Notes: Florence Nightingale, QSEN Core Competencies, and Health Promotion Across the Lifespan

FLORENCE NIGHTINGALE – EARLY LIFE

  • Born 1820 to a wealthy British family.
  • Felt calling to nursing despite societal expectations.
  • 1854 – Crimean War: Arrived at a British military hospital, found appalling conditions.
    • Implemented hygiene protocols, nutrition, compassionate care, assessments.
  • Evidence-Based Practice start: Collected mortality rate data and created statistical visualizations.
    • Result: Reduced death rates from 42%42\% to 2%2\% in six months.
    • Nightingale's Rose Diagram used to visualize data and justify reforms.

EVIDENCE-BASED PRACTICE

  • Collected mortality rate data during Crimean War.
  • Created statistical visualizations (e.g., Rose Diagram).
  • Outcome: Significant reduction in mortality with improved sanitation and care.
  • Emphasis on data-driven approaches to improve patient outcomes.

BEGINNING OF FORMAL NURSING EDUCATION

  • Founding Modern Nursing Education
    • 1860: Established the first secular nursing school at St. Thomas' Hospital, London.
    • Set new standards for nursing education and professionalization.
  • Nightingale's Educational Principles
    • Student selection based on character and intellect.
    • Structured theoretical and practical training.
    • Emphasis on sanitation and observation skills.
    • Professionalization of nursing: elevated nursing from occupation to profession.
    • Established need for specific education, skills, and ethical standards.
    • Laid foundation for modern nursing practice.

LCCC NURSING CURRICULUM DESIGN & QSEN CORE ORGANIZERS

  • Core idea: Integrate QSEN competencies into pre-licensure and graduate programs.
  • Core Organizer: QSEN Competencies (based on Institute of Medicine, 2003).
  • QSEN Competencies include:
    • Patient-Centered Care
    • Teamwork & Collaboration
    • Evidence-Based Practice
    • Quality Improvement
    • Safety
    • Informatics
    • Professional Identity

QSEN COMPETENCIES – CORE ORGANIZERS

  • Using IOM (2003) competencies, the QSEN framework defines targets for knowledge, skills, and attitudes in nursing education.
  • For each competency, targets are set for pre-licensure programs.
  • Emphasis on developing competencies throughout nursing education to ensure safe, high-quality care.

CORE ORGANIZERS – DEFINITIONS (WEEK 1 MODULES)

  • Patient-Centered Care: Nursing care provided with the understanding that the patient is a full partner in decision-making.
    • Compassionate and coordinated care based on patient preferences, values, and needs.
  • Teamwork and Collaboration: Coordination and communication between nursing and other disciplines to achieve quality patient care.
    • Promotes open communication, mutual respect, and shared decision-making.
    • Example: Meeting with a physical therapist after a strength evaluation to obtain expert input.
    • Outcome: Improves nursing care, patient satisfaction, and patient outcomes.

CORE ORGANIZERS – DEFINITIONS CONT.

  • Evidence-Based Practice (EBP): Integration of best current practices with clinical expertise, patient/family preferences and values, and nursing judgment and critical thinking.
  • Safety & Quality Improvement: Approaches to care that minimize risk of harm, based on data, outcomes, and processes.
    • Use improvement methods to analyze system effectiveness and individual performance.
    • Example: Handwashing audits.
    • Example: Turning a patient every 2 hours.
  • Informatics: Use of information technology in communicating patient information, managing data, and supporting decision-making.
  • Professional Identity: Internalization of core values and perspectives integral to nursing as an art and science.
  • Martti – Translation Services (note: brief mention in the source).

CONCEPT – HEALTH CARE DELIVERY

  • Health care delivery concept ties to how health services are organized and provided.
  • Emphasizes delivery systems, financing, coordination of services.
  • Nurses’ roles influenced by delivery models and health system structure.

HEALTH CARE DELIVERY – WEEK 1 CONCEPT

  • Definition: Nurses’ understanding of health and wellness shapes practice scope.
  • Clients’ health beliefs influence health practices.
  • Increasing emphasis on promoting health and wellness in individuals, families, and communities.
  • Nurses must work with diverse populations and examine their own values and beliefs.
  • Health systems relate to methods of delivery, financing, and coordination of services.
  • Quality improvement and quality management are pathways to high-quality care.
  • N120 Topics – Week 1 topics; topics further developed later.

TYPES OF CARE SETTINGS WHERE NURSES PRACTICE

  • Hospitals
  • Homes
  • Skilled Nursing
  • Schools
  • Hospice
  • Provider’s offices
  • Ambulatory Care Clinics
  • Surgery Centers
  • Public Health Agencies
  • Crisis Centers
  • Diagnostic Centers
  • Occupational Health Centers
  • Specialties: Dialysis, Burn rehab, Prisons, Urgent Care Centers

HOW CAN NURSING PROMOTE “HEALTH AND WELLNESS” IN EACH CARE SETTING?

  • Core idea: Health beliefs shape health practices; nurses promote wellness across settings.
  • Today’s nurses must work with diverse populations and reflect on their own values.
  • Healthcare systems involve delivery, financing, and coordination of services.
  • Nurses contribute to high-quality care through quality improvement and quality management.
  • Schools: Health promotion and wellness education, including basic hygiene practices (hand washing, teeth brushing).
  • Examples: Free dental clinic visits, eye exams, patient education.

CHARACTERISTICS OF HEALTH AND ILLNESS

  • Health: State of complete physical, mental, and social well-being, not merely the absence of disease.
  • Wellbeing: Positive emotions and moods; absence of negative emotions; satisfaction with life.
  • Illness: Personal state in which physical, emotional, intellectual, social, developmental, or spiritual functioning is diminished (does not necessarily mean disease).

CONTINUUM OF HEALTH AND ILLNESS (FIGURE 7.3)

  • Health to Illness continuum with stages:
    • Early signs of disability to major/end stage conditions.
    • Components include emotional, social, and physical aspects.
    • At the healthy end: yearly physicals, bloodwork, choosing a healthy lifestyle, diet, exercise, yoga, wellbeing, satisfaction with life.

HEALTH? WELLNESS? OR ILLNESS?

  • Conceptual distinction explored: health versus wellness versus illness and their implications for nursing practice.

PROMOTING HEALTH ACROSS THE LIFESPAN (TABLE 7-3)

  • Provides recommended health promotion activities from birth to adolescence.
  • newborn/infant: screening for congenital heart disease and hearing loss; health exams at 2 weeks and 2,4,6,9,12 months; DTaP, HIB, HepB vaccines; PKU screening; DDST-II; infant-parent bonding and attachment education; dental visits from tooth formation; fluoride supplementation if needed; nutrition, rest, exercise education; prevention of injuries.
  • toddler: immunizations continuation; dental visits with fluoride; nutrition, safety, rest, activities; health exams at recommended intervals; iron deficiency risk assessment around 15-30 months.
  • preschool/early childhood to school age: vaccines continuing; growth and development screenings; vision/hearing/dental screenings; nutrition and exercise education; safety promotion and injury prevention.
  • adolescent: Depression risk evaluation; drug and alcohol education; accident prevention; body image and sexuality information.
  • young adult to older adult: HPV vaccine; self-breast/testicular examinations; smoking cessation; dental/vision checks; cholesterol and glucose screenings; mammograms and colonoscopies; ongoing education on nutrition, sleep, maintaining strength.

PROMOTING HEALTH ACROSS THE LIFESPAN (TABLE 7-4 VARIATIONS)

  • Table 7-4 focuses on how to assess progress: questions like “How are you doing with recommended screenings and health promotion for your age group?” and identifying barriers and areas for improvement.

EXAMPLES OF HEALTH SERVICES TABLE 7.4 & 7.5

  • Infant: bonding education; injury prevention; seatbelts in car safety.
  • Toddler: nutrition, safety, rest; immunization schedules.
  • School Age: vision/speech/dental screenings; exercise/nutrition education.
  • Adolescent: depression risk evaluation; drug/alcohol education; accident prevention; body image and sexuality information.
  • Young Adult: HPV vaccine; self-exams; smoking, dental/vision checks.
  • Adult: cholesterol and blood glucose screenings; weight control education; mammograms and colonoscopy guidance.
  • Older Adult: fall prevention; flu/pneumonia/shingles vaccines; eye exams; education on nutrition, sleep, maintaining strength.

LEVELS OF PREVENTION (TABLE 7.3)

  • Primary prevention: Activities that block disease or injury BEFORE it occurs.
  • Secondary prevention: Activities to reduce the impact of disease or injury once it occurs.
  • Tertiary prevention: Activities to lessen the impact of ongoing illness or injury and to rehabilitate.

PATIENT ADVICE

  • When a patient asks how to make a health change, consider:
    • Assess readiness to change.
    • Identify specific, achievable goals.
    • Provide education tailored to the patient’s context.
    • Encourage engagement with preventive services and wellness activities.

MODIFIABLE VS. NON-MODIFIABLE VARIABLES FOR HEALTH

  • Modifiable Variables:
    • Diet
    • Activity
    • Social choices (smoking, drinking)
    • Other lifestyle factors: weight control, sleep, stress management, etc.
  • Non-Modifiable Variables:
    • Genetics
    • Age
    • Race
    • Family history of disease or mental illness
  • Emphasis: Focus on modifying behaviors and environments to improve health outcomes while recognizing fixed risk factors.