Chpt 1 fundamentals of nursing

Chapter Summary: Formation of Nursing

Historical Background

Early Civilizations: Nursing roles were distinct; animism influenced health beliefs. Ancient Greeks viewed illness as divine punishment.
Christian Era: Nursing became formalized with deaconesses visiting the sick.
16th Century: Shift from religious to secular care; nursing faced challenges due to a shortage of trained personnel.
19th-20th Century: Florence Nightingale's reforms elevated nursing status, leading to formal education and professional recognition.
1950s-Present: Expansion of nursing roles, emphasis on education, research, and evidence-based practice.

Definitions of Nursing

Nursing is defined as a blend of art and science focused on health promotion, illness prevention, and patient advocacy.
Central to nursing is the holistic care of individuals, families, and communities.

Aims of Nursing

Promote Health
Prevent Illness
Restore Health
Facilitate Coping with Disability/Death

Competencies

Blended Competencies: Cognitive, Technical, Interpersonal, Ethical/Legal.
QSEN Competencies: Patient-centered care, Teamwork, Quality improvement, Safety, Evidence-based practice, Informatics.

Professional Formation

Nursing educators shape professional identities, emphasizing values and ethics in practice.

Educational Preparation

Various pathways: Practical nursing, Associate Degree, Baccalaureate, Graduate education, Continuing education.

Professional Organizations

Key organizations include ICN, ANA, NLN, AACN, AAN, NSNA, and NBNA.

Guidelines for Nursing Practice

Governed by Nurse Practice Acts, Standards of Practice, and a Code of Ethics.

Current Trends in Nursing

Changing demographics, technological advancements, globalization, and the need for interdisciplinary collaboration.

Self-Care in Nursing

Nurses must prioritize their health to effectively care for others, addressing issues like compassion fatigue and burnout.

Resilience

Emphasizes coping mechanisms and supportive environments to foster well-being in nursing professionals.

Main Themes and Motifs

Evolution of Nursing: Transition from informal care to a recognized profession.
Holistic Care: Emphasis on the physical, emotional, and social aspects of health.
Professional Identity: Formation and recognition of nursing as a distinct discipline.
Education and Standards:

Formation

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Learning Objectives
After completing the chapter, you will be able to accomplish the
following:
 Describe the historical background of nursing, definitions of nursing,
and the status of nursing as a profession and as a discipline.
 Explain the aims of nursing as they interrelate to facilitate maximal
health and quality of life for patients.
 Explain how nursing qualifies as a profession.
 Describe the various levels of educational preparation in nursing.
 Discuss the effects on nursing practice of nursing organizations,
standards of nursing practice, nurse practice acts, and the nursing
process.
 Identify current trends in nursing.
 Discuss the importance of self-care in relation to the demands of the
nursing profession and the duty to model healthy behaviors.

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How does the World View Nursing
 The public has rated nursing as the most honest and ethical
profession in America for 18 yrs straight.
 “Nursing incorporates the art and science of caring, and focusing on
protection, promotion, and optimization of health and abilities;
prevention of illness and injury; facilitation of healing; and alleviation
of suffering through compassionate presence.
 Nursing is the diagnosis and treatment of human response, and
advocacy in the care of individuals, families, groups, communities,
and populations in recognition of the connection of all humanity
 Nursing care involves a wide range of activities, from carrying
out complicated technical procedures to something as
seemingly simple as holding a hand.

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Historical Perspective/Early Civilizations
to the 16th Century #1
 Theory of animism
o Good spirits brought health; evil
spirits brought sickness and death
o Roles of nurse and physician
separate and distinct: physician as
medicine man; nurse as caring
mother
 Ancient Greek civilization
o Temples became center of medical
care
o Illness caused by sin and God’s
displeasure
o Disease means “Dis-ease”
o Ancient Hebrews had rules through
the Ten Commandments, Mosaic
health code for ethical human
relationships, mental health and
disease control. Nurses cared for
the sick in the home and
community; practiced as nurse-
midwives

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Historical Perspective/Early Civilizations to the 16th Century #2
 Early Christian period
o Nursing role becomes more formal
and clearly defined; deaconesses
made visits to the sick
o Male and female nursing orders
were founded during the Crusades
 16th century
o Shift from a religious orientation to
an emphasis on warfare,
exploration, and expansion of
knowledge
o Many monasteries and convents
closed, leading to a shortage of
people to care for the sick.
o Shortage of nurses led to the
recruitment of female criminals to
care for the sick; to prevent them
from going to jail. In addition to
having poor reputation, these
untrained nurses had low pay, and
long work hours in unfavorable
conditions

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Historical Perspective/19th to 20th
Centuries #1
Social reforms changed the roles of nurses and of
women in general
Nursing as we now know it began, based on many
of the beliefs of Florence Nightingale
o Nightingale challenged prejudices against
women and elevated the status of all nurses
o She established the first training school for
nurses and wrote books about health care and
nursing education

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Historical Perspective/19th to 21st
Centuries #2
 Hospital schools organized to provide more
easily controlled and less expensive staff for the
hospital
 Female nurses were under the control of male
hospital administrators and physicians
 Lack of educational standards, in a male
dominant world with the belief that women were
subordinate to men contributed to slow
progression towards nursing as a profession
 World War II
o Large numbers of women worked outside
the home and became more independent
and assertive
o These changes in women and society
lead to an increased emphasis on
education. The war created a greater
need for more nurses
o Explosion in medicine and technology
broadened the role of nurses
o Growth of nursing as a professional
discipline

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Historical Perspective/1950s to Present
 Nursing broadened in all areas
o Efforts were directed at
upgrading nursing education
o Practice in a wide variety of
health care settings
o The development of a specific
body of knowledge
o The conduct and publication of
nursing research
o Recognition of the role of
nursing in promoting health
o Increased emphasis on
nursing knowledge as the
foundation for EBP led to
growth of nursing as a
professional discipline that
operates independent of other
disciplines

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Definitions of Nursing
 Originated from the Latin word nutrix (to nourish)
 ICN definition— Nursing includes the promotion of health,
prevention of illness, advocacy, promotion of a safe
environment, research, participation in shaping health policy,
and education
 ANA definition—describes the social context of nursing,
knowledge base for nursing practice, scope on nursing practice,
and standards of professional nursing practice, and the
regulation of professional nursing
 Patient is central focus of all definitions
o Includes physical, emotional, social, and spiritual
dimensions of the patient

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Nursing’s Aims And Competencies
Four broad aims of nursing can be identified in the definitions of nursing:
 Promote health
 Prevent illness
 Restore health
 Facilitate coping with disability or death
To meet these aims, the nurse uses four blended competencies:
Cognitive, Technical, Interpersonal, Ethical/legal
More recently these competencies have been further specified as the Quality and
Safety Education for Nurses (QSEN) project competencies:
 Patient-centered care, Teamwork and collaboration, Quality improvement,
Safety, Evidence-based practice, Informatics

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Interrelated Roles
Caregiver
Communicator
Teacher/Educator
Counselor
Leader
Researcher
Advocate
Collaborator

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Promoting Health
Health- is a state of optimal functioning or well-
being.
What does a person’s health include?
Nurses promote health by identifying, analyzing,
and maximizing each patient’s individual strengths
as components of preventing illness, restoring
health, and facilitating coping with disability or
death.
Health promotion is motivated by the desire to
increase a person’s well-being and health potential. A
person’s level of health is affected by many different
interrelated factors that either promote health or
increase the risk for illness.

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Health Promotion
Health promotion is motivated by the desire to
increase a person’s well-being and health potential.
 A person’s level of health is affected by many
different interrelated factors that either promote
health or increase the risk for illness.

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Factors Affecting Health
Genetic inheritance
Cognitive abilities
Educational level
Race and ethnicity; culture
Age and biologic sex
Developmental level
Lifestyle; environment
Socioeconomic status
Health Literacy

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Healthy People 2030 Health Promotion
Guidelines
Healthy People 2030 also establishes health promotion guidelines for the
nation as a whole. The guidelines are focused on meeting five
overarching goals:
1. Attain healthy, thriving lives and well-being, free of preventable
disease, disability, injury, and premature death
2. Eliminate health disparities, achieve health equity, and attain health
literacy to improve the health and well-being of all
3. Create social, physical, and economic environments that promote
attaining full potential for health and well-being for all
4. Promote healthy development, healthy behaviors, and well-being
across all life stages
5. Engage leadership, key constituents, and the public across multiple
sectors to take action and design policies that improve the health
and well-being of all
https://www.cdc.gov/nchs/healthy_people/hp2030/hp2030.htm

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Preventing Illness
 Reducing the risk of illness, promoting good health habits, and
maintaining optimal functioning
 Nurses prevent illness primarily by teaching and by personal
example. Examples include:
 Educational programs in areas such as prenatal care for
pregnant women, smoking-cessation programs, and stress-
reduction seminars
 Community programs and resources encouraging healthy
lifestyles
 Literature, TV, radio, or Internet information on healthy diet,
exercise, and good health habits
 Health assessments in institutions, clinics, and community
settings that identify areas of strength and risks for illness

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Restoring Health
 Focus on the person with an illness and are considered to be
the nurse’s responsibility. These activities done by nurse
include the following:
 Performing assessments that detect an illness
 Referring questions and abnormal findings to other health care
providers, as appropriate
 Providing direct care to the person who is ill
 Collaborating with other health care providers
 Planning, teaching, and carrying out rehabilitation for illnesses
 Working in mental health and chemical-dependency programs

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Facilitating Coping With Disability and
Death
 Nurses facilitate an optimal level of function through
Maximizing person’s strengths and potentials through:
o Patient teaching
o Referral to community support systems
 Providing end-of-care to patients and family members in:
o Hospice programs
o Hospitals
o Long-term care facilities
o homes

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Nursing as a Professional Discipline
Well-defined body of specific and unique knowledge
Strong service orientation
Recognized authority by a professional group
Code of ethics
Professional organization that sets standards
Ongoing research
Autonomy and self-regulation

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Professional Formation
Nursing educators have a responsibility to form the
professional identities of their students and
graduates; teaching not only how to do nursing, but
how to be a nurse
If successful, graduates will acquire a professional
identity that creates a sense of belonging to a group
that holds the same values

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Educational Preparation for Nursing
Practice
 There are many ways to enter the nursing field.
 Practical nurse and vocational nursing education (PN or VN)
 Registered nursing education:
o Diploma in nursing (hospital-based school of nursing)
o Associate degree in nursing (ADN) (Community College)
o Baccalaureate in nursing (BSN) (4-year degrees)
 Graduate education in nursing (Master’s and Doctoral degrees)
 Continuing education
 In-service education

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Professional Nursing Organizations
 International Nursing Organization (ICN)
 National Nursing Organizations:
o American Nurses Association (ANA)
o National League for Nurses (NLN)-Members don’t have to
be nurses.
o American Association of Colleges of Nursing (AACN)
o American Academy of Nursing (AAN)
o National Student Nurses Association (NSNA)
o National Black Nurses Association (NBNA)
 Specialty Practice and Special-Interest Nursing Organizations

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Guidelines for Nursing Practice
Standards of Nursing Practice
Nurse Practice Acts and Licensure
Code of Ethics and Professional Values
Nursing Process & Other Clinical Judgment Models

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Standards of Nursing Practice
Scope and Standards of Practice define activities
that are specific and unique to nursing.
Standards allow nurses to carry out professional
roles, protection for the nurse, patient, and
institution that healthcare is provided.
Competencies are expected levels of performance
that integrate knowledge, skill, abilities and clinical
judgements.
Each nurse is held accountable for their own quality
of practice and responsible for the use of these
standards to ensure knowledgeable, safe and
comprehensive nursing care.

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Nurse Practice Acts and Licensure
Nurse Practice Act
 Laws established in each state in the
US regulating the practice of nursing.
 They are broadly worded varying
among states, but all have certain
elements in common such as the
following:
 Protect the public by defining legal
scope of nursing practice
 Create a state board of nursing to
make and enforce rules and regulations
 Define important terms and activities in
nursing, including legal requirements
and titles for RNs and LPNs
 Establish criteria for the education and
licensure of nurses
Licensure
 The board of nursing for each state has
the legal authority to allow graduates
of approved schools of nursing to take
the licensing examination.
 Those who successfully meet the
requirements for licensure are then
given a license to practice nursing in
the state.
 The license, which must be renewed at
specified intervals, is valid during the
life of the holder and is registered in
the state.
 The license and the right to practice
nursing can be denied, revoked, or
suspended for professional misconduct
(e.g., incompetence, negligence,
chemical impairment, or criminal
actions).

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Code of Ethics and Professional Value
 Professional Values provide the foundation for nursing practice and
guide interactions with patients, colleagues and the public.
 Five values of the caring profession on nursing are: altruism,
autonomy, human dignity, integrity, and social justice.
 Code of Ethic:
 Ethics is a systematic study of principles of right and wrong conduct,
virtue and vice, and good and evil as they relate to conduct and
human flourishing.
 The word ethics is used when describing systematic ethics
incorporated within a code of professional conduct, such as nursing
codes of ethics.

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Nursing Process
 Nursing process is the guideline for nursing practice.
o Essential activities involve in the nursing process are
assessment, diagnosing, planning, implementing and
evaluating.
 Scope and Standards of Nursing Practice, states that
regardless of theoretical knowledge base upon which nursing
practice is derived, knowledge fits within the multidimensional
nursing process, the analytical, critical-thinking framework
guiding professional thinking and activities.
 Nurses implement their roles through the nursing process,
which integrates both the art and the science of nursing

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Thoughtful, Person-Centered Practice
 Framework for formation in professional nursing practice will
include:
o Personal attributes, knowledge base, and clinical
experience, which culminates in your development of
blended and QSEN competencies and growing confidence
o Clinical reasoning, judgment, and decision-making skills
o Patient-centered nurse process competencies in assessing,
diagnosing/problem identification, planning, implementing,
and evaluating and
o Ability to routinely engage in reflective practice leading to
personal learning and improvement

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National League for Nursing (NLN) Ten Trends to
Watch For Nursing Education #1
Changing demographics and increasing diversity
The technologic explosion
Globalization of the world’s economy and society
The era of the educated consumer, alternative
therapies, and genomic and palliative care
The shift to population-based care and the
increasing complexity of patient care
The cost of health care and the challenge of
managed care
The impact of health policy and regulation

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NLN Ten Trends to Watch For Nursing
Education #2
The growing need for interdisciplinary education and
collaborative practice
The current nursing shortage/opportunities for
lifelong learning and workforce development
Significant advances in nursing science and research

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Self-Care
The nurse owes the same duties to self as to others,
including the responsibility to promote health and
safety, preserve wholeness of character and
integrity, maintain competence, and continue
personal and professional growth
ANA defines a health nurse as one who actively
focuses on creating and maintaining a balance and
synergy of physical, intellectual, emotional, social,
spiritual, personal, and professional well-being

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Resilience
An individual’s aptitude for overcoming an adverse
life circumstance with a hopeful attitude
Utilizing healthy internal coping mechanisms
Utilizing external resources, such as supportive work
environments, mindfulness-based stress reduction
training, and assertive communication skills training