1. Chapter 1 Introduction to Nursing
Jennifer Dremann RN MSN

2. What is your definition of nursing?
There are many different responses and as you progress towards graduation, your definition will change.
Nursing care involves assisting pts, families, and communities to attain, recover, and maintain health from birth to old age.
Nursing skills can be basic (bathing) to more complex (starting an IV)

3. Development of Nursing from Early Civilizations to the 16th Century
Theory of animism-Early civilization
Good spirits brought health; evil spirits brought sickness and death. Illness had a supernatural cause.
Roles of nurse and physician separate and distinct: physician as medicine man; nurse as caring mother.
Ancient Greek civilization
Temples became center of medical care.
Illness was caused by sin and the gods displeasure.
Nurses cared for the sick in the home and community; practiced as nurse-midwives.

4. Development of Nursing from Early Civilizations to the 16th Century
Early Christian period
Nursing has formal and more clearly defined role; deaconesses made visits to the sick.
Nursing developed purpose, direction, and leadership.
16th century
Shift from a religious orientation to an emphasis on warfare, exploration, and expansion of knowledge
Nursing had a poor reputation; nurses received low pay and worked long hours in unfavorable conditions.
Women who convicted of crimes were recruited into nursing in lieu of serving jail sentences.

5. Tell whether the following statement is true or false.
In the beginning of civilization, the role of the physician was carried out by the medicine man and the nurse was the mother who cared for her family during sickness.
True
False
Answer: A. True.
Rationale: In the beginning of civilization, The physician was the medicine man who treated disease by chanting, inspiring fear, or opening the skull to release evil spirits. The nurse usually was the mother who cared for her family during sickness by providing physical care and herbal remedies.

6. Historical Perspective/18th–19th Century
In the middle of the 19th century 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.
Nightingale challenged prejudices against women and elevated the status of all nurses.
She established the first training school for nurses, and wrote books about health care and nursing education.
Florence Nightingale made many contributions in nursing including: identify personal needs of the patient, establish standards for hospital management, nursing a respected occupation, establishing nursing education, recognized health and illness, nursing is separate for medicine, nutrition important to health, continuing education for nurses, and maintaining accurate records.

7. Historical Perspective/19th to 21st Century
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.
World War II
Large numbers of women worked outside the home and became more independent and assertive.
Explosion in medicine and technology broadened the role of nurses.
Growth of nursing as a professional discipline

8. Historical Perspective/1950s to Present
Nursing broadened in all areas
Practice in a wide variety of health care settings
The development of a specific body of knowledge
The conduct and publication of nursing research
Recognition of the role of nursing in promoting health
Growth of nursing as a professional discipline

9. Definitions of Nursing
Originated from the Latin word nutrix (to nourish)
ICN (International Council of Nursing) definition—Promotion of health, prevention of illness, collaborative care
ANA (American Nurses Association) definition—the protection, promotion, and optimization, of health and abilities, prevention of illness and injury, alleviation of suffering through diagnosis and treatment, and advocacy in the care of individuals, families, community, and populations.
Patient is central focus of all definitions
Includes physical, emotional, social, and spiritual dimensions of the patient

10. E. The physical therapist
A hospital nurse works collaboratively with a physician, social worker, physical therapist, and home health care nurse to provide nursing care for a patient following an MVA. What should be the central focus of this care?
A. The nurses
B. The physician
C. The nursing care plan
D. The patient
E. The physical therapist
Answer: D. The patient
Rationale: The central focus in all definitions of nursing is the patient (person receiving care), which includes the physical, emotional, social, and spiritual dimensions of that person. Nursing is no longer considered to be concerned primarily with illness care.

11. Nursing’s Aims Promote health Prevent illness Restore health
Facilitate coping with disability or death

12. Four Blended Competencies
To meet these aims, the nurse uses four blended competencies:
Cognitive
Technical
Interpersonal
Ethical/legal
QSEN (Quality Safety Education for Nurses) Competencies-further specified
Patient-centered care
Teamwork and collaboration
Quality improvement
Safety
Evidence-based practice
Informatics

13. A nurse who uses critical thinking skills to develop a nursing care plan for an expectant mother of triplets is said to be using which skill?
A. Cognitive
B. Technical
C. Interpersonal
D. Ethical/Legal
Answer: A. Cognitive
Rationale: Cognitive skills involve thinking about the nature of things sufficiently to make decisions regarding care. Technical skills enable nurses to manipulate equipment to produce a desired outcome. Interpersonal skills involve caring relationships. Ethical/legal skills enable nurses to conduct themselves morally and professionally.

14. Interrelated Roles of Nurses
Communicator
Teacher
Counselor
Leader
Researcher
Advocate
Collaborator

15. Tell whether the following statement is true or false.
A nurse who explains a surgical procedure to a patient in order to obtain informed consent is fulfilling the role of counselor.
A. True
B. False
B. False.
Rationale: A nurse who explains a surgical procedure to a patient in order to obtain informed consent is fulfilling the role of advocate.

16. Promoting Health
Health is a state of optimal functioning or well being. Health is a subjective state-if a person is diagnosed with a specific illness they may still consider themselves healthy.
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.

17. Factors Affecting Health
Genetic inheritance
Cognitive abilities
Educational level
Race and ethnicity; culture
Age and gender
Developmental level
Lifestyle; environment
Socioeconomic status

18. Healthy People 2020 Health Promotion Guidelines
Attain high-quality, 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 life, healthy development, and healthy behaviors across all life stages.

19. Healthy People 2010/2020
Leading health indicators, areas where the government would like to see improvement include:
Access to health services
Preventative services
Environmental quality
Injury and violence
Maternal, infant, child health
Mental health
Nutrition, physical activity, obesity
Oral health
Reproductive and sexual health
Substance abuse
Tobacco

20. Preventing Illness
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

21. Restoring Health 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 in providing care
Planning, teaching, and carrying out rehabilitation for illnesses such as heart attacks, arthritis, and strokes
Working in mental health and chemical-dependency programs

22. Facilitating Coping With Disability and Death
Maximizing person’s strengths and potentials
Patient teaching
Referral to community support systems
Providing end-of-care
Hospice programs-assisting patients and their families in preparing for death and living as comfortably as possible

23. Nursing as a Professional Discipline
Definitions of nursing have expanded to describe more clearly the roles and actions of nurses, increased attention has been given to nursing as a professional discipline. Nursing is a profession based upon the following criteria:
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
*Nursing involves specialized skills and application of knowledge based on an education that has theoretical and clinical practice components.

24. Educational Preparation for Nursing Practice
Practical and vocational nursing education LPN, 1 year
Registered nursing RN education
Diploma in nursing 24-36m, hospital program
Associate degree in nursing, 2 years
Baccalaureate in nursing, 4 years
Multiple entry levels, and accelerated programs
Graduate education in nursing
Masters
Doctoral degrees-PhD, DNP
Continuing education-Ohio 24 total CEU’s with 1 Law CEU
In-service education-many hospitals provide education and training for employees

25. Professional Nursing Organizations
Concerned with current issues in nursing and health care
Benefits include networking with colleagues, having a voice in legislation, and keeping current with trends
American Nurses Association (ANA)-RN’s, involved in education, nursing standards, lobbying state and federal lawmakers to advance the profession of nursing
National League for Nurses (NLN)-open to all interested in nursing, objective to foster development and improvement of nursing services and nursing education
American Association of Colleges of Nursing (AACN)-baccalaureate and higher nurses, goals to establish quality educational standards, national accreditation of nursing programs provided through AACN. Credentialing ensures professional competence.

26. Guidelines for Nursing Practice
Standards of Nursing Practice-ANA has standards of nursing practice including assessment, diagnosis, outcomes, planning, implementation, coordination of care, consultation, evaluation, ethics, education, EBP, quality of practice, communication, leadership, collaboration, resource utilization, environmental health, collegiality
Nurse Practice Acts and Licensure-laws established in each state to regulate nursing practice, all have common elements-protect public, state board a regulatory body, define important terms and activities in nursing, establish criteria for education and licensure for nurses. Many states are members of the Nurse Licensure Compact-allows nurses who live in one state practice in another state.
Nursing Process

27. C. ANA standards of nursing practice D. National League for Nursing
Which of the following establishes criteria for the education and licensure of nurses?
A. Nursing process
B. Nurse practice acts
C. ANA standards of nursing practice
D. National League for Nursing
Answer: B. Nurse practice acts
Rationale: Nurse practice acts regulate the practice of nursing, including education and licensure. Nursing process is a guideline for nursing practice, enabling nurses to implement their roles. ANA standards of nursing practice protect and allow nurses to carry out professional roles. The National League of Nursing fosters the development and improvement of nursing services.

28. The Nursing Process
Assessing, diagnosing, planning, implementing, and evaluating
One of the major guidelines for nursing practice
Helps nurses implement their roles
Assists the nurse in identifying health care needs, implement a plan of care, and evaluate it
Integrates art and science of nursing
Allows nurses to use critical thinking and clinical reasoning
Defines the areas of care that are within the domain of nursing

29. NLN Ten Trends to Watch For Nursing Education
Changing demographics and increasing diversity
The technological explosion
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

30. NLN Ten Trends to Watch For Nursing Education (cont.)
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

31. National Supply and Demand Projections for Registered Nurses: 2000 to 2020

32. Institute of Medicine (IOM)
There are four key messages underlying their recommendations for transforming the nursing profession:
Nurses need to practice to the full extent of their education & training
Nurses should achieve higher levels of education
Nurses should be full partners with physicians and other health care professionals
Effective workforce planning and policy making require better data collection