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Lecture Notes

Introduction to Nursing 


  1. Selected theoretical definitions of nursing
    1. Nightingale (1860)
      1. "nursing is the act of utilizing the environment of the patient to assist him in his recovery"
    2. Peplau (1952)
      1. "nursing is a significant, therapeutic, interpersonal process that functions cooperatively with other human processes which make health possible for individuals"
    3. Henderson (1960)
      1. "the unique function of the nurse is to assist the individual, sick or well, in the performance of those activities contributing to health or its recovery (or to peaceful death) that he would perform unaided if he had the necessary strength, will or knowledge, and to do this in such a way as to help him gain independence as rapidly as possible"
    4. Levine (1973)
      1. "nursing is conserving or 'keeping together' the patient's energy and structural, personal, and social integrity as he/she struggles towards health and well-being to achieve a positive adaptation"
    5. King (1976)
      1. "nursing is an interpersonal process of action, reaction, interaction, and transaction whereby nurse and patient share information about their perceptions in the nursing situation"
    6. Roy (1976)
      1. "as a science, nursing is a developing system of knowledge about human beings used to observe, classify, and relate the processes by which persons positively affect their health status"
  2. Professional definitions of nursing
    1. International Council of Nurses (ICN) (1973)
      1. "the unique function of the nurse is to assist the individual, sick or well, in the performance of those activities contributing to his health, or its recovery (or to peaceful death) that he would perform unaided if he had the necessary strength, will, or knowledge and do this in such a way as to help him gain independence as rapidly as possible"
    2. American Nurses Association (ANA) Social Policy Statement (1980)
      1. "nursing is the diagnosis and treatment of human responses to actual or potential health problems"
  3. Legal definition of nursing
    1. Pennsylvania State Board of Nursing (1985)
      1. "nursing is diagnosing and treating human responses to actual or potential health problems through such services as casefinding, health teaching, health counseling, and provision of care supportive to or restorative of life and well-being, and executing medical regimens as prescribed by a licensed physician or dentist"
  4. Characteristics of a profession
    1. a well-defined, theoretically based, body of knowledge
    2. an ability to deliver a unique service to other human beings
    3. specialized, standardized, education based in colleges or universities
    4. standards of practice and education autonomously controlled by its members
    5. a code of ethics which requires integrity from its members
    6. career commitment by its members
    7. a professional association which protects the autonomy of its members
  5. Position of nursing on the occupation-profession model
    1. theory
      1. occupation = absent
      2. nursing = beginning stages
      3. profession = present
    2. unique service
      1. occupation = absent
      2. nursing = incomplete
      3. profession = present
    3. specialized education
      1. occupation = short; not specialized
      2. nursing = varied in length; some specialization
      3. profession = long; specialized
    4. autonomy
      1. occupation = absent
      2. nursing = incomplete
      3. profession = complete
    5. code of ethics
      1. occupation = undeveloped
      2. nursing = highly developed
      3. profession = highly developed
    6. commitment
      1. occupation = low
      2. nursing = varies; relatively short
      3. profession = long-term
    7. professional association
      1. occupation = rarely
      2. nursing = yes
      3. profession = yes
    8. motivation
      1. occupation = self-interest
      2. nursing = service
      3. profession = service
  6. Aims of nursing
    1. to promote wellness
    2. to prevent illness
    3. to restore health
    4. to facilitate coping
  7. Roles and functions of the professional nurse
    1. caregiver
      1. the provision of care to patients that combines both the art and the science of nursing in meeting physical, emotional, intellectual, sociocultural, and spiritual needs
    2. communicator
      1. the use of effective interpersonal and therapeutic communication skills to establish and maintain helping relationships with patients of all ages in a wide variety of health care settings
    3. teacher
      1. the use of communication skills to assess, implement, and evaluate individualized teaching plans to meet the learning needs of patients and their families
    4. counselor
      1. the use of effective interpersonal and therapeutic communication skills to provide information, make appropriate referrals, and facilitate the patient's problem-solving and decision-making skills
    5. leader
      1. the assertive, self-confident practice of nursing when providing care, effecting change, and functioning with groups
    6. researcher
      1. the participation in or conduction of research to increase knowledge in nursing and improve client care
    7. advocate
      1. the protection of human or legal rights and the securing of care for all patients based on the belief that patients have the right to make informed decisions about their own health and lives
  8. Selected expanded career roles and functions of the professional nurse
    1. nurse generalist
      1. education
        1. baccalaureate degree
      2. certifying body
        1. American Nurses Credentialing Center (ANCC)
      3. certification areas
        1. psychiatric and mental health nurse
        2. medical-surgical nurse
        3. pediatric nurse
        4. gerontological nurse
        5. community health nurse
        6. general nursing practice
        7. school nurse
        8. perinatal nurse
        9. college health nurse
        10. nursing continuing education/staff development
        11. home health nurse
        12. cardiac rehabilitation nurse
        13. informatics nurse
      4. certification designation
        1. RN, C (Registered Nurse, Certified)
      5. functions
        1. provide beside nursing or direct care in a general area
    2. nurse midwife
      1. education requirement
        1. certificate nurse-midwifery program, baccalaureate degree (by 1999)
        2. graduate nurse-midwifery program, master’s degree
      2. certifying body
        1. American College of Nurse-Midwives (ACNM)
      3. certification areas
        1. nurse midwifery
      4. certification designation
        1. RN, CNM (Registered Nurse, Certified Nurse-Midwife)
      5. functions
        1. provide prenatal and post-natal care and deliver babies to women with uncomplicated pregnancies
    3. nurse practitioner
      1. education requirement
        1. master's degree
      2. certifying bodies
        1. American Nurses Credentialing Center (ANCC)
          1. certification areas
            1. pediatric nurse practitioner
            2. school nurse practitioner
            3. adult nurse practitioner
            4. family nurse practitioner
            5. gerontological nurse practitioner
            6. acute care nurse practitioner
          2. certification designation
            1. RN, CS (Registered Nurse, Certified Specialist)
        2. American Academy of Nurse Practitioners (AANP)
          1. certification areas
            1. adult nurse practitioner
            2. family nurse practitioner
          2. certification designation
            1. NP-C (Nurse Practitioner-Certified)
      3. functions
        1. provide primary care: nursing assessments; physical assessments; counseling; teaching; treatment of minor, self-limiting diseases or conditions; treatment of stable long-term diseases or conditions
    4. clinical nurse specialist
      1. education requirement
        1. master's degree
      2. certifying body
        1. American Nurses Credentialing Center (ANCC)
      3. certification areas
        1. adult psychiatric and mental health nursing
        2. child and adolescent psychiatric and mental health nursing
        3. medical-surgical nursing
        4. gerontological nursing
        5. community health nursing
        6. home health nursing
      4. certification designation
        1. RN, CS (Registered Nurse, Certified Specialist)
      5. functions
        1. provide expertise in the following roles in a specialty area: direct care, education, consultation, collaboration, research, clinical leadership, change agent, role model, advocate
    5. nurse anesthetist
      1. education requirement
        1. master's degree
      2. certifying body
        1. American Association of Nurse Anesthetists (AANA)
      3. certification areas
        1. nurse anesthesia
      4. certification designation
        1. CRNA (Certified Registered Nurse Anesthetist)
      5. functions
        1. carry out preoperative visits and assessments, administer and monitor anesthesia during surgery, and evaluate postoperative status of patients
  9. Educational preparation for nursing practice
    1. practical and vocational nursing education
      1. length of study
        1. 1 year
      2. degree awarded
        1. certificate
      3. location
        1. high schools, community colleges, technical or vocational schools, and a variety of independent agencies
      4. test
        1. National Council Licensure Examination (NCLEX-PN) for licensure as a licensed practical nurse (LPN) and licensed vocational nurse (LVN)
    2. registered nursing education
      1. diploma
        1. length of study
          1. 3 years
        2. degree awarded
          1. diploma in nursing
        3. location
          1. hospitals; sometimes affiliated with community colleges, colleges, or universities
        4. test
          1. National Council Licensure Examination (NCLEX-RN) for licensure as a registered nurse (RN)
      2. associate degree
        1. length of study
          1. 2 years
        2. degree awarded
          1. associate degree in nursing (ADN)
        3. location
          1. community colleges; sometimes affiliated with colleges or universities
        4. test
          1. National Council Licensure Examination (NCLEX-RN) for licensure as a registered nurse (RN)
      3. baccalaureate degree
        1. length of study
          1. 4 years
        2. degree awarded
          1. bachelor of science in nursing (BSN)
        3. location
          1. colleges, universities, external degree programs
        4. test
          1. National Council Licensure Examination (NCLEX-RN) for licensure as a registered nurse (RN)
        5. NLN Characteristics of the Graduate of the Baccalaureate Program in Nursing (1987)
          1. provide professional nursing care, which includes health promotion and maintenance, illness, care, restoration, rehabilitation, health counseling, and education based on knowledge derived from theory and research
          2. synthesize theoretical and empirical knowledge from nursing, scientific, and humanistic disciplines with practice
          3. use the nursing process to provide nursing care for individuals, families, groups, and communities
          4. accept responsibility and accountability for the evaluation of the effectiveness of their own nursing practice
          5. enhance the quality of nursing and health practices within practice settings through the use of leadership skills and knowledge of the political system
          6. evaluate research for the applicability of its findings to nursing practice
          7. participate with other health care providers and members of the general public in promoting the health and well-being of people
          8. incorporate professional values as well as ethical, moral, and legal aspects of nursing into nursing practice
          9. participate in the implementation of nursing roles designed to meet emerging health needs of the general public in a changing society
      4. ladder programs (e.g., BSN completion; BSN transition; 2 + 2; RN – BSN)
        1. length of study
          1. varies
        2. degree awarded
          1. bachelor of science in nursing (BSN)
        3. location
          1. colleges, universities, external degree programs
    3. graduate nursing education
      1. master's degree
        1. length of study
          1. must be completed within five years after matriculation
        2. degree awarded
          1. master of science in nursing (MSN)
        3. location
          1. colleges, universities, external degree programs
      2. doctoral degree
        1. length of study
          1. must be completed within seven years after matriculation
        2. degree awarded
          1. doctor of philosophy (PhD)
          2. doctor of nursing science (DNS, DNSc)
          3. nursing doctorate (ND)
        3. location
          1. colleges, universities, external degree programs
    4. continuing education (CE)
      1. definition
        1. professional development experiences designed to enrich the contribution to health by the nurse
      2. provider
        1. colleges, hospitals, voluntary agencies, and private groups
      3. example
        1. CE experience on how to care for the myasthenic patient in crisis offered by the American Association of Neuroscience Nurses (AANN) to all nurses
      4. mandatory nature
        1. CE is mandatory in some, but not all, states for relicensure
    5. inservice education
      1. definition
        1. professional development experiences designed to increase the knowledge and skill of the staff nurse
      2. provider
        1. hospitals and health care agencies employing the staff nurse
      3. example
        1. inservice experience on how to use a new piece of equipment purchased by the hospital offered by the hospital to all their staff nurses
  10. Entry level into practice (as of 1985)
    1. practical and vocational nurses
      1. function = ?
      2. title = ?
    2. associate degree nurses
      1. function = technical nurse
      2. title = associate nurse (AN)
    3. diploma nurses
      1. function = ?
      2. title = ?
    4. baccalaureate nurses
      1. function = professional nurse
      2. title = registered nurse (RN)
  11. Professional nursing organizations
    1. national nursing organizations
      1. National Student Nurses Association (NSNA)
        1. established 1953
        2. mission
          1. organize, represent and mentor students preparing for initial licensure as registered nurses, as well as those nurses enrolled in baccalaureate completion programs; promote development of the skills that students will need as responsible and accountable members of the nursing profession; advocate for high quality health care
        3. official magazine
          1. Imprint
        4. headquarters
          1. 350 Hudson St., New York, NY, 10014
      2. American Nurses Association (ANA)
        1. established 1897
        2. mission
          1. advance the nursing profession by fostering high standards of nursing practice, promoting the economic and general welfare of nurses in the workplace, projecting a positive and realistic view of nursing, and lobbying the Congress and regulatory agencies on health care issues affecting nurses and the public
        3. official magazine
          1. American Journal of Nursing
        4. headquarters
          1. 600 Maryland Avenue SW, Suite 100 West, Washington DC, 20024
      3. National League for Nurses (NLN)
        1. established 1952
        2. mission
          1. advance quality nursing education that prepares the nursing workforce to meet the needs of diverse populations in an ever-changing health care environment
        3. official magazine
          1. Nursing and Health Care
        4. headquarters
          1. 350 Hudson St., New York, NY, 10014
      4. Sigma Theta Tau
        1. established 1922
        2. mission
          1. foster excellence, scholarship, and leadership in nursing to improve health care worldwide; promote the use of nursing research in health care delivery and make its resources available to all people and institutions interested in the latest knowledge in nursing care
        3. official magazine
          1. Image: Journal of Nursing Scholarship
        4. headquarters
          1. 550 West North St., Indianapolis, IN, 46202
    2. international nursing organization
      1. International Council of Nurses (ICN)
        1. established 1899
        2. mission
          1. provide a medium though which national nurses associations can develop the contribution of nursing to the promotion of health of the people and care of the sick; assist national nurses' associations to improve the standards of nursing and the competence of nurses including professional, social and economic positions; promote the development of national nurses associations; serve as a voice for nurses and nursing internationally
        3. official magazine
          1. International Nursing Review
        4. headquarters
          1. 3, rue Ancien-Port 1201, Geneva, Switzerland
    3. selected specialty nursing organizations
      1. American Association of Critical Care Nurses (AACN)
      2. Association of Operating Room Nurses (AORN)
      3. American Indian Nurses' Association (AINA)
      4. National Black Nurses' Association (NBNA)
      5. American Association of Neuroscience Nurses (AANN)
  12. Guidelines for nursing practice
    1. ANA Standards of Clinical Nursing Practice (1991)
      1. standards of care
        1. assessment: the nurse collects patient health care data
        2. diagnoses: the nurse analyzes the assessment data in determining diagnoses
        3. diagnoses: the nurse identifies expected outcomes individualized to the patient
        4. planning: the nurse develops a plan of care that prescribes interventions to attain expected outcomes
        5. implementation: the nurse implements the interventions identified in the plan of care
        6. evaluation: the nurse evaluates the patient's progress toward attainment of outcomes
      2. standards of professional performance
        1. quality of care
          1. the nurse systematically evaluates the quality and effectiveness of nursing practice
        2. performance appraisal
          1. the nurse evaluates his or her own nursing practice in relation to professional standards and relevant statutes and regulations
        3. education
          1. the nurse acquires and maintains current knowledge in nursing practice
        4. collegiality
          1. the nurse contributes to the professional development of peers, colleagues, and others
        5. ethics
          1. the nurse's decisions and actions on behalf of patients are determined in an ethical manner
        6. collaboration
          1. the nurse collaborates with the patient, significant others, and health care providers in providing patient care
        7. research
          1. the nurse uses research findings in practice
        8. resource allocation
          1. the nurse considers factors related to safety, effectiveness, and cost in planning and delivering patient care
    2. nurse practice acts
      1. laws established in each state to regulate the practice of nursing that:
        1. protect the public by defining the legal scope of nursing practice, excluding untrained or unlicensed people from practicing nursing
        2. create a state board of nursing or regulatory body having the authority to make and enforce rules and regulations concerning the nursing profession
        3. define important terms and activities in nursing, including legal requirements and titles for RNs, LPNs, and LVNs
        4. establish criteria for the education and licensure of nurses
    3. the nursing process
      1. a systematic method that directs the nurse and patient together as they determine the need for nursing care, plan and implement the nursing care, and evaluate the results
      2. composed of five steps
        1. assessing
        2. diagnosing
        3. planning
        4. implementing
        5. evaluating
  13. Trends in nursing
    1. changes in the financing of health care, e.g.:
      1. decreased reimbursement to providers for health care
      2. increased number of patients in managed health care programs
      3. decreased coverage for highly specialized procedures
      4. increased need for precertification prior to coverage of health care
    2. changes in cost containment activities in health care, e.g.:
      1. increased use of unlicensed assistive personnel in hospitals
      2. increased use of critical pathways in hospitals
      3. downsizing of personnel in hospitals
      4. increased shift in the provision of health care from hospitals to home settings
    3. changes in the needs of hospitalized patients, e.g.:
      1. increased need for safe, individualized, "high tech" but "high touch" care as they enter hospitals more acutely ill
      2. increased need for early, comprehensive discharge planning and education as they leave hospitals earlier and not completely recovered from their acute illnesses
      3. increased need for continuity of care between nurses in hospitals and home settings
      4. increased need to be able to care for themselves in home settings after their hospitalization where they completely recover from their acute illness
    4. changes in the demographics of hospitalized patients, e.g.:
      1. increased number are elderly
      2. increased number have one or more chronic diseases
      3. increased number are racial and ethnic minorities
      4. increased number are children living in female-headed single-parent households at or below the poverty level
    5. changes in the demand for nurses, e.g.:
      1. increased demand for nurses in home settings
      2. increased demand for highly-skilled nurses who can provide safe, individualized, "high tech" but "high touch" care to more acutely ill hospitalized patients
      3. increased demand for advanced practice nurses who can provide primary care
      4. increased demand for nurses who are competent in information technology

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This page was last modified on 6/1/03