1. JUDITH M. WILKINSON LESLIE S. TREAS KAREN BARNETT MABLE H. SMITH FUNDAMENTALS OF NURSING Copyright © 2015 F.A. Davis Company Chapter 1 Nurses Make a Difference

2. Copyright © 2015 F.A. Davis Company Images of Nursing Through the Decades Angel of mercy Handmaiden Battle-ax Sairey Gamp Nurse Ratched Naughty nurse Military battlefield caregiver Florence Nightingale Primarily Caucasian females Full-spectrum nurse

3. Copyright © 2015 F.A. Davis Company Thinking Skills Clinical judgment Observing, comparing, contrasting, and evaluating the client’s condition Critical thinking, reflective thinking Involves collecting and analyzing information and carefully considering options for action Problem solving Considering an issue and attempting to find a satisfactory solution

4. Copyright © 2015 F.A. Davis Company What is nursing? What does is encompass? ANA (1980): “The diagnosis and treatment of human responses to actual and potential health problems” (p. 2). Helps the public understand the value of nursing Helps differentiate activities of nursing from those of medicine Helps students understand what is expected of them

5. Copyright © 2015 F.A. Davis Company Profession Technical and scientific knowledge; be evaluated by a community of peers; have a service orientation and a code of ethics (Starr, 1982) Nursing: Profession, Occupation, or Discipline?

6. Copyright © 2015 F.A. Davis Company Nursing: Profession, Occupation, or Discipline? (cont’d) Occupation One’s regular, principal, or immediate business (Webster’s, 2003) Discipline To be considered a discipline, a profession must have a domain of knowledge that has both theoretical and practical boundaries. The theoretical boundaries are the questions that arise from clinical practice and are then investigated through research. The practical boundaries are the current state of knowledge and research in the field—the facts that dictate safe practice.

7. Copyright © 2015 F.A. Davis Company Nursing: Profession, Occupation, or Discipline? (cont’d) Nurses are not “trained”; they are educated. Flexner’s Criteria for a Profession (1916): must be intellectual and not physical; based on knowledge that can be learned; practical rather than theoretical; can be taught through formal education; has an internal organization of members; and has a practitioner component

8. Copyright © 2015 F.A. Davis Company How Can Nursing Improve Its Recognition as a Profession? Standardized educational requirements Uniform continuing education requirements Increased participation of students and nurses in professional organizations Education of the public about the true nature of nursing practice

9. Copyright © 2015 F.A. Davis Company Nursing Education Diploma programs 3-year program, hospital-based Associate degree programs 2-year program, community college Baccalaureate degree programs Undergraduate program, 8 semesters

10. Copyright © 2015 F.A. Davis Company Entry Into Practice Five levels of education for entry into practice: AAS or AS Diploma BSN MS or MSN – Prepares nurses to teach and to function in a more independent role CNS, NP, CNM, CRNA are Advanced Practice Nurses (APN’s) Doctorate DNP - Prepares nurse for advanced clinical practice PhD – Unique research to enrich the science of nursing

11. Copyright © 2015 F.A. Davis Company Informal Education Continuing education (CE) Professional strategy to maintain current clinical knowledge; 29 states require CE courses for renewal of a nursing license In-service education Programs offered at the work site Volunteer education

12. Copyright © 2015 F.A. Davis Company Phases of Nursing (Benner, 1984) Stage 1: Novice Stage 2: Advanced beginner Stage 3: Competence Stage 4: Proficient Stage 5: Expert

13. Copyright © 2015 F.A. Davis Company Regulation of Nursing Practice Nurse Practice Acts State Boards of Nursing Licensure Professional standards

14. Copyright © 2015 F.A. Davis Company Professional Organizations ANA and CNA National professional organizations NLN Establishes and maintains a universal standard of education ICN Federation of national nursing organizations

15. Copyright © 2015 F.A. Davis Company Professional Organizations (cont’d) Specialty Clinical, group identity, or value specific ACE - Acute Care for the Elderly NICHE - Nurses Improving Care for Healthsystem Elders NSNA Represents nursing students Sigma Theta Tau International National Honor Society for Nursing

16. Copyright © 2015 F.A. Davis Company Purpose of Nursing Care Health promotion Illness prevention Health restoration Palliative Care End-of-life care

17. Copyright © 2015 F.A. Davis Company Forces That Influence Nursing Practice Outside nursing Economy Consumers Direct-to-consumer marketing Legislation Women’s movement Collective bargaining

18. Copyright © 2015 F.A. Davis Company Forces That Influence Nursing Practice (cont’d) Inside nursing Increased use of CAM Increased opportunity for roles, settings, and autonomy Divergence between high tech and high touch According to data compiled in 2011, there are anywhere between 2.7-3 million nurses in the United States. 11% are men. Additionally, African Americans, Hispanics, American Indians, and Asians combined make up 11% of the nursing workforce. The rest are from Caucasian European descent. 650,000 work in the medical-surgical setting. 54% work in hospitals. We will need an additional 580,000 nurses by 2018. Average age for a nurse is 44.8. Average age for faculty is 57. Average yearly income is $67,000. 40% of RN’s will retire by 2020.

19. Copyright © 2015 F.A. Davis Company Think Like a Nurse The Quality and Safety Education for Nurses (QSEN) project and the Institute of Medicine (IM) have identified six quality and safety competencies for nurses. 1.Patient-centered care 2.Teamwork and collaboration 3.Evidence-based practice 4.Quality improvement 5.Safety 6.Informatics Which of these did Florence Nightingale demonstrate? Explain your thinking.