Nursing Fundamentals Summary

Basics of Nursing

Basic Principles

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Historical Context: The Crimson War & Florence Nightingale

  • The Crimson War (1853-1856) was a trade war between Europe and Russia.
  • Florence Nightingale, a nurse during this era, observed a high mortality rate among wounded soldiers.
  • The primary causes of death were not wounds but diseases like cholera, dysentery, and typhoid.
  • These diseases were linked to contaminated food and water.
  • Nightingale focused on environmental factors impacting health, leading to the development of her environmental theory.
  • This theory emphasizes the importance of clean environments, sanitation, and basic needs like food and water in patient care.

Impact of Technology

  • Advancements in technology prolong life, but this also leads to increased age and comorbidities.
  • As people live longer, they are more likely to develop multiple diseases, increasing the patient-to-nurse ratio.
  • There is a tendency to focus on treatments and medications, potentially overlooking the fundamentals of nursing.
  • These fundamentals are essential and make nurses irreplaceable, encompassing a wide range of care.

Nursing: Art and Science

  • Science: Factual knowledge that can be read in books.
  • Art: A nurse's experience when engaging with a patient.
  • Example: A 260-pound patient on a mechanical ventilator who refuses to move, increasing the risk of pressure ulcers.
  • Science dictates turning the patient every two hours to prevent pressure ulcers. Special air pressured matress
  • The patient refuses the mattress because it interferes with sleep, a basic physiological need.
  • A nurse successfully places pillows strategically to distribute weight, removing them gradually.
  • Another nurse labels pillows for specific body parts, streamlining the process due to compassion, dignity, and intuition.

Nursing Theories and Foundations

  • Nursing theories provide a foundation for practice and research.
Theory Defined
  • Theory: an idea or a situation or a phenomenon.
  • Theory addresses a situation by identifying the problem needing a solution.
  • Data collection is essential for research, including symptoms, sanitation, and environment.
  • Research involves re-searching the problem to find a scientific solution that can be practiced.
  • Meta-theory examines the relationship between various components of knowledge and discipline.
  • Theory simplifies to: Outcome == Concept ++ Phenomenon (the problem).
  • The outcome undergoes testing.
  • Testing involves questions, analytics, measurements, and respondents (patients) to prove the hypothesis.
Components of a Theory
  • Phenomenon: The problem.
  • Frameworks: Used in creating a thesis.
  • Assumptions: The hypothesis.
Domain of Nursing
  • Domain refers to the fields of nursing.
  • Paradigm is a pattern or conceptual framework that interrelates nursing skills, person, and collected data.
  • Nursing paradigm includes person, health, environment, situations, and nursing.
  • Person: Needs to be narrowed down by age group, gender, sex, health conditions, and religion.
  • Health: Focus on a particular disease.

Florence Nightingale's Environmental Theory

  • Nightingale's theory was the first of its kind in nursing.
  • Requires a broad range because there were no other theories to support its objective.

Eras of Nursing

  • Curriculum Era: 1900-1940.
  • Research Era: 1950-1970. Nightingale's research during the Crimson War concluded in 1959, leading to establishing a school in Europe. First nursing school opened in 1972
  • Theory Utilization Era: 1980s to the present, adapting to the changing environment.
  • Nursing has evolved from vocational to diploma-based, emphasizing academics and knowledge.

Types of Nursing Theories

  • Grand Theories: Such as Nightingale's Environmental Theory, have no point of comparison during that time.
  • Middle Range Theories: Limited in scope and less abstract.
  • Descriptive theories: focus on describing something, such as child development
  • Meta-theory and grand theories are the most abstract, practice theories and middle range theories become more specific
  • Post Nightingale most theories use the middle range approach which is easier due to fewer variables.

The Essence of Nursing

  • Nurses address the patient holistically, considering the impact of disease/anxiety and their health condition.
  • Nurses often act as altruists, wanting to help patients.
  • Theories from other healthcare fields also are used, such as the study of developmental stages to identify patient age/growth.

The Nursing Process

  • A critical process applied in hospitals.
Steps
  • Assessment: Gathering data. For example, difficulty breathing.
  • Nursing Diagnosis: Based on the assessment. For example, impaired oxygen exchange.
  • Independent Nursing Intervention: Actions taken without a doctor's order. For example, administering oxygen (2-3 liters/minute), depending on hospital policy and state regulations following nursing fundamentals.
  • Important considerations:
    • Oxygen Toxicity: High concentrations of oxygen can be harmful.
    • COPD Patients: High oxygen levels can disrupt the breathing process, CO2 is the stimulus for breathing. Normally you don't give oxygen above three liters to patients with COPD initially.

Key Nursing Theorists

  • It is imperative to read and be able to memorize as many as possible.
  • Theorists are very important to the field of nursing, one in particular is Abdaem.
  • When composing a theory, use a related preexisting theory for ease of development.

Nursing Theories and Pain Management

  • Pain scale ratings comes directly from the patient.
  • Make patient comfortable, so they have courage to cope and believe in treatment/therapy.

Additional Theories

  • Fender Health Promotion
  • American Association of Critical, those theories

Nursing Theories: Revisited.

  • Florence Nightingale’s Environmental Theory: Considered a grand theory.
  • Health Plus Interpersonal Theory: Focuses on interpersonal relationships between nurse, patient, and patient’s family, includes (pre-orientation, orientation, working, resolution).
    • It is common for a patient's family to feel pain as they witness their loved one's pain, therefore it is important to also build rapport with family.
  • OREM Self-Care Deficit: Focuses on patient self-care needs; continually assess self-care ability.
    • Example: Hemiparesis, place remote on the affected side to encourage use.
  • Leininger Culture, Care Theory of Culture, Care Diversity, and Universality: Integrates patient culture and tradition.
    • Important: Respect cultural/religious preferences. Example: Jehovah’s Witness won’t take blood. respect preferences and different nationalities have preferred speaking distances and muslim patients preference regarding the sex of providers.

Nursing Theory and National Council

  • National Council of State Boards (NCSBN), The CJM, and guides nursing educators.
  • Has different layers to develop a good nursing plan.
  • Different Layers of Nursing = good nursing process developed.

Nursing Knowledge

  • Nursing theoretical and experiential are linked among theories, knowledge development, and research.
  • Theoretical Knowledge: To stimulate thinking, creating broad understandings of nursing, sciences, and practice.
  • Experiential Knowledge: (The art of nursing) based on experiences providing patient care.

Theory-Based Research

  • Research is used to develop new theories.
  • Theories must be improved and improvised depending on the changing world.
  • Books take years to publish, creating a need to use the Internet to find the most up to date EBP (evidence based practice).
  • Can search EBP through universities, schools and websites of Vanderbilt University.

Historical Contributions.

  • Nurses have existed for 200+ years (19th Century).
  • Clara Barton created The American Red Cross.
  • First nursing school opened in 1972.
  • 4 Year degrees offered in 1970s.
  • Floris Nightingale: Founder of modern nursing. Was able to build a school in 1959 in London.
  • Used Evidence-Based Practice (EBP) and that we use today.

Development of Nursing Profession

  • NIH defines nursing as protecting, promoting and advancing client health.
  • Averted illnesses injuries through healthcare promotion. This is important to save money in the medical system.
  • Using the nursing process to facilitate clients recovery from illness or injury and minimizing/eliminating suffering need to always be advocates for patients.

Development of Nursing Skills

  • Professional nurse of practice, the legal aspects in each state establish rules and regulations. The scope varies by each state and one must confirm to all laws/policies in place.
  • Your code of ethics will protect you in nursing including, your scope, limitations, responsibilities, and liabilities.
  • If something goes wrong, will depend if one is assigned to carry out intervention vs delegated.
  • Assigned cases are your sole discretion, delegate means not the sole liability of the person delivering care.
  • Important always to ask if case is assigned vs delegated for purposes of liability.

Levels of Nursing Education

  • LPN/LVN: Do have limitations; aren’t allowed to use assessing (assessing skills).
  • RN’s- ADN/ BSN.
  • Graduates-MSN/ AP/BMP and PhD.
  • MSN will go a long way when retire, can teach at younger age.
  • SMSN required to achieve Nurse Practitioner (NP).
  • Need to take a continuing education course for this.
  • Patricia Benner, novice expert: The more experience in the hospital, the more you become a expert.
  • Don't be arrogant if you have more experience in ICU, try to respect MS floor who may have a different background with differences in patient care.

Nursing Foundation: Roles and Competency

  • Care Provider. Case Manager. Researchers. Educators. Leaders. Managers. Change Agents of Managers.
  • Advocacy. Change Management. Communication. Collaboration.
  • All the things above imply that a nurse is competent

Organizations for Nurses

  • Nursing Academy of Medicine.
  • National Student Nursing Association.

Nursing & Healthcare: Issues.

  • Own Futures Nursing Report: Health Nursing, Health Association.
  • Health Promotion + Healthy People in 02/1930.
  • Impaired Nursing, social media, and cell phone use of misuse.
  • Having a heart that never hardens, a temper that never tires, a touch that never hurts.

Important Reminders

  • Finish what you started.
  • Embrace and love field of nursing.
  • Practice perseverance to achieve objectives.

Caring and essence of a nurse.

  • Talk about caring.
  • The essence of care.
  • The thing that made us different from other members of the healthcare team.
  • CNAs spend a good time with patients.

AONE guiding principle for future care.

  • Patient's back relation
  • Patients are in the center of the healthcare team.

Theoretical views on caring.

  • Caring is primary.