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Nursing Professionalism and Practice: Key Concepts from Lecture Notes

Nursing as both Art and Science

  • Nursing is both an art and a science.

  • Core values: Compassion, Caring, Respect.

  • Also grounded in Science: Body of knowledge, Evidence-based practice.

Benner's Novice to Expert

  • Stages:

    • Novice: Just starting, no previous experience.

    • Advanced Beginner: Minimal experience, observes.

    • Competent: Has practiced in same area 2-3 years; experienced with a wide range of psychomotor skills.

    • Proficient: > 3 years of experience; manages care.

    • Expert: Diverse experience; intuitive practice.

  • Objective: Develop critical thinking skills.

Scope and Standards of Practice

  • American Nurses Association (ANA).

  • Scope: Actions, procedures, processes appropriate to level of practice.

  • Standards of Nursing Practice:

    • Assessment

    • Diagnosis

    • Outcomes identification

    • Planning

    • Implementation

    • Evaluation

  • The Nursing Process: Model for clinical decision-making.

Standards of Professional Performance

  • Ethics

  • Culturally congruent care

  • Communication

  • Collaboration

  • Leadership

  • Education

  • Evidence-based practice and research

  • Quality of practice

  • Professional practice evaluation

  • Resource utilization

  • Environmental health

Code of Ethics

  • Philosophical ideals of right and wrong.

  • Code of Ethics for Nurses; ANA; Fowler, 2025.

  • Guide to providing quality nursing care.

  • Ethical obligations in nursing practice.

Professional Responsibilities

  • Autonomy: Independent nursing interventions without medical orders.

  • Accountability: Accept responsibility; professional and legal.

  • Caregiver: Provide evidence-based care; promote physical well-being; restore emotional, psychological, spiritual, social health holistically.

  • Advocate: Act in patient’s best interest; defend patient autonomy and self-determination.

  • Educator: Provide education related to diseases, care, self-management.

  • Communicator: With patient, family, health care professionals.

  • Manager: Coordinate nursing care.

Nursing Careers

  • Advanced Practice Registered Nurses (APRNs):

    • Clinical Nurse Specialist

    • Nurse Practitioner

    • Certified Nurse Midwife

    • Certified Registered Nurse Anesthetist

  • Nurse Educator

  • Nurse Administrator

  • Management and business

  • Nurse Researcher

Nursing Shortage

  • Causes:

    • Lack of nursing faculty

    • Competition for available seats in nursing programs

    • Issues related to clinical sites

    • Healthcare organizations: recruitment and retention challenges

    • Nursing burnout

Historical Influence: Florence Nightingale

  • Notes on Nursing: What It Is and What It Is Not — first philosophy of nursing.

  • Responsibilities: Responsible for someone’s health; knowledge of disease; help recovery.

  • Established first nursing education programs.

  • Crimean War: She walked battlefield in Scutari, Turkey carrying a lamp.

  • Observations: Soldiers wounded yet otherwise healthy were dying due to sanitation, nutrition, wound management shortages.

  • Action: Gathered information, developed statistical data, presented to government.

  • Impact: Reforms reduced mortality from 42.7% to 2.2% in 6 months.

  • Significance: First nurse epidemiologist.

Mortality Diagram and Environmental Health Determinants

  • Diagram of causes of mortality in the army in the East (April 1854 to March 1855; April 1855 to March 1856).

  • Key components:

    • Blue wedges: deaths from preventible or mitigable zymotic diseases.

    • Red wedges: deaths from wounds.

    • Black wedges: deaths from all other causes.

  • Interpretive notes:

    • In October 1854 and April 1855, the black area coincides with the red area.

    • In January and February 1855, the blue area coincides with the black.

  • How to read: The entire areas can be compared by following the blue, red, and black lines enclosing them.

  • Contextual takeaway: Highlights environmental health determinants and preventable deaths.

Additional Historical Figures and Developments

  • Clara Barton: Red Cross.

  • Dorothea Dix: supervised army nurses during the Civil War; created mental asylums.

  • Mary Ann Bickerdyke: supervised hospitals during Civil War.

  • Mary Mahoney: cultural diversity.

  • Jessie Sleet Scales: public health nursing.

  • Isabel Hampton Robb: American Nurses Association (ANA).

  • Lillian Wald: public health nursing and school nursing; with Mary Brewster, opened Henry Street Settlement.

  • Mary Adelaide Nutting: nursing education in higher education settings; identified need for research-based nursing knowledge.

  • Army and Navy Nurse Corps.

  • Specialty nursing organizations.

Today’s Issues in Nursing

  • Changing societal needs.

  • Aging population.

  • Bioterrorism and disasters.

  • Emerging infectious diseases.

  • Technology.

  • End-of-life care.

Influences on Nursing Practice

  • Health care reform and costs.

  • Delivery of services shifting to community and home settings.

  • Focus on health promotion, disease prevention, and illness management.

  • Resource gaps and service gaps.

  • Costs for care and medications.

  • Demographics:

    • Aging population.

    • Racial and ethnic diversity.

    • Chronic disease prevalence.

    • Medically underserved populations and access issues.

    • Unemployment, low-paying jobs, mental illness, homelessness, rising health care costs.

Self-Care and Wellness for Nurses

  • Physical and emotional demands of nursing.

  • Compassion fatigue, burnout, and secondary traumatic stress.

  • Secondary trauma stress: stress from observing patients’ suffering.

  • Burnout: physical and mental exhaustion due to perceived resource-demand mismatch.

  • Lateral violence: nurse-to-nurse aggression (verbal and non-verbal).

Trends Shaping Nursing

  • Evidence-Based Practice (EBP).

  • Quality and Safety Education for Nurses (QSEN).

  • Technology integration.

  • Genomics.

  • Public perception of nursing.

  • Nurses’ impact on politics and health policy.

Becoming an RN: Pathways and Licensure

  • Prelicensure tracks:

    • Associate degree: approximately 2 years; basic science, theory, clinical courses.

    • Baccalaureate degree: approximately 4 years; basic science, theory, clinical, arts, humanities, social sciences supporting nursing theory.

  • Completion of one program and passing NCLEX-RN.

Continuing and Advanced Education

  • Graduate level:

    • Master’s degree

    • Doctoral degree

  • Continuing education:

    • Updating knowledge; may be required to renew nursing license.

  • In-Service education:

    • Provided by employer; updates on new devices, techniques, etc.

Nurse Practice Acts (NPA)

  • Each state regulates nursing practice within the state.

  • Focus of NPA: public safety, health, welfare.

  • Nurses must practice according to their state’s NPA.

  • Licensure: Pass NCLEX; may obtain specialty certification (e.g., medical-surgical, pediatrics, oncology).

Professional Nursing Organizations

  • American Nurses Association (ANA).

  • National Student Nurses Association (NSNA).

  • Specialty nursing organizations.

  • Role: Address concerns of those practicing in nursing.


\text{Mortality reduction observed during Nightingale reforms: } \text{Initial mortality } = 42.7\% , \text{Final mortality } = 2.2\% \
\text{Reduction factor} = \frac{42.7 - 2.2}{42.7} \approx 0.9495 \Rightarrow \approx 94.95\% \
\text{Hence, mortality decreased by about } 94.95\%