206 discipline and profession midterm (copy)

code of ethics professional values

-providing safe, compassionate, competent and ethical care

-promoting health and wellbeing

-promoting and respecting informed decision making

-honouring dignity

-maintaining privacy and confidentially

-promoting justice

-being accountable

NSCN transition to practice

this doc. was made to inform future nurses and others the general expectations and requirements of RNS

fundamental to provision of safe, competent, compassionate, and ethical care.

consists of:

cognitive: remember things over time, problem solve, develop professional judgement

behavioural: manage own self behaviour, deal with stress and conflict, appropriate conduct when working with patients, part of a team, time management

communication: understanding medical knowledge
recognize non verbals,

interpersonal: develop professional relationships with others for the purpose of education, support and counselling, recognize needs of clients and colleagues, maintain inter professional boundaries.

physical: hand eye coordination , good body mechanics.

sensory perceptual: using senses

environmental

transition to practice

after grad. and throughout nursing career you must meet entry level competencies and ensure continuing competence.

transition to practice, standards of practice

minimal professional practice expectations for any registered nurse

what are the 5 standards of practice

1. responsibility and accountability
2. knowledge based practice
3. client centred relationships
4. professional relationships and leadership
5. individual self-regulation

what is a boundary crossing?

Boundary crossings are brief excursions across professional lines of behavior made while attempting to meet a client’s therapeutic need. They may be inadvertent or purposeful; however, even when the action or behaviour may appear to be appropriate, it is not acceptable if it benefits the nurse and not the client.

ex: accepting gifts, giving gifts, use of social media with clients

what is a boundary violation?

Boundary violations are a breach of trust in the nurse-client relationship. Boundary violations occur when a nurse’s actions exploit the professional relationship to meet their own personal need at the expense of the client. Boundary violations are serious and often result in licensing sanctions. Boundary violations can result when there is confusion between the role of the nurse and the needs of the client.

they are never acceptable

ex: romantic or sexual relationships, borrowing or attempting to borrow money, situations where client cares for the nurse etc.

what is the Canadian Nurses Protective Society? (CNPS)

the can. nursing professions own legal support system,
non profit, created and operated for nurses by nurses.

occurrence based: RNs can seek help from the CNPS in respect of any incident in nursing practice

what is infoLAW

it is a CNPS publication that gives valuable legal risk management topics to nurses. it has topics from a diverse number of law-related challenges nurses face everyday.

why is mindfulness important in nursing

Mindfulness-based programs can help nurses develop skills to manage clinical stress and improve their health; increase overall attention, empathy, and presence with patients and families; and experience work satisfaction, serenity, decreased incidental overtime, and reduced job burnout

who is Florence nightingale gale?

the founder of modern nursing in Britain in the 19th century.
her focus was to improve standards of nursing care

she caused a decrease in morbidity and mortality due to better hygiene practices and comfort during the war

she elevated the status of nursing and as a result women were able to work outside the home.

environmental theory

used data to change practices that contributed to lowered morality rates (EBP)

what is thinking reflexivity?

challenging our own beliefs and assumptions about the world and our practice. it is about critical reflection using various lenses to view the world, feminist, anti-racist, social justice etc.

what is reflection on action

happens when we think back to what we did in the past and consider how we contributed to an outcome, pos or neg.
we examine for hidden assumptions or knowledge gaps on specific actions that were successful or not.

this informs future action and practice.

what is reflection in action?

this happens in the moment as we are carrying out an action. it helps us to think about if we are considering all of the assumptions and evidence acting appropriately.

indigenous perspectives

as you examine the history and evolution of nursing think about the contributions of indigenous people and how nursing is shaped by indigenous knowledge and how this knowledge can help reform the systems we live in including the healthcare system.

(circle model)

who were the first "nurses"

-the first European settlers that took care of sick people were men

-jesuits priests also served in nursing roles, they tried to convert indigenous people to Christianity. they tended to people with smallpox (brought over by europeans) and nursed people injured in the war with haudenosaunee.

- but as care needs increased, especially related to women in labor, female religious orders came from France to provide this needed care.

indigenous healing and birthing knowledge was relied upon, but assimilation (combining cultures) but this caused loss of valuable cultural knowledge and knowledge of traditional healing methods.

the political goal of this time period was to get rid of indigenous culture

who was Marie Rollet Herbert?

from France, was the first European woman in the haudenosaunee (indigenous) territory to provide nursing care (1600s)

she provided nursing care to indigenous people as well as settlers

taught indigenous children

she questioned the notion that indigenous peoples were in need of "saving" and actually sought their knowledge in the care of the ill

equality and social justice was a theme that was prominent from our early nursing history

what was the first nursing mission?

in 1639, the first nursing mission was established in Quebec City by 3 nuns. they provided care for indigenous people as well as settlers.
typhoid and cholera were rampant in the early days, diseases brought from Europe.

this mission later evolved into hotel-diet hospital, under the leadership of Jeanne Mance

what attributes were common to early nurses?

compassion, altruism (selfless giving and concern for the wellbeing of others)
strong ethical and moral compass
integrity and advocacy

first nursing school

1874, in Ontario, St. Catherine's general and marine hospital nurses home

who is jean Mance?

arrived in 1641 and founded the hotel dieu hospital, she is the founder of nursing in Canada
CNA's highest award is in her name

who is Marguerite d'youville

she formed the "sisters of charity" grey nuns in 1747. assisted the poor
-first visiting nurses, (outside of hospital setting)

who is Mary Seacole?

Jamaican doctress/nurse/business woman
used west African healing methods learned from her mother
knew the importance of the hygienic practice to reduce spread of disease before Florence nightingale.

- she traveled widely to provide care during infectious outbreaks and to soliders on the front lines where she met Florence nightingale.

-she was met with racial discrimination and obstacles which makes her contribution all the more noteworthy.

-note the absence of women in colour in textbooks relating to nursing history, this is a form of reflexive thinking

what happened in 1905 and 1908?

1905: first nursing journal was published
1908: Mary agnes snively was the first president of the CNA

who was Mary Agnes Snively?

superintendent of nurses at Toronto general hospital's school of nursing

established the first nursing student residence and strong curriculum.

co founded the international council of nurses and was its honorary treasurer from 1900-1904

founded and president of the CNA of trained nurses from 1908-1912.
later named CNA.

who was Jean I. Gunn

recognized for her contributions to public health in Canada, France, and England.

she encouraged students to take post graduate courses in public health nursing

promoted registration, licensure & standards & professionalization of nursing

had many of awards

what was the victorian order of nurses?

in 1897 the Victorian order of nurses was established
it was non profit
fully trained in midwifery and district nursing

what was the 1932 study by Dr. George Weir?

it was the first national study on nursing education
it found that hospital-nursing schools turned out a disciplined workforce but did not provide the quality of education.

he concluded that nursing education should be placed within the general education system (uni)
and the mn requirement should be 4 years of high school
followed by 3 years of nursing training.

it established people to talk about nursing as a profession

in Antigonish:

the sisters of st Marthas founded the hospital in 1901
and a hospital training school

they founded our uni program in 1926

nursing in the 1940s:

during World War II. nurses served overseas in military hospitals

this shortage of nurses back at home results in shorter programs (LPN)

1948: CNA established a demonstration school, independent of the metropolitan general hospital to prepare nurses in 2 year period.

nursing in 1950-1960s

baby boom years, few nurses attended uni
uni, developed first masters program in 1959
but enrolment was small, most people went into the 2 year program,

1957-Hospital and Diagnostic Services Act.. Covers expenses of hospital care
1968- Medicare act-covers expenses of physician care

at this time women were still encouraged to leave workforce to have babies

women fighting for rights, like right to vote

nursing in the 1960s-1970s

there was a massive proliferation of hospitals

healthcare was seen as being associated to the hospital
it was only free if it was in the hospital.

what came from the Lalonde report in 1974?

it gave a new perspective on healthcare
shifted from hospital, medical based model
4 health fields,
lifestyle, environment, health care organization, human biology.

what has happened to nursing since 1989?

nursing has moved from2-4 year diploma, uni

the RN diploma nursing schools closed in 1995

first doctoral program in nursing established in canada
university of Alberta.

education needs to be revised to meet needs of our changing society. (aging) advances in tech, early discharge issues

we need to develop complex, multi faceted care in the client's home.

what is the role of the NSCN?

it is given authority of the provincial governement to regulate the practice of nursing to protect the public

The 2018 RN act is what allowed them to have this authority, the authority to be the regulators for LPNS as well as RNS NPs

this authority is a privilege, both the regulatory body and each of it's members are responsible for self regulation and for upholding their commitment to adhere to laws, regulations and codes and expectations for the profession.

what are the NSCN entry level competencies?

Clinician
Professional
Communicator
Collaborator
Coordinator
Leader (leadership)
Advocate
Educator
Scholar

what is the NSCN professional conduct

Addresses complaints against nurses in the best interest of the public

NSCN licensure

NCLEX (measures entry level competence)
RN & NP jurisprudence exam, open book test 100 questions,
(tests understanding of provincial and regulatory policies and any provincial and federal laws related to nursing in NS)

what are the NSCN standards of practice?

Being responsible and accountable:
Registered nurses are responsible to practise safely, competently, compassionately and ethically and are accountable to clients, the employer, the profession and the public.

Using knowledge to provide care
Registered nurses practise using evidence- informed knowledge relevant to their legislated and individual scope of practice to provide client-centred nursing care and services.

Establishing a professional and therapeutic relationship (client centred relationship):
Registered nurses establish professional and therapeutic relationships using a client-centred approach

Being a leader and establishing professional relationships:
Registered nurses establish professional relationships with health care team members and demonstrate leadership to deliver quality nursing and health care services.

Being accountable to self-regulate:Individual registered nurses are accountable to regulate themselves in accordance with their legislated and individual scope of practice.

what are the NSCN code of ethics?

it is informative and regulatory and it informs others about the ethical values and responsibilities of nurses. intended for all nurses in all areas and domains

A. Providing Safe, Compassionate, Competent and Ethical Care
-nurses in compassionate care through body language, question, intervene, and report things when needed, they are honest and prevent patient accidents and learn from near misses

B. Promoting Health and Well-Being
Nurses provide care directed first and foremost toward the health and well- being of persons receiving care, recognizing and using the values and principles of primary health care.

C. Promoting and Respecting Informed Decision-Making
Nurses recognize, respect and promote a person’s right to be informed and make decisions.

D. Honouring Dignity
Nurses recognize and respect the intrinsic (essential) worth of each person.

E. Maintaining Privacy and Confidentiality
F. PromotingJustice
safeguarding, human rights, equity and fairness

G. Being Accountable

these 7 values are related and overlapping

what is primary healthcare?

a philosophy and approach that is focusing to improving the health of all canadians and the effectiveness of health service delivery in all care settings. it focuses on the way services are delivered and puts the people who receive those services at the centre of care. [Essential principles include] accessibility;
active public participation;
health promotion and
chronic disease prevention and management;
use of appropriate technology and innovation; intersectoral cooperation and collaboration”

what is the CNA and the CINA?

CNA: the national and global professional voice of canadian nursing, includes a membership.
within the CNA there is also the Canadian nursing students association which is the national voice for nursing students


CINA: Canadian Indigenous nurses association, the goal is to improve the health of indigenous people by supporting indigenous nurses and promoting the development and practice of indigenous health nursing.

how did the history of nursing education shift?

It shifted from being taught by physicians and having student be their apprentices to a hospital based program. most hospitals regardless of size and area had a nursing school.

university and nursing history

-the first uni program in can was in BC in 1919.
it focused on the theoretical aspects of nursing
students studied for a year and then moved to hospitals for hands on training

the Canadian Red Cross funded 1 year programs in public health for graduate nurses at Dalhousie, mccill, Toronto, western, Alberta and UBC.

1970-1980s nursing education

in this period non uni diploma programs gradually moved from hospital schools of nursing into community colleges.

from the mid 1980s, collaborative partnerships and programs were created between colleges and unit. this resulted in collaborative or joint baccalaureate degree programs in nursing.

the baccalaureate nursing degree

desired and required standard in all provinces but Quebec
still a large # of diploma prepared nurses in can.
the number of grads has steadily increased since 2000.

graduate nursing program

the 1st masters program, 1959, university of western Ontario
1st PhD program, 1991, uni of Alberta

what is important to know for career planning. (CNA-nurse one site)

its important to have self awareness, know who you are
-values
-likes and dislikes
-skills and attributes
-strengths and weaknesses

CNA certifications

22 nursing specialties
gain advanced knowledge of each speciality
gain credibility

Canadian association of schools of nursing (CASN)

speaks for Canadian nursing education and scholarship
it establishes and promotes national standards of excellence of nursing education
promotes the advancement of nursing knowledge
facilitates the integration of theory, research and practice
contributes to public policy
it provides a national forum for issues in nursing education and research

research within nursing

advances nursing knowledge and the profession and this leads to improved healthcare

it involves asking a question, collected data and presenting results

needs to begin at the baccalaureate level

starts with knowledge translation- application of research to nursing practice (taking what you learn and applying it to your work clinically)

nursing admin

In earlier years head nurses ran nursing units and had a lot of power, in the 1990s head nurse positions were reduced/eliminated

the new model is now inter professional teams and shared power
directors of nursing became program managers or professional nurse leaders not part of the senior leadership team

nursing identity formation became even more relevant in the context of inter professional practice.

social forces and inmates-1960s

changes happened in the perception of women and nurses
women were gaining control of their sexuality and reproductive rights

women started making advances in their careers but this empowerment of women gave rise to other competing images of women and of nurses

male nurses are also stereotyped

cna and improving the image of nursing

what can nursing students do?
there is a disconnect in the media about what nurses do.
we can educate others and when stereotypes are wrong.

what is professional presence?

it means acting with confidence, integrity, optimism, passion and empathy in accordance with professional standard guidelines and code of ethics

it includes professional reflective practice, verbal and nonverbal communication, communication and the ability to demonstrate positive role and professional image

how can professional presence be demonstrated?

active listening
attentiveness
therapeutic touch
empathy
caring
compassion
recognition of the clients psychological, psychosocial, and physiological needs
respect
integrity
understanding a clients cultural context and demonstrating cultural competence

it is about being aware of the nursing image you portray to other team members. professional presence includes developing positive and effective collaborative relationships with other nurses, health care team, regulatory body, government, associations or unions

Caring the human mode of being
(the 6 c's of caring)

1. compassion
2.competence ( the ability to do something efficiently or successfully)
3.confidence
4. conscience
5. commitment
6. comportment

the person who developed this influential theory of caring was sister Simone roach, she made the first code of ethics for nurses in can.
she spent 9 years building the Stfx nursing department

what are the 5 common qualities in the therapeutic nurse-client relationship

1. trust
2.respect
3. act in client's best interest
4. professional intimacy
5.power (nurses are responsible to recognize the power imbalance within the therapeutic relationship and be ware of the chance that the person may feel intimidated or dependant.

what is career development?

the ongoing process of managing your life, learning and work.
it involves developing skills and knowledge that enable you to plan and make informed decisions about your education and career choices

as a nursing student we should start to develop:
study strategies, time management, learning plans, portfolio Development

right touch regulator

by the NSCN, applying the minimal amount of regulatory force required to receive a certain outcome.

what is a learning plan?

it is a plan of how to meet a certain learning need
they are roadmaps for professional development

what are the CCP steps for RNS and NPs

1. complete a self reflection
2. complete a self assessment
3. develop a learning plan
4. participate in the audit process if selected

student learning plan steps:

1. identify learning needs
2.develop smart goals
3. identify and complete your learning activities
4. evaluate changes to your practice
5. reflect on your practice and get input from colleagues

what does a smart learning consist of?

1. specific, everyone reading should know exactly what you want to learn
2. measurable, quantifiable meaning you can see the results
3. attainable, can be achieved based on your skill and resources
4. relevant, applies to your current role and is clearly linked to your key role responsibilities
5. time limited, has specific timelines and a deadline. this will help motivate you to your goal and evaluate your progress.

how to write a smart learning goal?

1. start by identifying what you want to learn:
use action words (identify, develop, plan etc.)
2. make Sure it's realistic, related to your practice, reasonable time frame
make sure its what you need to learn and not a learning activity

once you have selected a goal, select a practice document. (ex. reading a journal, shadowing, simulation etc.)

now you have activity statements, you can complete the learning activites

portfolio development what is it and it's benefits?

it is a method to demonstrate your knowledge and abilities

benefits:
-bring to job interview to demonstrate what you have learned in your program

-helped you to build your resume

-having a record of transferable skills you possess

-allowing you to review what you have done and reflect on your practice requirements

-preparing you to participate in continuing competence programs required by regulatory bodies for licensure.

what is continuing competence and why is it important?

Entry-level RNs realize the importance of identifying what they know and do not know, what their learning gaps may be, and how and where to access available resources. They display initiative, a beginning confidence, and self-awareness in taking responsibility for their decisions in the care they provide

having that career Long knowledge and skill and reflecting on this.

what is knowledge based practice?

registered nurses practice using evidence informed knowledge relevant to their legislated and individual scope of practice to provide client-centred nursing care and services.

evidence based care: using evidence with clinical expertise as well as the wishes of the patient to improve health outcomes. we use this process in the nursing (ADPIE) process

Is it not a formula for approaching all situations
and a replacement for nursing assessment of a situation or individual.

practice that includes the best available evidence taken from
research, reports (grey literature), patient preferences, expert opinion. paired with competence and context of clinical practice.

what is external vs internal evidence?

evidence: collection of facts believed tending to prove or disprove a conclusion

external: generated from research

internal: generated from practice and managing outcomes

healthcare before EIP

healthcare was guided by expert opinion
ex. Oliver wendell believed women were dying in childbirth
because of germs on hands of doctors, no research was done to come to this idea.

Semmelweis

doctor in 1800s that determined that the cause of fever in women after delivery was infection due to poor hand hygiene

who was Archie Cochrane?

he was a British epidemiologist who stated that people should only pay for healthcare that is based on scientific evidence.

established the Cochrane centre:
research evidence needed to be prepped systematically

why is the need for ELP increasing?

pandemic
new inventions, interventions, meds, treatments
focus on patient safety
increased quantity of research

expert opinion and experience may have worked in the
past, but with the current state of health care has increased the need.

with new inventions being continually published there are less "experts"

who are consumers of evidence?

we are, nursing students, nurses etc

evidence is used to make policies and procedures

sources of evidence and were to find them:

research articles- medical databases

websites- search engines

clinical/ best practice guidelines- nursing and health organizations

electronic health records and other point of care systems-
hospital health info systems

pre printed orders, clinical pathways- hospital charts

pyramid of info sources level of detail from lowest to highest

1. systems (electronic links, patient records per ex)
2.summaries (text based specific to disease or condition)
3.synopses of synthesis (brief reports of pre appraised studies)
4. synthesis (systematic reviews of all studies)
5. synopses of studies (specific studies/ research -greatest range of info)
6. studies ( " " )

levels of evidences:

1. clinical trials, systematic reviews, meta analysis

2. well designed RCT (randomized controlled trial)

3. control trial without randomization

4. single non experimental study (case control, cohort study)

5. systematic reviews of descriptive and qual studies

6. single descriptive of qualitative study

7. expert opinion, committee

2 ways to search for internet evidence

1. identify credible websites and search through them

2. use big search engine like google and search your topic and filter through results

both of these require you to be able to assess the quality of the source

how to review a website for quality

Organization and purpose
Author credentials and bias
Accurate and verified content
Website and content maintained and current
Clear references –check them out!
Valid recommendations

non profit usually has credible info, while others may be trying to sell you a product

"last updated" to show it's current (within 5 Years is needed)

steps of evidence informed practice

Reflection!
Frame the question
Search for and collect the most relevant best research evidence
Critically appraise the evidence
Synthesis of findings from divergent literature
Adaptation of findings to practice
Implementation of practice change
Evaluation

the 3 types of evidence based practitioners and which do they want us to be?

1. reflection novice:
very basic reflection, largely descriptive
reflection on superficial level, existing knowledge base including differing theories but does not make any comments or critique on them.

2. Aware practitioner: takes a step back from what happened and starts to explore thoughts, feelings, assumptions, and gaps in knowledge. they make sense of what they have learned and what they might have to do in the future

3. reflective practitioner: most depth. shows the experience has created a change within a person, they need to be ware of the relevance of multiple perspectives from contexts beyond the chosen incident. how how this learning will impact on other situations. evidence/literature is needed to substantiate ideas, strategies (we want to become this one)

-look at examples on power point

what is a PICO question?

P: patient/problem
I:intervention
C: compassion
O: outcome

define leadership

the process of pursuing and influencing the thoughts, feelings, and behaviours of others regarding a course of action

-this is a core entry level competency
-does not require an formal position

what are formal leaders?

those in a position within an organization that have an authority, as well as a position description that outlines the description of the job

ex. management positions, board members, officers

what are informal leaders?

people who do not have this designated admin or management position, recognized by supervisors and peers because of their capabilities and actions.

comes from passion not position, any nurse that guides a group of people toward achieving goals and outcomes.
ex: clinical leader on nursing unit, mentor, clinical leader

why is leadership important in nursing?

to prepare us for the expectations of the professional nurse. critical component of nursing, nursing roles have expanded making leadership skills more important than ever.

nurses solve problems on the micro (patient level) and macro level (organizations, populations)

trait/great man theory

leaders are born not made, leadership qualities ae just acquired

style theory

considers what leaders do, they engage in 2 types of behaviour, task and relationship behaviours
how the leader combines these determines their effectivenes.

situational contingency theory

defining types of situations where certain leadership styles are more appropriate. this theory helps management choose leaders suited to guide the company to success.

transactional (theory)

follower expects a reward in exchange for effort

transformational (theory)

leaders and followers work together to set higher goals and work together to achieve them

autocratic (theory)

leader makes all the choices

democratic (theory)

equally considers groups opinions

laissez faire (theory)

group makes the choices not the leader, leaves the group to do it them themselves

hierarchy of needs (theory)

physiological needs must be taken care of first

two factor theory

working conditions are important for the motivation of employees, certain factors in the workplace cause job satisfaction some don't

expectancy theory

good outcomes motivate people. people are motivated by their conscious expectations of what will happen if they do certain things and are more productive when they believe their expectations will be realized.

organization behaviour modification (theory)

managers identify performance related employee behaviours and then implement an intervention strategy to strengthen desirable behaviour and weaken undesirable behaviour

shared (theory)

used work with teams, staff are empowered, to distribute leadership responsibilities within the group.

coercive (style)

use threat to punish leaders monitor workers. more women respond to this than men