Nursing 310: Introduction to the Nursing Profession and Historical Foundations
Introduction to the Nursing Profession and Historical Foundations
Communication Theories and Nursing Concepts
Communication Basics:
Purpose: To send and receive information.
Forms:
Verbal: Actual words spoken.
Nonverbal: Body language, facial expressions, eye contact, nodding, gestures.
Written: Emails, letters, patient handouts.
Interpersonal Communication in Nursing: Nurses engage in extensive interpersonal communication, not just with the client but also with providers, pharmacists, social services, physical therapy, occupational therapy, and other healthcare team members.
Significance: Communication is as crucial as the care itself, forming the most important aspect of safe and quality healthcare. Lack of communication can lead to poor patient outcomes and dissatisfaction.
Message Barriers & Misinterpretation:
Examples: Tone, miscommunication (using terms unfamiliar to others), nonverbal cues (e.g., all caps in text messages interpreted as shouting).
Challenges: Encoding and decoding messages can be difficult, leading to misinterpretation.
Sore Throat/Popsicle Example: Cultural and linguistic differences can drastically alter the meaning of a simple instruction.
"He's Going to Be Alright" Example: Demonstrates how tone, emphasis, and context can completely change a message. A factual transfer of information (sender to receiver) can be distorted by the transmission's nonverbal elements.
Components of a Message: Sender (conveyor), symbols (emojis, gestures), transmission (spoken word + nonverbal + tone/impact), meaning (interpreted by receiver), feedback.
Environmental Impact on Communication:
Factors: Time, place, historical context (e.g., specific rooms for bad news can cause apprehension).
Pap Smear Example: A distracted environment (toddler, screaming baby) prevents a patient from absorbing important diagnostic information, highlighting the need for an appropriate communication setting.
Key Communication Theories:
Systems Theory: Focuses on communication within a system (client, family, healthcare provider, facility, organization). Emphasizes input (message), throughput (meaning), and feedback (understanding). Crucial for non-native English speakers; mere head-nodding doesn't confirm comprehension, necessitating trained interpreters and translated documents.
Social Penetration Theory: Deals with conveying information to build a nurse-client relationship while maintaining professional boundaries. Nurses should avoid sharing inappropriate personal experiences but can use relevant professional experiences to build rapport (e.g., sharing resource information for a parent with Alzheimer's).
Communication Models:
Linear Model: Used in emergency situations requiring immediate, rapid-fire directives without waiting for detailed feedback (e.g., "Call 911", "Get the paddles").
Transactional Model: More reciprocal, allowing for delayed feedback and a back-and-forth exchange where both parties send and receive messages.
Communication in the Healthcare System:
Client-Centered Care: The patient/client is at the core of all communication and care. The healthcare team, family, organization, and environment all revolve around the client.
Interdisciplinary Coordination: Complex or acutely ill clients (e.g., with diabetes, COPD, CHF) require comprehensive communication and coordination among respiratory care, dietary, patient education, etc.
Involving Family & Loved Ones: Essential for informing and educating the entire care team.
Benefits and Outcomes of Effective Communication:
Physical Comfort: Patients are more comfortable when informed.
Respect for Preferences: Clients become partners in their care planning.
Timeliness: Accurate, frequent, and timely communication prevents patient neglect and improves satisfaction.
Advocacy & Social Justice: Ensures equal and fair treatment and care for all.
Value-Based Care & Patient Satisfaction: Impacts facility reimbursement. Nurses use "scripting" (e.g., for discharge instructions) to ensure patients recall receiving vital information for surveys.
Multiple Formats: Presenting information verbally, in writing, and reiterating critical points (e.g., emergency contact numbers) improves recall, especially for those who might be sedated or overwhelmed.
Entry-Level Nurse Communication Competencies:
Determine client preferences (e.g., room lighting, desired level of interaction).
Verify understanding, especially when language barriers exist; use trained interpreters.
Use open-ended questions like "Is there anything else you need?"
Provide full attention, make eye contact, and adapt to the client's communication style and cultural background.
Communicate responsibly to ensure safe care.
Utilize informatics tools (e.g., language lines, Electronic Health Records) to aid communication and coordination of referrals.
History and Social Context of Nursing
Influences on Nursing Demands:
Social Forces: How society reacts to health and illness.
Political & Economic: Impact of events like COVID-19 (e.g., treatment requirements, visitor policies, care costs).
Advances: Research progress, leading to increased longevity.
Key Historical Figures and Events:
Florence Nightingale ("The Lady with the Lamp"): A pioneering figure from the Crimean War. She formalized nursing training, collected extensive data on morbidity and mortality (acting as an "original nursing researcher"), and established principles of cleanliness and infection control. Her compassionate care for wounded soldiers also encompassed early hospice techniques. However, her early schools were exclusive and discriminatory.
Mary Seacole: A Jamaican nurse from the 1800s who was an expert on cholera. She was excluded from Nightingale's schools due to racial prejudice but provided vital care to soldiers.
American Civil War (late 1800s): Began without professionally trained nurses. Catholic orders initially provided much of the care. The demand for nurses led to a call to duty for women. Enslaved women like Sojourner Truth, Harriet Tubman, and Susie King Taylor provided nursing care to Union soldiers. This era highlighted the importance of nurses and nurse leaders.
Post-Civil War Era: Led to the establishment of the first formal nursing training schools and increased professionalism within the field.
Lillian Wald ("Mother of Public Health"): Founded the Henry Street Settlement in New York's Lower East Side, focusing on social justice and healthcare access for immigrants. She also co-founded the National Association for the Advancement of Colored People (NAACP) and was instrumental in establishing visiting nurse services.
Mary Eliza Mahoney: The first formally trained Black nurse in the US. Nursing remained segregated until well into the 1950s.
Spanish-American War: Further boosted the demand for nurses, pushing forward the platform for nursing education.
Early 20^{th} Century Licensure: Early efforts in licensure meant nurses couldn't use the "RN" title without registration. By the early 1920s, all states required an examination for licensure.
1950 (National League of Nursing - NLN): Created the first nationwide State Board Test Pool Examination, ensuring a standardized level of preparedness and competence for all graduating nurses, leading to safe patient care. The NCLEX RN (and NCLEX PN for practical nurses) is the descendant of this examination.
World War I: Led to army nurse training, like at the Vassar training camp. The 1918 flu pandemic further emphasized the need for and expansion of public health nursing.
Great Depression: Families couldn't afford private medical care. President Roosevelt's Civil Works Administration invested in public health services, particularly for vulnerable populations such as children, people with disabilities, and blind persons.
World War II: Again created a significant demand for nurses. Post-war, there was a rise in hospital construction and beds, further increasing the shortage of nurses needed to staff them.
Post-WWII Period (Healthcare Specialization & Social Security): Saw the rise of clinical specialization (e.g., pulmonologists, women's health). The Social Security Act of the 1960s introduced Medicare (care for older adults, currently 65+) and Medicaid (aid for those in need, regardless of age, covering newborns to disabled adults).
Vietnam War: Required mobile hospitals and led to more nurses being trained by the armed forces to serve overseas. Nurses often performed duties beyond their typical scope of practice due to battlefield conditions, contributing to higher rates of PTSD among medical personnel.
1980s - Early 2000s (HIV/AIDS & Technology): This period saw the recognition of HIV/AIDS, initially with poor communication and education, leading to stigma. Medical technology advanced rapidly, introducing more life support options like ventilators, which in turn raised ethical issues concerning advanced directives and the right to die.
2001 - 2020 (Disaster Management & Advocacy): Post-9/11 and Hurricane Katrina, there was a significant learning curve in disaster management. In 2006, the American Nurses Association (ANA) released a statement identifying actions for unfamiliar or unusual conditions, promoting collaboration and protecting nurses rendering aid in emergencies. The ANA also collaborates with educators (NLN) to ensure a strong foundation in nursing education for critical thinking and skills. The Affordable Care Act (ACA) was introduced in 2010, impacting healthcare access, with ongoing incremental changes and continuous advancements in information and medical technology.
2020 and Beyond (COVID-19 & Disparities): The COVID-19 pandemic (SARS-CoV-2) fundamentally shifted healthcare, leading to increased awareness of death, long COVID issues, and immense stress on healthcare providers. It starkly exposed huge disparities in health outcomes, standards of care, and access to healthcare, raising ethical dilemmas, such as vaccine status impacting eligibility for transplant lists.
Social Context of Nursing (Contemporary Issues):
Gender in Nursing: Traditionally, nursing was seen as a female profession due to prevailing sexist views. Men historically served disproportionately in military nursing, religious orders, or psychiatric care. Today, the profession is becoming more gender-balanced. Men in nursing are often younger, full-time, and may have entered nursing as a second career, motivated by a desire to help, career stability, and diverse opportunities. The first American Assembly for Men in Nursing was held in 1974.
Media Depiction & Public Image: The historical portrayal of nurses (e.g., "Nurse Ratched," stereotypical Halloween costumes) is evolving. Nurses are consistently rated among the most honest and ethical professions. Movements like the Johnson & Johnson campaign and the advocacy efforts of nursing organizations (ANA, NLN) help enhance the public image and advocate for issues like safe nurse-patient ratios.
Aging in America & Workforce Shortage: The US population is aging (e.g., Baby Boomers), while the number of mid-life adults is decreasing, leading to a shortage of nurses and nursing educators. Strategies to address this include incorporating more gerontology in nursing programs, encouraging gerontology specializations (e.g., Clinical Nurse Specialist, Nurse Practitioner), and utilizing student nurses to help fill staffing gaps.
Diversity in Client Population: An increasingly diverse client base necessitates culturally competent staff and culturally appropriate care (e.g., providing interpreters and translated materials).
Technology & Informatics: Advances like telehealth (e.g., remote consultations) and genetics/genomics (Human Genome Project, pharmacogenetics for personalized medication efficacy) are transforming care delivery. Nurses require constant learning and adaptation to use advanced IT systems (e.g., Epic EHR).
Nursing Shortage (Internal and External Factors):
Internal Causes: Nurse retirement (often accelerated by burnout post-COVID), perceived inadequate salary, and long working hours that impact work-life balance (e.g., missing family events).
External Causes: The increasing number of elderly and sicker patients (higher acuity), leading to a need for more staff per patient. A shortage of nursing faculty further exacerbates the problem by limiting the number of new nurses that can be educated. Historically, solutions have included creating less extensively trained workers to supplement the workforce (e.g., diploma or associate degree nurses).
Nursing Initiatives: Various organizations (e.g., Robert Wood Johnson Foundation, Warren Buffett Foundation) provide funding and support to address nursing shortages and improve the profession.
Nursing Theory
Definition & Purpose: Nursing theory comprises a group of related concepts, definitions, and statements that form the foundation of nursing care. It serves to describe, explain, and predict outcomes, helping nurses build their body of knowledge.
Importance:
Strengthens nursing as a profession.
Provides a framework for reasoning, critical thinking, and decision-making.
Facilitates the development of new knowledge.
Goal: To support excellence in practice by guiding the development of effective care, which evolves as new theories emerge and older ones are refined.
Key Nursing Theorists:
Florence Nightingale: Focused on the environment's influence on health, emphasizing clean air, water, ventilation, and sanitation (clean sheets, bandages). She was the original data collector, observing and documenting patient changes.
Virginia Henderson (Needs Theory): Identified basic patient needs that individuals cannot meet on their own, and how the nurse can assist in addressing these (e.g., aiding with bathing or oral hygiene).
Jean Watson (Caring Theory): Emphasizes caring as the core of nursing, focusing on providing compassionate and respectful care to build a trusting nurse-patient relationship, promoting health, restoring health, and preventing illness.
Dorothea Orem (Self-Care Deficit Theory): Focused on patient deficits in self-care and how nurses can support patients in achieving greater self-care, addressing both actual and potential self-care limitations.
Imogene King (Goal Attainment Theory): Stresses goal setting as a collaborative process between the nurse and patient, ensuring realistic and mutually agreed-upon goals for successful outcomes.
Sister Callista Roy (Adaptation Model): Focuses on patient adaptation to illness or changed circumstances by modifying the environment. Successful adaptation requires changes, and nurses assess demands on the client's coping skills to prevent ineffectual adaptation (e.g., addressing emotional needs before physical rehabilitation).
Hildegard Peplau (Interpersonal Relations Theory): Views the nurse-client relationship as a therapeutic process, helping clients survive, understand their health problems, and develop new behaviors (often applied in behavioral health for mood modification).
Ida Jean Orlando (Nursing Process Theory): Centers on nurse-client interactions to determine and meet patient needs, thereby relieving distress or discomfort (e.g., making a patient comfortable).
Madeline Leininger (Cultural Care Theory): Emphasizes the importance of incorporating a client's culture and diversity into their care to provide respectful and effective nursing.
Middle-Range Theories (More Recent):
Kristen Swanson (Theory of Caring): Similar to Watson, focused on caring.
Madeleine M. Leininger (Cultural Care Diversity and Universality Theory): Further expands on the relationship between culture and healing.
Merle Mishel (Uncertainty in Illness Theory): Addresses how patients cope with uncertainty related to their illness and the need for clear communication about expectations.
Epistemology of Nursing: This refer to the study of knowledge related to nursing, informing the body of knowledge we build upon.
Theory-Based Education & Practice:
Nursing curricula are built on basic theory to provide a strong foundation for critical thinking and practice (e.g., Grand Canyon University's nursing education is theory-based).
Theory-Based Practice: Combines nursing theory with the nursing process (ADPIE: Assess, Diagnose, Plan, Implement, Evaluate) to guide effective nursing care. For example, knowing cleanliness decreases infection leads to handwashing and proper room assignments.
Theory-Based Research: Originated with Florence Nightingale's early data collection and continues today with doctoral nurses conducting evidence-based research to advance nursing knowledge and practice.