Nursing: Art, Science, and Roles

• Nursing, as taught in NUR 200, is both an art and a science

Nursing as an Art

• It involves delivering care with compassion, caring, and respect for each patient's dignity and individuality

Nursing as a Science

• Nursing practice is based on knowledge and evidence-based practices

• It is continually changing with new discoveries and innovations

• Integrating the art and science of nursing ensures high-quality care that benefits patients and their families

• In nursing practice, the patient is the central focus

• Patients can be individuals, families, or communities, depending on the setting

• Nurses deal with a wide range of health care needs, knowledge levels, experiences, sensitivities, and expectations

• This diversity makes nursing both challenging and rewarding

• Nursing is not just a set of skills, it is a holistic practice

Science and Art of Nursing Practice

• It requires blending current knowledge and practice standards with an empathetic approach to patients' needs
• Clinical expertise requires time and commitment
• Well-thought-out care, combined with compassion and caring, provides patients with the best possible care

Scope and Standards of Practice

• Providing care requires the provision of a specific service according to standards of practice
• It needs to follow a code of ethics
• Professional practice integrates knowledge from social, behavioral, biological, and physiological sciences, as well as nursing theories
• The American Nurses Association (ANA) defined nursing in 2021
• It incorporates the art and science of caring, focusing on protecting, promoting, and optimizing health
• It includes preventing illness and injury, healing, alleviating suffering, and compassionate presence
• It also involves diagnosing and treating human responses
• Nursing also includes advocacy for individuals, families, groups, communities, and populations, recognizing the connection of all humanity

International Council of Nurses (ICN), 2021

• Nursing encompasses autonomous and collaborative care for individuals of all ages, families, groups, and communities, whether sick or well
• Nursing includes the promotion of health, prevention of illness, and care for the ill, disabled, and dying
• Advocacy, promotion of a safe environment, research, and participation in shaping health policy and health systems are included

American Nurses Association (ANA) Standards of Nursing Practice

• Assessment: Registered nurses collect relevant health data
• Diagnosis: Registered nurses analyze assessment data for potential issues
• Outcomes Identification: Registered nurses identify expected outcomes
• Planning: Registered nurses develop comprehensive strategies to reach goals
• Implementation: Registered nurses implement the identified plan
• Coordination of Care: Registered nurses coordinate care delivery
• Health Teaching and Health Promotion: Registered nurses instruct patients regarding health and well-being
• Evaluation: Registered nurses assess progress relative to outcomes

American Nurses Association (ANA) Standards of Professional Performance

• Ethics: Registered nurses integrate ethics in all aspects of practice

• Advocacy: Registered nurses advocate in all roles and settings

• Respectful and Equitable Practice: Registered nurses practice with cultural humility and inclusiveness

• Communication: Registered nurses communicate effectively in all areas of professional practice

• Collaboration: Registered nurses collaborate with health care consumers and stakeholders

• Leadership: Registered nurses lead within their practice setting and profession

• Education: Registered nurses seek knowledge and competence to stay current and futuristic

• Scholarly Inquiry: Registered nurses integrate scholarship, evidence, and research

• Quality of Practice: Registered nurses contribute to quality nursing practice

• Professional Practice Evaluation: Registered nurses evaluate their practice

• Resource Stewardship: Registered nurses use resources responsibly

• Environmental Health: Registered nurses promote environmental safety and health

• A nursing code of ethics represents philosophical ideals of right and wrong

• It establishes the guiding principles nurses use in patient care

Professional Responsibilities and Roles

• Nurses provide care and comfort to patients in various health care settings
• The focus on meeting patient needs remains the same, regardless of the care setting
• Autonomy and Accountability: Nurses independently initiate interventions
• Caregiver: Nurses help patients maintain/regain health and manage disease
• Advocate: Nurses protect patient rights
• Educator: Nurses educate patients
• Communicator: Nurses develop nurse-patient relationships
• Manager: Nurse managers direct the groups of nurses

Career Development

• Clinician: Nurses provide direct (hands-on) patient care
• Advanced Practice Registered Nurses (APRN): They possess a master's degree or Doctor of Nursing Practice (DNP)
• Clinical Nurse Specialist
• Nurse Practitioner
• Certified Nurse-Midwife
• Certified Registered Nurse Anesthetist
• Nurse Educator: A nurse educator works in schools of nursing and hospitals
• Nurse Administrator: A nurse administrator is responsible for management of the nursing staff in a health care agency
• Nurse Researcher: A nurse researcher is involved in evidence-based practice, and performance improvement, and conducts research

Historical Influences

• Understanding nursing history can provide an understanding of the discipline's social and intellectual origins
• Florence Nightingale: Established nursing's philosophy based on health maintenance
• She was also the first practicing nurse epidemiologist
• She connected poor sanitation with cholera and dysentery
• During the Crimean War in 1853, she volunteered in battlefield hospitals and was known as the "lady with the lamp"
• Her statistical analyses led to improvements in sanitary conditions
• Clara Barton founded the American Red Cross
• Dorothea Lynde Dix, Mary Ann Ball (Mother Bickerdyke), and Harriet Tubman were key figures during the Civil War
• Dix and Bickerdyke also organized hospitals, ambulances, and cared for wounded soldiers
• Harriet Tubman was active in the Underground Railroad
• Mary Mahoney was the first professionally educated African-American nurse
• Advocated for cultural diversity and respect
• Isabel Hampton Robb helped found the Nurses' Associated Alumnae of the United States and Canada in 1896 (later ANA)
• She also coauthored nursing textbooks
• Lillian Wald and Mary Brewster opened the Henry Street Settlement in 1893 focusing on health needs of the poor in NYC
• Early 20th Century a Movement towards scientific, research-based nursing knowledge began
• Mary Adelaide Nutting became nursing professor at Columbia Teachers College in 1906
• Specialty-nursing organizations included the American Association of Critical Care Nurses (AACN), AORN, INS, and ENA were created
• The Center for Ethics and Human Rights was established by the ANA in 1990
• 21st Century Challenges: o Adapting curricula for aging populations and cultural diversity

Contemporary Influences on Nursing

• Nurses Self-Care is essential in the demanding profession of nursing
• Compassion fatigue is possible because Nursing is physically and emotionally demanding
• Exposure to grief and loss can lead to compassion fatigue, characterized by burnout and secondary traumatic stress
• Early recognition programs and supportive work environments can help manage compassion fatigue
• Resiliency skills are essential for managing stress, conflict, and secondary traumatic stress
• Health Care Reform and Costs
• Health care reform emphasizes disease prevention and community-based care
• Community-based care: Nurses will need to adapt to improvements in patient care.
• With high health care costs, nurses must efficiently use resources.
• Demographic Changes
• The aging population requires expanded health care
• By 2030, all baby boomers will be over 65
• By 2044, more than half of the U.S. population will be a minority
• There is a shift from rural to urban areas, with more people living with chronic illnesses

Medically Underserved

• Factors like unemployment, mental illness, and homelessness contribute to this
• This group faces challenges in accessing care
• There are increasing numbers of underserved patients requiring palliative care services
• Low health literacy leads to less participation

Trends in Nursing: Summary

• Nursing evolves with societal and technological changes
• Current nursing now has a holistic focus
• Nurses need increasing awareness of patient safety
• Evidence-based practice: RNs use clinical judgments based on evidence in EBP
• The public is more informed about health care costs
• Health care agencies enforce EBP to control health

Quality and Safety Education for Nurses (QSEN)

• QSEN aims to prepare nurses with knowledge, skills, and attitudes (KSAs) to improve health care quality and safety
• QSEN defines patient-centered care, safety, and informatics for prelicensure and graduate programs

Emerging Information Technologies

• Technologies like EHR, CPOE, and telehealth improve accuracy

• They also enhance care delivery and understanding

• Nurses need to understand these technologies to guide patients

• Genomics involves studying all genes

• Nurses can help understand genomic tests and risk factors

• They can counsel patients and maintain confidentiality

• Public perception of nursing: Nursing is essential

• Consumers need information on Hospital Compare and HCAHPS

• The politics increasingly influence health policy

• The ANA promotes standards and development

Professional Registered Nurse Education

• Prelicensure Education: a 4-year degree program
• Social sciences, arts, and humanities included
• Graduate Education: Master's degrees prepare nurses for roles
• Master- level nurses also act as educators, administrators, and advanced practice
• Advanced Practice Registered Nurses (APRNS)
• Doctoral Degrees

Types of Nursing Doctoral degrees

• Doctor of Nursing Science (DSN or DNSC): Applying research is the focus
• Doctor of Philosophy (PhD): Enhances research and theory
• Doctor of Nursing Practice (DNP): It emphasizes evidence-based practice for APRNS

Continuing and In-Service Education

• Continuing Education: Updates nursing knowledge
• Enhances skills and knowledge: The healthcare agencies enhance the knowledge
• It also focuses on new tech and safety procedures

Nursing Practice

• Nurse Practice Acts regulate nursing scope
• State Boards of Nursing oversee Nurse Practice Acts
• Licensure: All RN candidates must pass NCLEX-RN
• Professional Nursing Organizations: Provide programs and mentorship

Student Organizations

• National Student Nurses' Association (NSNA) and Canadian Nursing Students' Association (CNSA)
• The Student organizations help students

Explore the art and science of nursing, its impact on patient care, and the role of nursing organizations like the ANA and ICN. Understand the diverse settings where nurses practice, from education to administration.