N1I02 - Week 1-Professional Presence and nursing as a profession STUDENT.pdf

N1I02-Week 1 Professional Presence & Nursing as a Profession September 2024 Ellen Dobson N1I02: Professional Presence Learning Goal This class introduces students to the concept of being present, scientific and humanistic caring, and the McMaster Model of Nursing. Professiona...

N1I02-Week 1 Professional Presence & Nursing as a Profession September 2024 Ellen Dobson N1I02: Professional Presence Learning Goal This class introduces students to the concept of being present, scientific and humanistic caring, and the McMaster Model of Nursing. Professional Presence-Large Group Identify and discuss the key elements of the McMaster Model of Nursing. For each section of the model (Context, Dialogue, Mutuality), discuss what the section means, how it is related to the rest of the model and the role of the nurse, and how it relates to caring. Define client-centered care (person-centered care), discuss its importance to nursing practice, and how nurses demonstrate or enact client-centered care. Discuss the remaining key terms and their application to professional nursing. View the following video demonstrating the ABCD of Caring from DignityinCare.ca ◦ http://www.dignityincare.ca/en/the-abcds-of-dignity-in-care.html What Does Caring Mean to You? Caring in Nursing Practice Caring: concern over a person, events, projects or things (Astle & Duggleby, 2024) Scientific caring Knowledge, skills, actions, interventions Communication, relational aspects, dignity, Humanistic caring respect The art of nursing Competent nursing practice includes caring practices and expert knowledge (Astle & Duggleby, 2024) McMaster Philosophy: Caring “We believe professional caring has both scientific and humanistic components. It is both a science and an art …” The scientific component of professional caring encompasses the beliefs that the nurse must possess knowledge of the client’s needs and capacities, knowledge and skill to be able to meet these needs, and the ability to choose actions based on tested or verified knowledge Inherent in the humanistic component of professional caring is the acknowledgment of the client’s rights to be treated as an individual entitled to dignity and respect. We believe that before nurses can engage in a professional caring relationship with a client, they must learn to value and care for themselves. Self-awareness and self-knowledge are foundational to the creation of a therapeutic relationship. McMaster BScN Program Handbook, 2023-2024  The Importance of Caring Helps focus on clients Assists with identifying successful nursing actions, implement individualized solutions To understand client’s illness and its meaning Vital to recovery from illness and maintain healthy practices Caring is vital to understanding patients, and to finding and implementing individualized solutions At the heart of nurses’ ability to work with patients in a respectful and therapeutic manner This Photo by Unknown Author is licensed under CC BY-ND Barriers to Caring Increasing use of technology Perception that caring is less important This Photo by Unknown Author is licensed under CC BY-ND ◦ Focus on biomedical model ◦ More value placed on scientific caring Time, institutional demands Caring is unique to each patient This Photo by Unknown Author is licensed under CC BY-SA Think, Pair, Share Think about your own experiences with illness and health care. oHow did (or didn’t) a nurse or a health care professional show caring? Stop and Think… A. A nurse enters the patient’s room, greets the patient warmly, introduces themselves, makes eye contact, sits down for a few minutes, and asks the patient about their thoughts and concerns. The nurse listens, checks the IV, takes vital signs, then leaves the room. B. The nurse enters the room, checks the IV, takes vital signs, talks to the patient but never sits down. The nurse makes eye contact from above while the patient is lying in bed. The nurse asks a few quick questions about the patient’s symptoms then leaves.  Calm presence: being there and being with ◦ Presence established through eye contact, body Caring in language, tone of voice, listening, positive & encouraging attitude Nursing Touch: physical and non-verbal, eye contact Practice Active listening ◦ Involves taking in patient’s story and conveying your understanding ◦ Establishes trust ◦ Must silence yourself to LISTEN Concern about patient well being Knowing the patient (Astle & Duggleby, 2024; Fahlberg & Roush, 2016) ◦ Aids in clinical decision making and your ability to detect changes in patient status and to select appropriate responses Caring in Nursing Practice  Patient Perspectives on Caring Patients become more active in the plan of care when nurses are sensitive, demonstrate empathy, and show interest in them as people Increases patient satisfaction with care This Photo by Unknown Author is licensed under CC BY-ND Comfort through touch (contact, non-contact) Listening-taking in, interpreting, understanding, and conveying that understanding Providing presence (being there and being with) (Fahlberg & Roush, 2016; Larsen, 2022; Zyblock, 2010) This Photo by Unknown Author is licensed under CC BY-SA Nursing Presence “a holistic and reciprocal exchange between the nurse and patient that involves a sincere connection and sharing of the human experience through active listening, attentiveness, intimacy and therapeutic touch, spiritual exploration, empathy, caring and compassion, and recognition of the patient’s This Photo by Unknown Author is licensed under CC BY-SA-NC psychological, psychosocial, and physiological needs” Fahlberg & Roush, 2016  Incorporating Mindful Presence Slow down Sit down This Photo by Unknown Author is licensed under CC BY This Photo by Unknown Author is licensed under CC BY Focus Learn about patients as people Empathize This Photo by Unknown Author is licensed under CC BY- SA This Photo by Unknown Author is licensed under CC Fahlberg & Roush, 2016 BY-SA-NC Person-Centered Care Health care focused on patient satisfaction and patient-centered care Nurses should select approaches that best meet patient needs ◦ Choosing different approaches based on client context ◦ Patient not being able to afford their medications vs. not understanding how to take them appropriately ◦ Teaching a patient to give their own insulin instead of doing it for them ◦ Supporting a client’s choice, even when it is not the choice you would personally make McMaster Philosophy: Patient- Centered Care “When a nurse engages in professional caring, a nurse-client relationship is established within which the nurse and client become partners working towards creating an enabling context in which the client can meet health-related needs.” BScN Program Handbook, 2023-24 Family Centered Care Family is an important resource How families share information, their understanding of treatments, and how interventions will fit with their daily lives will impact care Caring behaviours (Astle & Duggleby, 2024) ◦ Being honest ◦ Giving clear explanations, keeping family informed ◦ Making patient comfortable, teaching family how to keep patient comfortable ◦ Promoting patient independence ◦ Answering questions openly and willingly This Photo by Unknown Author is licensed under CC BY-SA-NC The ABCD’s of Dignity in Care Attitude Behaviour Compassion Dialogue http://www.dignityincare.ca/en/the- abcds-of-dignity-in-care.html (up to 11 mins) Share with the people beside you…. What are key messages you will take away from the video when ‘caring’ for patients and families? McMaster Philosophy of Nursing We believe that nursing is a scientific and humanistic activity of professional caring. The goal of nursing is the promotion and restoration of health. We believe that HEALTH is the extent to which people are able to achieve aspirations, satisfy needs and McMaster BScN Program Handbook cope with or change their context. Health is a dynamic life experience that can be threatened physically, mentally, emotionally, socially or spiritually at any given time. McMaster Nursing Philosophy & McMaster Model of Nursing The CLIENT may be an individual, family, group, population or community. The nurse and client become partners working towards creating an enabling context in which the client can meet health-related needs. McMaster BScN Program Handbook, 2023-24 McMaster Nursing Philosophy & McMaster Model of Nursing (cont’d) We believe that the nurse engages in PROFESSIONAL CARING by supporting the client in the processes of identifying, determining and acting upon experiences relevant to health and healing. We distinguish professional caring from the generic human capacity to care. Nursing as a profession is guided by professional standards, adheres to professional values, and uses learned behaviours, validated knowledge, theories, techniques and processes that characterize professional caring. McMaster BScN Program Handbook, 2023-24 McMaster Model of Nursing: What do these concepts mean? Self reflection: What are 2 strategies you will use in your professional caring practices? Tying it all together– A story of professional caring and presence Royal Alexandra Hospital Foundation. (2015). The Difference between Care and Caring. https://www.youtube.com/watch?v=wkf-WxMZVP8 References Astle, B.J. & Duggleby, W. (Eds.), (2024). Potter & Perry: Canadian fundamentals of nursing (7th ed.). Elsevier. Dignity in Care. (2022). The ABCDs of dignity in care. www.dignityincare.ca/en/the-abcds-of-dignity-in-care.html Fahlberg B, Roush T. (2016). Mindful presence: Being "with" in our nursing care. Nursing 2016, 46(3), 14-15. https://journals.lww.com/nursing/fulltext/2016/03000/mindful_presence__being__with__in_our_nursing_care.4.aspx Larsen, P. (2022). Being present. Rehabilitation Nursing, 47(2), 41-42. file:///C:/Users/000230893/Downloads/Being%20Present.pdf McMaster University BScN Program. (2023). Undergraduate nursing education: Program handbook, 2022-2023. McMaster University. Royal Alexandra Hospital Foundation. (2015). The Difference between Care and Caring. https://www.youtube.com/watch?v=wkf-WxMZVP8 Zyblock, M. (2010). Nursing presence in contemporary nursing practice. Nursing Forum, 45(2), 120-124. https://onlinelibrary-wiley-com.libaccess.lib.mcmaster.ca/doi/epdf/10.1111/j.1744-6198.2010.00173.x N1I02-Nursing as a Profession, Legislation & Regulation Learning Activities Characteristics of a profession and being professional Discuss legislation that guides nursing practice (RHPA, Nursing Act) Roles of the CNO, and documents that outline practice expectations (i.e. professional standards, code of conduct) Discuss Nursing Student organizations Components of professionalism, including social media use Defining Nursing  I am your nurse https://www. youtube.com/ watch?v=jy2V fUiv5dc What are your beliefs about the Nursing profession? Reflect on the following: 1.For me Nursing is….. (Consider why you want to become a nurse? What do nurses offer? What are your beliefs about nursing today?) 2.My Goal for my practice is…. (What kind of nurse do you want to be? Where do you want to work? What do you want to be remembered for?) 3.Key words/themes—Share key words/themes that emerge as you answer #1 and #2 Definitions of Nursing: Nursing Act “The practice of nursing is the promotion of health and the assessment of, the provision of, care for, and the treatment of, health conditions by supportive, preventive, therapeutic, palliative, and rehabilitative means in order to attain or maintain optimal function” Nursing Act, 1991 as cited in CNO, 2023a Definitions of Registered Nurse: College of Nurses of Ontario (CNO) “ Registered nurses are clinicians who provide safe, competent, ethical, compassionate, and evidence- informed care across the lifespan in response to client needs. Registered nurses integrate knowledge, skills, judgment and professional values from nursing and other diverse sources into their practice.” CNO, 2020 Definitions of Nursing (CNA) “Registered nurses are self-regulated health-care professionals who work autonomously and in collaboration with others to enable individuals, families, groups, communities and populations to achieve their optimal level of health. At all stages of life, in situations of health, illness, injury and disability, RNs deliver direct health- care services, coordinate care, support clients in managing their own health. RNs contribute to the health care system through their leadership across a wide range of settings in practice, education, administration, research and policy.” Canadian Nurses Association, 2015 Reflect How does your definition align with the ones we just considered? What is similar? What is different? How might you alter your own definition now? Nursing Legislation Legislation & Nursing Regulated The Regulated Health Professions Act, 1991 and the Health Nursing Act, 1991 determine how the nursing profession Professions Act (RHPA) (1991) is regulated in Ontario. ◦ RHPA applies to all Ontario self-regulated health professions Nursing Act ◦ Nursing Act defines scope of practice for the nursing (1991) profession The two Acts then dictate regulations in terms of College of registration, entry to practice requirements, controlled acts, quality assurance and professional misconduct Nurses of Ontario CNO, 2023b Regulated Health Professions Act 1991 (RHPA) Purpose: Protect and serve public; mechanism to improve quality of care; make health professions open and accountable Describe scope of practice, controlled acts, and regulatory colleges for each health profession There are 14 controlled acts which regulated health professionals can perform – depending on scope, can perform a portion or all. The regulatory colleges are then responsible for ensuring the health professionals provide services in a safe, professional, and ethical manner; also investigate complaints about members and discipline if necessary Applies to 26 regulated health professions Ministry of Health & LTC, 2018  Regulated vs non-regulated Regulated: health professions governed under the RHPA (1991). Have established health regulatory colleges, which regulate the profession in the public interest. Ex. Nurses, Physicians, Dieticians, Midwives, OT, PT, SLP, RT, Pharmacists, Dentists, Hygienists, Chiropractors etc. Unregulated: health professions not governed under the RHPA, but who provide health or other services to clients. The profession is not accountable to an external professional body. Ex. PSWs, Physician Assistants, Physiotherapy Assistants The Nursing Act 1991 Of the 14 controlled acts outlined by the RHPA, the Nursing Act 1991 allows RNs and RPNs to perform 5 controlled acts when ordered or permitted. An RN or RPN must ensure that they have the knowledge, skill and judgment to perform any of these controlled acts. NPs can perform 8 of the acts The Nursing Act also outlines a Nurses Scope of Practice CNO, 2023b  RHPA: 5 Controlled Acts for Nursing Controlled Act Example 1. Performing a prescribed procedure below the Packing a wound, cleaning a dermis or a mucous membrane wound 2. Administering a substance by injection or IM, SC injections inhalation 3. Putting an instrument, hand, or finger beyond Inserting an NG tube, the external ear canal; beyond the point in the nasopharyngeal suctioning, nasal passages where they normally narrow; inserting a urinary catheter beyond the larynx; beyond the opening of the urethra; beyond the labia majora; beyond the anal verge; or into an artificial opening into the body  RHPA: 5 Controlled Acts for Nursing Controlled Act Example 4. Dispensing a drug Preparing medication 5. Psychotherapy Treating a client using specific psychotherapy techniques CNO, 2023b Nursing Act 1991: Other purposes Defines the various classes of nurses that can be registered (ex. general, extended, temporary etc.) Outlines the regulations for entry to practice for each class Provides title protection (ex. only members of the College can use the title of Nurse, RN, RPN, NP.) Defines professional misconduct for nurses Once the Nursing Act and the RHPA Act were passed, lead to the creation of the College of Nurses of Ontario (CNO) CNO, 2023b Role of the CNO The College of Nurses of Ontario is the governing body for registered nurses (RNs), registered practical nurses (RPNs) and nurse practitioners (NPs) in Ontario, Canada. Mission: Regulating nursing in the public interest  protecting the public! Self-regulation is a privilege granted to those professions that have shown they can put the interests of the public ahead of their own professional interests. It recognizes that Ontario’s nurses have the knowledge and expertise to regulate themselves as individual practitioners and to regulate their profession through the College. Role of the College of Nurses of Ontario (CNO) The CNO fulfills its role by: 1. Establishing requirements for entry to practice 2. Articulating and promoting practice standards 3. Administering its Quality Assurance program 4. Enforcing standards of practice and conduct 5. Participating in legislation/policy development 6. Collecting statistical information about Ontario nurses 7. Communicating with Ontario nurses (The Standard) https://www.cno.org/en/what-is-cno/ CNO Entry to Practice Competencies https://www.cno.org/glo balassets/docs/reg/4103 7-entry-to-practice- competencies-2020.pdf CNO Practice Standards Nursing standards are expectations that contribute to public protection. They inform nurses of their accountabilities and the public of what to expect of nurses. Standards apply to all nurses regardless of their role, job description or area of practice. College of Nurses of Ontario Examples of CNO Practice Standards https://www.cno.org/en/learn-about-standards-guidelines/standards- and-guidelines/ Code of conduct Scope of practice Confidentiality and privacy Documentation Medication Therapeutic nurse-client relationship Nurse practitioner CNO Code of Conduct The College of Nurses of Ontario (CNO) upholds safe nursing care for the people of Ontario. The Code of Conduct explains the behaviour the public can expect of nurses when receiving health care. All nurses are accountable to this Code. Code of Conduct The Code consists of six principles: 1. Nurses respect the dignity of patients and treat them as individuals 2. Nurses work together to promote patient well-being 3. Nurses maintain patients’ trust by providing safe and competent care 4. Nurses work respectfully with colleagues to best meet patients’ needs 5. Nurses act with integrity to maintain patients’ trust 6. Nurses maintain public confidence in the nursing profession. CNO, 2023 CNO Scope of Practice Outlines key requirements for nurses when deciding whether to perform an activity for safe client care Profession & Professionalism Profession vs Professional Profession: ◦ Mastery of a complex body of knowledge and skills ◦ Knowledge and art used in the service of others ◦ Governed by code of ethics ◦ Profess a commitment to competence, integrity, morality, altruism and the promotion of the public good within their domain ◦ Commitments form a social contract between the profession and society ◦ The right to considerable autonomy in practice and the privilege of self regulation Cruess et al., 2004 Profession vs Professional Professional: ◦ “To Profess” refers to the public commitment to values and activities that is a right and privilege, not inherent but granted by society in return for certain behaviours and skills ◦ Professionals and their members are accountable to those served and to society. ◦ These commitments have been an implied in the past but is now an obligation ◦ Self regulation Cruess et al., 2004  Body of nursing knowledge and skills Nursing as a Profession clients Profession: An occupation whose core element is work based upon the mastery of a complex body of knowledge and skills. It is a vocation in which knowledge of some department of science or learning or the practice of an art founded Nursing upon it is used in the service of others. Its members are governed by codes of College of ethics and profess a commitment to competence, integrity and morality, Act, Nurses of altruism, and the promotion of the public good within their domain. These CNO commitments form the basis of a social contract between a profession and Ontario, Canadian practice society, which in return grants the profession a monopoly over the use of its knowledge base, the right to considerable autonomy in practice and the Nurses standards, privilege of self-regulation. Professions and their members are accountable to Association Quality those served and to society. Assurance Program (Cruess et al., 2004) Professionalism in Nursing (RNAO) Knowledge Self-Reflection… Spirit of Inquiry Accountability When reviewing your Autonomy notes, return to the RNAO Advocacy resource. Read the specific attributes the RNAO lists. Innovation & Visionary Even as a beginning nurse, Collegiality & Collaboration how can you begin to Ethics & Values demonstrate these (RNAO, 2007) attributes? Think about each item that is listed. Nursing Organizations In a group, explore one of the nursing organizations below and outline what they do for nurses, and for you as a student nurse. Which ones can you join as a student nurse? 1. International Council of Nurses (ICN) 2. Canadian Nurses Association (CNA) 3. College of Nurses of Ontario (CNO) 4. Registered Nurses Association of Ontario (RNAO) 5. Canadian Nursing Students’ Association (CNSA) 6. McMaster University Nursing Students Society (MUNSS) Six P’s of Social Media Use Professional — Act professionally at all times Positive — Keep posts positive Patient/Person-free — Keep posts patient or person free Protect yourself — Protect your professionalism, your reputation and yourself Privacy — Keep your personal and professional life separate; respect privacy of others Pause before you post — Consider implications; avoid posting in haste or anger INRC, 2017  Social Media Expectations Do not post about patients, negative comments about your workplace, co-workers, patient details, or party photos “Liking” a comment is like you made it yourself Once posted, it is there forever Represent yourself well always Consider the standards which you will now be held to: College of Nurses of Ontario Standards: Code of Conduct Therapeutic Nurse-Client Relationships McMaster University- Code of Student Rights and Responsibilities Mohawk College- Student Behaviour Policy Preparation for Week 1 Small Group Lab & Week 2 Week 1 – Small Group Lab Week 2 ◦ If you haven’t already… prior to o Infection Prevention & Control class reading listed on p. 12 & p. 16 of the Course Manual (part 1 & 2) ◦ Think of reasons you have chosen Complete Prior to Class to enter the nursing profession learning activities on p. 19- ◦ Find a picture that represents 25 of Course Manual caring and bring it with you to Bring PPE kit to lab small group lab References Astle, B.J. & Duggleby, W. (2024). Potter and Perry’s Canadian fundamentals of nursing (7th ed). Elsevier. Canadian Nurses Association. (2015). Framework for the practice of registered nurses in Canada. https://hl-prod-ca-oc-download.s3-ca-central-1.amazonaws.com/CNA/2f975e7e-4a40-45ca- 863c- 5ebf0a138d5e/UploadedImages/Framework_for_the_Pracice_of_Registered_Nurses_in_Canada __1_.pdf College of Nurses of Ontario (CNO). (2019). Entry to practice competencies for registered nurses. https://www.cno.org/globalassets/docs/reg/41037-entry-to-practice-competencies-2020.pdf College of Nurses of Ontario (CNO). (2023a). Scope of practice. https://www.cno.org/globalassets/docs/prac/49041-scope-of-practice.pdf College of Nurses of Ontario (CNO). (2023b). Legislation and regulation: An introduction to the Nursing Act, 1991. https://www.cno.org/globalassets/docs/prac/41064_fsnursingact.pdf College of Nurses of Ontario (CNO). (2023c). Code of conduct. https://www.cno.org/globalassets/docs/prac/49040_code-of-conduct.pdf References continued Cruess, S.R., Johnston, S., & Cruess, R.L. (2004). “Profession”: A working definition for medical educators. Teaching and Learning in Medicine, 16(1), 74-46. International Nurse Regulator Collaborative (INRC). (2017). Social media use: Common expectations for nurses. https://inrc.com/Social+Media+Use+Common+Expectations+for+Nurses.page McMaster School of Nursing. (2023). BScN handbook 2023-24. (available in A2L course shell) Ontario Ministry of Health & Long Term Care. (2018). Health workforce planning branch: Regulated health professions act, 1991. https://www.health.gov.on.ca/en/pro/programs/hhrsd/about/rhpa.aspx Provincial Health Services Authority. (2019). I am your nurse. [Video]. https://www.youtube.com/watch?v=jy2VfUiv5dc Registered Nurses Association of Ontario (RNAO). (2007). Professionalism in nursing. https://rnao.ca/bpg/guidelines/professionalism-nursing