Fundamentals of Nursing Review

Nursing as a Profession

  • Definition and Nature of Nursing: Nursing is not merely a collection of specific skills or being trained to perform tasks; it is a PROFESSION. It requires a basic liberal foundation and extended education.

  • Criteria for a Profession:

    • Requires a theoretical body of knowledge consisting of defined skills, abilities, and norms.

    • Provides a specific service to society.

    • Maintains autonomy in decision-making and practice.

    • Adheres to a code of ethics for practice.

  • Professional Actions of a Nurse:

    • Utilization of critical thinking skills.

    • Administration of quality, patient-centered care.

    • Demonstration of responsibility and accountability to oneself, patients, and peers.

    • Practicing in a safe, conscientious, and knowledgeable manner.

  • Professional Organizations and Guidance:

    • Health care advocacy groups: Influence the importance of nursing's role in national health.

    • Robert Wood Johnson Foundation (RWJF): Future of Nursing: Campaign for Action.

    • The National Academies of Science, Engineering, and Medicine (NASEM, 2021): Future of Nursing 2020-2030: Charting a Path to Achieve Health Equity.

The Art and Science of Nursing

  • Requirements for Practice:

    • Current knowledge and adherence to practice standards.

    • An insightful and compassionate approach.

    • Application of critical thinking and clinical judgment.

  • Nurse Expertise: To be an expert, a nurse must know how to modify care depending on pathology and treatment while considering the patient’s unique needs and personality.

  • Benner’s Stages of Nursing Proficiency:

    • Novice

    • Advanced beginner

    • Competent

    • Proficient

    • Expert

Formal Definitions of Nursing

  • American Nurses Association (ANA): Health protection, promotion, and optimization; prevention of illness and injury; alleviation of suffering through the diagnosis and treatment of human response; and advocacy in the care of individuals, families, communities, and populations.

  • International Council of Nurses (ICN): Nursing encompasses autonomous and collaborative care of individuals of all ages, families, groups, and communities, sick or well, and in all settings. It includes the promotion of health, prevention of illness, and the care of ill, disabled, and dying people. Advocacy, promotion of a safe environment, research, participation in shaping health policy and in patient and health systems management, and education are also key nursing roles.

Historical Highlights in Nursing

  • Florence Nightingale: Recognized as the first practicing nurse; served during the Crimean War.

  • Clara Barton: Founder of the American Red Cross.

  • Dorothea Dix: Organized hospitals and supplies to the troops during the Civil War.

  • Mary Mahoney: The first African American to graduate from an American nursing school in 1878.

  • Lillian Wald & Mary Brewster: Opened the Henry Street Settlement in New York City (NYC) during the late 19th Century.

The Nursing Process and Professional Roles

  • The Nursing Process (Cyclical Model):

    • Assessment: Gathering data.

    • Nursing Diagnosis & Critical Thinking: Identifying issues.

    • Planning: Setting goals and interventions.

    • Implementation: Executing the care plan.

    • Evaluation: Determining the effectiveness of care.

  • Nurse Responsibilities and Roles:

    • Autonomy & accountability: Self-governance and taking responsibility for actions.

    • Caregiver: Providing holistic care.

    • Advocate: Protecting patient rights.

    • Educator: Teaching patients and families.

    • Communicator: Facilitating information exchange.

    • Manager: Coordinating care and staff.

    • Career development: Continuous professional growth.

Nursing Education and Outcomes

  • Educational Pathways:

    • Registered Nurse (NCLEX).

    • Graduate education.

    • Continuing and In-Service education.

  • Professional Development Examples:

    • Live webinars: Often scheduled at 7pm ET, providing 11 contact hour.

    • Unlimited Contact Hours: Programs available (e.g., 27.95 USD27.95 \, \text{USD} for one year) with access to over 130130 courses and 270270 contact hours across 2323 categories.

  • Expected Student Outcomes (CSU-Pueblo):

    1. Demonstrate caring through advocacy, recognizing the patient is the source of control.

    2. Collaborate effectively within nursing and inter-professional teams.

    3. Use nursing judgment based on the best current evidence.

    4. Demonstrate professional identity, integrity, and leadership.

  • QSEN (Quality and Safety Education for Nurses) 6 Concepts:

    1. Patient-Centered Care

    2. Teamwork & Collaboration

    3. Informatics

    4. Student-Centered Learning

    5. Quality & Safety

    6. Evidence-Based Practice (Professionalism)

Health Care Delivery System Challenges

  • Four Major Nursing Challenges:

    1. The aging baby boomer generation.

    2. Shortage and uneven distribution of physicians.

    3. High rate of nurses’ retirements.

    4. Uncertainty surrounding health care reform.

  • Traditional Levels of Health Care:

    • Preventative

    • Primary

    • Secondary

    • Tertiary

    • Restorative

    • Continuing health care

Integrated Health Care Delivery Models

  • Primary and Preventive Care:

    • Primary Health Care: Focuses on improved health outcomes for an entire population; requires collaboration and includes health promotion programs.

    • Preventative Care: Focused on reducing and controlling risk factors for disease.

  • Secondary and Tertiary Care: Provided in hospitals, intensive care (ICU), mental health facilities, and rural hospitals. Includes discharge planning.

  • Restorative Care: Home care, rehabilitation, and extended care facilities.

  • Continuing Care: Nursing centers or facilities, assisted living, respite care, adult day care centers, palliative care, and hospice care.

Current Issues in Health Care Delivery

  • Operational Issues: Health care costs, quality, patient satisfaction, nursing shortage, and staff competency.

  • Magnet Recognition Program ®: Recognizes excellence in nursing and positive nursing-sensitive outcomes.

  • Technology: Implementation of robotics and telemedicine.

  • Diversity, Equity, and Inclusion (DEI): Focus on underserved populations and social determinants of health (SDOH), including economic stability, education, healthcare access, neighborhood/built environment, and social context.

  • Future Predictions:

    • System will be consumer-centered.

    • Increased use of telehealth and digital care.

    • Decrease in physical office visits.

    • Artificial intelligence (AI) used for early detection and disease progression analysis.

Population Health and Community-Based Care

  • Community-Based Health Care: Focuses on primary care over institutional care; reaches everyone in the community and provides health promotion knowledge.

  • Social Determinants of Health (SDOH): Biological, socioeconomic, psychosocial, behavioral, or social factors contributing to health status.

  • Health Disparities: Preventable differences in a population’s ability to achieve optimal health.

  • Vulnerable Populations: Individuals in poverty, children, older adults, the homeless, racial/ethnic minorities, those being abused, substance abusers, and individuals with severe mental illness.

  • Responsibilities of the Public Health Nurse:

    • Monitor health status to identify community problems.

    • Diagnose and investigate health hazards.

    • Inform, educate, and empower people.

    • Mobilize community partnerships.

    • Develop policies and plans.

    • Enforce laws and regulations.

    • Link people to needed personal health services.

    • Assure a competent public health workforce.

    • Evaluate effectiveness, accessibility, and quality of services.

    • Research for new insights and innovative solutions.

Theoretical Foundations of Nursing Practice

  • Nursing Theory: A set of concepts, definitions, and assumptions that explain a phenomenon. They provide the rationale for HOW and WHY nurses perform interventions.

  • Relationship to Research: Research builds the scientific knowledge base which is then applied to practice; improved research leads to improved patient care.

  • Types of Nursing Theories:

    • Grand: Abstract, broad in scope, complex.

    • Middle-range: Limited in scope and less abstract.

    • Practice: Narrow in scope and focus.

    • Descriptive: Describe phenomena and identify circumstances of occurrence.

    • Prescriptive: Address nursing interventions and predict consequences.

  • Selected Theories:

    • Nightingale’s Environmental Theory: Environment as the focus of care (Grand theory).

    • Peplau’s Interpersonal Theory: Focus on relations between nurse, patient, and family (Middle-range); phases include preorientation, orientation, working, and resolution.

    • Orem’s Self-Care Deficit Nursing Theory: Focus on assessing and meeting patient self-care needs (Grand theory).

    • Leininger’s Culture Care Theory: Theory of cultural care diversity and universality (Middle-range).

    • NCSBN Clinical Judgment Model: Layers explaining the cognitive process used by nurses to make clinical judgments.

Evidence-Based Practice (EBP)

  • Definition: A problem-solving approach to patient care that integrates the best evidence from research with clinical expertise and patient preferences/values.

  • The Case for EBP: Essential in the "age of accountability" to guide effective, timely, and appropriate clinical decisions.

  • Evidence Sources: Textbooks, journals, internet resources, policies, and practice guidelines.

  • Steps of EBP:

    1. Ask clinical questions.

    2. Collect the most relevant and best evidence.

    3. Critically appraise the evidence.

    4. Integrate evidence with expertise and patient preferences.

    5. Evaluate the practice change.

    6. Share the outcomes of the EBP change with others.

  • Components of EBP Clinical Decision Making:

    • Best available clinical evidence.

    • Clinical expertise.

    • Patient preferences and values.

    • Assessment of patient history, physical findings, and available health care resources.