Nursing Fundamentals and History

Nursing Profession

• Responds to the needs of patients, actively participates in policy, and adapts to challenges
• Makes clinical judgments and decisions based on knowledge, experience, and standard of care
• Care is provided according to standards of practice and a code of ethics

Florence Nightingale and Virginia Henderson

• Florence Nightingale: first epidemiologist, organized the first school of nursing, and improved sanitation in battlefield hospitals
• Her practices remain a basic part of nursing today
• Virginia Henderson: "the unique function of the nurse is to assist the individual, sick or well, in the performance of those activities contributing to health or its recovery (or to a peaceful death)"

Aims of Nursing

• Promote wellness: maintain physical, emotional, and mental well-being
• Prevent illness: reduce the prevalence and incidence of diseases
• Restore health: help patients recover from illness
• Facilitate coping: prevent harm or diminish threats

Influences on Nursing

• Changes in society lead to changes in nursing: health care reform, demographic changes, medically underserved, threat of bioterrorism, rising health care costs, and nursing shortage

Nursing as a Profession

• Requires an extended education
• Requires a body of knowledge
• Provides a specific service
• Has autonomy
• Incorporates a code of ethics

Nursing Discipline

• A unique perspective or way of viewing something
• A body of knowledge, practice, and system of rules
• Defines the boundaries in which we practice

Scope and Standards of Practice

• Goals: improve the health and well-being of all individuals, communities, and populations through significant and visible contributions of registered nursing using standards-based practice
• Standards of practice: assessment, diagnosis, outcomes identification, planning, implementation, and evaluation

Nursing Standards

• Provide guidelines for implementing and evaluating nursing care
• Standards of professional performance: ethics, education, evidence-based practice, and research

Code of Ethics

• Is the philosophical ideals of right and wrong that define principles used to provide care
• Important to incorporate personal values and ethics into practice

Nursing Roles

• Protect, promote, and optimize patient health
• Prevent illness and injury, alleviate suffering through diagnosis and treatment of human responses
• Advocate for the care of patients

Benner's Stages of Nursing Proficiency

• Novice, advanced beginner, competent, proficient, and expert

Professional Responsibilities

• Nurses are responsible for obtaining and maintaining specific knowledge and skills
• Now: provide care and comfort, and emphasize health promotion and illness prevention

Professional Roles

• Autonomy and accountability
• Caregiver, advocate, educator, communicator, and manager

Members of the Health Care Team

• Patient and family, volunteers, physicians, spiritual counselors, social workers, pharmacist, home health aides, therapists, and nurses

Specialty Certification

• Defined by the American Board of Nursing Specialties (ABNS) as a formal recognition of specialized knowledge, skills, and experience demonstrated by achievement
• Establishes a professional standard for qualified nurses, demonstrates commitment to a particular specialty

Challenges to Health Care

• Reducing costs while maintaining high-quality care for patients
• Improving access and coverage for more people
• Encouraging healthy behaviors
• Earlier hospital discharges

Health Care Settings and Services

• 1. Preventive care
• 2. Primary care
• 3. Secondary care
• 4. Tertiary care
• 5. Restorative care
• 6. Continuing care

Preventive Care and Primary Care

• Focuses on improved health outcomes for an entire population
• Requires collaboration among health professionals, health care leaders, and community members
• Health promotion lowers overall costs, reduces the incidence of disease, minimizes complications, and reduces the need for more expensive resources

Secondary and Tertiary Care

• Acute care: focus on diagnosis and treatment of disease
• Disease management is the most common and expensive service of the health care delivery system
• 20% of patients require 80% of health care spending
• Fastest-growing age group of uninsured is postponing care

Restorative Care

• Serves patients recovering from an acute or chronic illness/disability
• Helps individuals regain maximal function and enhance quality of life
• Promotes patient independence and self-care abilities
• Requires a multidisciplinary approach

Home Care and Rehabilitation

• Provision of medically related professional and paraprofessional services and equipment to patients and families in their homes
• Involves coordination of services, focuses on patient and family independence, and is funded by insurance or private pay sources

Continuing Care

• For people who are disabled, functionally dependent, or suffering from a terminal disease
• Available within institutional settings or in the home
• Includes nursing centers or facilities, assisted living, respite care, adult day care centers, and hospice

Institute of Medicine (IOM)

• Nurses need to be transformed by practicing to the full extent of their education and training
• Achieving higher levels of education and training through an improved education system that provides seamless progression
• Improving data collection and the information infrastructure

Healthcare Accreditation and Regulation

• Demonstrate quality and safety to evaluate performance, identify problems, and develop solutions
• Accreditation earned by the entire organization
• Patient Protection and Affordable Care Act (ACA) aims to provide access to health care for all, reduce costs, and improve quality

Theory in Nursing

• Helps explain an idea/concept, explains relationships among concepts, predicts outcomes, and presents ideas that are suggested or presented as possibly true but not known or proven to be true
• Components of theory: concepts, definitions, assumptions, and phenomenon
• Nursing theory: explains, describes, predicts, and prescribes

Nursing Domain

• A specific area of expert knowledge that describes the profession's subject, concepts, values, and beliefs
• The profession itself, past, present, and future

Theory and Nursing Process

• Theories generate nursing knowledge for use in practice
• Directs how to use the nursing process
• Adaptable to different patients and care settings

Interdisciplinary Theories

• Explain systematic views of phenomena, specific to the discipline of inquiry
• Basic human needs (Maslow), developmental, psychosocial systems

Evidence-Based Practice

• 6 steps: ask the clinical question, collect the best evidence, critique the evidence, integrate the evidence, evaluate the practice decision or change, and share the outcomes of EBP changes with others
• PICO question: P-patient population of interest, I-intervention of interest, C-comparison of interest, O-outcome, and T-time

Health and Wellness

• Healthy People goals: attain high-quality, longer lives free of preventable disease, disability, injury, and premature health
• 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 behavior across all life stages

Health Promotion and Prevention

• Primary prevention: true prevention that lowers the chances that a disease will develop
• Secondary prevention: focuses on those who have a disease or are at risk of developing a disease
• Tertiary prevention: occurs when a defect or disability is permanent or irreversible
• Risk factors that can increase the vulnerability of an individual or group to an illness or accident

Illness and Illness Behavior

• State in which a person's physical, emotional, intellectual, social, developmental, or spiritual functioning is diminished or impaired
• Acute illness: short duration and severe
• Chronic illness: persists longer than 6 months
• Illness behavior: involves how people monitor their bodies and define and interpret their symptoms, influenced by many variables and must be considered by the nurse when planning care