Nursing 170 Notes PDF

Caring Sciences 1.​ Humanity 2.​ Role Modeling 3.​ Nurturing 4.​ Holistic(bodymindspirit) -​ Focus on being human first -​ Shared humanity -​ Health promotion, quality of life, self-discovery, life-cycle -​ Understanding HUMAN EXPERIENCE Touch -​ Touching is an essential a...

Caring Sciences 1.​ Humanity 2.​ Role Modeling 3.​ Nurturing 4.​ Holistic(bodymindspirit) -​ Focus on being human first -​ Shared humanity -​ Health promotion, quality of life, self-discovery, life-cycle -​ Understanding HUMAN EXPERIENCE Touch -​ Touching is an essential and inevitable facet for patients during the provision of care -​ It is an essential impact of being human -​ Context and culture influence the experience of interpersonal touch -​ Pro: Engenders sympathy and humaneness in the experience of the patient and nursing care -​ Important component of non-verbal communication, modifying behaviour and affecting emotions -​ Pro: Increases communication between nurses and patients -​ Pro: Ensures the feeling of self-esteem by individuals—reducing psychosocial problems of patients -​ Pro: Strengthen nurse-patient relationship—deepening the bond between the nurse and the patients through the recognition of the emotional situation -​ Holistic approach helps avoid unnecessary suffering -​ Barrier: The rise of technology inevitably loses the human touch that characterizes care interactions -​ Risk for compassion fatigue and burnout in nurses that result from the loss of relationship or distancing from patients BSCN Philosophy 1.​ BEING–who we are as a person/nurse–awareness  2.​ KNOWLEDGE-nursing knowledge, self knowledge, world knowledge 3.​ DOING BEING -​ Being an individual, family, community, planet -​ Everybody is unique--knowledgeable & self-determining -​ Right to respect & dignity -​ Well-being-who we are today -​ Influenced by family, friends, religion -​ Life experiences shape what we do on a daily basis -​ Embodiment-influenced by the world around us -​ Journey to authentic connection -​ Human to look for connections KNOWING -​ Knowledge is always changing -​ Continuous pursuit-dynamic -​ Contexts may be ambiguous & constant flux -​ Palliative, ER, dying person -​ Multiple truths & perspectives -​ Different POVs: Age, gender, social identity, etc -​ Nurses should take in as many perspectives as possible -​ **** -​ Nursing is our GPS—helps u define and guide our thoughts actions -​ Provide a framework for making decision guide our practice -​ Helps to figure out how to do act and think -​ Articulates our relationships between concepts -​ Being, knowing, doing -​ Everyone is capable at this amount, some at this other amount -​ Put people in their best capacity to take care of themselves -​ What do we believe about people? -​ Assumptions -​ Propositions -​ How we use our 5 senses to make sense of different concepts -​ Someone shortness of breath—anxiety, sleeplessness, cancer, heart disease,etc -​ Is the symptom urgent?? -​ Assumptions are beliefs and values -​ Propositions is making sense between symptoms and their danger level (example) -​ Nursing theory is the language that makes us capable nurses through our thoughts and actions -​ Patterns of Knowing -​ Objective & subjective -​ Objective is things that we can measure and repeat -​ Subjective is personal—internal experience -​ Ethical knowing -​ Ethics— what is right, what is wrong -​ Social justice, moral justice, respect, dignity, giving people or nurses voice, how do we treat people? -​ Empirical knowing -​ Mostly objective -​ Borrowed health and social sciences -​ Measured -​ Nursing science comes first -​ Personal thinking -​ Stories, therapeutic use of self -​ Who you are as a nursing scientist -​ Utiizing, experimenting -​ Using knowledge we get from our patients -​ /Professional -​ Hard to separate between personal self and nursing scientist -​ Professional practice -​ Aesthetic thinking -​ Nursing science -​ How we do things -​ Expression of all our knowledge -​ Demonstrating through our thoughts and actions -​ These patterns need to come together -​ Social justice = emancipatory knowing -​ How do we free people from these health barriers -​ Barriers society has created -​ UNKNOWING -​ Open mind, open heart —sense-making -​ Recognizing that everyone is going to have a a different truth and perspective -​ “I don’t know” -​ ”I never thought of it that way” -​ SYNOPTIC KNOWING -​ Problem: Tend to compartmentalize knowledge -​ Using different knowledge in different contexts -​ Moving back and forth with knowledge -​ Knowledge about self, asking why I think this about a person—-biases -​ How do we touch someone? Barriers -​ Intergrated—one knowledge is not more important than the other -​ Safety plays a role in what knowledge we use -​ Everybody is unique -​ Courage to recognize of getting out of your comfort zone -​ Integrative—putting health and social sciences, as well as caring along -​ METAPARADIGM -​ A world view -​ A way for us to use ways of knowing and putting them into four distinct concepts -​ Nursing, Person, Health, Environment -​ Define nursing theory -​ Helps organize research -​ From nursing theories—nursing models= illuminate the phenomena from a unique perspective -​ PERSON -​ 1984 -​ One individual -​ How do nurses care for one person -​ One way -​ Sickness perspective -​ Not our partners—less than us -​ Saw patients as a task -​ NO social identity -​ Age, ethnicity -​ HEALTH -​ 1984 -​ Physical health—Body -​ Upcoming of WHO definition -​ Health and illness -​ Chronic diseases as not healthy -​ Were not studying nutrition -​ No mind and spirit effect -​ ENVIRONMENT -​ 1984 -​ Hospital -​ Physical environment -​ No outside resources -​ NURSING -​ 1984 -​ Clinician -​ Nurses who worked in a hospital -​ Skillset—diploma level -​ Robot—how to do job at a very low level -​ CRITICISMS -​ Lots of disagreement—Lack of consensus -​ No evidence -​ No relationship -​ patients not giving back -​ Colonial—western perspective  -​ No thinking outside the box -​ Nursology—study of nursing -​ MICGILL MODEL OF NURSING -​ assumption that people are capable -​ nurse works with what the person has -​ Capacity -​ Increased independnece -​ Empowerment -​ Put person in a good place to take care of themselves -​ Including social awareness, person to human beings (community, organization, people had capacity, hear their stories, everyone has different goals), environment (past physical to global, trauma informed care, people make choices who they are), planetary health (nutrition, health in community, gardens, distribution of foods), nursoliologst (study of nursing, think for yourself, carving out own path, what makes nursing unique contributions) People are capable, nurse might be educator, coach, etc. Capacity, capability, increased dependence, empowerment, Only as strong as our community (how do we care for everyone), Discipline -​ A way of studying -​ e.g. Medicine, Teaching, Dentistry -​ Focuses in the field -​ People focused on an area of expertise -​ Discipline of nursing: Focus is people Profession -​ How we express our knowledge -​ How we put our thoughts and actions into process -​ Five things: 1.​ Minimum of Bachelorette Education (4 years) 2.​ Code of Ethics a.​ Outlines what we believe b.​ What is good behavior what is bad 3.​ Association a.​ College of registered nurses of Alberta—make sure every RN is competent and protects the public from us 4.​ Specific service a.​ Different tasks for healthcare—improving people’s health 5.​ Disciplinary Knowledge/Unique body of knowledge ART and SCIENCE debate -​ Not a art, not a science, just nursing science Nurse Scientist -​ Someone who studies nursing topics  -​ Someone who understands human behaviour -​ Carry out or read about research and experiments -​ Education -​ Constantly Experimenting how to become a good and efficient nurse -​ Using disciplinary knowledge as trial and error -​ We ARE Nursing Scientists -​ ON FINAL**** -​ Should I use a different knowledge? Do I need someone to help? Healthcare system -​ Nurses work in this system, not a medical system -​ Nurses working in healthcare—reaching full potential -​ Nursing is our focus -​ We work closely together with Medicine-we are not apart of medicine -​ We borrow health and social sciences Nursing Science: The application of theory to practice. -​ Liberal Arts: analyze, problem-solve, communicate, think critically. -​ Science: Anatomy, physiology, chemistry, microbiology, psychology, sociology -​ To help guide our process, actions, thoughts Nursing Focus -​ Nurses focus on making sure people have self-knowledge, being able to take care of themselves -​ Good job when people have the education to make good choices for their health -​ Focus on patient experience across their entire health journey -​ If we can understand human experience we can shape our nursing practice -​ Being in-relationship -​ Connecting with patients -​ Being good with yourself -​ Build trust Healing vs Curing -​ Healing is more holistic—bodymindspirit -​ Being at peace -​ Accomplished what you wanted in life -​ Heaven -​ It is always possible if person wants to be in a place of healing -​ Purpose and meaning in life -​ Curing is fixing—seeing things as broken -​ Broken bones -​ Disease -​ Wounds -​ Not always possible -​ Nurses listen, offer pain meds, bring strategies to make surroundings more peaceful—healing -​ Lack of curing isn’t a fault -​ Our current healthcare system is fixing people mind’s and bodies, and healing them  -​ Curing isn’t sometimes in the best interest Nursing is something we lead people with, to discover and educate people in newer topics PERSPECTIVES -​ Inductive -​ Experimentation -​ When you have specific things and you make a generalization on them -​ Small idea—->Big idea -​ e.g. Symptoms of headache, sniffling, aching joints—Recognize patterns and define it by ill-like (flu) -​ -​ Deductive -​ Big idea—->Small idea -​ e.g. Green pus coming out of the wound—>Infection—> Check for fever, pus, check for pain, etc. -​ Gather data to see if hypothesis is right or wrong -​ Putting pieces together to put hypothesis Coming to Know -​ Grounded in relationships -​ Respect -​ Honoring differences and dignity -​ Agreeing we do not have to agree with each other -​ Understanding who you are to prevent trauma professionally -​ Listening -​ Critical reflexivity -​ Need other people -​ e.g. Being white in a black nursing group to understand their perspective and views -​ Curiosity -​ World is always changing quickly -​ Understand what is going on in the world -​ e.g. Upcoming diseases -​ Possibility -​ Innovation, creativity -​ Always do something different -​ Keeping heart and mind open -​ Biases affect this Sense-Making -​ Different framings -​ ”What if we do it this way? What if we do it that way?” -​ Multiple insights -​ Asking patients, peers, nurses, charge nurses, etc. -​ More knowledge, the better it is to make sense of it -​ Intuitive  -​ “Spider sense” -​ Body trying to make sense of patterns and just feeling that there is something -​ Collective -​ Informed opinions -​ Looking at that empirical evidence -​ Finding what reliable sources support the evidence—patients, other nurses, etc. -​ Openness -​ We do not have all the answers Critical Thinking -​ ALL Humans, even animals (e.g. dog) LEVELS 1.​ Basic -​ Concrete—absolute rules -​ RIght and wrong -​ Prescriptive 2.​ Complex -​ Creative, alternative options -​ Grey areas -​ flexibility -​ Difference in people, recognizing that someone might respond to this treatment but another person might respond to a different treatment 3.​ Commitment -​ Anticipate the issue -​ Context to assess viability -​ Growth as a clinician -​ Looking at the big picture -​ Figuring out the best interest for the patient -​ e.g. Not letting a patient go home until he is fully ready, not just following orders Nursing Process -​ Cyclic: -​ Follows a cycle -​ Working way through -​ Dynamic -​ Cient centeredness -​ All about making sure client is well -​ Problem solving and decision making model -​ interpersonal and collaborative style​ -​ Universal applicability -​ Critical thinking and clinical reasoning ADVANTAGES -​ Framework -​ Start with assessment————->Evaluation (Steps, knowing what comes next) -​ Fosters consistency  -​ Quality care -​ Care plan for the patient -​ Standardization, everyone gets treated the same -​ Patient-centered -​ Flexible enough to make small changes CHALLENGES -​ Decision making over sense making -​ Individual focus, not the system -​ Not focusing on the environment and problems that may affect certain groups—racist society -​ Missed care/biomedical focus -​ If person doesn’t fit plan, then no care -​ No care on spiritual and mental well-being -​ Colonial—“nurse knows best” -​ Power dynamic -​ Impersonal relationship -​ Seeing them as a disease or chore that needs to be cured right away ASSESSMENT -​ Gathering, sorting, analyzing all types of thinking with verification -​ Using the nursing model, nursing theory, and nursing framework -​ bodymindspirit PLANNING -​ Prioritiy setting -​ CURE -​ Critical—life saving, risk of death, shortness of breath-bleeding-suicide -​ Urgent—Done quickly, taking a swab -​ Routine—things we do everyday, head to toe assessment—looking at BP -​ Extra—Not life-altering -​ Goals & Outcomes -​ Working with patients collaboratively -​ Setting priorities IMPLEMENTATION -​ Putting plan into action -​ Independent nursing action -​ Do things without orders -​ e.g. Start oxygen, blood-glucose levels -​ Dependent nursing actions -​ Cannot describe or administer a medication without doctor permission -​ Collaborative intervention -​ In Maslow’s hierarchy needs, we mostly function in the bottom two levels -​ Physiological and safety needs EVALUATION -​ The question you need to ask: “How successful was the care plan?” -​ Good, partially good, partially bad, bad, etc.  -​ Patient feedback -​ Improvement for the patient for the patient and for YOU -​ ”What can I do better?” -​ ”What did I miss?” Why is the nursing process good? -​ Universal -​ Patient-oriented Why is it bad? -​ Individual-focused, not system-focused -​ Decision making over sense making—colonial -​ Nothing about ethics, not holistic -​ Patients are worked on, not work with 1.​ Recognize Cues -​ Assessment—how do we assess what is going on? -​ We use our senses, what do we see, hear, smell, feel, etc. -​ Environment, ourselves, our judgement -​ Source of information -​ Our seven Ways of Knowing -​ Metaparadigm -​ Nursing articles -​ Theories, models -​ Research study -​ From the patient directly, their chart (history) -​ Families -​ Health and social sciences -​ Political and economic aspect of the world -​ Filtering -​ Experience to be able to recognize specific symptoms -​ CURE -​ Thinking about what the patient tells us -​ More experience=Filtering things quicker and more effectively 2.​ Analyze Cues -​ Start to see cues beyond the physical -​ Sense-making -​ A patient’s needs, concerns, and problems, story, economic state, etc. -​ Relationships or connections -​ Co-interpretation -​ Asking others such as a healthcare professionals or a patient -​ What the patient thinks about the symptoms or their family members -​ Ask people’s stories to not become a technician 3.​ Prioritize hypotheses -​ CURE  -​ ***Maslow Hierarchy model—basic needs satisfied before everything else -​ Bottom line is to make sure our patient lives—physical safety -​ Sometimes we set priorities in life and death situations, as soon as patient is stable co-set priorities with the patient 4.​ Generate solutions -​ “brain-storming” -​ The patient’s capability/capacity as well as our own -​ Working towards confidence in patients -​ Wanting them to be as independent in themselves as possible -​ Understand ourselves in our knowledge, our strengths, -​ Having goals -​ Resources may prevent you from those goals -​ Solutions are always collaborative with patient or other healthcare professionals 5.​ Take Actions -​ Are our actions appropriate? -​ SMART goals -​ Highest priority over lowest priority -​ Maslow Hierarchy model -​ Base judgement on who needs the most care -​ Highest is life and death -​ Lowest is the nice kind things to do for a patient, to make them feel better about themselves -​ Promote well-being -​ Maintain and stabilize someone’s health -​ Curing patients -​ Educationizing patients effectively -​ Helping patients become pain-free 6.​ Evaluate outcomes -​ Stepped that is always skipped -​ First reason: To see what we did work -​ Degree of “met” -​ Fully met, partially met, not met -​ Asking patients how they feel -​ Practice should constantly evolve and improve -​ Quality insurance for the patient and ourselves -​ Comparison of expected to observed outcomes -​ Asking others for input -​ Things you might not know about or exposed to Environmental factors -​ Outside things that nurses cannot control -​ Staffing, supplies, health records, time pressure, cultural considerations, difficulty of task Individual factors -​ Knowledge, skills, speciality unit -​ Attitudes, prior and level of experience  -​ Nursing stress, problem-solving, memory, demands put on nurse -​ Personal— CASE STUDY -​ Objective: Vital signs such as her fever of 39.6, BP of 110/65, pulse is 120/min, urine is foul smelling and bloody, she is very warm -​ Dry and hot associated with fever -​ Busy emergency room -​ 2 mothers -​ Environment may be stressing for the 3 year old as well -​ Cognitive load may not be as effective from finding out bad news about mother, holistic care might not be as great—more technical -​ Your competence level may not be as good—not a seasoned nurse -​ Treatment plan: Antibiotics -​ Subjective: She appeared to be in discomfort, crying, inconsolable -​ Asking her mothers her condition, when did it start, what has she has noticed, what she has done to help with the symptoms so far -​ Prioritize that it is suspected to a UTI -​ Taking in account the symptoms, as bleeding may not be associated with the UTI -​ Could be abused—need to find out more info from parents -​ Treat symptoms -​ Goal is to reduce her temperature, mother is educated on how to clean her baby better to avoid infection as baby was probably not properly cleaned. Indigenous knowledge -​ Different relationship with the world we live in -​ Not all indigenous people have the same values and beliefs -​ Their meta paradigm: Healing (wellbeing, being who we are), relationship with the creator, spirituality, community, land (plants, animals, rocks, fish, birds, etc. Not just physical land) -​ Tribes have different views of their meta paradigm -​ Oral—pass their history on through storytelling -​ Purpose behind it -​ Share wisdom and teach, role model, nurture Two Eyed-seeing -​ Nurses need to see with two eyes—western perspective -​ Recognizing all knowledge gathered, borrowed health and social sciences, nursing sciences, -​ Other ways of coming to know -​ Recognize owned lived experiences -​ Sharing it -​ Figuring out how do we balance our knowledge out? How do we set priorities?  -​ ***Blending in indigenous and western ways of knowing, they both have strengths so individual’s can get a great quality of care -​ Being in the middle helps us look at lots of perspectives -​ Gathering as many perspectives to strengthen our sense-making Perceiving Canada -​ Tolerant—putting up with people we don’t like -​ We need to create a sense of belonging Colonization -​ Unseeded—no treaty -​ Treaties made indigenous people give up a lot of their rights -​ Democratic Racism -​ Policies and rules that take out the “human” out of people -​ Took land for the railroads—development of a white country -​ Put indigenous people in land where nobody will notice them -​ Entrenched in our society Indian Act -​ Holds Federal government responsible -​ Very racist -​ Forced them to be welfare recipients -​ No incentive to work -​ Cultural genocide -​ Goal: Eradicate indigenous people UNDRIP -​ Indigenous peoples have the right to their traditional medicines and to maintain their health practices… -​ Indigenous individuals have an equal right to the enjoyment of the highest attainable standard of physical and mental health. …. TRC Calls to action -​ Reconciliation is in the best interests of all of Canada -​ The TRC was an opportunity for Residential school survivors to share their stories -​ Work with financial compensation -​ Government had itemized trauma Time for a new era -​ Not all indigenous people have status -​ Leaving reserve=lost status, indigenous woman marrying white man=lost status -​ Status system is problematic Health disparities -​ Systemic discrimination(biggest risk factor) by excluding indigenous people from access to higher healthcare -​ Results in poverty -​ Rely on federal government -​ Greatest health influence is society’s discrimination on the indigenous, resulting in indigenous prone to addiction, poverty, mental health challenges, food insecurity -​ Houseless not homeless  -​ Residential schools, 60s scoop, Indian act also affect these Five principles -​ Protocol -​ How we engage in relationship with indigenous people -​ A way of honoring and respecting a relationship -​ Different on who you are asking -​ Every indigenous group have different protocols -​ Personal knowledge -​ Do more work and research on indigenous people and their history and their trauma yourself -​ Getting more insight -​ Partnerships -​ Both sides need to contribute to fix and reconciliation with the problem—both have to move forward, not just one side Planetary health and sustainability -​ Indigenous people see the land as sacred, to be sustained and cared for