Nursing Essentials

• Nurse

• Person

• Environment

• Health

What are the four paradigms in nursing?

Nursing theories help define nursing as a profession and differentiate it for from other professions.

What is the importance of nursing theories?

“Nursing is the protection, promotion, and optimization of health and abilities, prevention of illness and injury, and facilitation of healing, alleviation of suffering, and advocacy in the care of individuals, families, groups, communities, and populations.”

What is the ANA’s definition of nursing?

military (Crimean War and American Civil War)

The roots of modern day nursing stem from the _____.

Florence Nightingale

_____ is described as the first modern day nurse.

Founder of Modern Day Nursing

Florence Nightingale is also referred to as the “_____”.

Environment - advocated for clean environments to prevent the spread of disease.

Florence Nightingale focused on which paradigm? Explain.

air, light, nutrition, adequate ventilation, and space

In Nightingale’s Notes on Hospitals, she stated several factors essential for soldiers to recuperate. What were the essentials?

Nosocomial Infection

_____ refers to an infection associated with a healthcare facility.

healthcare-associated infections

Nosocomial Infections are now called _____.

• Growth in the number of formalized nursing schools

• Registry for nursing graduates

• Nurses practiced more independently

Describe nursing in the 1920s.

• Increase in medical diagnoses

• Increases workplace-related illness/injury

• Great Depression made care less affordable and hospitals lacked trained staff

• Formation of Blue Cross to ensure payment for services/resources

• Nurses started practicing less independently

Describe nursing in the 1930s.

The Great Depression made care less affordable, which led to the formation of the Blue Cross to ensure payment to hospitals and doctors, therefore, nurses practiced less independently because they now relied on hospitals and doctors receiving payments and funding for their salaries.

Why did nurses start practicing less independently in the 1930s?

• Growing demand for hospitals

• Health care advances, such as pain meds and antibiotics

• Health care costs increased with the cost to provide care

• Patient’s Rule

Describe nursing in the 1950s.

The legal standard for informed consent that requires physicians to disclose all information a reasonable patient would need to make an informed decision about their treatment. It emphasizes the patient’s right to self-determination and autonomy over their own body. 

What is Patient’s Rule?

• Private pay via private insurance, which required employers/individuals to pay premiums (fee-for-service)

• Medicare launched by Kennedy and Johnson administration

Describe nursing in the 1960s.

• Healthcare almost completely controlled by private insurance companies via DRGs

• Nursing theorists working to reclaim nursing identity, as well as standardize and differentiate the roles of a nurse from other healthcare professionals

Describe nursing in the 1970s and 1980s.

Diagnostic Related Groups (DRGs) serve as the basis for Medicare and other insurers' prospective payment systems, providing a fixed reimbursement rate per case instead of paying for each individual service.

What are DRGs?

• All-time high nursing shortage in 2010

• Health care errors became the third leading cause of death and disability in the US

• Institute of Medicine (IOM) - published a landmark document that focused on interprofessional communication and the need for health care professionals to work as a team, with a focus on quality and safety. Resulted in an increase in interprofessional education and formation of QSEN. 

• Quality and Safety Education for Nurses (QSEN) - focused on quality and safety education in nursing.

Describe nursing fro the 1990s through today.

Patricia Benner’s theory of novice to expert

What theory described the progression of a nurse’s professional development through experiences, which expand thinking and technical skills?

clinical nursing judgment

The most essential skill for nurses is _____, which involves thinking and reasoning about the care they provide.

• Disease Prevention and Promotion of Health and Well-Being

• Chronic Disease Care

• Regenerative and Restorative Care

• Hospice and Palliative and Supportive Care

What are the four spheres of care?

• Focus on the promotion of physical and mental health

• Persons are generally healthy but have minor acute needs or intermittent care needs

• Health promotion involves activities that prevent illness or injury before it occurs (ex: educating person on the importance of immunizations) 

• Disease prevention focuses on preventing complications from acute injuries (ex: applying antibiotic creams to a scrape or cut)

Describe Disease Prevention and Promotion of Health and Well-Being.

• Focus on the management of chronic conditions (like chronic pain, diabetes, COPD, celiac disease, arthritis, etc)

• Goal is help persons recognize early signs of progression and prevent complications (ex: routinely monitoring hemoglobin A1Cs in persons with diabetes and ensuring their compliance with their treatment plan)

Describe Chronic Disease Care.

• Focus on the management of acute and critical conditions, such as those that can result in death or disability without interventions

• Persons require hospitalization and may be seen in emergency rooms and intensive care units

• Some diseases managed in this sphere are acute heart attacks, severe infections causing sepsis, and issues requiring major surgery

Describe Regenerative and Restorative Care.

• Focus on end of life care (hospice care, palliative care, grief counseling)

• Care may be provided to persons requiring assisted living and memory care, or supportive care for conditions requiring long-term rehabilitation, such as spinal cord injuries and bariatric surgeries.

Describe Hospice and Palliative and Supportive Care.