Nursing Fundamentals: Art, Science, and Practice

• Fundamentals of Nursing with course code NUR 200

Nature of Nursing

• Nursing is both an art and a science
• As an art, nursing involves delivering care with compassion, caring, and respect for each patient's dignity and individuality
• As a science, nursing practice is based on a body of knowledge and evidence-based practices that are continually changing with new discoveries and innovations
• Integrating the art and science of nursing ensures quality care that benefits patients and their families

Nursing as a Profession

• Patients, including individuals, families, and/or communities, are at the center of nursing practice
• Patients bring diverse healthcare needs, knowledge, experiences, vulnerabilities, and expectations, making nursing challenging and rewarding
• Nursing is not just a collection of skills but a holistic profession

Science and Art in Practice

• Nursing requires blending current knowledge with insightful, compassionate care to meet individual patient needs
• Clinical expertise requires time and commitment
• Providing well-thought-out care with compassion ensures patients receive the best of both aspects

Standards of Practice

• Providing specific services according to standards and ethics is crucial in nursing care
• Professional practice is informed by knowledge from social, behavioral, biological, and physiological sciences, as well as nursing theories

American Nurses Association (ANA) Definition 2021

• Nursing integrates the art and science of caring
• The focus includes protecting, promoting, and optimizing health and abilities
• Prevention of illness and injury
• Facilitation of healing
• Alleviation of suffering with compassionate presence
• It involves diagnosing and treating human responses, advocating for individuals, families, groups, communities, and populations, recognizing the connection of all humanity

International Council of Nurses (ICN) Definition 2021

• Nursing encompasses autonomous and collaborative care for all ages, families, groups, and communities, whether sick or well, in all settings
• It promotes health, prevents illness, and cares for the ill, disabled, and dying
• It also involves advocacy, promotion of a safe environment, research, and participation in shaping health policy and systems

American Nurses Association (ANA) Standards of Nursing Practice

• Assessment: Collect pertinent data and information related to the healthcare consumer's health
• Diagnosis: Analyze assessment data to determine actual or potential diagnoses, problems, and issues
• Outcomes Identification: Identify expected outcomes individualized to the healthcare consumer Planning: Develop a plan encompassing strategies to achieve expected outcomes
• Implementation: Implement the identified plan
• Coordination of Care: Coordinate care delivery
• Health Teaching and Health Promotion: Employ strategies to teach and promote health and wellness
• Evaluation: Evaluate progress toward attainment of goals and outcomes

American Nurses Association (ANA) Standards of Professional Performance

• Ethics: Integrate ethics in all aspects of practice
• Advocacy: Demonstrate advocacy in all roles and settings
• Respectful and Equitable Practice: Practice cultural humility and inclusiveness
• Communication: Communicate effectively in all areas of professional practice
• Collaboration: Collaborate with healthcare consumers and other stakeholders
• Leadership: Lead within the professional practice setting and the profession
• Education: Seek knowledge and competence that reflects current practice and promotes futuristic thinking
• Scholarly Inquiry: Integrate scholarship, evidence, and research findings into practice
• Quality of Practice: Contribute to quality nursing practice
• Professional Practice Evaluation: Evaluate own and others' nursing practice
• Resource Stewardship: Utilize appropriate resources for safe, effective, and fiscally responsible care
• Environmental Health: Practice in a manner that advances environmental safety and health

Code of Ethics

• The nursing code of ethics defines the principles to provide care to patients

Professional Responsibilities and Roles

• Nurses provide care and comfort to patients in all healthcare settings
• They are concerned with meeting patients' needs through health promotion, illness prevention, disease and symptom management, family support, and end-of-life care
• Autonomy and Accountability: Initiating independent nursing interventions without medical orders is essential
• Caregiver: Helping patients maintain and regain health, manage disease, and maximize function and independence
• Advocate: Protecting patients' human and legal rights
• Educator: Educating patients to improve their health and recovery
• Communicator: Central to the nurse-patient relationship
• Manager: Nurse managers direct groups of nurses by establishing an environment for collaborative, safe, evidence-based patient-centered care

Career Development

• Clinician: Most nurses provide direct, hands-on patient care, typically in acute care settings
• Advanced Practice Registered Nurses (APRN): independently functioning nurses with advanced education
• APRNs have a master's or doctoral degree in nursing
• APRN is advanced education in pathophysiology, pharmacology, and certification and expertise in in physical assessment
• Clinical nurse specialist
• Nurse practitioner
• Certified nurse-midwife.
• Certified registered nurse anesthetist
• Nurse Educator: Works in staff development, schools of nursing, health care agencies, and patient education
• Nurse Administrator: Responsible for management of nursing staff in a health care agency
• Nurse Researcher: Nurse researchers conduct evidence-based practice, performance improvement, and research to improve nursing care

Historical Influences

• Knowledge of nursing history enhances understanding of the profession's social and intellectual origins
• Florence Nightingale established the first nursing philosophy based on health maintenance and restoration, and was the first practicing nurse epidemiologist
• Nightingale's statistical analyses linked hygiene with health outcomes; she volunteered in the Crimean War and became known as the "lady with the lamp" in 1853
• Clara Barton founded the American Red Cross
• Dorthea Lynde Dix, Mary Ann Ball (Mother Bickerdyke), and Harriet Tubman were key figures during the Civil War
• Dix and Bikerdyke organized hospitals, ambulances, and cared for wounded soldiers
• Harriet Tubman was active in the Underground Railroad
• Mary Mahoney became the first professionally educated African-American nurse, advocating for cultural diversity
• Lillian Wald and Mary Brewster opened the Henry Street Settlement in 1893, focusing on health needs of the poor in NYC
• Early 20th Century: Shift toward scientific, research-based nursing knowledge
• Mary Adelaide Nutting became the first nursing professor at Columbia Teachers College in 1906
• Magnet Recognition Program emerged, along with specialty nursing organizations, such as the American Association of Critical Care Nurses, AORN, INS, and ENA
• ANA established the Center for Ethics and Human Rights in 1990
• 21st Century Challenges: Adapting nursing practice and curricula for aging populations and cultural diversity

Contemporary Influences

• Nurses' Self-Care is essential
• Nursing is physically and emotionally demanding, requiring self-care to maintain compassionate care for others
• Exposure to grief and loss can lead to compassion fatigue, characterized by burnout and secondary traumatic stress
• Compassion fatigue results from prolonged emotional involvement without improved patient outcomes
• Burnout arises when demands exceed available resources, causing physical and mental exhaustion
• Early recognition programs and supportive work environments can help manage compassion fatigue
• Resiliency skills are essential for managing stress, conflict,

Health Care Trends

• Health Care Reform and Costs are Influenced
• Health care reform emphasizes health promotion, disease prevention, and community-based care
• Nurses will need to adapt to changes by improving resource management and patient discharge processes
• Rising health care costs require nurses to deliver quality care efficiently and economically

Demographic Shifts

• Demographic changes include that the population is aging and becoming more diverse, increasing the demand for expanded health care resources
• By 2030, all baby boomers will be over 65, and by 2044, more than half of the U.S. population will be part of a minority group
• Rural to urban shifts accompany more people living with chronic illnesses; these people are seeking community-based care

Medically Underserved

• Factors such as economic status, mental illness, and lack of access influence the medically underserved population
• This group faces challenges accessing care due to social, political, economic, and health literacy barriers
• There's an increasing reliance on home-based palliative care services
• Low health literacy impedes participation

Dynamic Nature

Nursing evolves with societal changes, health care priorities, and technologies

Nursing philosophies have a holistic focus, addressing the interconnectedness of health, illness, family, and community

• Increasing awareness of patient safety

Evidence–Based Practice (EBP)

• RNs must be able to make sound judgements based on evidence, not just education of experience
• EBP is Important because the public is more informed about the health markets, costs and risks of medical errors
• The goal of Health agencies adopting EBP is control and governance

Quality and Safety Education Nurses (QSEN)

• QSEN aims to prepare nurses with the skills to improve healthcare quality and safety
• QSEN focuses on patient-centered care, safety, and technology applications
• QSEN provides nurses with the knowledge, skills, and attitudes (KSAs) to improve health care quality and safety

Quality and Safety Education for Nurses Table 1.1

• Patient centered care: compassion and coordinated care for values, needs, and preferences, with respect for the patients autonomy
• Teamwork and collabration: high quality care through mutual respect and shared decisions
• Evidence-based practice: delivering best care
• Quality Improvement: monitoring process and imporement via testing and system design to improve safely and quality
• Safety: minimizing risk of both the individual/providers, and the system
• Informatics: knowledge, managment, support through use of tools that support the decision process
• Source info: OSEN competenices, prelicense KSAs via qsen.org

Emerging Technologies

• EHR, CPOE, and telehealth improve care accuracy, patient data management, and communication are examples of emerging technologies
• Nurses should understand these technologies to to enhance delivery and serve patients

Genomics

• Genomics is the the study of the genes, and their safety, qualitys, and costs
• It impacts nurses to understand and interpret tests, maintain privacy and counsel patients regarding risk factors

Politics and Health Policy

• Nursing affects influence in the community, health policies and in advocating for improvements
• ANA influences governance and politics by promoting health, high standards and professional development.

Professional Registered Nurse Education

• Prelicensure Education: Bachelor's Degree (BSN
• 4-year program covering sciences, nursing theory, social sciences, arts, and humanities.
• Graduate Education includes the masters of nursing (MSN) program that prepares you for further roles

Doctoral program

• PhD that focuses on the theory of development and the DSN or DNSC that focuses on the clinical practice of nursing

• Practice for APRNs are delivered by doctors of nursing practice

• Continuing and In-Service Education

• In-service educational program that enhances tools, practice and and skills are provided to help nurses continue their career

Nursing Practice

• Regulating the scope of nursing practice, ensuring public safety and defining legal practice limits
• It is overseen by state boards of nursing
• All RN candidates must pass the NCLEX-RN, with some state-specific requirements, Licensure and Certification

Professional Nursing Organizations

• Address issues related to practice and provides support
• Foster development, provide programs, create journals

Explore the core principles of nursing, encompassing its integration of art and science. Understand the patient-centered approach, professional standards, and the continuous development of clinical expertise. Investigate the roles within nursing, from clinical practice to nurse administration and education.