Introduction to Nursing – Comprehensive Study Notes

Angeles Institute – Statement of Philosophy

• Learning

  • Lifelong, self-initiated process to acquire knowledge, skills, attitudes, values

  • Occurs through perception → assimilation → formulation → synthesis (independently)

• Faculty role

  • Acts as facilitator; establishes climate of mutual respect

  • Provides learning opportunities & guidance across classroom, skills lab, computer labs, clinical/satellite settings

• Learning experiences

  • Organized for orderly progression → increasing complexity

  • Require participation & group discussion

  • Address cognitive, affective, psychomotor domains

  • Goal: prepare student for safe, competent basic practice & continued professional growth

• Ultimate responsibility for learning rests with the learner

Conceptual Framework – Dorothea Orem’s Self-Care Theory

• Individuals responsible for maintaining own health & that of dependents

• Healthy individual ⇒ meets self-care needs; impairment ⇒ nursing indicated

Self-Care Deficits (three potential areas)

• Universal Requisites

  • Air, water, food, elimination, activity & rest, solitude & social interaction, hazard prevention, skin integrity, normalcy

• Developmental Requisites

  • Elements essential for normal growth & development across life cycle

• Health Deviation Requisites

  • Genetic defects & deviations from normal structure/function impairing self-care ability

Nursing Intervention Categories (Orem)

• Wholly compensatory – nurse performs all self-care activities

• Partially compensatory – nurse + patient share care activities

• Supportive–educative – patient capable; nurse supports/teaches

Terminal Objectives for Angeles Institute Graduates

• Maintain safe environment for clients

• Demonstrate professional standards (dress, behavior, communication, attitude)

• Perform procedures per correct technique & institutional policy

• Manage medications (prep & administration)

• Collaborate with peers, inter-disciplinary staff; use effective communication

• Uphold ethical/legal standards; preserve confidentiality

• Think critically – evaluate, problem-solve, decide

• Use nursing process to collect/report/record data accurately & timely (with technology)

• Demonstrate basic knowledge: adult, obstetric, pediatric, newborn clients

• Provide basic care across life cycle & settings

• Utilize therapeutic communication & client/family education

• Exhibit basic leadership; integrate theory with clinical practice

• Advocate for clients & nursing profession; comply with LVN scope (Vocational Nurse Practice Act)

• Pass $\text{NCLEX–PN}$ (if eligible) & obtain employment/continue education

Requirements for Graduation

• Complete entire program or equivalency within $150\%$ of planned length

• Minimum $76\%$ in each system/term/course

• Clinical segments – Satisfactory (Pass “C”)

• Complete all theory & clinical hours

• Not on probation (attendance/behavior)

• Good financial standing; complete mandatory onsite/online labs ≥ $85\%$

• Pass all exit exams ≥ $85\%$

Requirements for Licensure (California BVNPT)

• Submit BVNPT application & fees; be deemed exam-eligible

• Apply & pay for National Council Licensure Exam; schedule exam

• Allocate adequate study time; pass exam; pay state licensing fee

Learning & Success

• Learning = lifelong acquisition of knowledge/skill

• Success tied to learner’s chosen strategies, positive attitude, and behavioral change

• Attitude = manner/feeling/position toward person/thing

Building Positive Attitude

• Create positive self-images; visualize goal attainment

• Recognize abilities; set realistic expectations; avoid perfectionism

• Develop basic skills: reading, writing, math, listening, speaking

  • Reading → comprehension of MD/nursing notes, orders, test results

  • Writing → assessments, transfer/discharge summaries, teaching plans, policies, journal articles

  • Math → dosage calculation & medication administration

  • Listening → interest, openness, focus, evaluation, note questions

  • Speaking → purposeful questioning, timing

Learning Strategies

• Identify learning style (Visual, Auditory, Kinesthetic)

• Time management: analyze commitments, know self, clarify goals, set priorities, discipline plan

• Study techniques – DOs

  • Preview–Read–Review daily

  • Note rationales & nursing priorities; apply nursing process (Assess–Analyze–Plan–Implement–Evaluate)

  • Ask questions; jot during reading; use mnemonics, flashcards

  • Quick review after class; daily study blocks; written exam schedule; practice questions; study groups

• Study techniques – DON’Ts

  • Over-prepare pre-class; memorize text; write everything in lecture; cram night before; leave class unclear

History of Nursing & Education

• Factors changing nursing: care methods, living conditions, environment relationships, education, technology

• Early civilization

  • Illness = divine disfavor or evil spirits; medicine men used rituals

• Ancient civilizations

  • Egypt – community health laws; India – public hospitals; China – acupuncture; Greece – Hippocrates (“Father of Medicine”): holistic care; Rome – military hospitals then superstition

• Early Christian era – deacons/deaconesses served marginalized; equality of men & women in service

• Middle Ages

  • Dark Ages: monasteries hospitals, Catholic dominance, shift to comfort care, plague, famine, war

  • Crusades: male caregivers; Maltese Cross → precursor to nursing pin

• Renaissance – medical science advanced; nursing declined as Church influence waned

• Reformation – Protestant break; monasteries closed; women subordinate; nursing status low (performed by low-status women)

• 18th–19th century – industrialization, poor social conditions; nursing menial (“dark ages” of nursing)

  • 1836 Pastor Theodor Fliedner – Kaiserswerth School: first formal nursing training (attended by Nightingale)

Florence Nightingale (1820-1910)

• “Lady of the Lamp” – first nursing theorist; Crimean War reforms

• Founded St. Thomas Hospital School in London; “Nightingale Plan” prioritizing education over hospital service

• Concepts: systematic assessment, individualized care, confidentiality, healing environment

Civil War & American Pioneers

• Need for nurses increased; women from religious orders volunteered

• Dorothea Dix – mental health reform & Civil War service; Clara Barton – founded American Red Cross (1881)

• Linda Richards – first U.S. diploma (1873); Mary Mahoney – first African-American RN; Adelaide Nutting – first nurse professor; Lavinia Dock – textbook author, AJN editor; Isabel Hampton Robb – organizational leader, Hopkins founder; Lillian Wald – public health nursing founder

• Additional pioneers: Mary Breckenridge (frontier midwifery), Mamie Hale (midwife education), Susie Walking Bear Yellowtail (Native healthcare advocate), Clara Maass (yellow fever research martyr)

Practical Nursing Development

• 1892 Ballard School (YWCA) – 3-month program

• 1907 Thompson Practical Nursing School; 1918 Household Nursing School (home health)

• 1908 American Red Cross home nursing courses

• 1914 Mississippi – first LPN licensure law; 1917 Smith-Hughes Act (voc-tech funding)

• 1919 first vocational school-based PN program (Minneapolis); 1941 Association of Practical Nurse Schools; 1942 U.S. Office of Education national PN curriculum; 1966 Chicago Public Schools PN program – first NLN accreditation

War-Related Developments

• WWI – emergency nurse training; Army School of Nursing

• WWII – U.S. Cadet Nurse Corps (>14,000 graduates, recruited men & women); prompted graduate education & expanded nursing roles

Twentieth-Century Changes

• Licensing: 1914 Mississippi first mandatory; by 1955 all states (NAPNE standards)

• Insignia/uniforms: Nightingale lamp, nursing pin, identifiable uniforms plus nametags

• Staff development & continuing education: orientation, in-service; CEUs mandated in some states; lifelong learning essential

• Competency focus; aging population drives care demand

Professional Organizations & Regulatory Bodies

• NAPNES – promotes PN education & practice; Journal of Practical Nursing

• NLN – excellence in nursing education; open membership; Nursing & Health Care Perspectives

• NFLPN – policymaking body for LPN/LVNs; Practical Nursing Journal

• ANA – standards for practice/education, research; membership RNs; journals AJN, American Nurse

• HOSA – student vocational organization for health occupations

• BVNPT (CA) – oversees LVN & Psychiatric Tech practice/education, program accreditation, newsletter

• NCSBN – develops $\text{NCLEX–RN}$ & $\text{NCLEX–PN}$

• International Council of Nursing – global nursing representation & health policy influence

Twenty-First Century Trends & Challenges

• Demographics – increasing life expectancy, geriatric needs

• Women’s health – reproductive, heart disease, cancer

• Men in nursing – growing numbers; still face stereotypes; often in management/ED/surgery

• Human rights – nursing advocacy for underserved (unemployment, undocumented, poverty)

• Nursing shortage – projected 26% increase needed by 2020

Program Credentialing & Educational Pathways

• State approval (BVNPT for CA) – ensures curriculum, faculty, facilities, clinicals, student needs met

• Accreditation (Angeles Institute: COE)

• PN program length: 11–18 months; articulation (e.g., LVN→RN bridge into 2nd year ADN)

Licensure – NCLEX-PN

• Purpose: protect public from unqualified practitioners

• State boards administer licensing; national exam = $\text{NCLEX–PN}$

LVN Professional Roles & Responsibilities

• Professional behavior/dress; accountable team member; within Nurse Practice Act scope

• Continuing education, professional organization participation, active license, mentoring future nurses

• Provider of care – assist in all nursing process phases; work with established diagnoses; practice under RN supervision

• Manager of care – first-line manager in LTC/extended care

• Teacher – initiate & reinforce health teaching

• Researcher – assist implementing findings

• Client advocate – uphold ethical & legal standards

Theoretical Foundations (selected)

• Nightingale – natural healing

• Henderson – independent functioning

• Orem – self-care (program framework)

• Leininger – transcultural care

• Roy – adaptation

• Parse – human becoming

• Benner & Wrubel – novice to expert

Nurse’s Professional Image

• Project professionalism; respect; good grooming; washable uniforms & nametag

• Maintain safety, hygiene, protection; sustain personal health

Healthcare System & Delivery

• Health care system = complete network within area; goal optimal health for population

• Wellness-Illness Continuum – dynamic position; holistic perspective

• Maslow’s hierarchy – prioritizes human needs

• Health promotion levels

  • Maintain wellness

  • Prevent disease complications

  • Manage serious health problems

• Continuity of care – patient-centered, coordinated

• Economic factors – rising costs, aging population, tech, insurance, malpractice; case management, cross-training

• Social/environmental factors – finances, lifestyle, social pressures, personal behavior

• Patient rights – AHA Patient Care Partnership; Residents’ Bill of Rights (LTC); provider rights

• Interdisciplinary approach – comprehensive plan, communication, documentation

• Nursing care models concepts: Nursing, Patient, Health, Environment

Contemporary PN/VN Practice

• LPN/LVN provides direct care under RN; safe, effective therapeutic, preventive, rehabilitative services across settings

• Education objectives: acquire specialized knowledge/skills; graduate approved program; pass $\text{NCLEX–PN}$; obtain license

• Responsibilities (per NAPNES)

  • Professional accountability; legal/ethical adherence

  • Effective communication; data collection from multiple sources

  • Collaborate with team; plan/revise care; caring/empathic implementation under supervision