Introduction to Nursing PDF

Prepared By Dr. Baghdad Hussein Adult Health Nursing Department Helwan University Outlines: 1-Definition of nursing. 2- Historical perspective of nursing. 3- Social Influences on Nursing. 4- Nursing as a profession. 5- Nursing code of Ethics. 6- Professio...

Prepared By Dr. Baghdad Hussein Adult Health Nursing Department Helwan University Outlines: 1-Definition of nursing. 2- Historical perspective of nursing. 3- Social Influences on Nursing. 4- Nursing as a profession. 5- Nursing code of Ethics. 6- Professional nurse responsibilities. 1  Introduction: - Nursing has responded to and always will continue to respond to the needs of its clients. In times of war, nursing has responded by meeting needs of the wounded in the combat zones and in military hospitals. - Nursing is a multidimensional profession. Nursing reflects the needs and values of society, implements the standards of professional performance and the standards of care, meets the needs of each client, and integrates current research and evidence based findings to provide the highest level of care. - When communities face health care crises, such as those that occur from infectious diseases or a lack of health care resources, nursing is their to establish community based immunization and screening programs, treatment clinics and health promotion activities. What is Nursing? ❖ The word "nurse", "nourish" and "nurture" all come from the Latin root "nutrire". ❖ Nurses provide a more comprehensive approach to client care than all of the other health team members. ❖ Nursing is an art and science. This means that a professional nurse learns to deliver care artfully with compassion, caring, and a respect for each client's dignity and personhood. As a science, nursing is based upon a body of knowledge that is always changing with new discoveries and innovations. 2 ❖ When nurses integrate the science and art of nursing into their practice, the quality of care provided to clients is at a level of excellence that benefits clients in innumerable ways. American Nurses Association (ANA) definition of nursing: Nursing is 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(ANA, 2003). Nursing practice as a direct service, goal oriented and adaptable to the needs of the individual, family& community during health and illness(ANA, 1973). (ANA, 1980), nursing is the diagnosis and treatment of human responses to actual or potential health problems. Certain themes are common to many of these definitions: 1-Nursing is caring. 2-Nursing is an art. 3-Nursing is a science. 4- Nursing is client centered. 5- Nursing is holistic. 6- Nursing is adaptive. 3  7- Nursing is concerned with health promotion, health maintenance, and health restoration. 8- Nursing is a helping profession. 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 community. 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". Traditionally, the person receiving health care has been called a patient. 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. Historical perspective of Nursing:  The founder of Modern nursing: Florence Nightingale established the first nursing philosophy based on health maintenance and restoration.  She developed the first organized program for training nurses the Nightingale Training school for nurses at St. Thomas' hospital in London (1860). Florence Nightingale 4   Nightingale was the first practicing nurse epidemiologist, she studied and implemented methods for major reforms in hygiene, sanitation, nursing practice and reduced the mortality rate. The Civil war to the Beginning of the twentieth century: ▪ The civil war (1860 to 1865) stimulated the growth of nursing in the United States. Clara Barton, founder of the American Red Cross, tended soldiers on the battle fields, cleansing their wounds, meeting their basic needs and comforting them in death. Clara Barton ▪ The U.S. congress ratified the American Red Cross in 1882 after 10 years of lobbying by Barton. ▪ The first African- American professional nurse was Mary Mahoney, RN she was concerned with relationships between cultures and races, and as a noted nursing leader, she brought forth an awareness of cultural diversity and respect for the individual regardless of background, race, color or religion. ▪ Nursing in hospitals expanded in the late nineteenth century. 5 Twentieth Century:  In the early twentieth century a movement toward a scientific research based defined body of nursing knowledge and practice was evolving.  Nurses began to assume expanded and advanced practice roles.  Mary Adelaide Nutting, a member of the first graduated class at Johns Hopkins Hospital was instrumental in the affiliation of nursing education with universities.  She became the first professor of nursing at Columbia University teachers (1907), she concluded that nursing education needed increased financial support and suggested that the money be given to university schools of nursing.  As nursing education developed, nursing practice also expanded. Graduate nurse- midwifery programs were initiated, and specialty nursing organizations as the Association of Operating Room Nurses, American Association of critical care nurses and oncology nursing society were formed in the late 1940s and early 1950s. 6  Twenty First century: Nursing practice and education must continue to evolve to meet the needs of society. In 1990, the American Nurses Association established the center for ethics and human rights. Today the profession is faced with multiple challenges. Nurses and nurse educators are revising nursing practice and school curricula to meet the ever- changing needs of society, including bioterrorism, emerging infections and disaster management. Advances in technology, the rising acuity of hospitalized clients, and early discharge from health care institutions require nurses in all settings to have a strong and current knowledge base from which to practice. 7  Nursing in Islam: Rufaidah bint Sa'ad, is recognized as the first Muslim nurse. She was born in Yathrib before the migration of the Prophet Muhammad. Rufaidah's father was a physician. She learned medical care by working as his assistant. Her history illustrates all the attributes expected a good nurse. She was kind and empathetic. Rufaidah was a capable leader and organizer, able to mobilize and get others to produce good work. She had clinical skills that she shared with the other nurses whom she trained and worked with. She did not confine her nursing to the clinical situation. She went out to the community and tried to solve the social problems that lead to disease. She was both a public health nurse and a social worker. Societal Influences on Nursing: There are many external forces that affect nursing, these include: Demographic changes of the population. Human rights. Increased numbers of medically underserved. Threat of bioterrorism. Demographic changes: Demographic changes affect the population as a whole. Changes that have influenced health care in recent decades include the population shift from rural areas to urban centers. The increasing life span, the higher incidence of chronic, long term illness and the increased incidence of diseases such as alcoholism and lung cancer. Women's Health care issues: The women's movement has brought about many changes in society as women have increasingly sought economic, political, occupational and educational equality. 8  As a result, there is greater sensitivity to the health care needs of women and the role of women in health care research. There are new health care specialties dealing with the needs of women. These new specialties address issues ranging from well women's examinations, to oncological subspecialties and management of menopause. The women's movement has caused female clients to seek more responsibility for and control for their bodies, health and lives in general. Human Rights movement: ❖ The human rights movement is changing the way society views the rights of all of its members including minorities, clients with terminal illness, pregnant women and older adults. ❖ Many groups have special health care needs, and nursing has responded by respecting all clients as individuals with a right to quality care and by supporting basic human rights. ❖ Nurses advocate the rights of all clients. Medically underserved: The rising rates of unemployment, homelessness and health care costs all contribute to an increase in the medically underserved population. The medically underserved population may be poor, they can not afford their own insurance. In addition, there is an increase in the mentally ill population who have little or no access to health care. Nurses have advanced preparation and function as advanced practice nurses, giving them the capability to provide direct health care. 9  Threat of bioterrorism:  Many health care agencies and communities have educational programs for nurses to prepare them in the event of nuclear, chemical or biological attack.  Nurses are active in disaster preparedness.  For example: nurses work in conjunction with community disaster preparedness groups and hospitals to determine what specific nursing activities are needed before the disaster. Cultural diversity: As the people of the world move about, nurses are confronted with caring for clients of many cultures different from their own. The nurse must now have an awareness of how different cultures view health and illness. Nurses are challenged to be culturally aware and competent. Health promotion and wellness:  Today there is a great emphasis on health promotion, health maintenance and illness prevention. Exercise, nutrition and healthy lifestyles are subjects that interest many people.  Nursing has responded to this greater concern for health promotion by providing programs in the community such as educational programs for specific diseases.  Health promotion activities are an important part of the role of a nurse. Rising health care Costs:  Skyrocketing health care costs present challenges to the nursing profession, consumer and health care delivery system as well.  Nursing's responsibility is to provide the consumer with the best quality care in an efficient and economically sound manner. 10   For example, clients may be taught to perform procedures in the home with clean versus sterile equipment.  Nurses need to clinically evaluate each client to determine which clients can perform procedures safely using clean technique. Nursing Shortage: Nursing shortage represents challenges and opportunities for the profession. Vast health care dollars are being invested in strategies aimed at recruiting a well educated, critically thinking, motivated and dedicated nursing work force. With fewer nurses in the work place, nurses must use their client contact time efficiently and professionally. Time management, therapeutic communication and client education are just few of the essential skills needed for the provision of quality nursing care. Nursing as a profession: Nursing is not simply a collection of specific skills, and the nurse is not simply a person trained to perform specific tasks. Nursing is a profession. When we say a person acts "professionally" for example, we imply that the person is conscientious in actions, knowledgeable in the subject, and responsible to self and others. Professions possess the following characteristics: 1) A profession requires an extended education of its members, as well as a basic liberal foundation. 2) A profession has a theoretical body of knowledge leading to defined skills, abilities, and norms. 3) A profession provides a specific service. 4) Members of a profession have autonomy in decision making and practice. 11 5) The profession as a whole has a code of ethics for practice. Code of Ethics:  Nursing has a code of ethics that defines the principles by which nurses provide care to their clients. In addition, nurses incorporate their own values and ethics into practice.  A code of ethics provides guidelines for safe and compassionate care. Nurses' commitment to a code of ethics guarantees the public that nurses adhere to professional practice standards. Nursing Education: As a profession, nursing requires that its members possess a significant amount of education. a) Professional registered nurse education: There are various educational routes for becoming a professional Registered Nurse(RN). Hospital schools of nursing were developed to educate nurses to work within those institutions. b) The associate degree program: is a 2 years program that is usually offered by a university or junior college. This program focuses on the basic sciences and theoretical and clinical courses related to the practice of nursing. Graduates of this type of program take the state board examination for RN licensure. c) The Baccalaureate degree program (Bachelor of science in nursing BSN), usually encompasses 4 years of study in a college or university. The program focuses on the basic sciences and on theoretical and clinical courses, as well as courses in the social sciences, arts and humanities to support nursing theory. 12  Graduate Education: a) Master's education: after obtaining a baccalaureate degree in nursing, a nurse completing a graduate program can receive the degree of master of science in nursing (MSN). A master's degree in nursing can be valuable for nurses seeking roles of nurse educator, clinical nurse specialist, nurse administrator, or nurse practitioner. b) Doctoral preparation: professional doctor programs in nursing (DSN or DNSc) emphasize the application of research findings to clinical nursing. Other programs emphasize more basic research and theory and award the degree of doctor of philosophy (PhD) in nursing. Continuing and in-service education:  Because nursing is a dynamic profession, continuing education programs help nurses remain current in nursing skills, knowledge, and theory. Continuing education involves formal, organized and educational programs offered by state nurses association and educational and health care institutions.  An in- service education program: is instruction or training provided by a health care agency or institution.  An in-service program is held in the institution and is designed to increase the knowledge, skills, and competencies of nurses and other health care professionals employed by the institution. Professional Nursing Responsibilities and Roles: In the past, the principal role of nurses was to provide care and comfort as they carried out specific nursing functions. 13 Changes in nursing have expanded the role to include increased emphasis on health promotion and illness prevention, as well as concern for the client as a whole. (1) Autonomy and Accountability:  Autonomy is an essential element of professional nursing.  Autonomy means that a person is reasonably independent and self governing in decision making and practice.  There are independent nursing measures a nurse can initiate without medical orders.  Nurses attain increased autonomy through higher level of education.  With increase autonomy come greater responsibility and accountability.  Accountability means that the nurse is responsible, professionally and legally, for the type and quality of nursing care provided. (2) Caregiver: As caregiver, the nurse helps the client regain health through the healing process. Healing is more than just curing a specific disease, although treatment skills that promote physical healing are important to care givers. The nurse addresses the holistic health care needs of the client, including measures to restore emotional, spiritual, and social well being. (3) Advocate:  In the role of client advocate, the nurse protects the client's human and legal rights and provides assistance in asserting those rights if the need arises.  The nurse advocates for the client, keeping in mind the client's religion and culture. 14   The nurse may defend clients' rights in a general way by speaking out against policies or actions that might endanger their well being or conflict with their rights. (4) Educator: As an educator, the nurse explains to clients concepts and facts about health, demonstrates procedures such as self care activities, determines that the client fully understands, reinforces learning or client behavior, and evaluates the client's progress in learning. (5) Communicator: Nursing involves communication with clients and families, other nurses and health care professionals, resources persons, and the community. The quality of communication is a critical factor in meeting the needs of individuals, families and communities. (6) Manager: As a manager, the nurse coordinates the activities of other members of the health care team, such as nutritionists, and physical therapists, when managing care for a group of clients. (7) Decision Maker: As clinical decision maker, the nurse uses critical thinking skills throughout the nursing process to provide effective care. Before undertaking any nursing action, whether it is assessing the client's condition, giving care, or evaluating the results of care, the nurse plans the action by deciding the best approach for each client. (8)Administrator: A nurse administrator manages client care and the delivery of specific nursing services within a health care agency. Nursing administration begins with positions such as the charge nurse or assistant nurse manager. 15  (9) Researcher: A nurse researcher investigates problems to improve nursing care and to define and expand the scope of nursing practice. (10) Consultant. (11) 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 psychological support. (12) Change agent. The nurse acts as a change agent when assisting others, that is, clients, to make modifications in their own 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. (13) A leader 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. Scope of Nursing: Nurses provide care for three types of clients: individuals, families, and communities. Nursing practice involves four areas: promoting health and wellness, preventing illness, restoring health, and care of the dying. Promoting Health and Wellness Wellness is a state of well-being. It means engaging in attitudes and behavior that enhance the quality of life and maximize personal potential. Preventing Illness The goal of illness preventing programs is to maintain optimal health by preventing disease. Nursing activities that prevent illness include 16 immunizations, prenatal and infant care, and prevention of sexually transmitted disease. Restoring Health focuses on the ill client and it extends from early detection of disease through helping the client during the recovery period. Nursing Activities Include the following; Providing direct care to the ill person, such as administering medications, baths, and specific procedures and treatments. Performing diagnostic and assessment procedures, such as measuring blood pressure. Consulting with other health care professionals about client problems. Teaching clients about recovery activities, such as exercises that will accelerate recovery after a stroke Rehabilitating clients to their optimal functional level following physical or mental illness, injury, or chemical addiction. Care of the Dying This area of nursing practice involves comforting and caring for people of all ages who are dying. it includes helping clients live as comfortably as possible until death and helping support person cope with death. Settings for Nursing In the past, the acute care hospital was the main practice setting open to most nurses. Today many nurses work in hospitals, but increasingly they work in clients homes, community agencies, ambulatory clinics, long-term care, health maintenance organization (HMOs), and nursing practice centers. 17 ANA) Standards of Clinical Nursing Practice: Assessment: the nurse collects patient health data. Diagnosis: the nurse analyzes the assessment data in determining diagnoses. Outcome identification: The nurse identifies expected outcomes individualized to the patient. Planning: the nurse develops a plan of care that prescribes interventions to attain expected outcomes. Implementation: the nurse implements the interventions identified in the plan of care. Evaluation: the nurse evaluates the patients progress toward attainment of outcomes. 18