Professionalism in Nursing Midterm
1. Early Civilization/Nursing
Family members took on the role of the nurse to care for ill family members and to assist with childbirth. First form of nursing = caring for mother and infant during childbirth. Role associated with compassion, kindness, health promotion. Modern Family Centered Care = trend back towards natural childbirth
2. Roman Era/Nursing
Roman battle far from the home front led to development of mobile war nursing = 1st military field hospitals. Nursing was no longer limited to family members
3. Industrial Revolution/Nursing
Overcrowding, poor living conditions, unsanitary, increased pests caused an increase in the spread of communicable diseases. Laborers were at an increased risk, especially children. The Chadwick Report: described the effects of unsanitary conditions and labor on health, led to the development of the 1st board of health & legislation on labor/mental health/child welfare in England. The Shattuck Report: census that showed high infant and population mortality & communicable diseases. Made recommendations for public health reform monitoring, well-child care, immunizations, education for all, health planning.
4. Florence Nightingale
“the Angel of Mercy” was a nurse administrator during the Crimean War, reformed military health (reduced death rate in military camps by 2/3), started a nursing school, focused on “health nursing”
Environmental Theory: nurse manipulates the environment to improve patient outcomes and health
5. Nursing Pioneers: What are they known for, most famous contribution to nursing
a. Clara Barton
Nurse during the civil war, founded the Red Cross
b. Mary Seacole
Originally from Jamaica, also a nurse during the Crimean War, was turned down by Nightingale, thus opened her own field hospital, rode into the battlefield to nurse wounded soldiers on both sides
c. Lillian Wald
Founded public health nursing, established Henry Street Settlement to care for poor families, public school nursing. Hired diverse nurses and paid them the same, equity.
d. Dorothy Dix
Pioneer for reformation of mental health
e. Anna May Hayes
Established maternity leave for female officers
f. Mary Breckenridge
Pioneer for nurse-midwifery in rural communities, first comprehensive healthcare system in the US, reduced mortality rates for moms & infants, established a model of college for frontier nursing service
6. Types of Nursing Programs (Diploma/Associates/Bacc.)
Diploma program = 3 years, 4% of students
Associate’s degree = 2 years program developed in response to nursing shortage post WWII, 58%
Bachelor’s degree = 38%
7. Definition of Theory
Concept – term that describes a phenomenon
Conceptual Model – a set of concepts and statements that integrate the concepts in a meaningful way
Propositions – statements that describe relationships among events, situations, actions
Theory – organized, coherent, systematic articulation of statements related to significant questions in a disciple that are communicated in a meaningful way
8. Jean Watson
Philosophy and Science of Caring theory: focuses on the mind-body-spirit, revolves around 10 caritas, focuses on the nurse being physically and mentally present with patients and developing relationships
9. Benner/Novice to Expert
Developed by Patricia Benner. Focuses on clinical judgement, clinical skills, ethic, research. A way of thinking about how new nurses grow in wisdom, confidence, and become seasoned nurses.
10. Metaparadigm of Nursing
The most global perspective of a discipline, made up of abstract concepts
- Person
- Environment
- Health
- Nursing
“The person receiving the nursing, the environment within which the person exists, the health-illness continuum within which the person falls at the time of the interaction with the nurse, and finally, the nursing actions themselves.
11. Orem’s Theory of Nursing Systems
Relationship between nurses and patients and varies depending on how much patients can do for themselves (self-care requisites)
- Wholly compensatory system: Pt is unable to perform an7 self-care activities
- Partially compensatory system: Both the Pt and the nurse participate in the Pt’s self-care activities
- Supportive-education system: The Pt has the ability for self-care but requires assistance from the nurse with decision-making, knowledge, or skill acquisition
12. American Nurses Association
National organization that represents the interests of registered nurses. Advances the nursing profession by fostering high standards of nursing practice, promoting a safe and ethical work environment, bolstering the health and wellness of nurses, and advocating on health care issues that affect nurses and the public.
Mission statement: Nurses advancing our profession to improve health for all.
Regulating body for ethics for all of nursing
Key areas of health care that nurses are responsible for
1) Quality health care
2) Health promotion, disease prevention, environmental measures
3) Expansion of nursing and healthcare knowledge through research and evidence in practice
4) Expansion of healthcare resources and health policy to enhance capacity for self-care
5) Planning for health policy and regulation
6) Weigh duties under extreme conditions
13. Purpose of ANA Nursing Code of Ethics (don’t need to memorize code)
Serve as an ethical framework for a nurses practice, provides a nurse with direction in respect to their ethical relationships, nursing responsibilities, appropriate behaviors and making day to day choices in their practice
14. Modern day bioethical issues
Abortion, suicide, ethical medical research, stem cell research, cloning, genetic testing, healthcare/Rx cost, HIPPA, marijuana legalization, opioid epidemic, vaccines, COVID-19
15. Moral Suffering
When nurses attempt to sort out their emotions when they find themselves in situations that are morally unsatisfactory or when forces beyond their control prevent them from influencing or changing these perceived unsatisfactory moral situations. Having to put aside what you personally think and having to do what parents want in the case of minors.
16. Morals vs Ethics vs Values
Morals are personal, they are the specific beliefs/behaviors/ways of being based on personal judgements derived from one’s ethics. Everyone’s morals are different. Ethics are what the general public has a consensus on. Values are individual or a group’s evaluative judgement about what is good or what makes something desirable – appreciating what is important for the profession, Pts, and nurses themselves.
17. Four principles of nursing ethics: definitions
a. Autonomy: one’s ability to self-rule and to generate personal decisions independently. Applies to nurse and Pt.
b. Nonmaleficence: Do no harm
c. Justice: What is fair
d. Beneficence: Do good
18. Self-Care (Definition/Components)
The proactive steps individuals take to preserve and improve their physical, mental, and emotional well-being
- Getting enough sleep, sunlight, movement, nutrition, social connection, stress management every day
19. Stress Management Techniques (Ex. EFT/Tai Chi/Mindfulness/etc…)
- Getting organized, time management, taking deep breaths, mindful observation, adjusting self-talk, breaking things into manageable steps
- Gratitude journaling
- Resilience: using emotional intelligence, self-care, self-efficacy, optimism
- Tai Chi: fluid movement that transforms stress into energy
- Tapping-Emotion Freedom technique: uses repetitive taps over acupressure points
20. Effects of Chronic Stress
- Hypertension
- Anxiety
- Tachycardia
- Depression
- Insomnia
- Migraine
- Changes in eating
- Weight changes
21. Where the Majority of Nurses Work
62.2% of nurses work in hospitals
22. Trends in Nursing
- Major need for ICU/ED nurses to treat COVID Pts
- Increased need for community health nurses
- Increased need for NPs & travel nurses
- Telehealth usage increasing
- Increased # of elderly to care for within the next 10-15 years
- Global aging (population is aging at an unprecedented rate)
- Nurses/faculty are aging (avg RN age is 50)
23. Values in Nursing
- Autonomy
- Alleviating suffering
- Privacy
- Teamwork
- Accountability
- Human rights
24. Nursing Shortage/Causes & Effects/Retention
Limited clinical facilities, limited faculty, many nurses about to retire, COVID/burnout, stress. 60% turnover within 1st year of employment.
Effects: fewer nurses with heavier Pt loads, increased work time/overtime for nurses, decreased quality of care & safety for Pts, increased hospital readmissions/decreased reimbursement, increased stress for nurses and decreased quality of life
25. Male nurses/Misconceptions vs Reality
About 14% of nurses are men.
Misconceptions: male nurses are overly feminine and are low achievers
Reality: male nurses are assertive, self-motivated, and gravitate toward high acuity areas, and are high achievers.
26. Benefits of Nursing Career
Abundant opportunities, room for advancement, flexible scheduling, great benefits, good job security, easy to find employment with relocation, rewarding and meaningful.
27. Self-Regulation in Nursing
The ability to control one’s emotions and behaviors, including thoughts and impulses. When facing a stressful situation, converting an initial reaction into a more constructive response. Inhibiting their impulse to react with the expression of a strong emotion or engage in a negative action.
28. Health Disparity/Cultural Competency
Social Determinants of Health: conditions in the environments where people are born, live, learn, work, play, worship, and age that affect a wide range of health, functioning, and quality of life outcomes and risks.
- Increasing the diversity of health care workers will help decrease healthcare disparities
Cultural competence: attitudes, knowledge, and skills necessary for providing quality care to diverse populations
- Avoid assumptions, active listening, reflect on biases, accommodation and education, using common & understandable language, recruiting diverse staff members, working in diverse settings, ask questions to understand
29. Socialization/Formation (Becoming a Nurse)
The process of adapting to and becoming a part of the culture of a profession. Begins with formal education, continues after graduation, boards, orientation in the workplace.
30. Nursing as Professional Career vs. Job
Job – mainly for the money, do the minimum requirement to pass/graduate/keep job.
Career – looks for opportunity, highly self-motivated, goal-oriented, work for advancement, take career seriously.
31. How to Shine in Classroom/Clinical
In the classroom: show up to class prepared, participate, ask for help when you need it, professional written communication with instructors, use good manners
In clinical: get enough sleep, eat breakfast before you go/bring snacks, appropriate uniform, seek out opportunities to learn, thank those who take time to teach you something, be respectful.
Other ways: get involved with nursing organizations on campus, volunteer, take on leadership roles in other organizations, get involved in nursing research
32. Networking
Fosters exchange of information and ideas among individuals or groups that share common interests, may be social or professional, opportunities start now, utilize professional organizations/volunteer opportunities/clinical experiences/social media
How to: be aware of opportunities, smile & introduce yourself, be other-centered, listen actively, ask questions, join organizations, utilize social media/linkedIn, attend workshops, volunteer.
33. Mentors
More experienced nurse provides guidance and leadership to less experienced nurse, helps with retention & job satisfaction.
34. Nurse Externships/Residency programs (definition/purpose)
Externship – paid summer program after completion of Med Surg I. Work within the hospital with preceptors, have classes with other externs, excellent way to gain experience.
Nurse Residency Program – Designed for new grad nurses, incorporate unit orientation with additional classes to support your transition to practice. Improves readiness for practice, decrease turnover, improved job satisfaction
35. Interview Tips
- Prepare your professional portfolio (resume/cover letter)
- Arrive 15 minutes early
- Professional dress
- Eye contact, firm handshake, be polite & respectful
36. STAR Interview method
Situation – give context to your answer
Task – elaborate on the challenge & your role
Action – explain how you handled the situation or overcame the challenge
Result – what you achieved in the process
37. Professional Dress
Men: business suit, tie, clean shaved or well-groomed
Women: minimal jewelry, low heeled & closed-toe shoes, hair up or pulled away from face
Everyone: don’t wear scrubs, neutral colors, no wrinkles, no strong scents, lay out your outfit the night before, be comfortable and confident, no shorts, no boobs/butt/belly
38. State Board of Nursing (Lifelong learning)
Nurses are responsible for keeping up with state requirements for licensure and renewals.
Nurses learn lifelong through required hospital/unit services, keeping up with evidence-based research, and keeping up with specialty standards of care.
39. Burnout
Unmanaged, chronic workplace stress that hasn’t been successfully managed. Is characterized by mental and physical exhaustion, mental distance from the job, cynicism, reduced efficacy in the workplace.
Tips to prevent burnout: self-care, time management, goals and boundaries, support and connection, movement.
40. Informed Consent (nurse role, definition, when required)
Nurses do not perform informed consent, doctors do, nurses may be witnesses & make sure Pt’s questions are answered. The legal duty to disclose needed material facts in terms that Pts can understand so they can make an informed choice. Meaningful information must be disclosed even if the clinician doesn’t believe the information will be beneficial.
41. What can be used in court with legal cases?
Legal documentation, standards/scope, expert witnesses, manufacturer’s instructions (equipment), hospital facility documents/policies/procedures, nursing literature/evidence based research, accreditation standards, professional organization standards, agency regulations
42. What leads to civil suits
- Failure to follow standards of care
- Failure to use equipment responsibly
- Failure to document
- Failure to assess and monitor Pt
- Failure to communicate
- Failure to get informed consent
- Medication errors
- Working while impaired
- Failure to properly supervise a Pt
- Failure to act as Pt advocate
43. State board of nursing (purpose, responsibilities, nclex, discipline, etc.)
State board of nursing is responsible for the nurse practice act, the licensure, and disciple of nurses. Nurses must pass the NCLEX, submit a criminal background check, have an endorsement from the school of nursing to apply for a license.
44. Evidence based practice (definition, benefits, barriers)
A framework used by nurses to deliver optimal healthcare through the integration of best current evidence, clinical expertise, and Pt/family values. Strong evidence based practice can decrease risk of lawsuits.
Benefits:
- Helps nurses provide higher quality of care
- Standardizes care
- Helps keep healthcare providers current and relevant
- Helps with decision making related to treatment of medical issues
Barriers:
- Lack of value of research
- Difficulty in changing practice
- Lack of administrative support/funding
- Insufficient time
- Lack of education/awareness about research
- Difficulty accessing or understanding research
- Feeling overwhelmed with the process
- Lack of support by management/leadership
45. Negligence and Malpractice (definition, differences)
Negligence – no intent to cause harm
Malpractice – intentional harm/professional negligence
46. What can you do to prevent legal action?
- Know laws, institutional policies & limits of your nursing role
- Follow your gut instinct
- Clearly document medical records
- Maintain a good bedside manner
- Continuous education
- Use your voice to communicate & help resolve problems with institutional processes
47. HIPAA
Health Insurance Portability Accountability Act
Pts:
- Be informed of their privacy rights
- Be informed as to who will see their records & for what purpose
- Have the right to inspect & obtain a copy of their medical records
- Personal data may not be used for marketing
- Valid authorization must contain certain information
- Understand information may be used for research purposes to assess outbreak of a disease, with identifiable data removed