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Nursing Foundations
Carolyne Richardson-Phillips, MS, RN
PNU145
Fall 2015
Learning Outcomes
By the end of the section, the PN Students will be able to:
• Discuss Florence Nightingale’s reformation and contributions to
nursing
• Discuss the historical progress of Nursing in the United States
• Discuss the components of nursing theory
• Compare the similarities and differences of 4 nursing theories and
the applications to nursing
• Discuss Nursing’s educational ladder, approval, accreditation, and
practical nurse education
• State the rationales for acquiring Continuing Education
• Describe the levels of responsibilities that Licensed Practical Nurses
perform using nursing process
• Identify current and future trends of health care affecting nursing,
the client and family
• Discuss proactive nursing strategies
• Discuss unique nursing skills nurses use in clinical practice
Nursing Historical Origins
• Nursing: youngest profession but Oldest art (assisting people)
• Evolved from roles of nurturing & caretaking
• Women-Early responsibilities-helping out with childbirth, feeding
newborns, attending to the ill, aged, the helpless within homes &
community settings
• Origin stood for Caring more than Curing
• Roman Empire-First hospital established
• Middle ages- religious groups (Catholic) performed nursing carePriests regarded as physicians
• Christian values of “love thy neighbor as thyself”
• Nursing care changed D/T a feud between King Henry VIII &
Catholic Church
• England took over nursing care of the sick
• Hospitals became poor houses
• Workers were: criminals, orphans, widows
• Workers paid back the Crown for their food, shelter, by tending
to the sick
History Of Men in Nursing
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First nurses throughout the world
First nursing school was in India 250 BC
Only men were felt to be pure enough to be nurses
Military, religious & lay orders of men continued to provide nsg care
during the Middle Ages; some of the most famous: the Knights
Hospitals, the Teutonic Knights, the Tertiaries, the Knights of St.
Lazarus, the Order of the Holy Spirit & the Hosp Brothers of St.
Anthony
St Camillus (25 May 1550 – 14 July 1614) invented the symbol of the
red cross and created the first ambulance service (was an Italian priest
who founded a religious Order dedicated to the care of the sick)
Crusades saw formation of knights-provided nursing care-built hospitals
During the Black Plague, a group of men formed one of the first
hospitals to care for the victims
In 1783 James Durham, a slave from New Orleans, earned his freedom
by working as a nurse; later became one of the first black MD in the US
Walt Whitman (1819-1892), a poet and a writer, volunteered as a
hospital nurse in Washington, DC during the Civil War.
History of Male Nurses Cont.
• First American Nurse
• Friar Juan de Mena----first identified nurse in what was to
become the U.S. (Seventy years before the Pilgrims landed on
Plymouth Rock; Mena-was shipwrecked off the coast of Texas)
• First Massachusetts nurse: Frank Bertram in 1896
• In the early 1900's- Men were excluded from nursing in the
military- did not resume this function until the early 1950's, after
the Korean War
• Nursing Schools For Men
- Mills School for Nursing and St. Vincent's Hospital School for
Men- founded in New York in 1888
• Pennsylvania Hospital opened a school for female nurses in 1914
and simultaneously opened a separate men’s nursing school
Nightingale Reformation
• Florence Nightingale
• Founder of Modern Nursing
• Crimean War 1854-1856
• British casualties high, Arrived at
hospital with 38 Nurses, cleaned up
filth, improved environment
• Helped control infection & reduced
death rate from 60% to 1%
1820-1910
Florence Nightingale (cont’d)
• Called “Lady with the Lamp”
• Acted as a banker, sending
men's wages home to families,
wrote home on behalf of
soldiers
• Introduced reading rooms to
hospital
• When returned to England
received money and started
the first NURSING SCHOOLS
Florence Nightingale’s Contributions to Nursing
• Changed negative image of Nursing to a positive one
• Contributions
• Trained women for future work
• Selective- only those with upstanding characteristics for a
potential nurse
• Identifying client’s needs and how nurses could meet them
• Improving sanitation conditions for sick & injured in the filed
and hospitals
• Reduced death rate of British soldiers
• Establishing nursing education-Provided classroom & clinical
(skills) teaching
• Advocated for life-long nursing education
• Good documentation
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Nursing in the United States
• Civil War: around the same time as
Nightingale’s reformation
• United States- No organized or trained
nursing staff
• Military relied on untrained corpsmen,
civilian volunteers
• Nursing Leader-Dorothea Dixnoted social reformer of the mentally ill
• Volunteered to form an Army Nursing
Corps
• Convinced skeptical Military officials, that
women could perform the work acceptably
D. Dix-1802-87
Nursing in United States (cont’d)
• In 1862, Dorothea followed Nightingale’s advice; established a
selection criteria for potential nurses
• Dix’s requirements
• Not be flighty and marriage-minded young women
• Only accepted applicants who were matronly, plain looking
• Ages 30 to 50
• Needed to be educated, neat, orderly, sober, have a serious
disposition
• Be industrious-Applicants-needed 2 letters of recommendation
attesting to their moral character, integrity, and capacity to care
for the sick
• Had to agree to serve for at least 6 months
• Dress code of modest black or brown or gray skirts and forbade
hoops or jewelry.
Nursing in the United States (cont’d)
• Nursing Leader
• Civil War nurse
• Establish hospitals
• Cared for soldiers on both sides
of the battle field
• Known as “Angel of the
Battlefield”
• Founder of American Red Cross
in 1882
Clara Barton-1821-1912
U.S. Nursing Schools
• After Civil War-established training schools for nurses
• Standards deviated from Nightingale’s which were planned,
consistent, formal education
• U.S. training- unsubsidized apprenticeship
• Later, U.S. curricula & content training improved became more
organized & uniform
• Longer training time established
• Graduate nurses-received diplomas
Nursing in the United States Cont.
• Lillian Wald (1867-1940)
• Nursing Leader
• Established/Opened a
neighborhood service for the poor
sick - Henry Street Settlement in
New York City
• First community health nurse in US
• Considered the founder of Public
Health Nursing (VNA today)
Contemporary Nursing: Combining Nsg Art w/ Science
• Beginning of nursing education consisted of learning the ART –
ability to perform an act skillfully
• Learned by watching & imitating the techniques performed
• Mentors passing nursing skills to students
• Contemporary Nursing added another dimension: Science-body of
knowledge unique to a particular subject
• Science: develops from observing & studying the relation of one
phenomenon to another
• Developing a unique body of knowledge, now possible to predict
which nursing interventions that may produce the desired outcomes
Integrating Nursing Theory
• Theory: opinion, belief, or view that explains a process (provides
an orderly way)
• Nightingale & others-examined relationships among humans,
health, the environment & nursing-outcomes of this analysis
becomes basis for Nursing theory
• Nursing theory – proposed ideas about what is involved in process
identified as nursing
• Purposes of nursing theory: define nursing, describe what
nurses do and provide goals or outcomes of care
• Components:
• Nursing:
• Patient/Client:
• Health:
• Environment:
Integrating Nursing Theory (cont’d)
• Nursing programs adopt-theory:
• serves as conceptual framework or model for philosophy,
curriculum, and importantly nursing approach to clients
• Some of the many theories:
1. Environmental theory -Nightingale
2. Basic Needs theory -Henderson
3. Self-Care theory -Orem
4. Adaptation theory -Roy
Nursing Model: Nightingale
• What is Florence Nightingale’s contribution to nursing theory?
• Recognized as the first nurse Theorist
• Described nursing as both an art and a
science
• Environmental Theory
• Recommended adjusting the environment to
improve the person’s health
• Application to Nursing Practice
NURSING- modify unhealthy environment to put client in best
condition for nature to act
Nursing Model: Virginia Henderson
• Basic Needs Theory
• Definition of Nursing-adopted by
International Council of Nurses
• Included health promotion-not just
illness care
• Application to Nursing Practice
• Nurses- assist in performing
activities that client would perform if
had strength, will, knowledge
• Do this in such a way as to help them
gain independence as soon as
possible
1897-1996
Nursing Model: Dorothea Orem
• Self-Care Theory
• Focuses on each individual’s ability to
perform self-care (Optimal level of selfcare)
• Defined as 'the practice of activities that
individuals have learned -initiate and
perform on their own behalf in
maintaining life, health, and well-being
• Person (client/patient) external elements
that man interacts on the struggle to
maintain self-care environmental
situations
1914-2007
Dorothea Orem (cont’d)
Areas Applicable to Self-Care Theory
• Direct nursing care (nurse has direct contact with client/family
• Providing care or teaching in the following areas
• Nutrition and weight control
• Hygiene
• Mobility –exercise & physical fitness
• Medications
• Behavior - stress management
• Maintenance of social support systems
• Environmental control
• Application to Nursing Practice
Nurses-assist clients with self-care to improve or to maintain health
Nursing Model: Sr. Callista Roy
• Adaptation Theory:
• Model provides a way of thinking about
people & their environment that is useful in
any setting
• Helps one prioritize care and challenges the
nurse to move the patient from survival to
transformation
• Major Concepts:
• Person or group as an adaptive system to
changes in environment
• Environment as internal and external stimuliin continuous state of change
• Application to Nursing Practice
• Nurses assess biologic, psychological, &
social factors interfering w/ health; help w/
altering the stimuli causing the maladaptation
• Then evaluate the effectiveness of the action
taken
1939 to present
Psychosocial Development Theorists
• Research related to human motivation
A hierarchy of human needs
• Based on two groupings:
• deficiency needs
• growth needs
• Within the deficiency needs, each
lower need must be met before moving
to the next higher level
Abraham Maslow (1954)
Maslow (cont’d)
1.
2.
3.
4.
5.
Physiological: hunger, thirst, bodily comforts, etc.
Safety/security: out of danger;
Belonging and Love: affiliate with others, be accepted; and loved
Esteem: to achieve, be competent, gain approval and recognition
Cognitive: to know, to understand, and explore; and Aesthetic:
symmetry, order, and beauty
6. Self-actualization: to find self-fulfillment and realize one's
potential; and
7. Self-transcendence: to connect to something beyond the ego or to
help others find self-fulfillment and realize their potential
Psychosocial Development Theorists
• 8 stages of Psychosocial Development
• Expanded Freud’s theory of
development to include entire life span
• Believed people continue to Develop
• Nurses: be aware of positive & negative
resolutions for each stage
• Developmental stage
• Help client develop coping skills
• Strengthen client’s attitude by
providing encouragement
** Environment- highly influential in development
Erik Erikson
Erickson’s Stages
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Stage 1- Hope -Infant stage - Basic Trust vs. Mistrust
Stage 2 -Toddler stage -Will - Autonomy vs. Shame and Doubt
Stage 3 - Kindergarten- Purpose - Initiative vs. Guilt
Stage 4 - Around age 6 to puberty- Competence - Industry vs.
Inferiority
Stage 5 - Teenager- Fidelity - Identity vs. Role Confusion
Stage 6 - Young adult-Love -Intimacy vs. Isolation
Stage 7 - Mid-life crisis-Caring - Generativity vs. Stagnation
Stage 8 - Old age wisdom - Ego Integrity vs. Despair
Defining Nursing
• Nightingale-earliest definition--“putting individuals in the best
possible condition for nature to restore and preserve health”
• Henderson-definition adopted by The International Council of
Nurses---Nursing involves a special relationship and service between
the nurse and client
• Nursing’s Social Policy Statement 3rd ed. (2010) American Nurses
Association (ANA) defines nursing as
• Protection, promotion, optimization of health & abilities
• Prevention of illness & injury
• Alleviate suffering through diagnosis & treatment of human
response
• Advocate the care of individuals, families, communities &
populations
Defining Nursing (cont’d)
• ANA (2010) –Six essential features added
– 1. Provision of a caring relationship that facilitates health and
healing
– 2. Attention to the range of human experiences and responses to
health and illness within the physical and social environments
– 3. integration of objective data with knowledge gained from an
appreciation of the client’s or group’s subjective experience
– 4. Application of scientific knowledge to the processes of
diagnosis and treatment through the use of judgment and critical
thinking
– 5. Advancement of professional nursing knowledge through
scholarly inquiry
– 6. Influence on social and public policy to promote social justice
• ANA: nursing has an independent area of practice in addition to
traditional dependent & interdependent functions involving MDs
The Educational Ladder
• Lavinia L. Dock Established the National
League for Nurses (NLN)– NLN -Responsible for accreditation of
nursing schools
• Education
– Practical (Vocational) Nursing
– Registered Nursing
• Each program provides knowledge and skills for
a particular entry level of practice
Practical/Vocational Nursing
• Abbreviated nursing program created during WWII
• 1892-First training for LPNs (YWCA)
• 1893- Ballard School -First school for LPNs
• Program was 3 months long
• Goal: prepare graduates to care for health needs of infants, children,
& adults -mildly or chronically ill or convalescing
• 1941 -Formed the National Association for Practical Nurse
Education and Service, Inc. (NAPES)
• Worked to standardize the program & to facilitate licensure of
graduates
Practical/Vocational Nursing (cont’d)
• Once education completed-qualified to take licensing examinationNCLEX-PN National Council Licensure Examination for Practical
Nurses (NCLEX-PN))
• LPNs – Scope of Practice under the Nurse Practice Act of the state
they are working in
• Performing skills may differ from state to state
• LPN/LVN-work under supervision of a RN, physician, dentist,
NP
• May supervise unlicensed and or licensed assistive personnel
• Career mobility-offer path to RN via Associate or Baccalaureate
degrees
Registered Nurse
• Students can choose one of 3 paths
1. Hospital-based diploma
2. Associate degree
3. Baccalaureate
* Once educated- may take NCLEX-RN
National Licensing Examination
• Work under supervision of a physician, NP, or dentist in
various settings-preventative to acute
– Educate clients and public
– May work directly at bedside or supervise others
(delegate care to others)
Hospital-Based Diploma Programs
• Diploma programs –traditional route- thru middle of 20th century
– 1873 Linda Richards first nurse to be given a diploma from the
New England Hospital for Women and Children. She is identified
as "the first trained nurse" in the U.S.
– Programs have become less
– Reasons – movement to increase professionalismcolleges/universities, hospitals can no longer support
nursing programs
– Diploma nurses: well trained, vast clinical experience
– Hospital-based program-last 3 years
– Can transfer credits-science & Humanities courses to Pursue
associate and or baccalaureate degrees
Associate Degree Program
• Mildred Montag- advocated the
creation of an associate degree in
nursing – 2 year program
• Nurse –referred to as a
technical nurse – would not be
working in a management
Position
* * Once educated-may take NCLEX-RN
National Licensing Examination
Baccalaureate Program
• ANA & National League for Nursing pushing for this program to be
entry level for all nurses
• Longest program & most expensive
• Nurses have greater flexibility qualifying for jobs-staff & managerial
* These nurses are preferred in areas where need for independent
decision making
Graduate Nursing Programs
• Master’s and Doctoral levels
• Master’s prepared-clinical
specialists
nurse practitioners,
administrators,
educators
• Doctoral prepared-conduct
research
and advise, administer, &
instruct
nurses pursuing undergraduate
and
graduate degrees
Delegation-LPN/LVN -RN
• Delegation-Six guidelines
1. Right task: matching the client’s needs with the caregiver’s
skills
2. Right circumstance: ensuring that the situation is appropriate
3. Right person: knowing the unique competencies of the caregiver
4. Right direction (communication): providing sufficient
information
5. Right supervision: being available for assistance
6. Right follow-up: validating that the task was completed,
obtaining the results, and analyzing if further actions are
necessary
Continuing Education (cont’d)
• Any planned learning experience that takes place beyond basic
nursing program
– 1. No program provides all the knowledge or skills needed for
this lifetime career
– 2. New advances in technology better than old ones
– 3. Assuming responsibility for self-learning shows personal
accountability
– 4. Nurses need to demonstrate evidence of competence to
maintain consumer’s confidence
– 5. Practicing nursing care according the current nursing standards
helps to ensure care is legally safe
– 6. Many states require nurses to show proof of continuing
education to renew their nursing license
• Learning- lifelong process
Future Trends
• Two major issues:
– 1. Elimination of shortage of nurses
– 2. Strategies for responding to a growing aging population with
chronic health problems
• Shortage-retirement, attrition of aging faculty, disappointing
salaries, job dissatisfaction
• Client-to-nurse ratios• More high-acuity clients, heavier work loads,
• mandatory overtime,
• Downsizing nursing staff
• Continuous health care costs & reimbursements
• Information & Telecommunications
Government Responses
• Federal Gov-tried to help with the shortage
– Passed-American Recovery & Reinvestment Act:
1. Loan repayment programs & scholarships
2. Funding public service announcements to encourage people to
enroll into nursing
3. Career ladder programs
4. Establishment of nurse retention & client safety enhancement
grants
5. Grants to incorporate gerontology into curricula of nursing
programs
6. Loan repayment program for nursing students who agree to teach
following graduation
Proactive Strategies
• Nurses are taking up the challenge:
– Switching from part-time to full-time
– Delaying retirement
– Pursuing post-licensure education
- Training for advanced practice
- Becoming cross-trained
- Learning more about multi-cultural diversity
- Supporting legislative efforts
- Promoting wellness programs
- Helping clients with chronic diseases
- Referring clients with health problems for treatment
- Discharge planning- clinical pathways
- Participating in quality assurance
- Concentrating on continuing knowledge and skills
Levels of Responsibilities for Nursing Process
• Assessing-gathers data
• Diagnosing
• Planning-Setting realistic goals
- Suggests interventions
- Assists in writing plan of care
• Implementing- Performs basic nursing care
• Evaluating-shares observations on how well or not –client is doing
and adjusts plan of care as needed
Unique Nursing Skills
• Assessment skills –need to determine client’s needs & problems
– Involves collecting data-Interviewing, observing, & examiningclient and or family or both
– Review medical record, talk with other health care workers
Unique Nursing Skills (cont’d)
• Comforting Skills- illness causes
feelings of insecurity
• Insecurity may threatened client
and or family’ ability to cope
• Nurse uses comforting skillsinterventions that provide stability
and security during a healthrelated crisis
• Nurse becomes-guide, companion,
interpreter
• Nurse helps to reduce fear, worry
and instills trust
Standards of Care
• Nurse Practice Act -Legal acts-laws established in each state and
province to define scope of nursing practice and regulate/govern the
profession in the United States
– Practice acts differ from state to state, but have a common
purpose, to protect the public
• Standards of Nursing Practice: allow nurses to carry out
professional roles and serves as protection for nurses, patients and
institutions
– Purpose- describe the responsibilities for which nurses are
accountable
Standards of Care (cont’d)..
• The National Federation of Licensed Professional Nurses (NFLPN)is the professional organization for licensed practical nurses and
licensed vocational students/nurses in the United States:
• National Federation of Licensed Practical Nurses, Inc, have
identified standards:
- Education
- Legal / Ethical status
- Practice
- Continuing education
- Specialized nursing practice
Professional Organizations-LPN
• American Licensed Practical Nurses Association
• National Association for Practical Nurse Education and Service
• The National Federation of Licensed Professional Nurses (NFLPN)
References
• Civil War Nurses Retrieved May 1, 2014 from web site:
http://www. topics.nurse.com/civilwar
* Dorothea Dix Bibliography Retrieved May 1, 2014 from web site:
http://www2.webster.edu/~woolflm/dorotheadix.html
* Erik Erikson Retrieved on 5/1/14 from web site:
http://www.simplypsychology.org/Erik-Erikson.html
* Florence Nightingale Retrieved 2007 from web site:
http://nursing-theory.org/nursing-theorists/Florence-Nightingale.php
Dorothea Orem. Retrieved 5/1/14 from web site: http://nursingtheory.org/nursing-theorists/Dorothea-E-Orem.php
• LPN history Retrieved on 5/1/14 from web site:
http://www.ehow.com/about_5452553_history-licensed-practicalnurses.html
• Men in nursing Retrieved 8/21/14 from web site:
http://allnurses.com/men-in-nursing/men-nursing-historical-96326.html.
• Timby, B. K., (2013) (10th ed). Fundamental Nursing Skills and
Concepts. Philadelphia: Lippincott Williams & Wilkins
Historical Pictures of Nursing
Nursing at Bedside
Nurses in Uniform
Student Nurses
Graduating Nurses
VNA Nurses 1930
Community Health Nurses
Visiting Nurses
Korean War Nurse
Female & Male Nurses in Iraq
History Male Nurses
Syringe & Needle
Medicines
Maternity Instruments
Breast Pump
Surgical Instruments
1800 eye surgery
Hearing aid
Leeches
Stethoscopes
Orthopedic Hammer
Vaccination needle
Bedpans & Utensils
Surgical Instruments
1800 - 1855
Dental drill
Civil War Instruments
Ancient Roman Surgical
Instruments
Surgeon's chest on board Mayflower.