Nursing Profession: History, Aims & Knowledge

Fundamentals of Nursing Prelims

• Nursing has evolved into a respected profession with formal education after hundreds of years.
• A profession requires specialized knowledge, skills, and preparation through extensive training.
• Criteria includes prolonged training, service orientation, ongoing research, autonomy, and professional organization.
• Nursing is increasingly recognized as a profession due to its development in education, practice, and research.
• Nursing addresses humanistic and holistic needs of clients and families related to health.
• Expertise in the field comes from theoretical knowledge and practical experience.

Aims of Nursing

• It aims to maintain and promote wellness, prevent illness, care for and rehabilitate the sick/disabled, reduce stress.
• It aims to provide comfort during the disease process.
• It aims to provide service to individual families and societies.
• It aims to assist clients to gain independence, develop nurse-client interaction, and focus on holistic qualitative participation.

Characteristics of Nursing Profession

• It has a well-defined body of knowledge that evolves with scientific improvements.
• Its education of practitioners is entrusted, applying knowledge into practice autonomously.
• Nurses should provide freedom and opportunity for continued professional growth and economic security, seeing it as a chosen occupation.

Steps of Professional Development

• It involves recognizing a problem, followed by untrained personnel using basic skills to handle it initially.
• A theoretical knowledge base is developed and members work together, codes/standards are developed, and methods for enforcing standards are set.

Status of the Profession

• People have high expectations from nurses in society due to their knowledge, ideals, and service quality.

Nursing as a Public Service

• It emphasizes acquiring knowledge, scientific principles, and skill development.
• Nurses should use common sense and mature judgment when planning patient care.
• Nurses function dependently and independently.

Function of Nurses

• Dependent functioning is implementing doctor's orders with interpretation and understanding why, what, how, when.
• Questioning orders for clarification ensures patient safety, indicating knowledge and skill.
• Independent functions are defined by nurse practice acts, level of competence, and safe nursing practices.
• These functions involve patient supervision, symptom observation, accurate reporting, personnel supervision, and application of nursing procedures.

Role of Professional Nurse

• Delivering specialized care in hospitals/communities includes complex skills in assessment, diagnosis, planning, implementation, and evaluation.
• Maintaining collaborative relationships, coordinating care plans with medical care is important.
• Observing, assessing and reporting therapy effects, changes are made in nurse regime if indicates.
• Interpreting and demonstrating nursing care skills to others is key, initiate care plan changes and use health practices for patient/family education.
• Functioning as a team leader, progressing from teaching, to consulting.
• Recognizing patient needs for counseling, providing support without violating their identity/privacy is important.
• Understanding the historic role of nursing, participating with other professionals in solving community health problems is important.

Codes for Professional Nurse

• Nurses offer services with respect for human dignity, regardless of nationality, race, creed, color, or status.
• Privacy is protected by guarding confidential information.
• The code maintains individual competence, accepts responsibility for actions/judgement.
• Patient safety are safeguarded when other's conduct is incompetent, unethical, or illegal.
• Competence is used as a basis for delegated tasks.
• Research activities are participated in when rights of individual participants are protected.
• Nurses participate in improving standards of nursing practice and conditions for high quality care.
• Nurses collaborate with health professionals and advocate for health needs, while avoiding endorsements for commercial products.

Roles and Functions of a Nurse

• Caregiver
• Communicator
• Teacher
• Client advocate
• Counselor
• Change agent
• Leader
• Manager
• Expanded roles include nurse practitioner, clinical nurse specialist, nurse anesthetist, nurse midwife, nurse researcher, nurse administrator, nurse educator, and nurse entrepreneur

Nursing Note Documentation and Reporting

• Documentation in health records is integral for safe practice, and accuracy and comprehensiveness show critical thinking and a nurse’s unique contribution.
• Effective and timely communication is important.
• Safety is a vital part of ethical/ effective nursing whether on paper or electronically.

Why Documentation is Important

• It ensures communication among healthcare teams, preventing fragmentation.
• It plans care using data for client records.
• It audits health agencies' records for quality assurance purposes.
• It aids for research to help with treatment plans.

Documentation Guidelines

• Correct patient identification is included
• Opinions aren't recorded.
• Writing for other people isn't done
• It is charted as closely as possible to care time stating what occurred with medications or treatment.

Do's for Nursing Documentation

• Charting must be done if healthcare is needed for patient.
• The correct chart must be checked.
• Documentation must reflect nursing process.
• Documentation must include time/route of medication given and patient response.
• Document patient care ASAP.

Don'ts for Nursing Documentation

• Don't chart symptoms with pain with no nursing action recorded, as it is a criminal offense.
• Don't use unaccepted abbreviations or imprecise descriptions.

Do's for Nursing Documentation

• Write in blue/black ink and ensure patient’s name/room/record is on record form.
• State date/time for each recording, spell correctly, documenting events in order, using common abbreviations, and your signature.

Don'ts for Nursing Documentation

• Don't erase mistakes, destroy notes, write procedures not done or leave blanks.
• Documenting with a computer increases quality, saves time/space and analyzes data.

Confidentiality guidelines include

• Needing a password and never leaving unattended monitors, client info for others to see.
• Know facility policy for corrections.
• Nurse signs recording with name/title/initials/unique code for identification.
• Date/time, telephone reports must include subject and signature.

Reporting

• Recording shouldn’t be done before care.
• Reports are an exchange of information among caregivers, be it oral (immediate) or written (permanent for several personnel).

Types of Reports

• Change of shift reports allows nurses to report information so other nurses have continuity of care.
• Transfer reports involve patient transfers to other units for differing levels of care.
• Incident reports document any event inconsistent with routine healthcare operations, which occur when patient under care.
• Incident reports are a major part of unit quality improvement, done via telephone.

Week 3 Infection Control

• Communicable diseases are illnesses from infectious agents/toxic products, transmitted between humans, animals, or the environment.
• Studying communicable diseases helps understand changing patterns, discover new infections, and identify origins of chronic diseases.

Epidemiology

• According to (Last, 1983) is the study of how health issues are distributed, what causes them and how a population is affected to control health problems
• Infection includes the introduction, growth, and amplification, but not always illness.
• The absence of signs/symptoms is called Asymptomatic
• Contamination occurs on body surfaces/items, lodgment of arthropods equals infestation.
• Contagious diseases are transmitted via contact, host is where infectious agents subsist.
• Vectors are carriers transporting agents.

Other Definitions

• Reservoir: where agents live and multiply.
• Incidence: rate of new cases in a population over a period.
• Prevalence: the proportion of cases in a population during a period.
• Epidemic: when cases exceeds unusual occurences.
• Endemic: a constant disease in an area
• Hyperendemic: a disease that is always present with a high rate
• Holoendemic: high level of early life infection in most children
• Pandemic: an epidemic affecting a large area.
• Exotic diseases: diseases outside of a country.
• Sporadic: scattered, irregularly occurring cases.
• Medical asepsis ("clean technique") confines microorganisms.
• Surgical asepsis (sterile technique) keeps areas free of microorganisms.

Types of Infection

• Local (ex; pimple)
• Systemic (body system)
• Bacteremia (bacteria in the blood)
• Septicemia (a lot of effects in the body)
• Acute (early stage infections)
• Chronic (chronic infections)
• Infections originating from healthcare facilities are nosocomial.
• Opportunistic infections take advantage of weak immune system.
• Immunosuppressed: weak immune system.

Eradication/Elimination

• Termination of infection transmission via extermination.
• Elimination removes disease from a large region, which are polio/measles, indicating reproductive rates have potential to spread.

Chain of Infection

• Susceptible host: anyone who has the pathogen.
• Pathogens of bacteria
• Virus
• Fungi
• Parasite.
• Reservoir: people/ animals/ soil/food/water.
• Portal of exit includes coughing, sneezing, secretions, and feces, transmitted by direct/indirect contact or vectors.
• Portal of entry includes the mouth
• Nose, eyes/cuts in the skin.

Other infection agents

• Etiologic microorganisms, number, virulence, and ability to invade a host.
• Causative agents: parasites, protozoa, fungi, prostate.
• Infection from reservoirs require nutrition, right setting, light and moist.
• It is transmitted by droplets/ vehicles/ vectors/ airborne.
• Carriers occur from inadequate treatment, forming three elements: presence in body, no symptoms, agent shedding in discharge.
• Zoonosis passes from animals to humans like rabies.

Susceptible Host

First line of defense

• Intact skin/mucous membranes
• Cilia of the nasal passages
• Tears, GI acids, vagina acidity/urine flow

Second line

• Inflammatory Response

Inflammation stages

• Vascular: constriction, permeability, leukocyte production
• Exudate: fibrinogen and platelets clump
• Reparative: Regeneration, granulation, and tissue form.

Third Line of defense

• Specific Defenses

Active immunity

• Host produces antibodies (natural/from infection: artificial/administered).

Passive immunity

• Ex. from mother to baby through breastmilk is natural and artificial is through infection.

Disease

Factors influencing infections

• Age
• Genetics
• Stress
• Nutrition
• Medication
• Health history and physical assessment identifies infections in stages, tested through labs, urine, blood, cultures.
• The CAUSATIVE AGENTS include elevated WBC and erythrocyte sedimentation rate (ESR). Prevention is key through restoring defenses and avoiding spread of infection.

Stopping the Chain of Infection

• Breaking one link prevents transmission.
• The chain includes infectious agent, reservoir, portal of exit, transmission mode, portal of entry, and susceptible host.
• HAI's are facility infections from weakened immunity and procedures.

CDC

• CDC updated precautions in 2007, highlighting respiratory hygiene, safe injections, and mask use for spinal procedures, including daily equipment.
• CDC's preventions use standard/transmission-based precautions via hand hygiene, PPE, controls and etiquette.

Protocols

• Standard precautions are applied to blood and fluids.
• Transmission-based precautions prevent known infections via contact, airborne transmissions, and droplet.
• Limits must be applied for patient room supplies and transport.
• Disposables should be used plus supply should be kept outside the room as well.
• Private rooms can be used as well. Contact precautions
• Direct or indirect contact, including drug-resistant bacteria (MRSA/VRE).

Other issues

• Extended-spectrum beta-lactamase-producing infection: Clostridium difficile (requires more water than hand sanitizer).
• Workers, when caring for a patient should wear gowns and gloves, and should be disposed of after the care ends.
• Wash your hands.
• Resistance against Multidrug is also important.
• Airborne (small droplets – TB, measles, varicella) demands negative pressure.
• Droplet (larger droplets – pertussis, mumps) needs 3 ft. diameter.
• PPE.
• Isolation affects the sensory, interaction and emotion factors.

Sterile Technique

• Field has: sterile gloves/gowns. Regulate/control health care worker with regulations/hazard

Chain Reaction

• Contaminated needles/sharps injury
• Skin/Mucous contact requires medical asepsis, PPE, care to bloodborne pathogens, immediate area care, incident report, evaluation, follow ups.
• Reports from 1825 showed washing prevents odors/transmission, yet compliance is low and pathogens spread to individuals.
• Washing of hand is standard practice that should occur as soon as gloves are removed, and before eating, and after restroom/procedure/diaper change, 40-60 seconds following proper steps .

Hand Rub Protocols

• Workers must allot 20-30 seconds, if hands are soiled, and must follow steps to ensure proper sanitization.
• Hands not safe until dry.

Vital Signs

• Indicate life via heartbeat and breathing, and they assess a patients well being.
• The four traditional measure body temp with normal range 36.6-37.2 degree Celsius and 98-99 degree Fahrenheit.
• Normal with afebrile or fever with febrile/ pyrexia.
• Also normal is measuring pulse, respiration, and blood pressure/ oxygen saturation.
• The Joint Commission designated PAIN as ⅚ to be assessed with the other four, changing with variables. - Measurements occur seated and relaxed.
• The patient should have the chance to relax.
• Variables that change vitals include age, stress/, habits, temperature, eating, meds and observations of the patient.
• Body temperature varies on recent activity, food, time of day, and menstrual cycle on a thermometer Celsius or Fahrenheit where a fever occurs past 38.5 C or 101.5 F.

Measurements

• Rectal is highest, oral is average, axillary is lower, and ear special.
• Fever arises above 98.6° F orally or 99.8° F rectally.
• Hypothermia falls under 95° F.
• Celsius degree is under 35 and high is over 41.
• Respiration rate is breaths in a minute, counted, while the patient shows dyspnea.
• Respiration increases with fever.
• Age -Under 1 year with respiration rate 30-40 -Ages 1-2 25-35 -Ages 2-5 years years 25-30 -Ages 5-12 years 20-25 -While over 12 the rate is 12-20.
• Abnormal involves under16 breaths / over 20 breaths. Breathing range: 12 to 20 breaths per minute.
• Bradypnea is below 8 bpm, tachypnea exceeds 30 bpm, dyspnea is hard to breath, and apnea no breath.

Pulse Rate

-Normal is 60 to 100 bpm while athlete pulse rate is 40.

• Variations increase with age.
• Use temporal arteries.
• Carotid- used during cardiac arrest/shock in adults, used to determine circulation to the brain
• Apical- routinely used for infants and children up to 3 years of age, used in conjunction with some medications
• Brachial- used to measure blood pressure used during cardiac arrest for infants
• Radial - readily accessible
• Femoral- used in cardiac arrest/shock, used to determine circulation to a leg.
• Feel beats to check pulses by firmly pressing arteries. Pulse can be found on lower neck, elbow, wrist, measure a person's pulse a minute.
• Quantity is beats/minute, regularity shows beats constant.
• Volume has low level means shock in stroke numbers, with low volume.
• Tachycardia exceeds 120 bpm, bradycardia has low rate of 50 bpm.
• Arrhythmia disturbs heartbeat.

Measuring Blood Pressure

• Patient should abstain from eating, drinking, smoking and taking drugs 1 hour prior, use a quiet room at a normal temperature - the room temperature should be recorded.

Preparing to Measure Blood Pressure

• The patient should be arm/back supported with feet on the floor and their right arm out.

Measuring Blood Pressure: Key details

• Patient arm should be resting and raised to heart level.
• Palm should face up and the arm remains bent.
• Minimum Cuff width: ⅔ upper arm length
• Bladder encircles arm. Also Cuff length = 40% limb. Circumference and Bladder = 80%
• Large cuff if greater than 34cm
• A large cuff is needed if their upper arm needs a forearm cuff or is greater than 50cm.
• Incorrect cuff sizes gives the inaccurate blood results.

Measuring Blood Pressure: Procedure

• Wrap cuff, find pulse in the elbow interior and pump above the top stroke using the left hand, listening at artery "bump, bump"- Sounds of Korotkoff.
• Systolic rate shows the first sound of heart.
• Diastolic rate shows the last pulse.
• Avoid moving your hands or disturbing patients.
• Readings among arms should be within 10-15.
• High measurements is at the end of the test.
• Palpitation measures the BP.

Systolic Rate

• Pressure-rate is in the blood is ejected into arteries
• Diastolic pressure- rate is in the arteries between heartbeats. Is the variation of the pressure range which must not be 20 mmHg.
• Auscultate to hear minimum beats since physician will review rates.

Hypertension and readings

• Elevated pressure or readings show irregular readings from arm positions, meals and the patient's pain/emotions.

• Orthostatic shows rate after one stands for 2 minutes.

• Blood pressure does not vary by 20 points, while irregularities may result dizziness from autonomic dysfunction.

• Normal Blood Pressure: Less than 120/80 mmHg

• Prehypertension: 120-139/80-89 mmHg

• Hypertension Stage 1: 140-159/90-99 mmHg

• Hypertension Stage 2: 160/100 mmHg

Explore the historical evolution and characteristics of nursing as a profession. Understand the criteria for professional acceptance and the unique aspects that define nursing. Learn about the aims of nursing, including promoting health and facilitating coping with illness.