Nursing Notes

Comparing Nursing Yesterday and Today

  • Yesterday:
    • Diploma programs produced most nurses.
    • Advanced practice nurses (APNs) had limited authority.
    • Nursing research was minimally supported and recognized.
  • Today:
    • Increased enrollment in AD and BSN degree programs.
    • APNs' roles have expanded to include prescriptive authority in many states.
    • National Center for Nursing Research established in 1993.

Influence of Healthcare Settings

  • Rising costs
  • Complexity of healthcare settings and services
  • Expanding community health services
  • Increasing use of ambulatory care services

Technologic Advances

  • Less invasive diagnostic tools and procedures.
  • Computerized monitoring systems and critical care interventions.
  • Expense of new life-saving technology leads to questions of resource allocation.

Access to Healthcare and Financial Resources

  • Access to healthcare services refers to a person’s ability to find and receive care from a healthcare provider, which is related to income, race, and geographic location.
  • Healthcare providers are asked to put a dollar value on their services and relate their services to patient outcomes.
  • Rising healthcare costs spurs debate between quality of life and quantity of life.

Future Challenges for Nursing

  • Healthcare cost containment
  • Scientific and technologic advances
  • Social issues
  • Find ways to balance the demands of being an adult learner with the responsibilities of adult life.

Evolution of Professional Nursing

  • Ancient History:
    • Hippocrates recognizes need for nurses.
    • Boundary between nursing and medicine often blurred.
    • Christianity improves status of nursing by attracting intelligent individuals and establishing military nursing orders.
  • Florence Nightingale:
    • Improved health laws, reformed hospitals, reorganized military medical services
    • Established nursing as a profession.
    • Published Notes on Nursing
    • Started the Nightingale Training School for Nurses.
  • Military Influence on American Nursing
    • Civil War: Dorothea Dix found Nurse Corps of the U.S. Army, expanding nursing’s role; Clara Barton found American Red Cross.
    • Spanish American War: Volunteer Nurse Corps (1898) established and becomes the Army Nurse Corps (1901); Navy Nurse Corps established in 1908.
    • World War II: Black nurses first admitted into military service.
  • Professional Nursing Organizations and Journals Emerge in Early 20th Century:
    • American Nurses Association (ANA)
    • National League for Nursing (NLN)
    • American Association of Colleges of Nursing (AACN)
    • American Journal of Nursing.
  • 21st Century Nursing:
    • Nurses need to be able to render care in a wide range of settings, adapt to needs of diverse patients, and be knowledgeable of emerging technologies.

Educational Preparation

  • Practical Nursing Programs:
    • Graduates eligible to take the National Council Licensure Exam-Practical Nursing (NCLEX-PN) to become a licensed practical nurse (LPN) or licensed vocational nurse (LVN).
  • Registered Nurse Programs:
    • Graduates eligible to take the National Council Licensure Examination-RN (NCLEX-RN).
    • Programs include diploma nursing programs, associate degree programs, baccalaureate degree programs, and graduate entry programs.

Socialization Into a Profession

  • Socialization:
    • A process involving learning both theory and skills and also of internalizing an identity appropriate to a specific role.
  • Criteria of a Profession:
    • Having a specific body of knowledge and a set of values and skills that differentiate members of a profession from others.
  • Skill Proficiency in Nursing:
    • Benner identified five levels of proficiency in acquiring and developing nursing skills: Novice, Advanced Beginner, Competent, Proficient, and Expert.

Beyond Entry Level Into Practice (Advanced Nursing Education Programs)

  • RN to BSN
  • Master’s Degree (MSN/APN)
  • Doctorate of Nursing Practice (DNP)
  • Research Doctorate Degree (PhD; EdD, DNS)

Advancing Education

  • Continuing Education:
    • Some states require acquisition of continuing education for ongoing licensure.
  • Certification:
    • Certification is a voluntary process that provides professional recognition of the knowledge, skills, and abilities within a practice area.

Expanded Nursing Roles

  • Nurse practitioner (NP)
  • Clinical nurse specialist (CNS)
  • Nurse midwife
  • Nurse anesthetist
  • Nurse researcher
  • Nurse administrator
  • Nurse educator

Professional Nursing Practice

  • Standards of practice are the minimum acceptable guidelines for providing and evaluating nursing care.
    • The ANA designates professional nursing responsibilities such as assessment, diagnosis, outcome identification, planning, implementation, and evaluation.
  • Scope of practice is the legislation describing what nurses are legally authorized to do.
    • The Nurse Practice Act of each state defines the practice of nursing within the state.

Nurse Practice Acts

  • Each state’s Nurse Practice Act defines the practice of nursing within its jurisdiction.
  • The state’s board of nursing sets requirements for licensure.
  • New nursing graduates must pass the NCLEX to qualify for a nursing license.

Nursing Responsibilities

  • Patient
  • Caregiver
  • Educator
  • Advocate
  • Decision maker
  • Manager and coordinator
  • Communicator

Nursing Competencies

  • The Quality and Safety Education for Nurses (QSEN) initiative identified key quality and safety competencies for nurses:
    • Patient-centered care
    • Teamwork and collaboration
    • Evidence-based practice
    • Quality improvement
    • Safety
    • Informatics

Nursing Program Accreditation

  • Program accreditation is a voluntary process that demonstrates achievement of national standards of excellence.
  • Organizations accredited by the U.S. Department of Education to accredit nursing programs are the following:
    • Commission for Nursing Education Accreditation (CNEA): Accredits practical nursing programs, all entry-level registered nurse programs and nursing master’s and doctoral programs.
    • Commission on Collegiate Nursing Education (CCNE): Accredits baccalaureate and higher degree programs.
    • Accreditation Commission for Education in Nursing (ACEN): Accredits nursing programs at all levels of education.

Professional Nursing Organizations

  • American Nurses Association (ANA):
    • Sets the standards of practice for nurses and makes decisions about the functions, activities, and goals of the nursing profession.
  • Sigma Theta Tau International (STTI), Honor Society of Nursing:
    • Provides leadership and scholarship in practice, education, and research to enhance the health of all people.
  • National Student Nurses’ Association (NSNA):
    • An autonomous organization that is financed and administered by students that serves as the voice of nursing students.

Nursing Theory

  • There are four central concepts in nursing practice that are defined and described in nursing theories.
  • Each nursing theory defines, relates, and emphasizes the following four concepts differently:
    • Person
    • Environment
    • Health
    • Nursing

Nonnursing Theories Used or Adapted by Nursing

  • General systems theory (von Bertalanffy)
  • Human needs theory (Maslow hierarchy of human needs)
  • Change theory (Lewin)

General Systems Theory

  • Major assumptions of this theory include the following:
    • All systems must be goal directed.
    • A system is more than the sum of its parts.
    • A system is ever changing, and any change in one part affects the whole.
    • Boundaries are implicit, and human systems are open and dynamic.
  • Nursing theorists who have used this approach include Roy, Neuman, Johnson, and Parse.

Maslow Hierarchy of Human Needs

  • Physiologic needs: The need for oxygen, food, water, elimination, activity, rest, temperature maintenance, and sexuality.
  • Safety needs: The need to be physically safe and free from fear and anxiety resulting from lack of security and protection.
  • Love needs: The feeling of belonging and being loved to avoid loneliness and isolation.
  • Esteem needs: Composed of esteem derived from others (respect) and self-esteem.
  • Self-actualization needs: The need to maximize one’s potential.

Lewin Change Theory

  • Change theory offers insight into expected behaviors when significant change occurs within an environment.
  • Three recognized stages are as follows:
    • Unfreezing: Recognition of the need for change and the dissolution of previously held patterns of behavior.
    • Movement: Shift of behavior toward a new and more healthful pattern.
    • Refreezing: Long-term solidification of the new pattern of behavior.