Introduction to Nursing Concepts

Definitions

  • Nightingale Definition: “The act of utilizing the environment of the patient to assist him in his recovery.” (Nightingale, 1860-1969)

  • Nurse (SYN):

    • Tend

    • Care for

    • Nourish

    • Nurture

    • Feed

    • Train

    • Mind

    • Attend
      (Webster’s Thesaurus, 2001)

  • American Nurses Association (2018) Definition: The protection, promotion, and optimization of health and abilities; prevention of illness and injury; alleviation of suffering through diagnosis and treatment of human responses; and advocacy in the care of individuals, families, communities, and populations.

Nursing Images Throughout History

  • Images Representing Nursing Roles:

    • Women’s Role

    • Angel of Mercy

    • Battle-Ax

    • Professional Handmaiden

    • War

    • The “Naughty Nurse”

    • Caucasian

Important Qualities of a Nurse

  • Qualities Identified:

    • Critical thinking skills

    • Caring and compassion

    • Detail oriented

    • Organizational skills

    • Speaking skills

    • Listening skills

    • Patience

    • Competence

    • Emotional stability

    • Physical stamina

Nursing as a Profession

  • Characteristics of a Profession:

    • Prolonged, specialized training to acquire knowledge to work in that role

    • Orientation toward service to others

    • Ongoing research

    • Code of Ethics

    • Autonomy

    • Professional organizations

The Roles and Functions of the Nurse

  • Roles Defined:

    • Direct care provider/caregiver:

    • Aspects include physical, emotional, spiritual care for clients & families — either direct or delegated.

    • Case Scenario: The nurse is caring for a client noted to be crying while looking at a photo. How as a caregiver can you assist this client?

    • Communicator:

    • Includes interpersonal and therapeutic communication; both verbal and written forms.

    • Ability to communicate is an absolute necessity.

    • Case Scenario: The nurse is caring for a client newly diagnosed with diabetes. What strategy can you implement merging this role?

    • Client Advocate:

    • Responsible for protecting, representing, and assisting clients.

    • Counselor:

    • Involves assisting clients and families to recognize and cope with stressors.

    • Case Scenario: A client desires to stop treatment against family wishes. How should you implement your roles as a client advocate and counselor?

    • Change Agent:

    • Assists with modifying behaviors of the client, family, or groups including nurses.

    • Leader:

    • Influences others to work cohesively to achieve a goal.

    • Case Scenario: There are negative sentiments regarding a new computerized documentation system. How can you assist others in this situation?

    • Manager:

    • Coordinates and manages activities of all team members (e.g., assigns clients to staff nurses).

    • Case Manager:

    • Oversees a caseload of clients, coordinating care (e.g., discharge services for a client).

    • Research Consumer:

    • Applies evidence-based research to enhance quality & care (e.g., by attending conferences, reading journals).

Types of Nursing Education

  • LPN/LVN: Programs typically 9-12 months, include classroom and clinical work, capped with the NCLEX-PN exam for state licensure.

    • Work under the direction of an RN, with limitations on practice.

  • RN Education Routes:

    • Diploma Programs: 3-year hospital-based programs. Minimal academic offerings.

    • Community College/AD Programs: 2-year programs initially designed to address nursing shortages during WW II.

    • Baccalaureate Degree Programs: 4-year programs integrating liberal arts, sciences, and humanities. All three education options allow graduates to take the NCLEX-RN exam but may confer varying degrees of responsibility and autonomy.

Nursing Education

  • Graduate Nursing Education:

    • Master’s Program: Typically two years; advancement through various specializations (Education, Forensics, Nurse Practitioners, Administration, etc.)

    • Doctoral Programs: Generally 3-4 years, includes PhD, EdD, or DNP programs.

Continuing Education (CE)

  • Requirement: Necessary to maintain state licensure.

    • Massachusetts requires 15 contact hours every 2 years.

    • New Hampshire mandates 30 contact hours every 2 years.

  • Purpose: To stay current in the field.

    • 1 CEU (continuing education unit) is 10 contact hours; 1 contact hour equals 60 minutes of education.

Socialization of Nursing

  • Definition: Socialization is the process through which individuals become members of groups by learning the rules, culture, and norms pertinent to that group.

  • Goal: To instill attitudes, values, and norms essential to sustaining the nursing profession.

  • Critical Values/Norms for Nurses: What essential values need to be maintained by nursing professionals?

Benner's Novice to Expert Model

  • Stages of Nursing Expertise:

    • EXPERT: Has an intuitive grasp of situations, focusing on problem areas

    • PROFICIENT: Perceives situations holistically

    • COMPETENT: Recognizes recurring meaningful situational components

    • BEGINNER: Can note important situational components but lacks prioritization

    • NOVICE: Lacks professional experience

    Benner's Novice to Expert Model

Practice Regulation

  • Nurse Practice Acts:

    • Defines nursing practice standards

    • Establishes criteria for RNs and LPNs

    • Determines scope of practice

    • Enforces rules governing nursing

  • Standards of Practice:

    • Describe the competent level of nursing practice and performance; utilized by nurses, employers, and professional organizations.

Nursing Organizations

  • Major Organizations:

    • American Nurses Association (ANA): Works to advance the nursing profession by establishing standards of nursing practice, advocating for health care reform, and promoting the welfare of nurses.

    • National League for Nursing (NLN): Aims to prepare the nursing workforce to meet the demands of an evolving health care environment through education, research, and community partnerships.

    • International Council for Nursing (ICN): Focuses on representing nursing worldwide, promoting health policies, and enhancing the global nursing workforce through leadership and collaboration.

    • National Student Nurse Association (NSNA): Promotes the professional development of nursing students by providing opportunities for leadership, advocacy, and networking.

    • Sigma Theta Tau International (STTI): A prestigious honor society that recognizes and promotes academic excellence and leadership in nursing, supporting global health initiatives and research that improve healthcare delivery.

Purpose of Nursing

  • Core Objectives:

    • Promoting health & wellness

    • Preventing illness

    • Restoring health

    • Caring for the dying

  • Exam Type Question: Which activity exemplifies health promotion?

    • a. Promoting comfort measures to a dying client

    • b. Providing hygiene care for an incapacitated client

    • c. Administering pain medication

    • d. Providing nutrition teaching to a senior center group

Models of Nursing Care

  • Types of Care Models:

    • Case Method: Total care, primarily in ICU, maternity, and private duty; one-on-one care.

    • Functional Nursing: Care tasks assigned based on team members' competencies (e.g., RN, LPN, aides).

    • Team Nursing: Collaboration between nurses and assistive personnel, managing a group of clients.

    • Primary Nursing: One nurse assigned to a client group, providing continuity of care.

    • Differentiated Practice: Care assignments based on expertise and demonstrated competencies.

Trends in Healthcare & Nursing

  • Emerging Trends:

    • Complementary & alternative medicine (CAM)

    • Variety of care settings

    • Interprofessional collaboration

    • Expanded nursing roles

    • Nursing assistive personnel

    • Healthcare policy

    • High-tech vs. high-touch approaches

Factors Affecting Health Care Delivery

  • Influences on Healthcare Delivery:

    • National economy

    • Increase in demand for services due to aging population

    • Healthcare literacy

    • Women’s movement

    • Relevant legislation

    • Collective bargaining

Evidence-Based Practice: Theory & Research

  • Definition: Involves using solid scientific data instead of anecdotal evidence or tradition in medical and nursing decision-making (Treas, 2022).

Evidence Based Practice (EBP) Steps

  1. Identify a clinical nursing issue

  2. Formulate a searchable question

  3. Conduct a systematic review of published evidence

  4. Evaluate the quality of gathered evidence

  5. Compile and analyze collected data

  6. Translate evidence into practice

  7. Integrate evidence with clinical expertise and client preferences

Nursing Research

  • Standard of Nursing Practice: Governed by ANA standards and various educational competencies (QSEN, NLN, National Academy of Medicine [IOM]).

  • Historical Context: Nursing research initiated by Florence Nightingale; sustained through nursing's evolution.

  • Research Institutions: NIH oversees a National Center for Nursing Research.

  • Resources: Multiple nursing research journals are currently in publication.

Approaches to Nursing Research

  • Quantitative Research:

    • Conducted under controlled conditions, analyzed statistically, applying deductive reasoning (e.g., measuring effects of nutritional education on BMI).

  • Qualitative Research:

    • Explores subjective experiences, with concurrent data collection and analysis (e.g., coping techniques of hospice nurses dealing with loss).

  • Comparison Reference: See table 4-2 on page 107.

The Rights of the Human Subject (Informed Consent)

  1. Right Not to Be Harmed:

    • Protection from all forms of harm (physical, emotional, legal, social, and financial).

    • Treatment must not be withheld for experimental purposes.

  2. Right to Full Disclosure:

    • Participants must be fully informed of their role in the research study.

  3. Right of Self-Determination:

    • Participants should never feel coerced to join studies.

  4. Right to Privacy and Confidentiality:

    • All participant information must remain private, identifiable only by a code number.

Health Promotion

  • Health Care System Goals: Focus on PREVENTION

Three Levels of Disease Prevention

  • Levels of Prevention Strategies:

    • Primary Prevention:

    • Focus on preventing disease development by removing risk factors.

    • Secondary Prevention:

    • Aims for early detection and treatment to prevent disease progression.

    • Tertiary Prevention:

    • Focuses on reducing complications of established diseases.

Primary Prevention

  • Healthy People 2030 Initiative:

    • URL: https://health.gov/healthypeople

    • Goal: Increase quality and duration of healthy life.

    • Encompasses nutrition, weight control, exercise, stress reduction, and immunizations.

    • Emphasizes illness prevention at community levels to reduce health disparities.

Secondary Prevention

  • Goals: Early detection for diagnosis and treatment.

  • Methodologies:

    • Screenings such as MRIs, blood pressure tests, and dental exams.

    • Treatment covers hospitals, physician offices, and outpatient clinics.

Tertiary Prevention

  • Goals: Support clients in returning to prior levels of function.

  • Services Include: Rehabilitation/restoration and palliative care for comfort at end-of-life stages.

Providers of Health Care

  • Key Provider Roles in Health Care:

    • Physical Therapist (PT): Develops strength and exercise plans

    • Medical Doctor (MD): Creates the medical plan prescribing medications and treatments

    • Pharmacy: Administers medications

    • Respiratory Therapist (RT): Offers breathing techniques and treatments

    • Case Manager (CM): Develops home care planning

    • Occupational Therapist (OT): Advises on energy conservation

    • Dietician: Creates low salt diet plans

    • Nurse: Compiles a comprehensive plan of care for clients, such as those with heart disease.

Health Promotion Components

  • Focus Areas:

    • Dissemination of health information

    • Behavior and lifestyle modifications

    • Environmental protection

    • Wellness assessment and health risk appraisal

    • Health screenings and counseling services

Medicare

  • Overview: Title 18 of the Social Security Act providing health insurance to adults aged 65 and over.

  • Parts of Medicare:

    • Part A: Covers hospitalization, home care, and hospice services.

    • Part B: Voluntary, covering outpatient and physician services.

    • Part C: Medicare Advantage plan encompassing A and B, may include some D benefits.

    • Part D: Voluntary coverage for prescription medications.

Medicaid

  • Overview: Title 19 of the Social Security Act; a public assistance program funded by federal and state resources but managed on a state-by-state basis.

Insurance Terminology

  • Key Terms:

    • Prospective Payment Systems: Legislation to restrict payment rates to hospitals serving Medicare patients.

    • Diagnostic Related Groups (DRGs): A classification system establishing fixed reimbursement rates for specific diagnoses (e.g., Appendectomy = $2,306).

    • Private Insurance: Purchased privately or through employer plans.

    • Third Party Payer: Insurance companies that compensate health providers.

    • Group Plans: Offer aggregate medical services, managed akin to Health Maintenance Organizations (HMOs) or Preferred Provider Organizations (PPOs).

Nurse of the Future Nursing Core CompetenciesⓇ

  • Knowledge Areas and Skills:

    • Knowledge

    • Attitudes

    • Skills

Core Competencies

  • The Art and Science of Nursing

  • Practice Environment:

    • Evidence-Based Practice

    • Patient-Centered Care

    • Professionalism

    • Quality Improvement

    • Safety

    • Leadership

    • Systems-Based Practice

    • Teamwork and Collaboration

    • Communication

    • Technology and Informatics