1. Definition of Nursing
Nursing is the protection, promotion, and optimization of health and abilities, prevention of illness and injury, alleviation of suffering through diagnosis and treatment of human response, and advocacy in the care of individuals, families, communities, and populations (ANA, 2003)

2. Definition of Nursing
Nursing encompasses autonomous and collaborative care of individuals of all ages, families, groups, and communities, sick or well in all settings. Nursing includes the promotion of health, prevention of illness, and the care of ill, disabled, and dying people (International Council of Nurses, 2002).

3. Definition of Nursing
Advocacy, promotion of a safe environment, research, participation in shaping health policy and in patient and health systems management, and education are also key nursing roles (ICN, 2002).

4. Definition of Nursing Nursing = Care of Others
Blend of Art and Science

5. History of Nursing Ancient Civilizations through the Renaissance
Illness had supernatural causes
Women delivered custodial care to family
Medicine men treated disease
As civilizations grew priests were seen as physicians
Under Christianity educated and wealthy women dedicated themselves to care of the sick
Phoebe became the 1st Deaconess
During the Crusades all-male military orders flourished and all-female religious orders declined
During the Renaissance medicine moved into the University
Male nurses vanished from profession
Home major locality for nursing care
Only poor hospitalized, cared for by prostitutes and female criminals

6. History of Nursing Colonialism and Revolution
Physicians not required to have license
Hospital care only available in cities
Mentally ill “warehoused”
More soldiers died in Revolutionary War due to disease than wounds

7. History of Nursing Industrialization Population explosion
Increased incidence illness, injury, and early mortality
Hospitals opened
Schools of nursing started: Sisters of Charity, Kaiserworth school of nursing in Germany 1836, Dr Joseph Warrington in Philadelphia 1839

8. History of Nursing Influence of War
Crimean war, notable for Florence Nightingale
American Civil War, emergence of early nursing leaders
Training for nurses more apprenticeship than education, hospital-based schools of nursing
WWI, female nurses under control of male hospital administrators and physicians
WWII, large # women working outside home
Increased need for nurses
Move into university and college settings

9. History of Nursing Influence of War
Korean War, growth of AD programs in community colleges
Vietnam War, expansion civilian hospitals, advancement of specialization
Concept of nursing diagnosis
Masters and PhD programs in nursing

10. Current Trends in Nursing
Change in education, disappearance of hospital based schools of nursing
Nursing shortage
Evidence-based practice
Decreased hospital length of stay
Community based nursing
Aging population
Increase in chronic health conditions
Culturally competent nursing care
Increase costs of health care/managed care

11. Major Factors to Evolution of Nursing
Industrial revolution
Wars
Closure of diploma programs
Nursing shortage
Movement from inpatient to outpatient
Increasing costs of health care

12. Florence Nightingale Wealthy well-educated
In Crimean War reduced soldiers mortality from 42.7% to 2.2% in 6 months
Established training school for nurses
Wrote books about healthcare and nursing education “Notes on Nursing”

13. Florence Nightingale 1st Nursing Theorist
Nursing is separate and distinct from medicine
All women are natural nurses
Emphasized importance of environment: fresh air, cleanliness, nutrition
Maintained accurate records, 1st Nursing Researcher

14. Is Nursing a Profession?
Well-defined body of specific and unique knowledge that undergoes continual growth through research
Services provided are vital to human beings and the welfare of society
Practitioners have autonomy and control their own policies and activities
Practitioners are motivated by the service they provide and consider their work important to their lives (altruism)
Practitioners decisions and conduct are guided by a code of ethics
Professional organization sets standards
Practitioners receive education in institutions of higher learning

15. Registered Nursing Education
Diploma in Nursing
Associate Degree in Nursing
Baccalaureate in Nursing
Direct entry Masters Degree in Nursing
Advanced practice Masters in Nursing
PhD in Nursing

16. Mathematics & Statistics
Physical Sciences
A & P Biology Microbiology Chemistry
Pathophysiology
Food & Nutrition
Humanities
Ethics Literature
History
Philosophy
Pharmacology
NURSING
Abnormal Psychology
Psychology Sociology
Growth & Development
Social Sciences
Research
Mathematics & Statistics
Writing & Composition
Liberal Arts & Nursing

17. Professional Nursing Organizations
American Nurses Association (ANA): establishes standards of practice, encourages research to advance nursing practice, and represents nursing for legislative actions
National Student Nurses’ Association (NSNA)
OSNA

18. Professional Nursing Organizations
National League for Nursing (NLN): foster development and improvement of nursing education; voluntary accreditation
American Association of Colleges of Nursing (AACN): national accreditation for collegiate nursing programs
International Council of Nurses (ICN)
Specialty Nursing Organizations: Sigma Theta Tau International Honor Society of Nursing

19. Professional Organizations and Nursing Process
Term 1st used in 1955
ANA Standards of Nursing Practice
Canadian Nurses Association standard of effective use of nursing process
Joint Commission of Accreditation of Healthcare Organizations requires care documentation according to nursing process
ANA recommends educational programs incorporate nursing process

20. Nursing Process and Critical Thinking
Nursing process provides a framework for critical thinking

21. CRITICAL THINKING Abstract concept Learned thinking skills
Has a purpose
Considers evidence, context, past knowledge, alternatives, creativity

22. WHY CRITICALLY THINK? Nursing is an applied discipline
Nursing draws on knowledge from other fields
Nurses deal with change in stressful environments
Nurses make frequent, varied, and important decisions

23. CRITICAL THINKING SKILLS Objectively gather information
Recognize need for more info
Recognize gaps in own knowledge
Listen carefully; read thoroughly
Separate relevant from irrelevant data
Group info in meaningful way
Draw tentative conclusions

24. SKILLS (cont) Integrate findings with previous knowledge
Identify potential solutions
Evaluate each potential solution
Choose best solution
Carry out intervention
Evaluate credibility and usefulness of sources of info
Sound like the problem-solving or scientific method?

25. CRITICAL THINKING ATTITUDES Independent thinking
Intellectual curiosity
Intellectual humility
Intellectual courage
Intellectual perseverance
Fair-mindedness

26. STAGES OF SKILL ACQUISITION
Novice
Rule-governed, limited, inflexible
Total recall mode
Advanced Beginner
Notes recurrent aspects
Beginning development of professional habits
Competent
Able to recognize own thinking
Able to analyze problems
Lacks speed and flexibility of proficient nurse
2-3 years in setting

27. BENNER (cont) Proficient Expert Perceives each situation as a whole
Long-term goals
Advanced level of critical thinking
3-5 years in setting
Expert
Intuitive grasp of situation
5-15 years in setting
Patricia Benner: From Novice to Expert

28. OBSTACLES
Overuse of habit with questioning “We’ve always done it that way”
Anxiety
Working under deadlines
Biases, own as well as patient
Lack of confidence in own thinking

29. NURSING PROCESS
Structure for critical thinking

30. NURSING PROCESS Assessment Nursing Diagnosis
Planning (expected outcomes)
Nursing Intervention
Implementation of plan
Evaluation

31. NURSING PROCESS Nursing Diagnosis Assessment Standards of Professional
Practice
ANA code of Ethics
Evidence-Based
Planning
Evaluation
Intervention