History of Nursing and Scope of Practice

History of Nursing

• Florence Nightingale: Founder of modern nursing, improved sanitation, and established the Nightingale Training School.
• Clara Barton: Founder of the American Red Cross.
• Mary Seacole: Provided holistic care during the Crimean War.
• Lillian Wald: Pioneer in public health nursing, founded the Henry Street Settlement.
• Dorothea Dix: Advocate for the mentally ill, improved asylum and hospital conditions.

Key Achievements

• Nightingale reduced mortality rates through hygiene.
• Barton organized care for soldiers during the Civil War.
• Wald introduced school nursing and health education.

Scope of Practice & Delegation

• How to know your scope of practice: Refer to Nurse Practice Act (varies by state) and follow institutional policies.
• Resources: Consult professional nursing standards, guidelines, state board of nursing, employer policy manuals, and ANA Scope and Standards of Practice.
• 5 Guidelines for Delegation: Consider task appropriateness, patient stability, delegatee competence, clear instructions, and performance monitoring.

The Nursing Process

• Characteristics: Patient-centered, dynamic, organized, and evidence-based.
• Steps (ADPIE): Assessment, Diagnosis, Planning, Implementation, Evaluation.

Assessment

• Gathering data about the patient's health status.
• Subjective data: Information verbally expressed by the patient. Example: "I feel nauseous."
• Objective data: Observable or measurable data. Example: Blood pressure, temperature.
• Primary sources: Patient.
• Secondary sources: Family, medical records, other healthcare providers.

Planning/Goals

• Setting priorities, goals, and outcomes.
• Use SMART goals (Specific, Measurable, Achievable, Relevant, Time-bound).
• Selecting Nursing Interventions: Evidence-based actions to achieve goals.

Implementation

• Performing interventions.

Evaluation

• Determining if goals were met and revising the care plan if necessary.

Legal and Ethical Considerations

• Laws (6 Categories): Criminal, Civil, Administrative, Common, Statutory, Regulatory.
• Malpractice Case Elements (3): Duty, Breach of Duty, Causation

Ethics

• Codes of Ethics: Guides for ethical practice, such as the ANA Code of Ethics.
• Ethical Dilemmas: Situations with conflicting moral principles.
• Patient Rights (7 Examples): Information, refuse treatment, privacy, confidentiality, respectful care, participate in decision-making, access medical records.
• Ethical Principles (6 Examples): Autonomy, beneficence, non-maleficence, justice, fidelity, veracity.

Health

• Health vs. Wellness: Health is the state of physical, mental, and social well-being; wellness is the active pursuit of activities promoting health.

Cultural Considerations

• Aspects of Transcultural Nursing: Awareness, knowledge, sensitivity, and competency.
• Components of Cultural Assessment: Language, beliefs, values, family structure, and health practices.
• Language Barriers: Use interpreters, visual aids, and clear, simple language.

Nurse-Client Relationship

• Nurse Responsibilities: Advocacy, confidentiality, education, trust.
• Patient Responsibilities: Communicating needs, accurate information, following care plans.
• Phases of the Relationship (3): Orientation, Working, Termination

Therapeutic Communication

• Techniques: Active listening, empathy, open-ended questions, and reflection.
• What to avoid: Giving advice, interrupting, medical jargon, and personal opinions.

Charting & Documentation

• Types of Charting: Narrative, SOAP, PIE, Focus Charting.
• SOAP Note: Subjective, Objective, Assessment, Plan.
• SBAR: Situation, Background, Assessment, Recommendation.

HIPAA & Privacy

• HIPAA: Legislation that ensures patient privacy and confidentiality of medical records.
• Nurse Responsibilities: Safeguard patient information, access necessary data, educate others on privacy protocols.