric civilization health practices

acts intended to deter evil gods and demons

Egypt health beliefs and practice

preventative measures taken to appease the gods, developed specific laws on cleanliness, food use and preservation, drinking, exercise, and sexual relations

Egypt nursing

used by kings and aristocrats to deliver babies and care for the sick

Palestine health beliefs and practice

developed the mosaic code

palestine nursing

Hebrew priest took on the role of health inspectors

Greece health beliefs

gods and goddesses controlled health and illness, temples build to honor aesculapius (god of medicine)

Greece medical science

aescelpius staff was model for medical caduceus, Hippocrates is father of medicine

India health beliefs and practice

vedas was source of info about health practices (emphasized hygiene and prevention of sickness)

india medical science

developed procedures to perform major and minor operations, understood importance of prenatal care

india nursing

physicians performed surgeries (limb amputations, c-sections, suturing wounds), in rare instances women could work outside the home, public hospitals constructed in 274-236BC

china health beliefs

teachings of Confucius, believed in yin and yang philosophy (imbalance would result in ill health)

china health practices

used acupuncture, hydrotherapy, massage, exercise to promote health and harmony

rome

adapted health and medical practices from conquered countries, established first military hospital in Europe, military orders made of men to care for injured, practiced advanced hygiene and sanitation

Middle Ages

women used herbs and new healing methods in the home, men used purging, leeching, and mercury, physicians mostly translated medical essays, Catholic Church became figure in health care, wives of emperors and women became nurses, changes in health care based on charity, cross used became a badge and design of nursing pins

renaissance and reformation

major advancements in medicine: pharmacology, chemistry, medical knowledge

“dark ages” of nursing

religious orders became extinct due to separation of church, nursing no longer appealing to women of high social status, job went to poor women, nursing became an undesirable job (poor pay, long hours, strenuous work)

social conditions in renaissance and reformation

famine, plague, filth, crime in Europe, nursing orders established out of concern for social welfare

sisters of charity

recruited young intelligent women for nurse training, developed educational programs, cared for abandoned children

st. Vincent de Paul

established hospital for the foundling to care for orphaned and abandoned children

colonial American period- Mexico

first colonists in Mexico were catholic, hospital of the immaculate conception was first hospital in NA, first medical school build at University of Mexico, individuals with disease were isolated

colonial america

health care was deficient, low life expectancy, plagues (scarlet fever and smallpox), physicians were poorly trained, ben Franklin and the Pennsylvania hospital (first hospital in US, 1751)

florence nightingale

demonstrated value of aseptic techniques and infection control, demonstrated value of political activism and effect on health care reform, established first nursing school in England, kept careful statistics (decrease in death rate of soldiers)

Dorothea dix

appointed to organize military hospitals, provide trained nurses, disperse supplies; received no official status and no salary

civil war period

6mil. people hospitalized during war, epidemics plagued country (syphillis, gonorrhea, malaria, smallpox, typhoid)

contributions of black nurses

tubman cared for soldiers and established Underground Railroad, truth was an advocate for sanitary conditions, Taylor worked on the battlefront with no pay or pension

contributions of volunteer nurses

barton opened the Red Cross, Alcott wrote about nursing experience for a newspaper

first nursing school for black women

spelman college (was Atlanta baptist seminary) established by Rockefeller in 1886

1900-ww1

most states by 1910 requires nurse registration, entry level for students upgraded to HS graduate, nurse training programs improved to be more comprehensive, wald developed a practice for public health nursing (Henry street settlement house)

ww1 and the 1920s

improved hospital care and surgical techniques, environmental conditions improved, serious epidemics of previous century became nonexistent, nurse anesthetists, Red Cross became more active, Breckinridge established frontier nursing service, Sheppard-towner act (assist special pop. and provide resources to public health nurses)

the Great Depression

economy was disintegrated, nurses became unemployed, new deal enacted to provide medical care, social security act of 1935 provided avenues for public health nursing

ww2

programs enacted to expand education, nursing became part of military and attained officer rank

post ww2

unemployment at all time low, women encouraged to go back to motherhood and marriage, nurses valued during Korean War, emerged as a true profession, all states adopted state board test pool, more bac. programs, assoc. programs developed

nurse training act of 1943

first instance of federal funding to support nurse training

hill-burton act

provided funding to construct hospitals, led to a demand for professional nurses

1960s

legislation had major impact (community mental health centers act of 1963, medicaid and medicare 1965), medicare encouraged hospital occupancy, hospital became usual practice site, home health movement initiated, fairer wages, developed community programs, NP recognized as cost-effective provider

1980s

increase in homeless and indignant, AIDS, hospitals reduced pt. length of stay, case management, outpatient services

1990s

managed care movement

21st century

nursing shortage expected to grow as baby boomers age, schools struggling to expand capacity, higher compensation is luring educators away from teaching, COVID highlighted critical role of nurses

affordable care act 2010

provided insurance for over 32 million uninsured Americans

Robert wood Johnson foundation and IOM- future of nursing

nurses should practice to full extent of training, achieve higher levels of education, partner with physicians to redesign health care, improve health care workforce data collection

impact of covid on nurses

fear they might be infected or endanger their families, long shifts, stress and depression, supply shortage, ethical dilemmas, diverse unknowns, lots of death

patient protection and affordable care act (2010)

increase student loan amounts, provided $ to fund nurse managed health centers, funded gerontology nursing fellowship programs, provided loan repayment, strengthened advanced nursing education grants, grants for graduate nursing

antiquity’s image of nursing

earliest references to nursing are in the Bible and chronicle two nurse midwives in approx. 1900BC

victorian image of nursing

Dickens’ portrayal of sairey gamp, drunken and uncaring nurse who profited from the sick and dying; Longfellow’s portrayal of nightingale as a heroine in santa Filomena

florence nightingale and nursing image

created a positive image

art and 20th century nursing

opportunities offered to nurses by war captured attention of artists and portrayed nurses as dedicated, heroic, and caring

image in the 1930s

radio, movies, and sculpture portrayed nurses as dedicated, brave, intelligent, a “holy vocation”; “the white angel” based on nightingale; statue in Arlington national cemetery to honor military nurses

image in the 1940s

nurses were war heroes through movies, stamps; found low salaries and poor working conditions at home, glamorized in romance novels

image in 1960s

tv showed nurses as background figure to physicians, movies showed nurses as cruel power figure

image in the 1970s

media portrayed nurses negatively

image in 1980s and 1990s

movies portrayed nurses as nonjudgemental, caring, heroic; advertisements portrayed nurses as sex objects

image in millennial media

image of men is usually absent in media, lots of tv shows

nursing and social media

comments about patients, practices, and managers creates professional problems, nurses shouldn’t “friend” patients or families, no posting pics of patients, state boards have disciplined nurses, student nurses have been expelled

nurses of America campaign

1990 campaign implemented by tri-council designed to convey to the public that nurses are experts, make nurses care of the invisibility of nursing in news media

IOM landmark report recommendations

higher levels of education, removal of barriers to full scope of practice, inclusion of nurses as full partners with physicians, improved data collection and information infrastructure

what the public believes about nursing

honesty and ethics (Gallup polls), heroes (especially post 9/11)

reality of the contemporary staff nurse

modern health care institutions exist to deliver nursing care, public highly values the profession, nursing’s heroic and noble public image is long lasting, nurses have a high sense of satisfaction with their profession, grads are entering the profession younger, more than half of nurses practice in hospital, 59% of med. prof. are nurses, 12.7% of BSN students are male, 41% of CRNAs are male

nursing self-sabotage activities

inappropriate dress, deferential positioning in meetings and collaborative activities, wearing uniforms in public places

creating a new nursing image

nurses should tell people what nurses do well, keep disagreements in-house, dress the part, recognize benefit of national memberships

skills required of nurses

assessment, critical thinking, communication, patient teaching, caring, advocacy

practice-based competency outcomes

must achieve outcomes that develop the skills actually needed in practice, must change from memorizing notes to learning to integrate knowledge, make decisions, and be competent and confident

sociodemographic changes in nursing education

aging population, diverse population, increase in people living in poverty, disrespect for others, domestic abuse, substance abuse, violence, obesity epidemic, nontraditional families

community-focused, interprofessional approaches

inter professional emphasis, influenced by efforts to reduce healthcare cost, shift from illness care to health promotion

consumer-oriented care: engagement, safety, and privacy

shift from giving care to working with the patient, increase in medical errors have supported the need for competency based performance exams

ethics and bioethical concern

different ways of responding to illness, care providers, and therapies raise ethical issues of who is right and who has the right to prevail

shortage of nursing and faculty

trend over past decades, consequence is medical errors, current workforce is older with fewer nurses available, nursing workforce doesn’t mirror population

disasters, violence, and terrorism

domestic violence has increased, violence in workplaces and schools, more has disasters, nurses need to be prepared to function effectively with other first responders

LPN/LVN programs

shortest programs that prepare students for licensure, 9-12 mints long and focus on technical aspects of nursing care, state boards of nursing set scope of practice in each state

hospital diploma programs

1-3 calendar years, less than 10%

associate degree programs

developed in the 1950s to shift education from the vocational and apprenticeship orientation to the college environment, 2 years academic study with 2 semesters of liberal arts and sciences, largest % of nurses are ADN

baccalaureate degree programs

Yale offered the first BSN degree in 1924, developed with the idea that nurses could provide more comprehensive and compassionate care with a foundation of arts and sciences, 2 years arts and sciences, 2 years nursing courses, 126-136 credits

masters degree programs

developed due to the need for nurse educators, administrators, and expert clinicians, increase in funding for these programs (health amendment act of 1956, nurse practice act of 1964)

LACE report- model of regulation

licensure, accreditation of programs, certification, and education

4 APRN roles

nurse anesthetist, nurse midwife, clinical nurse specialist, nurse practitioner

clinical nurse leader program

new role, masters prepared generalist clinician

types of MSN programs

accelerated, second degree programs, RN to MSN

doctor of philosophy

for students interested in research and generating new knowledge

doctor of nursing practice

for students interested in advanced clinical nursing practice and clinical leadership

external degree model

ex. university of Phoenix online

history of nursing registry

started by nightingale in 1860, distinguished nurses fro, local citizens, provided institutions and patients the means to gauge the skills and knowledge of graduates

purpose of licensure

protection of the public

early licensure activities

1896- first attempt to license nurses

1901- ICN decided states should examine and license nurses

1903- 4 states had permissive licensure

1915- ANA designed model nurse practice acts

1923- all states had permissive licensure

1947- NY first state to require mandatory licensure

1950-NLN gave first state board test pool exam

1982- first NCLEX

1994- computerized NCLEX

components of nurse practice acts

define professional nursing, protect title of nurse and safety of the population, define advanced practice, requirements for licensure, requirements for entry into practice, renewal of licensure, establishment of a regulatory board, guidelines for delegation

current licensure activities

mutual recognition model, continued competency

special cases of licensure

military and government nurses, foreign nurse graduates, international practice

sunset legislation

laws to ensure legislation is current and reflects the needs of the public

history of certification

began as a voluntary effort controlled by nursing organization, nurse anesthetists was first specialty to certify, need for standardization in certification programs recognized in 1975

current issues in certification

legal issues of scope of practice for advanced practice nurses, reimbursement for nursing services, federal regulations allow direct reimbursement for some nursing services, yet state and local practices vary

criteria for theory acceptance

inclusiveness, consistency, accuracy, relevance, fruitfulness, simplicity

5 aspects of scientific inquiry

hypothesis, method, data collection, results, evaluation

theory

abstract generalization that presents a systematic explanation about how phenomena are interrelated (must include at least 2 concepts)

conceptual model or framework

concepts that are assembled because of their relevance to a common theme, more loosely structured than theories

schematic models

visual demonstration of concepts, clarify and show relationships between complex concepts

grand theory

broad, large segment of the human experience

middle range theory

smaller in scope and may refer to a specific population

first nursing theorist

nightingale

theory of practice- nightingale

ventilation and warming, noise, variety, diet, light, chattering hopes and advice, cleanliness

the system model- neuman

focus on response of client system to actual or potential environmental stressors and use of nursing prevention interventions for client wellness

interpersonal relations as a nursing process- peplau

explored interpersonal relationship of the nurse and client, identified clients feelings as a predictor of positive outcomes related to health and wellness