History and Evolution of Nursing

Evolution of Nursing Profession

• Nursing started as an informal role, with care provided by family, religious orders, or untrained women
• Nursing became more formalized in the 19th century
• Florence Nightingale greatly impacted, emphasizing cleanliness, sanitation, and education
• Nursing in Canada evolved from hospital-based apprenticeships to college/university programs during the 20th century
• Nursing shifted from a vocation to a regulated profession, with focuses on evidence-based practice, research, and leadership

Significant Historical Contributions to Nursing

• Florence Nightingale(1820-1910) pioneered modern nursing
• Nightingale established the first nursing school in London
• Nightingale emphasized sanitation, hygiene, and education
• Mary Agnes Snively (1847-1933) was known as the "Mother of Nursing" in Canada
• Snively founded Canada's first nursing program at Toronto General Hospital
• Snively advocated for higher education standards for nurses
• Jeanne Mance (1606-1673) was one of the first nurses in New France (now Canada)
• Mance founded Hôtel-Dieu de Montréal, one of the first hospitals in Canada
• Indigenous women and healers played vital roles in health care, using traditional medicines/holistic healing before colonization

Impact of Colonization, Residential Schools, and Canadian Laws on Indigenous Peoples

• Colonization dismissed/undermined Indigenous ways of knowing and healing
• Colonization displaced Indigenous communities and marginalized traditional health practices
• Residential schools forcibly removed Indigenous children from families
• Residential schools caused abuse, neglect, and cultural erasure
• Residential schools had intergenerational impacts on Indigenous peoples physical, mental, and emotional health
• Canadian laws restricted Indigenous autonomy, including their health/healing practices
• Access to equitable health care was limited, increasing the health disparities seen today

Discrimination in Nursing Education in Canada

• Nursing schools historically excluded racialized groups like Indigenous, Black, and Asian students
• Indigenous nurses were often excluded from training programs or forced to adopt Eurocentric practices, disregarding traditional knowledge
• Historically, men were excluded from nursing until gender roles in health care slowly shifted
• Indigenous caregivers were often expected to do the hardest, least valued work

Professional Expectations

• Must be caring and compassionate, central to nursing practice
• Practice must be Evidence Based, with decisions grounded in current research
• Must have Lifelong learning
• Nurses are expected to maintain and enhance their knowledge
• Practice advocacy acting in the best interest of patients, particularly vulnerable populations
• Practice to ethical standards following the Code of Ethics from organizations like the Canadian Nurses Association (CNA)

Carper's Ways of Knowing

• Four fundamental ways of knowing guide nursing practice
• Empirical Knowing (Science of Nursing) based on objective, evidence-based knowledge from research and facts
• Aesthetic Knowing (Art of Nursing) reflects personal style, creativity, and intuitive understanding in patient care
• Personal Knowing involves self-awareness/reflection, recognizing how personal experiences shape practice
• Ethical Knowing focuses on moral and ethical obligations, recognizing what is right/wrong in clinical practice

Five Steps of the Nursing Process

• The Nursing Process is a systematic, patient-centered approach
• Assessment involves collecting data about the patient's health status (history, physical, lab results)
• Assessment includes subjective data (patient-reported symptoms) and objective data (measurable signs like vitals)
• In diagnosis, nurses analyze assessment data to identify actual/potential health problems
• The nursing diagnosis utilizes NANDA-I (North American Nursing Diagnosis Association) classifications
• Planning develops SMART (Specific, Measurable, Achievable, Relevant, Time-bound) goals for patient care
• Planning prioritizes problems using Maslow’s Hierarchy of Needs (physiological needs first)
• Implementation carries out planned nursing interventions (e.g., administering medications, patient education, wound care)
• Implementation can be independent, dependent (physician-ordered), or collaborative (team-based)
• Evaluation determines plan effectiveness
• Adjustments to the the care plan maybe needed to set new goals
• Sources of data include Primary-patient, Secondary - family member/doctors and Tertiary-Charts/health history

Nursing Metaparadigm

• Four core concepts guide nursing practice
• Person (Client/Patient) is the recipient of care as an individual, family, or community
• Nurses focus on holistic care, considering physical, emotional, and spiritual needs
• Health is a dynamic state ranging from wellness to illness
• Nurses aim to promote health, prevent illness, and aid recovery
• Environment includes the external/internal factors influencing a patient’s health (e.g., social determinants, hospital setting, culture)
• Nurses advocate for healthier environments to improve outcomes
• Nursing includes the actions, interventions, and care provided by nurses based on evidence-based practice/professional standards
• Guides nursing practice by helping nurses make decisions and by directing the development of nursing theories/frameworks
• Fifth concept is Social Justice which ensures allocation of Health resources are accessible to everyone

Holistic Care Concepts

• Healthcare considers the physical, emotional, mental, spiritual, and social aspects of a person’s well-being, beyond just treating disease
• Health is dynamic well-being including physical, mental, and social aspects, influenced by genetics, lifestyle, environment, and healthcare access
• Wellness is the active pursuit of good health and well-being beyond treatment, including self-care, mindfulness, and balance
• Medicine Wheel represents balance in physical(body exersice, nutrition), mental(thoughts, learning, emotions), emotional(relationships, self-awareness), and spiritual (connection to culture, traditions, beliefs) that is used by Indigenous cultures to guide healing and well-being
• Illness is a subjective experience of feeling unwell influenced by personal beliefs, culture, and emotional state
• Disease is a biological or physiological condition diagnosed by a healthcare provider that may or may not cause illness

Person-Centered Care

• Model of care that focuses on the individual’s needs, values, and preferences
• The patient is an active participant in decision-making
• Consider Cultural beliefs and traditions, Personal goals and values, Family involvement, and Emotional and psychological well-being in practice of healthcare

Holism Concepts

• Respect and integration of different healing practices is expected
• Complementary Therapies (Used alongside conventional medicine) include massage(reduces pain), acupuncture(energy balancing), mindfulness( supports mental health)
• Alternative Therapies (Used instead of conventional medicine) include traditional indigenous healing(sweat lodges), Ayuverda, Chinese medicine( herbal remedies)
• Some cultural practices in healthcare include prioritizing spiritual healing over medical treatment, dietary restrictions, and family roles in medical decision-making
• Respect and consideration of these practices while ensuring patient safety is required

Cultural Conflict

• Arises when healthcare providers and patient's have differing beliefs, leading to misunderstandings
• Can arise from End-of-life care beliefs where some cultures perfer family-centered decision making vs the Western focus on pt autonomy, Pain management where some see it as a sign of weakness, and Gender roles where some perfer providers/ personal to be same gender
• Can impact care in miscommunication, distrust, or reluctance to seek medical help
• Nurses can navigate with use of cultural sensitivity and communicating skills

Cultural Safety

• Cultural Safety surpasses cultural awareness to acknowledge power imbalances, ensuring respectful and inclusive care by encouraging self-reflection.
• Achieved by self refection, considering bias and stereotypes when dealing with patients of a different culture. Active listening, adapting individual requirements and advocating for equatable health access
• Care is exemplified by acknowledging past discrimination and working with indigenous elders

Evolution of Health Care Approaches

• Health care evolution has shifted from using the biomedical model to holistic socially concicsous means
• Medical Model's key point is diagnosis and treatment focusing primarily on the absence of illness
• Behavior Models is the lifestyle choices keying in on healthy behavior and holding individuals accountable
• Socio Envionmental Model aims to recognize factors such as housing and poverty and advocates for a helathy outcome for all

Nursing Assessment

• Aims to gather data, idenify the needs, and help care planning
• Subjetive Data comes from the source in the form of symptoms and beliefs while objective is observed through measuring vitals
• Past data of the patient is key in the form of Family History and cultural/social factors such as support systems from various communities along with socioeconomic factors such as employment history

Nursing Metaparadigm

• The patient is the wholeness including physical, emotional, and spiritual health
• Health as a whole being and well being including life quality
• The enironment is physical, social and economical
• Nursint includes caring and education while advocating as a compassionate, evidenced based safe space

Social determinants

• Social determinants impact diverse population
• Indigenous-historical trauma is the burden-higher rates diabetes etc
• LGBTQ2-discrimination stigma
• Racialized racism

Health equity vs inequities

• Helath enitity focus and access to all people whil inequities highlights disparities due to injustices
• The health role in equitably addresses discrimination

The Nursing Process

• The nursing process links meta paradigm includes assessment for patient and planning based of environemtn
• The nursing then can be implemented with social justice for all