NURS 2200

30 AUGUST 2022

There was no formal nursing training before the founder “Florence Nightingale.”

  • She was born in 1820 and came from a wealthy family, family did not agree with her in becoming a nurse
  • Before F.N. nursing was not sanitary, family used to care, home was the “hospital”
  • Nursing was not respected and it was seen as a lower-level occupation
  • Crimean War, improved the conditions with fresh water, fresh bandages, clear food, clear air
  • Reduced death rates to 2/3s
  • After the war, she started the nursing school at St. Thomas Hospital in London (first start of nursing school)
  • Notes on Nursing

Mary Seacole 1805- 1881

  • Her mother was the community doctor and was part of natural remedies
  • Cholera : learned how to treat it, in Panama, managed the care of the soldiers of crimea and went to the battlefield by herself

Clara Barton “Angel of the Battlefield”

  • American Red Cross in 1881, American Public School

  • Took care of her brother

  • Worked at the US patent office

  • Civil War 1861-1865

  • Aided the soldiers and went to the front lines

CIVIL WAR NOTABLES

Dorothea Dix

  • Advocate for the mentally ill and prisoners (CW superintendent of union army nurses)

Louisa May Alcott

  • Author, served as a nurse and wrote about her experiences
  • Author of “Little Women”
  • Wrote “Hospital Sketches”

Mary Ann Bickerdyke

  • Known as  “Mother Bickerdyke” traveling to care for soldiers and establishing more than 300 field hospitals
  • Followed similar sanitary processes like Nightingale

The First Training Schools

  • U.S. Training School - 1872

  • By 1902, there were 492 schools of nursing in the U.S.

  • Schooling was free, hospital used nurses for free labor (education for free)

  • Just women only (expectation at the time and social norms)

Mary E.P. Mahoney 1845 - 1926

  • First black woman to graduate from nursing school
  • Admitted in 1878 to nursing school
  • 1886 the first separate school for black nurses was founded at Spelman Seminary
  • She recognized the issues and advocated
  • First woman to register for voting

1893 - 3 nurses meet at Chicago World’s Fair and form what later became the National League for Nursing (NLN)

1896 - American Nurses Association (ANA) - deal with government more and advocate for nurses

1890s 

Lilian Wald

  • Henry Street House/Settlement and took care of patients that had babies, sickness
  • Public Health

1898 - 1908 congress established the Army Nurse Corps and Navy Nurse Corps

1900 American Journal of Nursing

1903 State legislatures in North Carolina, New Jersey, New York, and Virginia passes licensure laws for nursing

1923 All states required examinations for licensure but they were not standardized

1950 NLN assumed responsibility for state boards

1917 - 1930

  • WW1 nurses gained more responsibility
  • 1925 Mary Breckenridge (FNS) - rode horseback to see her patients- came from Europe and pioneered the frontier nursing services

1931-1945

  • A lot of nurses lost their jobs during the Great Depression
  • Many families could no longer afford private duty nurses
  • Free clinics and increased need for charity care
  • Public Health nursing became even more prevalent

WW2

  • Presented the need for more nurses
  • Lots of military incentives
  • Cadet Nurse Corps
  • Schooling in exchange for commitment to serve
  • 1943-1948 there were 124,000 nurses volunteered, graduated, and certified for military services in the Army and Navy Nurse Corps

1945-1960: the rise of hospitals

1946: Hill-Burton Act

  • Provided the growth of new facilities and increased need for nurses
  • Associate degree in nursing began
  • 1946: Journal of Nursing Research first published
  • 1947 Military nurses were awarded full commissioned officer status both Army and Navy Nurse Corps
  • 1954 men allowed in military nursing corps

1961-1982 Vietnam

  • 1960’s Era of specialty care and clinical specialization for nurses
  • 1971 Idaho was first state to recognize diagnoses and treatment as a legal scope of practice for NP’s
  • Nurse Practitioner

1983 - Today

  • 80’s HIV/AIDS epidemic
  • PPE (gloves, shoe covers, goggles, etc)
  • Technologies raised ethical questions (pacemakers) people wondered if they were doing too much/ or not
  • Before 9/11 US was not ready for terrorist attacks/natural disasters
  • After 9/11 new challenges with natural disasters and terrorist attacks
  • Affordable Care Act in 2010 - Obama Care: to get more people in health insurance
  • Ebola was another situation that : COVID
  • Many More

IMAGING OF NURSING

High in the Rankings

  • Gallup Poll: nurses are #1 in ethics and honesty every year since 1999

  • Exception is 2001

Nursing Shortage

  • Causes of Nursing Shortage

  • Internal Causes: salary issues, long hours, increased responsibility for unlicensed workers, and significant responsibility with little authority

  • External Causes: changes in demand for nursing services, the increasing age of the American population, greater acuity (degree of illness) of hospitalized individuals, public perceptions of nursing as a profession, and ever-widening career options for women

Nursing Faculty Shortage

  • Key aspect is attributed to shortage of nursing faculty

  • Shortage of nursing faculty factors

  • Doctoral-prepared and masters prepared are more than 50 years of age

  • Nurses with advanced degrees are hired in more lucrative private sector

  • Not enough doctoral-or master’s prepared nurses are produced to meet demands for education

  • Also a shortage of clinic sites

Other Contributing Factors

  • Aging nurse - supply of those entering cannot meet the demand of those exiting
  • Population is aging requiring additional health care needs

Possible solutions

  • Increase supply of nurses

  • Import from english speaking countries

  • Travel nursing

  • Create less trained workers to supplement nursing workforce

  • Shorter training and education

  • CNA and others can help nurses (tech: change linens, vital, comfortable, check patients)

06 SEPTEMBER 2022

Today's Health Care System

  • Reform continues to be a hot topic in America and in the political scene
  • Focuses on treating health problems once they have occurred rather than encouraging wellness and healthy habits

Healthy People 2020 - Overarching goals

  • Attain high quality,live longer lives free of preventable disease, disability, injury, and premature death
  • Achieve health equity, eliminate disparities, and improve the health of all groups
  • Create social and physical environments that promote good health for all
  • Promote quality of live, healthy development, and healthy behaviors across all life stages
  1. Physical environment
  2. Health services
  3. Individual behavior
  4. Biology and genetics
  5. Social environment

Major Categories of Health Care Services

  1. Health promotion (patient has to be involved: smoking and drinking, diets, driving, safe sex, prenatal classes, wellness visit) and maintenance including early detection (cancer)
  2. Illness prevention
  3. Diagnosis and treatment (blood work, exams, x-rays, CT, MRI, EKG (heart), PT scans)
  4. Rehabilitation and long-term care (chronic illnesses: diabetes, migraines, graves disease, high BP, heart failure) (nursing homes)

        

        Health Care Agencies

  1. Government (Public) Agencies
  • Primarily funded by taxes
  • 3 levels: Federal (CDC), State (hospitals), and Local (vaccinations, well-visits)
  1. Voluntary (Private) Agencies
  • Private donations, sometimes grants
  • Staffed by volunteers, may later higher personnel (Red Cross, AHA, American Cancer Society, mission Arlington)
  1. Not-for-Profit (excess of funds go back to the agency) vs For-Profit (excess of funds go to make money)

                

        Levels of Health Care Services Provide

  1. Primary Care services (PCP, student health care, ED)
  2. Secondary Care services (specialists: radiologist, cardiologist, podiatrist, dermatologist, etc)
  3. Tertiary Care services (multiple health professionals: interdisciplinaries: burn victim, rehab center or long term health center, physicians, hospice care)
  4. Subacute Care services (provide lower-cost care for a patient with a chronic illness…, someone that has CF)

        Organizational Structure

  • Board of directors, medical staff vs Nursing staff, Accreditation and Quality Improvement (Doctor, nurses, CNA, pharmacist)

        The Health Care Team

Financing Health Care

                Methods of Payment

  • private insurance, medicare, medicaid, personal (out-of-pocket) payment

                Nurse’s Role

  • Help to reduce unnecessary spending
  • Awareness of cost (supplies, testing)
  • Nursing measures that can reduce costs - preventing hospital acquired conditions: EX: turning patients to prevent pressures ulcers, good handwashing to prevent infection

SEP 13 2022

Career Pathways

  • Law, medicine, and clergy

  • Authority to control its own work

  • Exclusively unique body of knowledge

  • Extensive period of formal education and training - this is holding “nursing” as an official profession

  • Specialized competence

  • Control overwork performance

  • Service to society

  • Self-regulation

  • Credentialing systems to certify competence

  • Legal reinforcement of professional standards

  • Ethical practice

  • Creation of collegial subculture

  • Intrinsic rewards

  • Public acceptance

Why is nursing not a profession

  • Nursing meets all but one criterion

  • Three levels of education qualify people to take licensing exam

  • ADN

  • Diploma nursing program

  • BSN

  • Why is this a challenge to professional status?

  • Nursings lack of a standardized requirement for a minimum of a BSN and preferably a masters degree stands in sharp contrast with other health care professions requiring more education to practice

  • Diploma programs

  • 1800 early 1900s diploma programs provided formal education and jobs to women

  • Modified apprenticeship model

  • Demanding schedule

  • Duration: 3 yrs

  • PEAR 1920-1930 200 programs in almost any state

  • MID 1960s dramatic decline

  • BSN

  • Theoretical, scientific orientation of the BSN program was in sharp contrast to the “hands-on” skill and service orientation that was the hallmark of hospital based diploma education

  • 4 year GEN EDU + NuR courses

  • Faculty qual. Min master's degree

  • \

  • Nurses need a bachelors to qualify nursing as a recognized profession and to provide leadership in administration teaching and public health

  • UNI MINNESOTA 1909 first bsn program

  • 1919

  • ADN 1952 accessibility of community college, low tuition cost, part time and evening study opportunities, shorter duration of programs, graduates eligibility to take the RN licensure exam

  • Advanced Degrees in Nursing: Master’s EDU

  • BSN, RN, GRE, experience

  • 18-24 mths

  • theory , research, clinical practice, and courses in other disciplines. Master’s students generally select both an area of clinical specialization

  • MS and MSN are most common; can choose RN/MSN track

  • Can get an MSN/MBA;MSN/JD

  • Doctoral Education

  • Prepare nurses to become faculty members in universities, administrators in schools of nursing or large medical centers, researchers, theorists, and adv practitioners

  • Research focused degree - doctor of philosophy

  • Practice focused degree - doctor of nursing practice

  • CNA

  • Hs diploma

  • $36,487

  • LVN LPN  

  • Nursing practice

  • ADN RN

  • DNP Phd

  • Continuing education (CE) maintaining expertise and staying current

  • Keep up with CE and keep the files

Becoming Certified: Validating Knowledge and Proficiency

  • Licensure refers to state regulation of the practice of nursing

  • Req of individuals at the entry point to practice and must be renewed periodically

  • Legal designation that ensures public safety by assessing basic and continuing competence

  • Certification goes beyond licensure by validating a high level of knowledge and proficiency in a particular practice area

  • Certification has professional but not legal status

Comparing occupations and professions

SOCIALIZATION IN NURSING

  • To teach you to think like a nurse

  • Professional socializations - process of interaction

  • Facilitating the transition from student to nurse

  • Formal (nursing school)

  • Nursing faculty as the first mentor

  • Orderly, building block fashion

  • Informal socialization

  • Incidental lessons

  • Professional socialization (first job and beyond)

  • Absorbing the culture of nursing- rites, rituals and valued behaviors

  • Learning vocabulary

  • Learning new roles and anxiety

  • Benner’s stages of Nursing Proficiency: 1984 from novice to expert

  • Novice (beginner, no experience, step-by-step), advanced beginner, competent practitioner, proficient practitioner (Intuitive grasp on clinical performances), expert practitioner

  • Factors Influencing Socialization

  • Code of ethics for nurses requires that nurses work with all patients regardless of their beliefs

  • What personal feelings and beliefs conflict with professional values?

  • Certain issues like: negative health behaviors, substance abuse, self-destructive behaviors, abortion, sexual orientation, infertility (treatments), and care at the end-of-life

  • Unexamined biases are more likely to influence behavior than examined ones

  • Becoming a professional nurse requires learning how to deal with values conflicts while respecting patients differing viewpoints

  • Key Point:

  • Identify those “hot button” issues that seem to affect you negatively so that you can understand you own responses and how to set them aside while still providing excellent care of your patients

20 SEPTEMBER 2022

  • Evidence and EBP

  • Taking the current research and taking it into the nursing clinical practice

  • Improve patient outcomes

  • Safety

  • Effectiveness

  • Evidence Based Practice

  • Practice of health care in which the practitioner systematically finds, appraises, and uses the most current and valid research finding as the basis for clinical decisions

  • EBP in nursing

  • Allows nurses to provide high quality patient care based upon research evidence and knowledge rather than tradition myths hunches advice from peers outdated textbooks

  • Provides a means for safe decision making

  • Results in better patient outcomes

  • Decreased variations in nursing care-consistency

  • Provides a standard

  • Barriers to EBP

  • Inability to critically read and understand research studies (articles) and scholarly writing

  • Perception that research is just for educators and advanced practice nurses - not applicable to staff nurses - they are not taught how to find and read research for practice

  • Lack of knowledge about evidence-based practice

  • Lack of administrative support

  • WEBSITES

  • National Guideline ClearingHouse

  • UTA library databases

  • CINAHL Plus, MEDLINE with MeSH, Cochrane Library

  • ANA American Nurses Association

  • AJN

  • Nursing Research

  • Advances in Nursing Science

  • Centers for Disease Control and Prevention

  • US Dept. of Health and Human Services

  • The Mayo Clinic

  • US National Library of Medicine and National Institutes of Health

  • Medline Plus

  • National Cancer Institute

  • The RN as a Nurse Scientist/Scholar

  • Clinical studies

  • Assist with informed consent and data collection

  • Follow research protocols for enrolled patients

  • Involvement in unit-based or hospital wide committees to support nursing or interdisciplinary research

  • Serve on an institutional review board (IRB)

  • Review research proposals, verify that ethical standards are met

  • All research studies are subject to IRB review

  • Examples of Areas of Interest

  • Fasting before surgery

  • Family presence during resuscitation

  • Interventions for confused patients

  • oral/mouth care

  • Pain management

  • Hand-hygiene products

  • Prevention of hospital acquired conditions

  • Falls, infections, pressure ulcers

  • 1. Identification of a research problem

  • 2. Review of literature

  • 3. Formulation of the research question or hypothesis

  • 4. Design of the Study

  • 5. Implementation of the study

  • 6. Drawing conclusions based on findings

  • 7. Discussion and/or clinical implications

  • 8. Dissemination of findings