Foundations of Nursing: Evolution, Law & Ethics, and Medical Terminology
Chapter 1: The Evolution of Nursing
- Chapter objectives (learning goals):
- Identify the major leaders in nursing history
- Identify the major nursing organizations
- List the major developments of practical nursing
- Identify the components and participants in the health care system
- Describe the complex factors involved in the delivery of patient care
- Define practical nursing
- Describe the purpose, role, and responsibilities of the practical nurse
- Describe the evolution of nursing & nursing education
- Discuss the significant changes in nursing in the 21st century
- Discuss societal influences on nursing
- Nurse definitions and identity
- To nurse = to nurture, to feed, to foster, to support
- Nurse is a verb: it’s what we do
- Nurse is a noun: it’s who we are
- Designations include LPN, RN, CNM, CRNP, CNS, DNP, PhD
- The History of Nursing and Nursing Education – societal influences
- Societal factors that have changed nursing:
- How we care for the sick
- The relationship of people with their environment
- The search for knowledge and truth through education
- Increased recognition of the value of preventative care
- Technologic advances
- Changes in needs, policies, and society
- Care of the Sick Throughout History
- Nursing is evolving and changing in relation to time and culture
- Role of women in nursing
- Move from home care to hospital care
- Formalized nursing training developed
- Impacts on nursing history: World War I; World War II cadet nurses
- Florence Nightingale
- Known as the “Lady of the Lamp”
- Credited as the first nursing theorist
- Helped shift views of nursing education
- Established a nursing school in London
- Promoted new standards of nursing
- “Nightingale Plan” established
- Mary Seacole (FYI)
- Major US Nursing Leaders (examples)
- Dorothea Dix
- Clara Barton
- Mary Eliza Mahoney (1845–1926): Recognized as the first qualified Black nurse in the US; worked to improve acceptance of Black nurses in the US
- Significant Changes in Nursing during the Twenty-First Century
- Demographic changes
- Women’s health care issues (gender-specific)
- Men in nursing: < 10% (aim to increase)
- Human rights considerations
- Medically underserved populations
- Nursing shortage
- Development and Licensing of Practical and Vocational Nursing
- Attendant nurses: ~3 months education; home care focus
- After WWII, PN programs improved educational standards
- 1919: States began to mandate licensure
- American Nurses Association (ANA)
- Articulation and professional associations
- Organizational Influence (FYI)
- National Federation of Licensed Practical Nurses (NFLPN): Now the National Association of LPNs; Founded by Lillian Kuster in 1949; membership limited to LPN/LVNs
- National League for Nursing (NLN): In 1961, established the Department of Practical Nursing Programs; developed an accreditation service for these programs (Council of Practical Nursing Programs)
- Accreditation – p. 10 (FYI)
- Voluntary review to determine if programs meet pre-established criteria
- Factors that Influenced Practical and Vocational Nursing (FYI)
- Need for trained caregivers
- World War I
- The self-taught practical nurse (not after 1950)
- Duties of LPN/LVNs
- 1965 ANA position paper aimed at RNs
- Usually 12ext−−18extmonths programs
- Career advancement opportunities
- Health Care Delivery Systems (FYI)
- Network of agencies, facilities, and providers within a geographic area
- Goal: to achieve optimal levels of health care for a defined population
- Participants/Stakeholders involved in delivery of care
- Maslow’s Model of Health & Illness (referenced)
- Introduced as a model to understand health and illness priorities
- Delivery of Patient Care (FYI)
- Involves determining patient’s individual needs
- Developing a plan of care
- Meeting the needs of the patient
- Preventing and treating disease and injury
- Restoring optimal wellness
- Education of patients and families
- Participants in the Health Care System (FYI)
- Professional health care specialists, RNs, LPNs/LVNs, other caregivers
- Technologists (Bachelor’s degree)
- Technicians (certified)
- Paraprofessionals/UAPs (trained to assist)
- Interdisciplinary Approach to Health Care (FYI)
- Development of a comprehensive care plan
- Effective communication
- Accurate documentation
- Four Major Concepts of Nursing Care (p. 18)
- Nursing: Roles and actions of the nurse
- Patient: Person receiving care
- Health: Wellness-illness continuum on which the patient sits
- Environment: Setting for nurse–patient interaction
- Practical and Vocational Nurse Defined (p. 19)
- LPN/LVN provides specific services under direct supervision of an RN
- Educated to provide safe, responsible, and effective care
- Performs basic therapeutic, rehabilitative, and preventive care
- Provides care in all types of settings
- Works with stable patients
- LPN: Role and Responsibilities (p. 19)
- Professional behavior, accountability & appearance
- Effective communication
- Collect holistic data
- Collaborate with RN and others to plan and revise care based on nursing diagnoses
- Demonstrate caring and empathetic approach to safe care
- Implement patient care (or delegate to UAP) under direct supervision of RN/physician/dentist
- Knowledge of nurse practice act
- See Box 1.3 for more information
- Chapter 1 Learning Objectives (reiterated)
- Reflects emphasis on leaders, organizations, practical nursing development, health care system components, and societal influences
- Chapter 2 overview (transition to Legal & Ethical Aspects of Nursing)
- Introduction to legal/ethical foundations relevant to practical nursing
Chapter 2: Legal & Ethical Aspects of Nursing
- Learning Objectives
- Discuss legal relationship between patient and nurse
- Explain standards of care
- Explain nursing malpractice
- Provide strategies to avoid lawsuit involvement
- Identify legal issues in health care
- Summarize structure and function of the legal system
- Distinguish ethical vs unethical behavior
- Understand commonly used medical terminology
- Discuss HIPAA privacy rules
- Provide care within the legal scope of practice
- Explain the term code of ethics
- Overview of the Legal System
- Laws govern people’s actions within society; allow acceptable behavior; prohibit unacceptable behavior
- Criminal law vs. Civil law
- Accountability, liability, and depositions
- Malpractice (p. 24)
- Professional negligence by a nurse
- Four key elements needed:
- Duty: established nurse–patient relationship
- Breach: failure to perform to a reasonable standard
- Harm
- Proximate cause of harm
- Legal Relationships and Advocacy
- Nurse–patient relationship: nurse assumes responsibility for patient care; failing to provide care to expected standards creates legal liability
- Advocate: defender of a patient’s interests; nurses have legal and ethical obligation to safeguard patient interests
- Standards of Care (p. 26)
- Acts that are permitted or prohibited; provide direction on what is required
- Obligated to know and follow established standards
- Failure to adhere can lead to liability
- LPNs must report to RN or charge nurse
- Be prepared to perform to the standard of care; apply appropriate measures and universal guidelines
- Scope of Practice (p. 26)
- Defines nurse’s responsibilities and obligations
- Follows state laws; Nurse Practice Acts define scope of practice and prohibitions
- Regulation of Practice (p. 26)
- Nurses must know the Nurse Practice Acts in their state(s)
- Institutions may set policies/procedures within the act
- PA Practical Nurse Law (illustrative heading)
- Legal Issues (p. 27–31)
- Patient’s Bill of Rights: legal protections of patient expectations
- Informed Consent and Confidentiality
- Social Media: risks of employment consequences
- Mandatory reporting of abuse (including off-duty) and duty to report unethical behavior; follow proper chain of command
- Battery: performing a procedure without patient consent; signs of consent must be documented
- HIPAA (p. 27)
- Health care institutions must uphold patient rights:
- Right to receive care without prejudice and with dignity
- Right to privacy and confidentiality (including medical records)
- Right to personal safety and complete information about one’s condition and treatment
- How to Avoid a Lawsuit (p. 31–32)
- Provide compassionate, competent nursing care
- Build trust and respect; open and honest communication
- Adhere to standards of care and scope of practice
- Good Samaritan laws may offer immunity in certain situations
- Proper documentation: 'If it isn’t charted, it wasn’t done'
- Ethical Aspects of Nursing (p. 33–35)
- Ethics: values that help define right and wrong
- Advance directives: Living wills; Durable power of attorney; Patient Self-Determination Act (PSDA) of 1991
- Values, values clarification, ethical dilemmas
- Ethical Principles in Nursing Practice (p. 36)
- Respect for people (most fundamental principle)
- Autonomy: freedom of personal choice
- Beneficence: doing good or acting for someone’s benefit
- Nonmaleficence: do no harm
- Justice: what is fair
- Ethical Issues (p. 36–37)
- Society’s changes influence ethics (e.g., informed consent)
- Practitioner-assisted suicide (PAS): active euthanasia
- Abortion: ensure assignment-related adjustments and continued care
- Do not resuscitate (DNR) orders must be followed
- Right to refuse care
- Chapter 2 Learning Objectives (reiterated)
- Emphasis on relationship, standards, malpractice, strategies to avoid litigation, and the legal system
Medical Terminology: Foundations and Language Learning
- Medical Terminology Objective
- Develop a basic understanding of commonly used medical terminology
- How to Learn Medical Terminology (Language Learning Approach)
- Part System: Prefix – Root – Suffix
- Focus on building a mental language for medical terms
- Abbreviations and Safe Practice
- Flashcards are useful; review repeatedly; practice with family or peers
- Some abbreviations are 'DO NOT USE' due to safety concerns; write out fully
- Common units and terms to know include: Units of measure, international units, and frequently misused examples (e.g., morphine sulfate, magnesium sulfate)
- Decimal Points and Zeros (Safety in Numerics)
- Trailing zeros: avoid writing, e.g., 17.0; write 17
- Leading zeros: always use, e.g., 0.12 not .12; 0.75 not .75
- Common Abbreviations (examples)
- Milligram = mg
- Milliliter = mL
- Millimeter = mm
- Millimeters of Mercury = mm Hg
- Nasogastric = NG
- Hours of Sleep = HS
- Before meals = AC
- After meals = PC
- No known allergies = NKDA
- No known drug allergies = NKDA (alternate form)
- Nothing by mouth = NPO
- By mouth = PO
- Ad libitum = ad lib (as tolerated or freely as desired)
- Oxygen = O2
- Ounce = oz
- At regular intervals: PRN, q, TID, QID, etc. (typical schedule abbreviations)
- ROM = range of motion; STAT = immediately
- 3-Part System (Prefix, Root, Suffix)
- Prefix: the beginning of the word; usually describes; may be adjective
- Root (or Stem): main/essential part of the word
- Suffix: end of the word; adds meaning or describes; not always used
- Examples:
- Microscope = Micro- + scope
- Biology = Bio- + logy
- Microbiology = Micro- + bio- + logy
- Root Words Overview (body systems and terms)
- Neuro Root Words
- Neuro = nerve
- Encephalo- & Enceph- = brain/tissue
- Cerebral = pertaining to the brain
- Vertebrae = spinal bones
- Esthesia = feeling; anesthesia = without feeling
- Psych-, Psycho-, & Ment- = mind; mental = pertaining to the mind
- Phobia = fear; hydrophobia = fear of water
- Mania = madness; hypermania = excessive madness
- Nose Root Words
- Naso- or Nas- = nose
- Rhin- or Rhino- = nose; rhinorrhea = discharge from the nose
- Eye Root Words
- Opt- or Opto-, Ophthalm-, Oculo-; Optical & Ocular = pertaining to the eye
- Ophthalmology = study of the eye
- Ear & Throat Root Words
- Oto- = ear; otoscope = instrument to look into the ear
- Tympan- or Myring- = eardrum; tympanic = pertaining to the eardrum
- Laryng- = larynx; laryngitis = inflammation of the larynx
- Cardiac Root Words
- Cardiac = pertaining to the heart
- Arterio- = artery; arteriosclerosis = hardening of the arteries
- Veno- or Phleb- = vein; venous = pertaining to veins; phlebitis = inflammation of a vein; phlebotomy = cutting into a vein to draw blood
- Angio- or Vaso- = vessel; angiography = image of vessels; vasospasm = contraction of vessels
- Respiratory Root Words
- Pneumo- or Pulmo- = lungs
- -pnea = breathing; apnea = without breathing; tachypnea = fast breathing
- Thorac- = chest/thorax
- Trache- = trachea; tracheostomy = opening into the trachea
- Bronch- = airway; bronchitis = inflammation of airways
- Gastrointestinal Root Words
- Stoma = mouth/opening
- Dent- = teeth; gingiv- = gums; emesis = vomit; colo- = colon (large intestine)
- Genitourinary Root Words
- Neph- & Ren- = kidney
- Uro- & Uria- = urine
- Lith- = stone
- Cysto- = bladder
- Musculoskeletal Root Words
- Osteo- = bone
- Chondr- = cartilage
- Arthr- = joint
- Myo- = muscle
- Cost- = rib
- Ped- = foot
- Reproductive Root Words
- Mammo- = breast; mammography = image of breast tissue
- Hyster- = uterus; hysterectomy = removal of uterus
- Test- or Orchi- = testicle; testicular = pertaining to testes; orchiectomy = removal of testicle
- Oophor- = ovary; oophorectomy = removal of the ovary
- Blood, Lymphatic, & Misc. Root Words
- Gluco- & Glyco- = glucose (sugar)
- Hem- = blood
- Thromb- = clot
- Phago- = eating
- Cyto- = cell
- Febr(i)- & Pyr- = fever
- Skin Root Words
- Derm-, Derma-, Dermat-, Dermato
- Dermatology = study of the skin
- Intradermal = within the skin
- Prefixes (key prefixes and meanings)
- A- & An- = without
- Anti- = against
- Ante- & Pre- & Pro- = before
- Intra- = within
- Post- = after
- Mono- & Uni- = one
- Bi- = two
- Tri- = three
- Multi- & Poly- = multiple or many
- Suffixes (purpose and common examples)
- End of a word; adds meaning; not always used
- Often indicates disease, diagnosis, or type of procedure
- Examples of diagnosis-related suffixes:
- -emia = blood
- -iasis = presence or formation of
- -itis = inflammation
- -malacia = softening
- -trophy = growth
- -megaly = enlargement
- -oma = tumor
- Let’s Put Them All Together
- Practice by combining prefixes, roots, and suffixes to form terms
- Use in context to interpret meanings of medical terms
- Miscellaneous Tips
- Not every word has a prefix or suffix; focus on roots and context
- Greeks/Latin origins are common in medical terms
- Visual learners can draw associations or pictures
- Connecting terms to real-world contexts aids memory