Nursing Practice History: A Guide for Contemporary Nurses PDF

Chapter 1 Historical and Contemporary Nursing Practice Heidi S. Arit & Reference: Dr. Jacqueline G. Polancos Berman, A. & Synder, S. (2016) Kozier & Erb’s Fundamentals of Nursing. 10th ed. Pearson Education, Inc. (pages 2 – 22). ...

Chapter 1 Historical and Contemporary Nursing Practice Heidi S. Arit & Reference: Dr. Jacqueline G. Polancos Berman, A. & Synder, S. (2016) Kozier & Erb’s Fundamentals of Nursing. 10th ed. Pearson Education, Inc. (pages 2 – 22).  Nursing has undergone dramatic changes in response to societal needs and influences. Historical A look at nursing’s beginnings reveals its Perspective continuing struggle for autonomy and professionalization (p. 2) Recurring themes of women’s roles and status, religious (Christian) values, war, societal attitudes, and visionary nursing leadership have influenced nursing practice in the past.  Evolution of Nursing Practice Women’s roles and status Religious (Christian) values War Societal attitudes Nursing leaders Nursing education Women’s Roles (p. 2) Traditional female roles (wife, mother, daughter, sister) have always included the care and nurturing of other family members. From the beginning of time, women have cared for infants and children; thus, nursing could be said to have its roots in “the home.” In which generally, the care provided was related to physical maintenance and comfort. Thus, the traditional nursing role has always entailed humanistic caring, nurturing, comforting and supporting. Religion (p. 2) Played a significant role in the development of nursing Christian value of “love thy neighbor as thyself” and Christ’s parable of the Good Samaritan that had a significant impact on the development of Western nursing. Early religious values: self-denial, spiritual calling, and devotion to duty and hard work, have dominated nursing throughout its history. Religion (cont.) (p. Nurses’ commitment to these 2) values often resulted in exploitation and few monetary rewards. For some time, nurses themselves believed it was inappropriate to expect economic gain from their “calling”. War (p. 3) Wars have accentuated the need for nurses. The role of Florence Nightingale played in addressing this problem is well known. Nightingale and her nurses transformed the military hospitals by setting up sanitation practices: handwashing and washing clothing regularly.  War (p. 3) Nightingale is credited with performing miracles; the mortality rate in the Barrach Hospital in Turkey, for example, was reduced from 42% to 2% in 6 months. During American Civil War, several nurses emerged who were notable for their contributions to a country torn by internal strife. Figure 1-2 Harriet Tubman (1820–1913) was known as “The Moses of Her People” for her work with the Underground Railroad. During the Civil War (1861–1865), she nursed the sick and suffering of her own race. (© Corbis)  Figure 1-3 Sojourner Truth (1797–1883), abolitionist, Underground Railroad agent, preacher, and women’s rights advocate, was a nurse for over 4 years during the Civil War and worked as a nurse and counselor for the Freedmen’s Association after the war. (Randall Studio (1805-1875) Sojourner Truth (c. 1797-18-), abolitionist. © 1870. Photograph, Albumen Silver Print. Copyright National Portrait Gallery, Smithsonian Institution/Art Resources, NY.) Figure 1-4 Dorothea Dix (1802–1877) was the Union’s Superintendent of Female Nurses during the Civil War. (CORBIS Images) Societal Attitudes ▪ Society’s attitudes about nurses and nursing have significantly influenced professional nursing. ▪ Before the mid-1800s, nursing was without organization, education, or social status; the prevailing attitude was that a woman’s place was in the home and that no respectable woman should have a career.  The role for the Victorian middle-class woman was that of a wife and mother, and any education she obtained was for the purpose of making her a pleasant Societal companion to her husband and a responsible mother to her children. Attitudes Nurses in hospitals during this period were poorly educated; some were even incarcerated criminals. Sairy Gamp She “cared” for the sick by neglecting them, stealing from them, and physically abusing them. This literary portrayal of nurses greatly influenced the negative image and attitude toward nurses up to contemporary times.  In contrast, the guardian angel or angel of mercy image arose in the latter part of the 19th century, largely because of the work of Florence Nightingale during the Crimean War. Born to a wealthy and intellectual family. She believed she was “called by God to help others… [and[ to improve the well-being of mankind” ✔After Nightingale brought respectability to the nursing profession, nurses were viewed as noble, compassionate, moral, religious, dedicated, and self- sacrificing. ✔Doctor’s handmaiden – another image that arise in the 19 century that affected subsequent th generations of nurses and the public and other professionals working with nurses. Heroine portrayal evolved from nurse’s act of bravery in World War 11 and their contributions in fighting poliomyelitis – in particular the work of the Australian Nurse Elizabeth Kenney.  During the past few decades, the nursing profession has taken steps to improve the image of the nurse. In the early 1990s, the Tri-Council for Nursing (the American Association of Colleges of Nursing, the American Nurses Association [ANA], the American Organization of Nurse Executives, and the National League for Nursing [NLN] initiated a national effort, titled “Nurses of America,” to improve the image of nursing.  Launched in 2002, Johnson & Johnson corporation continues their “campaign for Nursing’s Future” to promote nursing as a positive career choice. Through various outreach programs, this campaign increases exposure to the nursing profession, raises awareness about its challenges (e.g. nursing shortage), and encourages people of all ages to consider a career in nursing. Nursing Leaders The contributions of Florence Nightingale to nursing are well documented. Her achievements in improving the standards for the care of war casualties in the Crimea earned her the title “lady with the Lamp.” Her efforts in reforming hospitals and in producing and implementing public health policies also made her an accomplished political nurse: She was the first nurse to exert political pressure on government. Through her contribution to nursing education – perhaps her greatest achievement – she is also recognized as nursing’s first scientist-theorist for her work Notes on Nursing: What It is, and What It is Not (1860/1969).  When she returned to England from the Crimea, a grateful English public gave Nightingale an honorarium of £4,500. She used the money to develop the Nightingale Training School for nurses which opened in 1860. The school served as a model to other training schools with their graduates traveled to other countries to manage hospitals and institute nurse-training programs. Figure 1-9 Florence Nightingale (1820-1910) influenced nursing education, practice, and administration and helped establish nursing as a profession. (© Bettman/CORBIS.)  Despite poor health that left her an invalid. FN worked tirelessly until her death at age 90. As a passionate statistician, she conducted extensive research and analysis. Nightingale is often referred to as the first nurse researcher. For example, her record keeping proved that her interventions dramatically reduced mortality rates among soldiers during the Crimean War. Figure 1-10 Clara Barton (1812–1912) organized the Red Cross, which linked with the International Red Cross when the U.S. Congress ratified the Geneva Convention in 1882. (© Bettman/CORBIS.) Her responsibility was to organize the nursing services.  Figure 1-11 Linda Richards (1841–1930) was America’s first trained nurse. National Library of Medicine ✔ Richards is known for introducing nurse’s notes and doctor’s orders. ✔ She also initiated the practice of nurses wearing uniforms (ANA, 2013b). ✔ She is credited for her pioneering work in psychiatric and industrial nursing.  Figure 1-12 Mary Mahoney (1845–1926) was the first African American trained nurse/ professional nurse. Schomburg Center for Research on Black Culture, New York Public Library The ANA gives a Mary Mahoney Award biennially in recognition of significant contributions in interracial relationships. Figure 1-13 Lillian Wald (1867–1940) founded the Henry Street Settlement and Visiting Nurse Service (circa 1893), which provided nursing and social services and organized educational and cultural activities. She is considered the founder of public health nursing. (Schevill, William Valentine (1864- 1951) Lillian D. Wald (1867-1940). Public health nurse, social worker. 1919. Oil on Cardboard. Copyright National Portrait Gallery, Smithsonian Institution/Art Resources, NY.) Figure 1-14 Nursing leader and suffragist Lavinia L. Dock (1858–1956) was active in the protest movement for women’s rights that resulted in the U.S. Constitution amendment allowing women to vote in 1920. (Courtesy of Teachers College, Columbia University.) Figure 1-15 Nurse activist Margaret Sanger, considered the founder of Planned Parenthood, was imprisoned for opening the first birth control information clinic in Baltimore in 1916. (© Bettman/CORBIS.) Figure 1-16 Mary Breckenridge, a nurse who practiced midwifery in England, Australia, and New Zealand, founded the Frontier Nursing Service in Kentucky in 1925 to provide family-centered primary health care to rural populations. (Courtesy of Frontier Nursing Service, Inc., Wandover, KY.) Men in Nursing Men have worked as nurses as far back as before the Crusades. Steve Miller, 1971, organized “Men in Nursing” group of male nurses in Chicago. 1981 it was renamed American Assembly for Men in Nursing with the purpose of providing a framework for nurses, as a group, to meet to discuss and influence factors that affect men as nurses.  Men in Nursing 2009 & 2010, members of the AAMN discussed ways to change the image of men in nursing in both recruitment and retention. Subsequently introduced the theme “Do what you love and you’ll love what you do”. The idea led to AAMN’s initiative “20 x 20 Choose Nursing.” which has the goal of increasing the enrollment of men in nursing programs nationally from the currently 10% to 20% by 2020 (Anderson, 2011). Luther Christman (1915 – 2011) – first man to be a dean at a university school of nursing, nominated first president of ANA, first man elected to American Academy of Nursing (named “Living Legend” by this organization), first man inducted into ANA’s Hall of Fame for his extraordinary contributions in nursing.  Men comprised 9.6% of the nation’s nursing workforce in 2011 (U.S Census Bureau, 2013). The nursing profession and nursing education need to address issues concerning barriers met by men in nursing. Improved recruitment and retention of men and other minorities into nursing will strengthen the profession. Barriers Men do experience to becoming nurses: ✔Nursing image is one of feminity & nursing has been slow to neuter this image, thus many people may believe that only homosexual men enter nursing which is not true.  Barriers Men do experience to becoming nurses: ✔Lack of male role models in nursing & caring (differences in caring styles between men and women) ✔Suspicion surrounding intimate touch NURSING EDUCATION Controlled by state boards of nursing and professional organizations Originally taught knowledge and skills for hospital practice Now more varied practice settings, critical thinking, health promotion and maintenance Two entry levels: RNs or LPN/LVN  Nursing Education (cont’d) Although educational preparation varies considerably, all RNs in the US take the same licensure examination, the National Council Licensure Examination (NCLEX-RN) Mutual recognition – a regulatory model that allows for multistate licensure under one license. States that enter into these agreements are called compact states.  Nurses who have received their training in other countries may be granted registration after successfully completing the NCLEX. Both licensure and registration must be renewed regularly in order to remain valid. All nursing programs must be approved by the board of nursing.  Also the nursing school should be accredited by an accreditation agencies. Accreditation is a voluntary, peer review process. Accredited programs meet standard requirements that are evaluated periodically through written self-studies and on-site visitation by peer examiners. Types of Nursing Education Practical or vocational nursing Registered nursing Diploma Associate degree Baccalaureate Graduate nursing Masters Doctoral Types of Nursing Education (cont'd) Continuing education In-service education Figure 1-18 A nurse practitioner holds a master’s degree and assumes an advanced practice role.  Because of changes in the practice environment, the nurse who holds a baccalaureate degree generally experiences more autonomy, responsibility, participation in institutional decision making, and career advancement than the nurse prepared with a diploma or associate degree (p. 37).  Doctoral Programs Doctoral programs in US began in 1960s. Before that year, nurses who were into doctoral degree choose related fields like education, psychology, sociology, and physiology. Two primary doctoral degrees in nursing are PhD and DNP (doctor of nursing practice). Nurses who earn PhD in nursing generally assume faculty roles in nursing education programs or work in research programs. DNP is the highest degree for nurse clinicians. Doctorate in related fields such as education or public health are still highly relevant for nurses depending on their practice role. Continuing Education formalized experiences designed to enhance the knowledge or skills of practicing professionals. Whereas, advanced educational programs, which result in an academic degree. Courses tend to be more specific & shorter. Participants may receive certificates of completion or specialization.  Continuing Education Is the responsibility of all practicing nurses. Constant updating and growth are essential to keep abreast of scientific and technologic changes and changes within health care and the nursing profession. Some states require nurses to obtain a certain number of CE credits to renew their license. Required contact hours typically range from 15 – 30 hours per 2-year license renewal period. Continuing Education programs usually are designed to meet one or more of the following needs: 1) To inform nurses of new techniques and knowledge; 2) To help nurses attain expertise in a specialized area of practice, such as critical care nursing; and 3) To provide nurses with information essential to nursing practice, such as knowledge about legal and ethical aspects of nursing. In-service education program Is a specific type of CE program that is offered by an employer. It is designed to upgrade the knowledge or skills of employees, as well as to validate continuing competence in selected procedures and areas of practice. Example: An employer might offer an in-service program to inform nurses about a new piece of equipment or new surgical procedure, new documentation procedures, or methods of implementing a nurse theorist’s conceptual framework for nursing. Some in-service programs are mandatory on a regular basis, such as cardiopulmonary resuscitation and fire or back safety programs. CONTEMPORARY NURSING PRACTICE Definition of Nursing Florence Nightingale (nearly 150 years ago) defines nursing as “the act of utilizing the environment of the patient to assist him in his recovery. ✔She considered a clean, well-ventilated, and quiet environment essential for recovery. ✔She raised the status of nursing through education. ✔Nurses were no longer untrained housekeepers but people educated in the care of the sick. Virginia Henderson – one of the first modern nurses to define nursing. She wrote, “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 peaceful death) that he would perform unaided if he had the necessary strength, will, or knowledge, and to do this in such a way as to help him gain independence as rapidly as possible.” ✔Henderson saw the nurse as concerned with both healthy and ill individuals, acknowledged that nurses interact with clients even when recovery may not be feasible, and mentioned the teaching and advocacy roles of the nurse. ✔Latter half of the 20 century – theorist developed th their own theoretical definitions of nursing. In which it goes beyond simplistic common definitions. Certain Themes common to definitions of Nursing Caring Art Science Client centered Holistic Adaptive Concerned with health promotion, health maintenance, & health restoration. Helping profession ANA described nursing practice as “direct, goal oriented, and adaptable to the needs of the individual, the family, and community during health and illness (ANA, 1973, p. 2) In 1980 (ANA, p.9), the definition changed to “Nursing is the diagnosis and treatment of human responses to actual or potential health problems 2003 edition of Nursing’s Social Policy Statement: “Nursing is the protection, promotion, and optimization of health and abilities, preventions 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. Research to explore the meaning of caring in nursing has been increasing. Recipients of Nursing Care Consumer = an individual, a group of people, or a community that uses a service or commodity. People who use health care products or services are consumers of health care. Patient = a person who is waiting for or undergoing medical treatment and care. Patient from Latin word meaning “to suffer” or “to bear”. Some nurses believe the word patient implies passive acceptance of the decisions and care of health professionals. With emphasis on health promotion and prevention of illness, many recipients of nurses care are not ill. Moreover, nurses interact with family members and significant others to provide support, information and comfort in addition to caring for the patient. For these reasons, nurses increasingly refer to recipients of health care as Clients = a person who engages the advice or service of another who is qualified to provide this service. presents the receivers of health care as collaborators in the care, that is, as people who are also responsible for their own health. Thus, the health status of a client is the responsibility of the individual in collaboration with health professionals. Scope of Nursing Nurses provide care for the three types of clients: Individuals Families Communities Four areas of nursing practice: Promotion of health and wellness Prevention of illness Restoration of health Care for the dying Promoting health and wellness Nurses promote wellness in clients who are both healthy and ill. This may involve individual and community activities to enhance healthy lifestyles, such as improving nutrition and physical fitness, preventing drug and alcohol misuse, restricting smoking, and preventing accidents and injury in the home and workplace. Preventing illness The goal of illness prevention programs is to maintain optimal health by preventing disease. Nursing activities that prevent illness include immunizations, prenatal and infant care, prevention of sexually transmitted infections. Restoring health Focuses on ill client, it extends from early detection of disease through helping the client during the recovery period Nursing activities includes: Providing direct care to the ill person: administering medications, baths & specific procedures and treatments Performing diagnostic and assessment procedures: measuring BP, examining feces for occult blood  Restoring health Nursing activities includes: (cont.) Consulting with other health care professionals about client problems Teaching clients about recovery activities: exercises that will accelerate recovery after a stroke Rehabilitating clients to their optimal functional level following physical or mental illness, injury, or chemical addiction. Caring for the Dying Involves comforting and caring for people of all ages who are dying. Includes helping clients live as comfortably as possible until death and helping support persons cope with death. Nurses carrying out these activities work in homes, hospitals, & extended facilities (hospices). Settings for Nursing Acute care hospitals Clients’ homes Community agencies Ambulatory clinics Long-term care facilities Health maintenance organizations (HMOs) Nursing practice centers Figure 1-19 Nurses practice in a variety of settings. Nurses have different degrees of nursing autonomy and nursing responsibility in the various settings. Nurse Practice Acts ✔or legal acts for professional nursing practice, regulate the practice of nursing. ✔Though differs in various jurisdiction, the common purpose is to protect the public. ✔Nurses are responsible for knowing their state’s nurse practice act as it governs their practice. Standards of Nursing Practice Establishing and implementing standards of practice are major functions of a professional organization. ANA Standards of Practice is to describe the responsibilities for which nurses are accountable.  Standards of Nursing Practice (cont.) The ANA developed standards of nursing practice that are generic in nature, by using the NURSING PROCESS as a foundation and provide for the practice of nursing regardless of area of specialization. The ANA Standards of Professional Performance describe behaviors expected in the professional nursing role.  Roles and Functions of Nurses (p.15) Caregiver Change agent Communicator Leader Teacher Manager Client advocate Case manager Counselor Research consumer  Roles and Functions of Nurses (cont'd) Caregiver The require nursing actions may involve full care for the completely dependent client, partial care for partially dependent client, and supportive-educative care to assist clients in attaining their highest possible level of health and wellness. Caregiving encompasses the physical, psychosocial, developmental, cultural, and spiritual levels. A nurse may provide care directly or delegate it to other caregivers.  Roles and Functions of Nurses (cont'd) Caregiver The nursing process provides nurses with a framework for providing care.  Roles and Functions of Nurses (cont'd) Communicator Communication is integral to all nursing roles. In the role of communicator, nurses identify client problems and then communicate these verbally or in writing to other members of the health care team. The quality of a nurse’s communication is an important factor in nursing care.  Roles and Functions of Nurses (cont.) Communicator The nurse must be able to communicate clearly and accurately in order for a client’s health care needs to be met. Expanded Career Roles Nurse practitioner Clinical nurse specialist Nurse anesthetist Nurse midwife Nurse researcher Expanded Career Roles Nurse administrator Nurse educator Nurse entrepreneur Forensic nurse Things to Consider What are the criteria of a profession? Profession Professionalism – professional character, spirit, or methods. - It is a set of attributes, a way of life that implies responsibility and commitment. (Nursing professionalism owes much to the influence of Florence Nightingale) Things to Consider Professionalization - is the process of becoming professional, that is, of acquiring characteristics considered to be professional. Criteria of a Profession Prolonged, specialized education, knowledge, and expertise about the role to be performed Body of knowledge Service orientation Ongoing research Code of ethics Autonomy Professional organization Specialized Education - is an important aspect of professional status Body of Knowledge ✔ As a profession, nursing is establishing a well- defined body of knowledge and expertise. ✔A number of conceptual frameworks contribute to the knowledge base of nursing and give direction to nursing practice, education, and ongoing research. Service Orientation ✔ This differentiates nursing from an occupation pursued primarily for profit. ✔Many consider altruism (selfless concern for others) the hallmark of a profession. ✔Nursing has a tradition of service to others. This service, however, must be guided by certain rules, policies, or code of ethics. ✔Today, nursing is also an important component of the health care delivery system. Ongoing Research ✔ Increasing research in nursing is contributing to nursing practice. ✔ Most early research was directed at the study of nursing education. ✔In the 1960s – 1970s, studies were often related to the nature of the knowledge base underlying nursing practice. Code of Ethics ✔ Nurses have traditionally placed a high value on the worth and dignity of others. ✔The nursing profession requires integrity of its members; that is, a member is expected to do what is considered right regardless of the personal cost. ✔Ethical codes change as the needs and values of society change. Autonomy ✔ A profession is autonomous if it regulates itself and sets of standards for its members. ✔Providing autonomy is one of the purposes of a professional association.  Autonomy (cont.) ✔ If nursing is to have professional status, it must function autonomously in the formation of policy and in the control of its activity. ✔To be autonomous, a professional group must be granted legal authority to define the scope of its practice, describe its particular functions and roles, and determine its goals and responsibilities in delivery of its services.  Autonomy (cont.) ✔ To practitioners of nursing, autonomy means independence at work, responsibility, and accountability for one’s actions. ✔Autonomy is more easily achieved and maintained from a position of authority, e.g. legislation granting NPs supervisory, collaborative, or independent authority to practice. Professional Organization ✔ Operation under the umbrella of a professional organization differentiates a profession from an occupation. Governance – is the establishment and maintenance of social, political, and economic arrangements by which practitioners control their practice, their self- discipline, their working conditions, and their professional affairs.  Professional Organization (cont.) Nurses, therefore, need to work within their professional organizations. ANA is a professional organization that advances the nursing profession by fostering high standards of nursing practice, promoting the rights of nurses in the workplace, projecting a positive and realistic view of nursing, and by lobbying the Congress and regulatory agencies on health care issues affecting nurses and the public” (ANA, 2013a) Nursing Socialization Socialization – the process by which people (a) learn to become members of groups and society (b) learn the social rules defining relationships into which they will enter The goal of professional socialization is to instill in individuals the norms, values, attitudes, and behaviors deemed essential for survival of the profession.  Nursing Socialization (cont.) Interactions with fellow students – one of the most powerful mechanisms of professional socialization. Within this student culture, collectively they establish level and direction of their scholastic efforts. They develop perspective about the situation in which they are involved, the goals they are trying to achieve, and the kinds of activities that are expedient and proper, establish set of practices congruent with all of these. Students become bound together by feelings of mutual cooperation, support, and solidarity.  Various models of the socialization process have been developed. Benner’s Stages of Nursing Expertise Novice Advanced beginner Competent Proficient Expert Experience is essential for the development of professional expertise. Critical Values of Nursing It is within the nursing educational program that the nurse develops, clarifies, and internalizes professional values. Specific professional nursing values are stated in: Code of ethics Standards of nursing practice Nurse practice acts in the legal system NSNA’s Code of Academic and Clinical Conduct Factors Influencing Contemporary Nursing Practice Economics Consumer demands Family structure Science and technology Information, telecommunications, and telenursing Legislation Factors Influencing Contemporary Nursing Practice (cont’d) Demography Current nursing shortage Collective bargaining Nursing associations National and International Nursing Organizations American Nurses Association (ANA) Canadian Nurses Association (CNA) National League for Nursing (NLN) International Council of Nurses (ICN) National Student Nurses’ Association (NSNA) International Honor Society: Sigma Theta Tau  Nursing education curricula are continually undergoing revisions in response to new scientific knowledge and technologic, cultural, political, and socioeconomic changes in society. Highlights (p. 22 – 23) Originally, nursing education focused on teaching knowledge and skills to enable nurses to practice in hospital settings. Today, curricula have been revised to enable nurses to work in more diverse settings and assume more diverse roles.  Continuing education is the responsibility of each practicing nurse. Highlights The scope of nursing practice includes promoting wellness, preventing illness, (p. 23) (cont.) restoring health, and caring for the dying. Nurse practice acts vary among states (countries), and nurses are responsible for knowing the act that governs their practice.  Highlights (p. 23) (cont.) Every nurse may function in a variety of roles that often occur together and serve to clarify the nurse’s activities. These roles include: caregiver, communicator, teacher, client advocate, counselor, change agent, leader, manager, case manager, and research consumer. With advanced education and experience, nurses can fulfill advanced practice roles such as clinical nurse specialist, NP, nurse midwife, nurse anesthetist, educator, administrator, and researcher.  A desired of goal of nursing is professionalism, which necessitates specialized education, a unique body of knowledge, including specific skills and abilities; a service orientation; ongoing research; a code of ethics; autonomy; Highlights and a professional organization. (p. 23) (cont.) Participation in the activities of nursing associations enhances the growth of involved individuals and helps nurse collectively influence policies that affect nursing practice.  Socialization is the process by which people learn to become members of groups & society, learn social rules. Socialization to professional nursing practice Highlights is the process whereby the values and norms of the nursing profession are internalized (p. 23) (cont.) into the nurse’s own behavior and self- concept. Although several models of socialization process have been developed but Benner’s serve as guidelines to establish the phase and extent of an individual’s socialization.  Contemporary nursing practice is influenced by health care reform; quality and safety in health care; consumer demands; family structure; science and Highlights technology; information, telehealth, and (p. 23) (cont.) telenursing; legislation; demographic and social changes; the nursing shortage; collective bargaining; and the work of nursing associations.  Chapter 1 Historical and Contemporary Nursing Practice Reference: Berman, A. & Synder, S. (2016) Kozier & Erb’s Fundamentals of Nursing. 10th ed. Pearson Education, Inc. (pages 28 – 51).