Transcript Introduction to Nursing

Introduction to Nursing
Pamela M. Llana, MSN, RN
Definition
Nursing
• “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, 2010, p. 10)
• Requires:
– Creativity
– Sensitivity
– Applications based on scientific rationale
Nursing History
• 1836-Florence Nightingale
“founder of modern nursing”
• Defined nursing as “the act of
utilizing the environment of the
client to assist him in his
recovery” (1859)
• Hygiene and comfort
• Developed nursing schools
• Changed society’s view of
nursing-from the “dregs of
society” to dignity and value,
worthy of respect
• 1872
Linda Richards
“America’s first trained
nurse”
• 1882
Clara Barton forms
American Red Cross
• Historical timeline pp.
3-4 (not responsible to
know!)
Nursing Theory
• Theories provide different explanations of the
nursing discipline but share four central concepts
that are defined, related and emphasized differently
–
–
–
–
Person
Environment
Health
Nursing
• Nightingale – first theorist
• 16 additional theorists through the 1980’s
Image of Nursing
• Not physician’s
“handmaiden”
• Professional
• High-tech
• Respected/trusted
• Changing faces of
nursing
Nursing Roles & Responsibilities
• Caregiver
• Decision-maker
• Patient (client)
advocate
• Manager
• Coordinator
• Communicator
• Educator
Professional Nursing Education
• Registered Nurse (RN)
– Associate Degree (ADN)
• 2 years
– Diploma
• 3 years (phasing out)
– Baccalaureate (BSN)
• 4 years
Professional Nursing Education
• Advanced Education
– Master’s (MSN)
• Family Nurse Practitioner
• Acute Care Nurse Practitioner
• Pediatric Nurse Practitioner
• CRNA-Certified Registered Nurse Anesthetist
• Nurse Educator
– Doctorate (Ph.D. – research; DNP – clinical)
– Certification
Nursing Organizations
• ANA – American Nurses Assn.
• MNA – MS Nurses Assn.
• MASN – MS Assn. of Student
Nurses
• NOADN – National Org. for
Associate Degree Nursing
• MOADN – MS Org. for ADN
• MOSA – MS Org. Student Assn.
• SNA – MOSA Chapter at NWCC
Nursing Organizations
• Special Interest organizations
– Surgical nurses, Men, Critical Care, Emergency,
Pediatric, Oncology, Nurse Executives
• ACEN – accreditation; ensures public need of nursing
is met; formerly called NLNAC
• Alpha Delta Nu – Honor Society of Nursing (ADN)
• Sigma Theta Tau – Honor Society of Nursing (BSN,
MSN)
• International Council of Nurses – develops nursing
throughout the world
Nursing Research
• National Center for
Nursing Research in the
National Institutes of
Health
• Findings used in clinical
practice
“Evidence-based Practice”
• Problem-solving approach to clinical practice
• Integrates use of:
Best evidence with
Clinician’s expertise and
Client’s preferences and values
• Research-based articles
• Evidence-based care – 28% better outcomes
“Evidence-based Practice”
• EBP-references on class guides
• Textbooks – may be outdated
• EBP Sources:
– Articles-library search engines
– AHRQ-Agency for Healthcare Research and
Quality
– Cochrane Database
– National Guidelines Clearinghouse
– Joanna Briggs Institute
Health and Wellness
• Health – “state of
complete physical,
mental and social wellbeing, not merely the
absence of disease or
infirmity” (WHO, 1947)
• Difficult to define –
individual concept
• It is MORE than absence
of disease.
Health Promotion and Disease Prevention
• Health promotion
– exercise/nutrition
• Wellness education
– stress management
• Illness prevention
– screening guidelines
3 Levels of Prevention
• Primary Prevention (true prevention)
– Health Promotion (nutrition, sex education)
– Specific Protection (immunizations)
• Secondary Prevention
– Early Diagnosis & Prompt Treatment (screening)
– Disability Limitations (tx to prevent complications)
• Tertiary Prevention
– Restoration & Rehab
ILLNESS
Health beliefs – a person’s ideas, convictions and attitudes
about health and illness – can be positive (+) or negative (-)
• “state in which physical, emotional, intellectual, social,
developmental, or spiritual functioning is diminished or
impaired compared with previous experience
• Acute – short term and severe
• Chronic – persists, usually longer than 6 months, affects
functioning
• Impact-illness behavior – how people monitor their bodies,
take action and use the health care system
Risk Factors for Illness or Injury
• Definition: any situation, habit, environmental
condition, physiological condition that increases
likelihood of illness or accident
• Genetics (including Race)
• Gender
• Physical (weight, pregnancy)
• Age
• Environment (toxins, chemicals)
• Lifestyle (alcohol/drugs/sexual behavior)
Vulnerable Populations
• High risk for health problems
• Due to excess risk; limited health care
• Dependent on others for care
• Includes: homeless, poverty, older adults,
immigrants, abusive relationships, substance
abusers, severely mentally ill
Holistic Health – Complementary or
Alternative Medicine
Person as bio-psycho-social and spiritual being;
Interventions focus on interrelated needs of body, mind,
emotions, and spirit
Holistic Health includes:
•
•
•
•
•
•
•
•
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Vitamins/herbals
Chiropractic care
Biofeedback
Meditation
Therapeutic touch
Art/music therapy
Humor
Prayer
Guided imagery
• Nurse’s Role
– Assess client’s need
and use of CAM
– Provide CAM within
scope of practice
when appropriate
– Inform/refer
– Evaluate outcomes
of CAM
Nursing Care of Individual, Family and Community
Community Nursing
• Our clients include the family and the community
• Goal: promote, maintain and restore health
• Examples of nursing care for:
– Family: Therapy to deal with acute or chronic
illness of family member
– Community: TB screening of employees,
replacing soda machines with water/juice in
schools
Nurse Roles in the Community
• Community-based Nursing – provides acute and
chronic care services to individual within community
• Community Health Nursing - provides services to
individuals, families, and groups identified by risk
factors of community
• Public Health Nursing – provides focus of practice on
primary prevention with the community as client
Wellness-Illness Continuum
Wellness
__Disability__Symptoms__Signs
Premature
Model
Awareness__Education__Growth___
Treatment Model
Highest level
Death
Wellness
Neutral Point
(No discernible illness or wellness)
Health Care Delivery Systems
• Participants
– Consumers (patient/client and community)
– Providers (licensed and unlicensed)
• Settings
– Hospitals
– Home, Schools
– Skilled-nursing, Assisted-living, Extended care,
Rehab units, Hospice
– Health Departments
– Adult Daycare centers
Delivery Systems – cont.
• Regulatory agencies
– FDA
– State/local health agencies
– State licensing
– The Joint Commission
• Financing mechanisms
– Private plans – Insurance
– Public funding
• Medicare – over 65
• Medicaid – low income – state determined
Interdisciplinary Team
• Collaborates to provide holistic
care
• Nursing personnel
– RN/LPN
– Advanced Practice:
NP, CRNA, Educator,
Administrator
– CNA, PCA, Nurse
intern/extern
• Non-nursing
(Dietician, lab tech,
pharmacist, PT, MD, radiology,
respiratory therapy, social
worker, speech therapy,
clerical)
Discharge Planning
• Starts AT ADMISSION!
• Provides continuity of care:
– From health care facility to the home
– From one level of care to another
• Goals:
– Reduce readmission
– Improve patient outcomes
• Collaboration required:
– With patient AND family
– With other members of the healthcare team
Delegation of Nurse-related Tasks
• RN – responsible & accountable for care
• Use professional judgment & critical thinking
skills to implement 5 rights of delegation:
– Right task
– Right circumstances
– Right person
– Right direction/communication
– Right supervision
Delegation
• To LPN – Licensed Practical Nurse
– Patient Assessment (not all assessments)
• RN must do initial assessment, post-surgical assessment, unstable
patient assessments
– Care must be coordinated/supervised by RN
– Certain areas restricted to RN
• To PCA – Patient Care Assistant/Nurse’s Aide
– Can feed, bathe, turn pt., vital signs unless unstable or
facility policy (i.e. BP)
– NO medications
– NO sterile procedures
Thinking Strategies for Nursing
• Nursing Process
A D P I E
• Critical Thinking
What Critical Thinking Is
• Purposeful thinking that aims to make
judgments based on evidence
(Alfaro-LeFevre, 2003)
• Reasonable, reflective thinking focused on
what to believe or do
(Ennis & Milman, 1985)
What it is NOT
• Common sense
• Working in isolation
• Spontaneous responses • Being competitive
• Regular or “normal”
thinking
• Being critical or
judgmental
• Inability to
communicate with
others
• Disorganized
• Lack of concern with
motives, facts,
underlying reasons
• Task-oriented
• Emotion-driven
How does this translate to nursing?
• Reflective, reasonable thinking about nursing
problems with more than one solution
• Clinical decision-making, diagnostic reasoning,
and professional judgment
Components of Critical Thinking
• Knowledge
Education – basic, continuing, and advanced
• Experience
Success with other patients
• Competence
Evidence-based practice
DSM - 5
• Standard classification of
mental disorders used by
mental health professionals
in United States
• Contains listing of
diagnostic criteria for every
psychiatric disorder
recognized by U. S.
healthcare