Nursing is a practice discipline with a specialized perspective related to:
"Principles and laws that govern the life processes, well-being, and optimum functioning of human beings, sick or well."
"Patterning of human behavior in interaction with the environment in critical life situations."
"Processes by which positive changes in health status are affected."
(Donaldson and Crowley, 1978, p. 113)
Nursing's Metaparadigm
Person
Environment
Health
Nursing
Framework of Competency in Nursing
Nursing Discipline
Professional Responsibility & Accountability
Knowledge-based practice
Ethical Practice
Service to the Public
Self-Regulation
Canadian Nurses Association
Client/Families, Groups, Community, Populations
Regulated Nurses
Licensed/Registered Practical Nurses
Registered Nurses
Registered Psychiatric Nurses
Nurse Practitioners
The Art and Science of Nursing
Nursing combines both the art and the science of care.
Four Priorities for Action in Health Care
Four stages of life and health, connected by the need for coordination across time and health care:
Staying healthy: preventative care
Getting better: acute care
Living with illness/disability: chronic care
Coping with end-of-life: palliative care
Patterns of Knowing
Empirical: making objective observations.
Personal: connecting with people.
Aesthetic: personalizing interventions based on the person’s needs.
Ethical: basing care on ethical standards of practice.
Emancipatory: awareness of social problems and social justice issues.
(Carper, 1978; Chin & Kramer, 2015)
Caring in Nursing
An essential functional construct in professional nursing practice which defines the person-centered relationship and the development of interpersonal relationships in practice settings.
(Wagner & White, 2010)
Communication in Nursing
Effective interpersonal communication supports the safety and quality of health care delivery.
Communication connects people and ideas through words, nonverbal behaviors, and actions.
"Communication represents the very essence of the human condition." (Hargie, 2011, p. 2)
Basic Assumptions of Communication Theory
It is impossible not to communicate.
Every communication has a content and a relationship aspect.
We only know about ourselves and others through communication.
Faulty communication results in flawed feeling and acting.
Feedback is the only way we know that our perceptions about meanings are valid.
Silence is a form of communication.
Communication systems are interrelated.
People communicate through both verbal and nonverbal behaviors; both are needed to interpret a message appropriately.
(Bateson G, 1979. Mind and nature. Dutton: New York; Watzlawick P, Beavin-Bavelas J, Jackson D [1967].)
Impact of Communication Between Health Care Providers and People
Impacts the way care is delivered.
Develops a collaborative care partnership.
Person-centered care planning
Is as important as the care itself.
Outcomes relate to higher satisfaction on the part of the person being cared for and productive health changes.
People are more likely to understand their conditions through meaningful communication.
People are more likely to alert providers when something isn’t working.
Linear Models of Communication
Sender → Message → Receiver → Channels → Context
Transactional Model of Communication
Includes feedback loops and considers the dynamic interaction between individuals.
Evidence-Informed Nursing Practice
Serves as critical foundation for nursing praxis, education, research.
Evidence-informed nursing practice: “The ongoing process that incorporates evidence from research, clinical expertise, client expertise, client preferences and other available resources to make nursing decisions about clients.”
(Canadian Nurses Association, 2010)
Nursing Process (ADPIE)
Assessment
Subjective data
Objective data
Diagnosis
Data analysis
Problem identification
Label
Planning
Priorities
Goals
Interventions
Implementation
Nurse-initiated treatments
Physician-initiated treatments
Evaluation
Data
Diagnosis
Etiologies
Plans
Interventions
Source: Lewis, S. L. Heikemper, M. M., Dirksen, S. R., O'Brien, P. G. Barry, M. A., Goldsworthy, S., & Goodridge, D. (2010). Medical-surgical nursing in Canada: Assessment and management of clinical problems (2nd ed., p. 9, Fig. 4-1). Toronto: Elsevier Canada.
Clinical Decision Making Process
Step 1 PROCESS: Information
Notice/assess pt situational factors
Biophysical Data
Incorporate pt preferences
Seek more info if needed
Step 2 ACT: Act to apply clinical knowledge
Interpret/identify problem
Diagnose and set goals
Incorporate ethical values (professional and personal)
Step 3 REFLECT: Actions and outcomes
Implement interventions
Evaluate outcome
Re-evaluate actions
Reflect on new learning
Systems Theory Foundations
Focuses on interrelationships within given systems and is based on the whole being greater than the parts.
Foundation for understanding the quality and safety of health care and professional nursing practice.
Examines individual health issues and how they link and work together in relation to larger health system care outcomes.
(WHO, 2007; Porter O’Grady and Malloch, 2014; Weberg 2012)
Interprofessional Practice
6 Competency Domains:
Interprofessional communication
Person/client/family/community-centred care
Role clarification
Team functioning
Collaborative leadership
Interprofessional conflict resolution
(Canadian Interprofessional Health Collaborative, 2010)
Principles of Team-Based Health Care
Teamwork is essential in healthcare.
The Future of Nursing: Leading Change, Advancing Health
Important role in transforming the health care system.
New roles focusing on the needs of diverse populations, including people who are Indigenous.
Offering care across the life span, preventing and treating a wide range of diseases, and promoting health and well-being.
Ensuring access to care for vulnerable populations, addressing the social determinants of health through collaborative action.
(Canadian Nurses Association, 2015; WHO, 2020)
Summary
Numerous theoretical frameworks guide the practice of nursing.
The concepts of caring and communication are central to the delivery of effective nursing care.
Health care today is undergoing dramatic changes.
Nurses have many opportunities to be involved in health care reform.