Professional Nursing Practice Overview

Professional Nursing Practice

• Nursing is defined in different ways by various organizations.
• Florence Nightingale (1858) viewed nursing as "to put patient in best condition for nature to act upon him."
• The American Nurses Association (2010) defined nursing as "the protection, promotion and optimization of health and abilities, prevention of illness and injury, alleviation of suffering through the diagnosis and treatment of human response, and advocacy in the care of individuals, families, communities, and populations."
• Healthy People 2030 prioritizes improving national health and well-being, collaborative efforts across agencies, and reducing health disparities.
• The World Health Organization (WHO, 2006) describes health as a state of complete physical, mental, and social well-being, not merely the absence of disease.
• Wellness, defined as equivalent to health, has four components (Hood, 2018): capacity to perform best, ability to adapt, reported well-being, and a sense of harmonious unity.
• Cultural diversity in the US is expected to increase significantly by 2030, with racial and ethnic minority populations tripling.
• Five races are identified by the 2019 census: White, Black or African American, Asian, Native American, Native Hawaiian/Pacific Islander. Hispanic is primarily classified under White.
• Asian race is projected to experience the largest increase. Hispanic populations account for half of the overall population increase.

Changing Patterns of Disease

• Chronic diseases account for 7 out of 10 leading causes of death (CDC, 2019).
• Common chronic diseases are cardiovascular, cancer, diabetes, and chronic lung diseases.
• Nearly half of all adults have at least one diagnosed chronic condition.
• 60 million US adults have two or more chronic conditions (CDC, 2019).

Major Health Concerns

• Tobacco use
• Substance use
• Poor physical activity and nutrition
• Obesity

Health Informatics

• Health Information Technology (HIT)
• Technology Informatics Guiding Education Reform (TIGER)
• International Classification of Diseases (ICD-10)
• Electronic Health Record (EHR) Incentive Program
• Telehealth

Health Promotion

• Increased emphasis on health, health promotion, wellness, and self-care.

Health Promotion and Technology

• Websites
• Chat groups
• Social Media
• Computer technology and informatics (e.g. Fitbit™ and Carb Manager)
• Mobile health apps

Evidence-Based Practice

• Best practices are based on reliable research studies.
• Healthcare setting, patient values, and clinical judgment should be considered.
• Evaluate current literature and research for patient care.
• Evidence-Based Practice Bundles improve patient outcomes measurably (Melnyk & Fineout-Overholt, 2018).

Quality and Safety Education for Nurses (QSEN)

• Key knowledge, skills, and attitudes (KSAs): patient-centered care, teamwork and collaboration, evidence-based practice (EBP), safety, informatics.
• QSEN (2020)

Individual Needs (Maslow's Hierarchy)

• Physiological needs
• Safety needs
• Belongingness and love needs
• Esteem needs
• Self-actualization needs

Interprofessional Collaborative Practice

• Core competencies for interprofessional collaborative practice focus on multiple health professionals working together with patients, families, and communities. This aims to deliver best practices.

Critical Thinking

• Metacognition, deliberate and outcome oriented, occurs through inquiry, examination/analysis of data.
• Formulation of conclusions or alternatives.
• Critical thinkers are “inquisitive truth seekers” whose skills are developed over time
• Critical thinking is used in clinical reasoning.

Critical Thinking Skills

• Interpretation
• Analysis
• Inference
• Explanation
• Evaluation
• Self-reflection
• Self-regulation

Components of Critical Thinking

• Identify priorities
• Gather and validate information
• Analyze the information
• Draw on past experience and knowledge
• Maintain flexibility
• Consider alternatives
• Formulate decisions

Critical Thinking in Nursing Practice

• Critical thinking is the foundation of clinical reasoning and judgment (Alfaro-LeFevre, 2017).
• It is used in all practice settings.
• Decision-making involves cognitive, metacognitive skills, and logical reasoning.
• Development involves learning and practice through experience.

Question #1 (Genetics Care)

• The correct answer is B. Assess and analyze family history data for genetic risks. Critical thinking involves gathering information, analysis, and drawing conclusions.

The Nursing Process

• Assessment, Diagnosis, Planning, Implementation, Evaluation.

Assessment

• Health history
• Physical assessment
• Ongoing assessment
• Relevant information from family, health team, medical record
• Electronic Health Record (EHR)

Diagnoses

• Included in ANA's Scope and Standards of Practice (2015)
• NANDA-I (NANDA International)
• Based on data collection and analysis.
• Identifies actual or potential health problems.
• Not medical diagnosis.
• Collaborative problems.

Differentiating Nursing Diagnoses and Collaborative Problems

• Redrawn from Carpenito, 2017 (Chapter on Nursing Diagnoses). Outlines a decision tree to differentiate.

Planning

• Prioritization using Maslow’s hierarchy
• Establish expected outcomes (Attainable and quantifiable)
• Establish goals (immediate, intermediate, long-term).
• Determine nursing action (planned interventions).
• Standardized interventions from NIC system

Implementation

• Carrying out the plan of care.
• Nurse assumes responsibility.
• Goals are used as a focus.
• Continuous assessment ("ongoing").
• Make revisions when necessary.
• Interventions are patient-focused and outcome-directed.

Evaluation

• Allows the nurse to determine a patient's response to interventions.
• Determines if expected outcomes are achieved.
• Document findings.

Question #2 (Nursing Process)

• The correct answer is A. Interviewing and obtaining a nursing history. This is the initial or baseline assessment during initial patient contact.

Individualized Nursing Care Plan

• Refer to Chart 1-5 for examples.

Ethics and Morality in Nursing

• Ethics is the formal, systematic study of moral beliefs.
• Morality are specific values, characters, or actions. Ethical outcomes are examined systematically.
• The terms are often used interchangeably.

Ethics Theories

• Teleological/ consequentialism: Focuses on the results/consequences of actions (e.g. Utilitarianism).
• Deontological/formalist: Ethical standards and principles exist independently of consequences (e.g., Sense of duty).
• Note that this provides a brief summary of these different ethical frameworks.

Approaches to Ethics

• Meta-ethics analyzes concepts like informed consent-a significant consideration for nurses.
• Applied ethics addresses moral permissibility of actions and practices. Nursing ethics is a part of applied ethics.

Moral Situations

• Dilemmas: A conflict between two or more moral principles
• Problems: Competing moral claims or principles
• Uncertainty: Difficulty defining a moral situation or applying principles.
• Distress: Aware of correct action, but institutional constraints prevent it. -Note these descriptions are concise and provide starting points for further study.

Nursing Ethical Standards

• International Council of Nurses (ICN) Code of Ethics for Nurses (2012)
• American Nurses Association (ANA) Code of Ethics for Nurses.
• ANA has a center for ethics and human rights—position statements.

Most Common Ethical Issues in Nursing

• Confidentiality
• Use of restraints
• Truth-telling
• Refusal to provide care
• End-of-life decisions and palliative care

Question #3 (Trust Building)

-Correct answer: C. Use a compassionate and caring disposition when discussing diagnosis with patients and families.

Patient Self-Determination

• The Patient Self-Determination Act (1991) deals with advanced directives, living wills, health care representatives and POLST (Physician Orders for Life-Sustaining Treatment).

Ethical Decision Making

• Ethical dilemmas are common and diverse, lacking clear solutions.
• Fundamental philosophical principles used.
• Nursing process is an approach to ethical decision-making.
• Ethical analysis (Refer to Chart 1-10).

Explore the multifaceted definitions of nursing, from Florence Nightingale's historical perspective to contemporary definitions by organizations like the ANA and WHO. This quiz highlights the importance of wellness and health in nursing practice and the goals set for national health improvement. Test your knowledge on the principles guiding professional nursing today.