Introduction to Nursing Profession PDF

Introduction to nursing profession Definitions of Nursing: The word nurse originated from the Latin word nutrix meaning to "nourish". International council of nurses (2010) defined nursing as: Nursing encompasses autonomous and collaborative care of individuals of all ages, families, groups and com...

Introduction to nursing profession Definitions of Nursing: The word nurse originated from the Latin word nutrix meaning to "nourish". International council of nurses (2010) defined nursing as: Nursing encompasses autonomous and collaborative care of individuals of all ages, families, groups and communities, sick or well and in all setting. Nursing includes the promotion of health, prevention of illness and care of ill, disabled and dying people. Advocacy, promotion of safe environment, research, participation in shaping of health policy and in patient and health systems management and education are also key nursing role. American Nurses Association (ANA, 2010) defined professional nursing as: "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" Scope of Nursing: Nurses provide care for three types of clients:  Individuals  Families  Communities Nursing's aims: Four broad aims of nursing practice can be identified in the definition of nursing: 1. To promote health:  Health is an essential part of each of the other aims of nursing.  Nurses promote health by identifying, analyzing and maximizing each person's own individual strengths and components of preventing illness, restoring health and facilitate coping with disability or death. US department of health and human services (healthy people 2020) established health promotion following guidelines:  Attain high quality, longer lives free of preventable disease, disability, injury and premature death.  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, health development and healthy behaviors across all stages. 2. To prevent illness:  The objectives of illness-prevention activities are to reduce the risk for illness, to promote good health habits, and to maintain optimal functioning  Nurses prevent illness primarily by teaching and by personal example. Such activities include: educational program in areas such as prenatal care, smoking cessation and stress-reduction seminars  Community program and resources that encourage healthy life style  Literatures, television, radio or internet information on healthy diet, exercises and importance of good health habits.  Health assessment in institutions, clinic, and community settings that identify areas of strength and risks for illness. 3. To restore health:  Activities to restore health encompass those traditionally considered to be nurses' responsibility. These focus on the individual with illness and range  from early detection of a disease to rehabilitation and teaching during recovery. Such as:  Performing assessment that detects illness e.g. measuring blood glucose.  Referring questions and abnormal findings to other health care providers.  Providing direct care of the person who is ill  Collaborate with other health care providers  Planning, teaching and carrying out rehabilitation for illnesses such as heart attacks……..etc.  Working in mental health and chemical-dependency program. 4. To facilitate coping with disability or death:  Nurses facilitate coping of patient and family toward altered function, life crisis, and death.  Nurses facilitate an optimal level of function through maximizing the person's strength and potentials through teaching and referral to community support system.  Provide care for patients and families during end of life care. Nursing Roles in all settings: 1. Caregiver:  Is the primary role of the nurse.  It means provision of care to patients that combine both the art and science of nursing in meeting physical, emotional, intellectual, sociocultural, and spiritual needs.  As a caregiver nurse integrates the role of communicator, teacher, counselor, leader, researcher, advocate and collaborator to promote wellness through activities that prevent illness, restore heath and facilitate coping with disability or death 2. Communicator: The use of effective interpersonal and therapeutic communication skills to establish and maintain helping relationship with patients of all ages in a wide variety of health care settings. In the role of communicator, nurses identify client problems and then communicate these verbally or in writing to other members of the health team. The quality of a nurse's communication is an important factor in nursing care. 3. Teacher/ educator: As a teacher, the nurse helps clients learn about their health and the health care procedures they need to perform to restore or maintain their health. the nurse uses of communication skills to assess, implement, and evaluate individualized teaching plans to meet learning needs of patients and their families. Nurses also share their expertise with other nurses and health professionals. 4. Counselor: Counseling is the process of helping a client to recognize and cope with stressful psychological or social problems to develop improved interpersonal relationships, and to promote personal growth. It involves providing emotional, intellectual, and psychologic support. The nurse counsels primarily healthy individuals with normal adjustment difficulties and focuses on helping the person develop new attitudes, feelings, and behaviors by encouraging the client to look at alternative behaviors, recognize the choices, and develop a sense of control. By this role the nurse uses therapeutic interpersonal communication skills to provide information, make appropriate referrals and facilitate the patient problem solving and decision- making skills. 5. Leader:  The assertive, self-confident practice of nursing when providing care, effecting changes, and functioning with groups.  A leader influences others to work together to accomplish a specific goal. The leader role can be employed at different levels: individual client, family, groups of clients, colleagues, or the community.  Effective leadership is a learned process requiring an understanding of the needs and goals that motivate people, the knowledge to apply the leadership skills, and the interpersonal skills to influence others. 6. Researcher: the participation in or conduct of research to increase knowledge in nursing and improve patient care. 7. Client Advocate:  The protection of human or legal rights and securing of care for all patients based on the belief that patients have the rights to make informed decisions about their own health and lives.  Acts to protect the client. In this role the nurse may represent the client's needs and wishes to other health professionals, such as relaying the client's wishes for information to the physician. They also assist clients in exercising their rights and help them speak up for themselves. 8. Collaborator: the effective use of skills in organization, communication and advocacy to facilitate the functions of all members of the heath care team as they provide patient care. 9. Change Agent: The nurse acts as a change agent when assisting clients to make modifications in their behavior. Nurses also often act to make changes in a system, such as clinical care, if it is not helping  a client return to health. Nurses are continually dealing with change in the health care system. Recipients of nursing: The recipients of nursing are sometimes called consumers, sometimes patients, and sometimes clients.  A consumer: is 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.  A patient: is a person who is waiting for or undergoing medical treatment and care. The word patient comes from a Latin word meaning "to suffer" or "to bear." Usually, people become patients when they seek assistance because of illness or for surgery. Some nurses believe that the word patient implies passive acceptance of the decisions and care of health professionals. Additionally, with the emphasis on health promotion and prevention of illness, many recipients of nursing 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 client: is a person who engages the advice or services of another who is qualified to provide this service. The term client 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. Standard of nursing practice: standards allow nurse to carryout professional roles, serving as protection for the nurse, patient and the institution where health care is provided. A. Standard of practice: address the key steps involved in caring for patients. The purpose of the Standards of Practice is to describe the responsibilities for which nurses are accountable. describe a competent level of nursing care as demonstrated by the nursing process. B.Standard of professional performance: describe behaviors expected in the professional nursing role. ANA, 2010 standard of practice: Standard of practice:  Standard (1): Assessment: collect comprehensive data pertinent to the patient's health situation  Standard (2): Diagnosis: analyze the assessment data to determine the diagnosis issue  Standard (3): Outcomes identifications: identifies expected outcomes for a plan individualized to the patient or the situation.  Standard (4): Planning: develop a plan that prescribes strategies and alternatives to attain expected outcomes.  Standard (5): Implementation: implement the identified plan, coordinate care delivery, employ strategies to promote health and safe environment and provide consultation and use prescriptive authority and treatment.  Standard (6): Evaluation: evaluate progress toward attainment of outcomes Standard of professional performance:  Standard (7): Ethics: practice with ethics  Standard (8): Education: attain knowledge and competence that reflects current nursing practice  Standard (9): Evidenced-based practice and research: contribute to quality nursing practice  Standard (10): Quality of practice: contribute to quality nursing practice  Standard (11): Communication: communicate effectively in all areas of practice  Standard (12): Leadership: demonstrate leadership in the professional practice setting and profession  Standard (13): Collaboration: collaborate with health care consumer, family and others in the conduct of nursing practice.  Standard (14): Professional practice evaluation: evaluate her or his nursing practice in relation to professional practice standard and guidelines, relevant status, rules and regulations.  Standard (15): Resources utilization: utilize appropriate resources to plan and provide nursing services that are safe, effective and financially responsible.  Standard (16): Environmental health: practice in an environmentally safe and healthy manner.  Standard (17): Collegiality: interact with and contribute to the professional development of peers and colleagues.  Health Care Delivery System Definitions:  Health care delivery system is defined by World Health Organization (WHO, 2006) as: the combination of resources, organization & management that culminate the delivery of health services to the population.  Inpatient: is a person who enters a hospital and stay for an indeterminate time (from days to months).  Outpatient: those who are not hospitalized overnight but who require diagnosis or treatment. Patient may also be categorized as outpatient when they are admitted, treated and discharged within 23 hours. TYPES OF HEALTH CARE AGENCIES AND SERVICES: 1. Hospitals: Hospitals vary in size from the 12-bed rural hospital to the 1,500- bed metropolitan hospital.  Hospitals can be classified according to their ownership as governmental (public) or nongovernmental (private).  Hospitals are also classified by the services they provide. General hospitals admit clients requiring a variety of services, such as medical, surgical, obstetric, pediatric, and psychiatric services. Other hospitals offer only specialty services, such as psychiatric or pediatric care. An acute care hospital provides assistance to clients whose illness and need for hospitalization are relatively short term, for example, several days.  The variety of health care services hospitals provide usually depends on their size and location. The large urban hospitals usually have inpatient beds, emergency services, diagnostic facilities, ambulatory surgery centers, pharmacy services, intensive and coronary care services, and multiple outpatient services provided by clinics. Small rural hospitals often  are limited to inpatient beds, radiology and laboratory services, and basic emergency services. The number of services a rural hospital provides is usually directly related to its size and its distance from an urban center. 2. Subacute Care Facilities: Subacute care is a variation of inpatient care designed for someone who has an acute illness, injury, or exacerbation of a disease process. Clients may be admitted after, or instead of, acute hospitalization or to administer one or more technically complex treatments. Generally, the individual's condition is such that the care does not depend heavily on high-technology monitoring or complex diagnostic procedures. Subacute care is generally more intensive than long-term care and less than acute care. 3. Extended Care (Long-Term Care): formerly called nursing homes, extended care (long-term care) facilities provide levels of personal care for those who are chronically ill or are unable to care for themselves without assistance. Services provided include care for people with chronic illnesses or those who are unable to care for themselves and restorative care until client is ready for discharge to home. 4. Rehabilitation Centers: usually are independent community centers or special units. Rehabilitation centers play an important role in assisting clients to restore their health and recuperate. Drug and alcohol rehabilitation centers, for example, help free clients of drug and alcohol dependence and assist them to reenter the community and function to the best of their ability. Today, the concept of rehabilitation is applied to all illness and injury (physical and mental). 5. Home Health Care Agencies: Home health care nurses and other staff offer education to clients and families and also provide comprehensive care to acute, chronic, and terminally ill clients. 6. Day-Care Centers: serve many functions and many age groups. Some day- care centers provide care for infants and children while parents’ work. Other centers provide care and nutrition for adults who cannot be left at home alone but do not need to be in an institution. Elder care centers often provide care involving socializing, exercise programs, and stimulation. Some centers provide counseling and physical therapy. 7. Rural Care: Office of Rural Health assesses and identifies interventions for the health care needs of the local population. Nurses in rural settings must be generalists who are able to manage a wide variety of clients and health care problems. 8. Hospice Services: it is interdisciplinary health care service for the dying, provided in the home or another health care setting. The hospice movement subsumes a variety of services given to the terminally ill, their families, and support persons. Their concern is improving or maintaining the quality 'of life until death. Hospice nurses serve primarily as case managers and supervise the delivery of direct care by other members of the team. Clients in hospice programs are cared for at home, in the hospital, or in skilled nursing facilities. 9. Crisis Centers provide emergency services to clients experiencing life crises. The primary purpose of the center is to help people cope with an immediate crisis and then provide guidance and support for long-term therapy. The nurse must immediately identify the person's problem, offer assistance to help the person cope, and perhaps later direct the person to resources for long-term support. 10. Occupational Health Clinics: The industrial (occupational) clinic is gaining importance as a setting for employee health care. Employee health has long been recognized as important to productivity. Community health nurses in the occupational setting have a variety of roles. nursing functions in industrial  health care include work safety and health education, annual employee health screening for tuberculosis, and maintaining immunization information. Other functions may include screening for such health problems as hypertension and obesity, caring for employees following injury, and counseling. 11. Ambulatory Care Centers: Most ambulatory care centers have diagnostic and treatment facilities providing medical, nursing, laboratory, and radiological services, and they may or may not be associated with an acute care hospital. Some ambulatory care centers provide services to people who require minor surgical procedures that can be performed outside the hospital. 12. Physicians' Offices: The majority of physicians either have their own offices or work with several other physicians in a group practice. Clients usually go to a physician's office for routine health screening, illness diagnosis, and treatment. People seek consultation from physicians when they are experiencing symptoms of illness or when a significant other considers the person to be ill. Providers of health care: The providers of health care, also referred to as the health care team or health professionals, are nurses and health personnel from different disciplines who coordinate their skills to assist clients and their support persons. Their mutual goal is to restore a client's health and promote wellness. Providers of health care include the following: 1. Nurse:  A registered nurse (RN): assesses a client's health status, identifies health problems, and develops and coordinates care.  A licensed vocational nurse (LVN) or licensed practical nurse (LPN): provides direct client care under the direction of a registered nurse,  physician, or other licensed practitioner. Nurses can pursue a variety of practice specialties (e.g., critical care, mental health, and oncology). 2. Advanced practice nurses (APNs): provide direct client care as nurse practitioners, nurse midwives, certified registered nurse anesthetists, and clinical nurse specialists. These nurses have education and certifications that allow them to provide primary care, prescribe medications. 3. Physician: The physician is responsible for medical diagnosis and for determining the therapy required by a person who has a disease or injury. 4. Alternative (Complementary) Care Provider: Alternative or complementary health care refers to those practices not commonly considered part of Western medicine (e.g. herbalists, acupuncturists, massage therapists, reflexologists, holistic health healers) 5. Case Manager: The case manager's role is to ensure that clients receive fiscally sound, appropriate care in the best setting. This role is often filled by the member of the health care team who is most involved in the client's care. Depending on the nature of the client's concerns, the case manager may be a nurse, a social worker, an occupational therapist, a physical therapist, or any other member of the health care team. 6. Dentist: Diagnoses and treats conditions affecting mouth, teeth, and gums Performs preventive measures to promote dental health. 7. Dietitian or Nutritionist: Plans diets to meet special needs of clients. Promotes health and prevents disease through education and counseling. May supervise preparation of meals 8. Occupational Therapist: An occupational therapist (OT) assists clients with impaired function to gain the skills to perform activities of daily living. 9. Paramedical Technologist: Laboratory technologists, radiological technologists, and nuclear medicine technologists are just three kinds of paramedical technologists in the expanding field of medical technology. Paramedical means having some connection with medicine. 10. Pharmacist: A pharmacist prepares and dispenses pharmaceuticals in hospital and community settings. The role of the pharmacist in monitoring and evaluating the actions and effects of medications on clients. 11. Podiatrist: Doctors of podiatric medicine (DPM) diagnose and treat foot conditions. 12. Respiratory Therapist: A respiratory therapist is skilled in therapeutic measures used in the care of clients with respiratory problems. Administers pulmonary function tests. Performs therapeutic measures to assist with respiration (e.g., oxygen administration, ventilators) 13. Social Worker: Assists clients with psychosocial problems (e.g., financial, marital), conducts discharge planning and makes referrals for placement 14. Spiritual Support Personnel: religious or spiritual advisors serve as part of the health care team by attending to the spiritual needs of clients. 15. Unlicensed Assistive Personnel: Unlicensed assistive personnel (UAPs) are health care staff who assumes delegated aspects of basic client care. These tasks include bathing, assisting with feeding, and collecting specimens.  Basic Human Needs A need is a requirement or a lack. Maslow's hierarchy of needs: Abraham Maslow (1970) defined the basic needs of all people as a progression from simple physical needs (needed for survival) to more complex ones. human needs are ranked on an ascending scale according to how essential the needs are for survival.  Primary needs (lower-level need): must be met to maintain life.  Secondary needs (higher level need): must be met to maintain quality of life. The five levels of needs are as follows: 1. Physiologic needs 2. Safety and security needs 3. Love and belonging needs 4. self-esteem needs 5. self-actualization need  S elf-Actu alizatio n S elf -E steem H ig h er-le ve l n eeds L o ve & B e lo n gin g L ow er-le ve l S afety n eeds P h ysio lo g ic nee d s 1. Physiologic needs:  Physiologic needs, the most basic in the hierarchy of needs, are the most essential to life and therefore have the highest priority. Physiologic needs include:  Oxygen, water, food, elimination, temperature, physical activity, sleep and rest and sexuality.  These needs must be met at least minimally to maintain life. A. Oxygen: is the most essential of all needs because all body cells require oxygen for survival. Oxygenation of body cells is carried out primarily by the respiratory and cardiovascular systems, and any alteration in their structure or function can result in an increased need for oxygen. This need may be acute such as when cardiopulmonary resuscitation is needed or chronic which requiring special positioning, treatments and teaching.   Nurse evaluates patients' oxygen needs by assessing skin color, vital signs, anxiety levels, responses to activity and mental responsiveness. B. Water and fluid: water is necessary to sustain life. The body can survive only a few days without water, although certain conditions may alter this length of time. A balance between the intake and elimination of fluids is essential to life. Changes of the water balance of the body are evidenced by either dehydration or edema (the collection of fluid in the body tissue). Dehydration occurs from conditions such as severe diarrhea or vomiting, whereas causes of edema include diseases of cardiovascular or renal system or trauma.  The nurse can assist in these conditions by measuring intake and output, checking the condition of the skin and mucus membrane weighing the patient daily and observing intravenous infusion of fluids. Examples of conditions in which individuals may require assistance to meet their fluid needs include unconsciousness, inability to swallow and severe mental illness. C. Food: Nutrients are necessary to maintain life, although the body can survive for several days or weeks without food. Poor nutritional habits, inability to chew or swallow nausea and vomiting, food allergies, refusal to eat and overweight pose threats to a patient's nutritional status.  The nurse helps by feeding the patient, monitoring caloric counts or maintaining alternative methods of nutrition such as tube feeding. Nutritional status is assessed with a variety of indicators, including weight, muscle mass, and laboratory investigations. D. Elimination: elimination of the body waste products is essential for life and comfort. The body eliminates waste in several ways. The lungs eliminate carbon dioxide and water; the skin eliminates water and sodium; the kidneys eliminate fluids and electrolytes; the intestines discharge solid wastes and fluids. If the body inappropriately allows wastes to accumulate, many serious conditions can result. A bowel obstruction, bladder cancer, kidney diseases disrupt normal elimination.  The nurse may help the patient eliminate waste by giving medication to relieve diarrhea or constipation, an enema, urinary catheter or assisting with dialysis. E. Temperature: the body has mechanism to assist in temporary regulation of body temperature. These mechanisms include shivering and perspiration.  Several factors can threaten the body's need for temperature regulation, including excess external heat or cold or a high internal fever in response to an infection. Body temperature is assessed as vital signs by the nurse. F. Physical activity: activity stimulates both the mind and body. Exercise helps maintain the body's structural integrity and health by enhancing circulation and respiration.  The nurse can assist the patient to obtain needed exercise in many ways. Examples include encouraging a person to walk after surgery, teaching the patient in a cast to do exercise, providing passive range of motion or turning the immobilized person to prevent lung problems, skin breakdown (bedsores) and other complications of immobility. G. Sleep and rest: sleep and rest are important in maintaining health. The amount of sleep that people need varies; factors such as pregnancy, age and general health have an influence. The absence of sleep is not immediately life threatening but can cause various disorders if allowed to  continue. For example, sleep deprivation aggravates some forms of mental illness.  The nurse can assist patient to get enough sleep and rest by providing safe, comfortable and quiet environment. Various treatments such as back rub, warm bath, warm milk and certain medication can promote sleep. H. Sexuality: sexuality is an integral part of each individual and may be affected by physical and emotional illnesses. The need for sex is not vital to the survival of the individual, but it is vital to the survival of the species. 2- Safety and security needs: come next in priority. The need for safety has both physical and psychologic aspects. The person needs to feel safe, both in the physical environment and in relationships. A. Physical safety and security means protected from potential or actual harm. Nurse carryout a wide variety of activities to meet patient's physical safety needs such as the following:  Using proper hand washing and sterile technique to prevent infection  Using electrical equipment properly  Administer medications knowledgably  Using skill when moving and ambulating patients  Teaching parents about household chemicals that are dangerous to children. B. Emotional safety and security involve trusting others and being free of fear, anxiety and apprehension. Patients entering the healthcare system often fear the unknown and may have significant emotional security needs. Nurse can help meet such needs by:  Encouraging spiritual practices that are source of strength and support, by allowing as independent decision making as possible and by carefully explaining new and unfamiliar procedures and treatments. 3- Love and belonging needs: After physiologic and safety and security needs, this is the next priority and is often called a higher-level need. The third level of needs includes giving and receiving affection, attaining a place in a group, and maintaining the feeling of belonging Some nursing interventions to help meet this need are as follows:  Including family and friends in the care of the patient.  Establishing a nurse-patient relationship based on mutual understanding and trust by demonstrating caring, encouraging communication and respecting privacy.  Referring patient to specific support groups such as cancer group.  Encouraging visitors, cards and telephone calls whenever possible. 4- Self-esteem needs: the next highest priority on the hierarchy is self-esteem needs. The individual needs both self-esteem (i.e., feelings of independence, competence, and self-respect) and esteem from others (i.e., recognition, respect, and appreciation)  Many factors affect self-esteem, when a person's role changes (e.g. through a job change or through death of a spouse), self-esteem can be seriously altered because the person's responsibilities and relationships have also changed.  Other changes that may affect self-esteem include a change in body image, such as losing of body part. Nurses can help meet patient's self-esteem needs by:  Accepting their values and beliefs  Encouraging patients to set attainable goals and facilitating support from family or significant others.  These actions promote a sense of worth and self-acceptance. 5- Self–Actualization needs: When the need for self-esteem is satisfied, the individual strives for self-actualization. The term self-actualized implies a fully functioning person. Maslow described this state as a comfortable relationship with reality., the innate need to develop one's maximum potential and realize one's abilities and qualities. Maslow's Characteristics of a Self-Actualized Person:  Is realistic, sees life clearly, and is objective about his or her observations  Judges people correctly Has superior perception,  is more decisive Has clear notion of right and wrong  Is usually accurate in predicting future events  Understands art, music, politics, and philosophy Possesses humility,  listens to others carefully Is dedicated to some work, task, duty, or vocation  Is highly creative, flexible, spontaneous, courageous, and willing to make mistakes  Is open to new ideas Is self-confident and has self-respect  Has low degree of self-conflict; personality is integrated  Respects self, does not need fame, possesses a feeling of self -control  Is highly independent, desires privacy  Can appear remote and detached  Is friendly, loving, and governed more by inner directives than by society  Can make decisions contrary to popular opinion  Is problem centered rather than self-centered Accepts the world for what it is To help meet patient's self-actualization needs, the nurse focuses on:  The person's strength and possibilities rather than on problems.  Nursing intervention is aimed at providing a sense of direction and hope and providing teaching that is aimed at maximizing potentials. Applying of Maslow's hierarchy: It is useful for: 1. Identify unmet needs 2. Establishing priorities of care 3. Understanding the relationship of basic human needs