Professionalism (Class 5)

Art and science

Nursing is an ____ and a ______.

Benner’s Stages of Nursing Proficiency

1. Novice
2. Advanced Beginner
3. Competent
4. Proficient
5. Expert

Novice

First out of nursing school or any nurse in an unfamiliar situation. Usually learns a set procedure which is stepwise and linear.

Advanced Beginner

Some level of experience, but only observational. Can still identify the situation though.

Competent

A nurse who has been in the same clinical position for 2-3 years (same unit.)

Proficient

This nurse has more than 2-3 years in the same clinical position. Perceives a patient’s clinical position as a whole. Assesses the entire situation and incorporates their multiple previous experiences. Managing care as opposed to managing and performing skills.

Expert

Nurses with diverse experiences, intuitive grasp, and can zero in on the problem while focusing on multiple dimensions. Focuses on the needs of novice nurses.

Standards of Professional Nursing Practice

Standards that describe a competent level of nursing care that demonstrates the critical thinking model.

Standards of Professional Performance

Describes a competent level of behavior in a professional role.

Professional Roles and Responsibilities

1. Autonomy and Accountability
2. Caregiver
3. Advocate
4. Educator
5. Communicator
6. Manager

Autonomy

Initiation of independent nursing interventions without medical orders

Accountability

Responsible professional and legally for the things you do.

Autonomy Example

Patient is uncomfortable, so we sit them up in the bed to make them more comfortable, we don’t need an order for this.

ANA Standards of Nursing Practice

1. Assessment
2. Diagnosis
3. Outcomes
4. Planning
5. Implementation
6. Evaluation

Assessment

The RN collects pertinent data and info. Relative to the healthcare consumers health or situation.

Diagnosis

The RN analyzes data to determine the diagnosis.

Outcome Identification

RN identifies expected outcomes for a plan individualized to the patient.

Planning

RN develops a plan encompassing strategy to achieve expected outcomes

Implementation

RN implements the care plan.

Evaluation

RN evaluates progress toward attainment of goals and outcomes.

Code of Ethics

What is right and what is wrong.

Advanced Practice RNs

1. Nurse Practitioner
2. Certified Nurse Midwife
3. Certified Nurse Anesthetist
4. Clinical Nurse Specialist

Florence Nightingale

* Organized the first nursing school
* First practicing epidemiologist
* Improved sanitation in battlefield hospitals
* Established the first nursing philosophy on health maintenance and restoration.

Clara Barton

Founder of the American Red Cross

Doretha Lynde Dix and Mother Bickerdyke

* Organized hospitals and ambulance hospitals for wounded soldiers.
* Created the first ambulance service.

Harriet Tubman

* The Underground Railroad
* Served as nurse during the Civil War for African American slaves

Mary Mahoney

* First professionally trained African American Nurse.

Isabel Hampton Robb

* Founder of the Nurses Association (ANA)

Lillian Wald and Mary Brewster

* Opened the Henry Street Settlement which focused on the poor people of New York.
* Essentially opened the first clinic.

Mary A. Nutting

First nursing professor at Columbia college.

Florence Nightingale’s Environmental Theory

Environmental as the focus of nursing care.

Dorothea Orem’s Self Care Deficit Nursing Theory

* Focuses on patient’s self-care needs.
* Continually assess how much self-care a patient is able to perform.

Madeleine Leininger’s Culture Care Theory

* Theory of cultural care, diversity, and universality.
* Integrates patients’ cultural traditions, values, and beliefs into care plans.

Callista Roy’s Adaption Theory

Nurses help patients to come with or adapt to changes.

Hildegard Peplau’s Interpersonal Theory

Focus on therapeutic interpersonal relations between nurse, patient, and patient’s family.

Jean Watson’s Caring Theory

Focuses on caring as a fundamental component of professional nursing.

Quality and Safety Standards for Nurses

Prepares future and advanced nurses to have the skills and mindsets to improve the quality and safety of healthcare systems within where they work.

False

True or False: Nursing is a set of specific skills.

False

True or False: Care among patients should be standardized among patients.

American Nurse Association (ANA)

* Represents the 3.6 million nurses in the United States.
* Fosters high standards of nursing practice.
* Promotes the rights of nurses in the workplace.
* Projects a positive, realistic view of nursing.
* Lobbies Congress, and federal regulatory agencies.
* Writes issue briefs expressing opinions on the effects of laws, and rules on nurses, and patients.
* Publishes documents that serve as guiding principles and standards for RNs.

National League for Nurses (NLN)

* First nursing organization in the United States, founded in 1893.
* Their mission is to promote excellence in nursing education to build a strong, diverse nursing workforce to advance health in the United States and around the world.
* Nursing education programs, faculty, nurse and non-nurse leaders in nursing education.
* Program membership includes practical nursing, associate degree, BSN, MSN, and doctoral programs.
* Member Services:
* Professional development
* Research
* Student exam services
* Nurse educator certification
* Public policy
* Networking

National Student Nurses Association (NSNA)

Considers issues that are important for students. Do activities with other professional organizations

Accreditation Commission for Education in Nursing (ACREN)

Accredits clinical doctoral, master’s, baccalaureate, associate, diploma, and practical education programs.

Nurse Practice Act (NPA)

* Overseen by State Boards of Nursing
* Regulates the scope of nursing practice for the state
* Protect public safety, health, and welfare. Particularly, by shielding the public from unqualified nurses.

National Council Licensure Exam (NCLEX)

* Must be taken by BOTH LPNs and RNs.
* Provides a national minimum standard for nurses.
* Once you have sat for it you do not need to retake it in another state.

Continuing Education for Nurses

* Required training hours that update your knowledge about the latest research, specializations, and skills.
* Get credit for these hours.

In-Service Education for Nurses

* Instructions of training provided by a healthcare agency or institution (in-house)
* Designed to increase your info with a particular product, skill, or policy.

Theory

Explains an event by defining ideas or concepts, explaining relationships among the concepts, and predicting outcomes.

Nursing Theory

Conceptualizes an aspect of nursing to describe, explain, predict, or prescribe nursing care.

Link between theory and knowledge development

Nursing knowledge is theoretical and experimental.

Theoretical Knowledge

Goals are to stimulate thinking and create a broad understanding of nursing science and practice.

Experimental Knowledge

Based on nurses’ experiences in providing care to patients.

Relationship between nursing theory and nursing research

* Theories provide direction for nursing research.
* Build the knowledge base for nursing, which is then applied to practice.
* Refines the knowledge base of nursing.
* Nurses incorporated research-based interventions into theory-based practice.

Evidence-based Practice

Problem-solving approach to clinical practice that combines the best evidence with a clinician’s expertise, patient preferences, values, and healthcare resources in making decisions about patient care.

True

True or False: An article older than five years is no longer valid.

Steps of Evidence-Based Practice

1. Cultivate a spirit of inquiry
2. Ask a clinical question PICOT format
3. Search for the most relevant evidence
4. Critically appraise the evidence you gather
5. Integrate all evidence with your clinical expertise and patient preferences and values
6. Evaluate the outcomes of practice decisions or changes using evidence
7. Share the outcomes with others

PICOT Format

P- Patient Population

I- Intervention of interest

C- Comparison of interest

O- Outcome

T- Time

Intervention of interest

Identify the underlined part below as a part of the PICOT format:

\
In adult patients with total hip replacements, how effective is __pain medication__ compared to aerobic stretching in controlling postoperative pain during the perioperative and recovery time?

Patient Population

Identify the underlined part below as a part of the PICOT format:

\
In __adult patients with total hip replacements__, how effective is pain medication compared to aerobic stretching in controlling postoperative pain during the perioperative and recovery time?

Time

Identify the underlined part below as a part of the PICOT format:

\
In adult patients with total hip replacements, how effective is pain medication compared to aerobic stretching in controlling postoperative pain during the __perioperative and recovery time__?

Outcome

Identify the underlined part below as a part of the PICOT format:

\
In adult patients with total hip replacements, how effective is pain medication compared to aerobic stretching in c__ontrolling postoperative pain__ during the perioperative and recovery time?

Comparison

Identify the underlined part below as a part of the PICOT format:

\
In adult patients with total hip replacements, how effective is pain medication __compared to aerobic stretching__ in controlling postoperative pain during the perioperative and recovery time?

Nursing Research

* A way to identify new knowledge, improve professional education and practice, and use resources effectively.
* Many professional and specialty nursing organization support the conduct of research for advanced nursing science.

EBP

Use of information from the research and other sources to determine safe and effective nursing care with the goal of improving patient care and outcomes.

Research

Systematic inquiry answers questions, solves problems, and contributes to the generalizable knowledge base of nursing; may or may not improve patient care.

Performance Improvement

Improves local work processes to improve patient outcomes and health system efficiency; results are usually not generalizable.

Nurse Midwife

Provides independent care, including pregnancy and gynecological services.

Clinical Nurse Specialist

Expert clinician in a specialized area of practice such as adult diabetes care.

Nurse Practitioner

Provides comprehensive care, usually in a primary care setting, directly managing the medical care of patients who are healthy or have chronic conditions.

Nurse Anesthetist

Plans and delivers anesthesia and pain management to patients across the life span.