Role of the RN

Definitions

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

  • Nurse (SYN) (Webster’s Thesaurus, 2001):

    • Define actions such as: tend, care for, nourish, nurture, feed, train, mind, attend.

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

  • Box 1-1: Contains various descriptions throughout the evolution of nursing.

Nursing Images Throughout History

  • Representation of the female role:

    • Angel of Mercy

    • Battle-Ax

    • Professional Handmaiden

    • War

    • The "Naughty Nurse"

    • Demographics: Caucasian

Important Qualities of a Nurse (p. 9 Box 1-2)

  • 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 for the role.

    • Orientation toward service to others.

    • Ongoing research.

    • Code of Ethics.

    • Autonomy in practice.

    • Presence of professional organizations.

The Roles and Functions of the Nurse (p. 7 Table 1-1)

  • Roles used in conjunction with each other:

    • Direct care provider/caregiver:

    • Focus on physical, emotional, spiritual care for clients and families, which can be direct or delegated.

    • Case Scenario: Caring for a client crying over a photo; what can you do as a caregiver?

    • Communicator:

    • Required interpersonal therapeutic communication, both verbal and written.

    • Essential to meet client needs.

    • Case Scenario: Developing a strategy for a client with newly diagnosed diabetes.

    • Client Advocate:

    • Protecting, representing, and assisting clients.

    • Case Scenario: Navigating a situation where a client refuses treatment against family wishes.

    • Counselor:

    • Assisting clients and families to cope with stressors.

    • Implementation of these roles requires sensitivity and understanding of client issues.

    • Change Agent:

    • Assists in behavior modification for clients, families, or groups, including the nursing team.

    • Leader:

    • Influencing others to collaborate and meet shared goals.

    • Case Scenario: Addressing resistance to a new computerized documentation system.

    • Manager:

    • Coordinating activities among team members and managing client assignments.

    • Case Manager:

    • Overseeing a caseload of clients and coordinating care, including discharge services.

    • Research Consumer:

    • Applying evidence-based research to enhance the quality of nursing care.

Types of Nursing Education

  • LPN/LVN:

    • 9-12 months programs including classroom and clinical work.

    • Candidates sit for NCLEX-PN exam for state licensure.

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

  • RN Education Routes:

    • Diploma Programs: 3-year programs, typically hospital-based with minimal programs.

    • Community College/AD Programs: 2-year program founded during WWII to address nursing shortages.

    • Baccalaureate Degree Programs: 4-year programs including liberal arts, sciences, and humanities.

    • All paths allow graduates to sit for NCLEX-RN.

    • RN standards remain consistent, but BSN graduates may receive greater autonomy.

Graduate Nursing Education

  • Master’s Program: Usually two years; offers MSN degrees in various specialties (e.g., Education, Forensics, NP’s, Administration).

  • Doctoral Programs: Usually 3-4 years; includes PhD, EdD, or DNP.

Continuing Education (CE)

  • Requirement to maintain state licensure:

    • Massachusetts: 15 contact hours every 2 years.

    • New Hampshire: 30 contact hours every 2 years.

  • Purpose: To stay current in nursing practices.

    • 1 CEU (continuing education unit) equals 10 contact hours.

    • 1 contact hour is equivalent to 60 minutes of education.

Socialization of Nursing

  • Socialization Process: Individuals become group members by learning the rules, culture, and norms pertinent to the group.

  • Goal: Instilling attitudes, values, and norms essential for maintaining the nursing profession.

Benner's Novice to Expert Model

  • Stages of Expertise:

    • Expert: Intuitive grasp of the situation and identifies accurate problem areas.

    • Proficient: Sees situations holistically rather than isolating components.

    • Competent: Understands actions in relation to long-term goals.

    • Beginner: Recognizes recurrent meaningful components but cannot prioritize.

    • Novice: Lacks professional experience.

Practice Regulation

  • Nurse Practice Acts:

    • Define nursing practice.

    • Establish RN/LPN criteria and determine scopes of practice.

    • Enforce rules governing nursing.

  • Standards of Practice:

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

Nursing Organizations

  • Significant entities:

    • American Nurses Association (ANA)

    • National League for Nursing (NLN)

    • International Council for Nursing (ICN)

    • National Student Nurse Association (NSNA)

    • Sigma Theta Tau International (STTI)

    • Various specialty organizations.

Purpose of Nursing

  • Key Goals:

    • Promoting Health & Wellness

    • Preventing Illness

    • Restoring Health

    • Caring for the Dying

Models of Nursing Care

  • Case Method: Total one-to-one care typically used in ICU and maternity settings.

  • Functional Nursing: Assigning specific care tasks to team members based on training.

  • Team Nursing: Nurses paired with assistive personnel to care for a group of clients; an efficient care model.

  • Primary Nursing: A single nurse manages a client group and develops their care plan, providing continuity.

  • Differentiated Practice: Assigning care based on expertise and demonstrated competencies.

Trends in Healthcare & Nursing

  • Current Trends:

    • Complementary & alternative medicine (CAM)

    • Variety of care settings

    • Interprofessional collaboration

    • Expanded nursing roles

    • Nursing assistive personnel

    • Influence of healthcare policy

    • Balance between high-tech and high-touch approaches.

Factors Affecting Health Care Delivery

  • Key Influences:

    • National economy.

    • Increasing demand due to an aging population.

    • Healthcare literacy impacts on care.

    • Influence of women’s movement.

    • Legislative factors.

    • Collective bargaining in healthcare.

Evidence-Based Practice: Theory & Research

  • Evidence-based practice focuses on utilizing scientific data over anecdotal evidence in clinical 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 obtained evidence.

  5. Compile and analyze data.

  6. Translate evidence into practice.

  7. Integrate evidence with clinical expertise and client preferences.

Nursing Research

  • Components:

    • Standard of Nursing Practice (ANA standards).

    • Educational competencies (e.g., QSEN, NLN, National Academy of Medicine).

    • Integral in achieving client outcomes, originating from Florence Nightingale's pioneering work.

    • NIH houses a National Center for Nursing Research with multiple journals in publication.

Approaches to Nursing Research

  • Quantitative Research: Obtains measurable data under controlled circumstances; uses deductive reasoning.

    • Example Question: Does nutritional education affect the BMI of elementary school students?

  • Qualitative Research: Explores subjective experiences; data collection and analysis occur concurrently to identify patterns.

    • Example Question: What coping techniques do hospice nurses utilize for client loss?

  • See table 4-2 on page 107 for comparison.

The Rights of the Human Subject (Informed Consent)

  1. Right Not to Be Harmed:

    • Clients should never be subjected to harm for study purposes.

  2. Right to Full Disclosure:

    • Clients must be fully informed about their participation in studies.

  3. Right of Self-Determination:

    • Clients should not feel pressured to participate in research.

  4. Right to Privacy and Confidentiality:

    • Confidential handling of client information; participants known only by code names or numbers.

Health Promotion

  • Primary Goal: Prevention of diseases through three levels of prevention strategies:

    • Primary Prevention: Avoidance of disease development through risk factor removal.

    • Secondary Prevention: Early detection and treatment to prevent disease progression.

    • Tertiary Prevention: Reduction of complications from established diseases.

  • Health Promotion Strategies:

    • Dissemination of information.

    • Lifestyle and behavior changes.

    • Environmental protection.

    • Health appraisal & risk assessment.

    • Counseling services.

Medicare

  • Overview: Title 18 of the Social Security Act providing health insurance to senior citizens (65+).

  • Parts of Medicare:

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

    • Part B: Voluntary outpatient and physician services.

    • Part C: Advantage plan incorporating A & B, possibly D.

    • Part D: Voluntary prescription coverage.

Medicaid

  • Overview: Title 19 of the Social Security Act providing federal public assistance, funded by federal & state money but managed by states.

Insurance Terminology

  • Key Terms:

    • Prospective Payment Systems: Legislation that limits hospital payments for Medicare services.

    • Diagnostic Related Groups (DRG’s): System used to set reimbursement rates based on diagnosis.

    • Private Insurance: Insurance purchased through personal purchases or employer plans.

    • Third Party Payer: The insurance company paying for the service.

    • Group Plans: Insurance designed to provide extensive medical coverage, managed within specified financial limits (e.g., HMO’s, PPO’s).

  • Patient-centered care: Emphasizes understanding individual patient needs, preferences, and values, ensuring that patient choices guide all clinical decisions. This requires active listening, compassionate communication, and involving patients in their own care plans.

  • Professionalism: Encompasses ethical practice, accountability, and adherence to legal regulations. Nurses must demonstrate integrity, reliability, and a commitment to high standards in all professional interactions.

  • Leadership: Involves guiding and inspiring others in nursing practice, fostering a collaborative environment, and advocating for quality patient care. Leadership can manifest in various forms, such as charge nurses, clinical nurse specialists, or nurse managers.

  • System-based practice: Requires understanding the larger healthcare system, including policies and procedures that impact patient care. Nurses must navigate this landscape to deliver effective care and advocate for system improvements that benefit patients and healthcare professionals alike.

  • Communication: Essential for effective teamwork, communication must be clear, concise, and tailored to the audience, utilizing both verbal and non-verbal methods to ensure comprehension across diverse populations.

  • Teamwork & collaboration: Involves working harmoniously with diverse healthcare teams, utilizing each member's strengths to foster a supportive care environment that prioritizes patient outcomes.

  • Safety: Recognizing and mitigating risks in the healthcare environment is crucial to protecting patient welfare. This includes adhering to safety protocols, reporting hazards, and fostering a culture of safety within the healthcare team.

  • Evidence-based practice: Utilizes the best current evidence combined with clinical expertise and patient values to inform practice decisions. This approach not only improves patient outcomes but also leads to continuous improvement in nursing care practices.