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Definition of Nursing

  • Nursing is the protection, promotion, and optimization of health and abilities, prevention of illness and injury, alleviation of suffering through diagnosis and treatment of human response, and advocacy in the care of individuals, families, communities, and populations (ANA, 2003)


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Definition of Nursing

  • Nursing encompasses autonomous and collaborative care of individuals of all ages, families, groups, and communities, sick or well in all settings. Nursing includes the promotion of health, prevention of illness, and the care of ill, disabled, and dying people (International Council of Nurses, 2002).


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Definition of Nursing

  • Advocacy, promotion of a safe environment, research, participation in shaping health policy and in patient and health systems management, and education are also key nursing roles (ICN, 2002).


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Definition of Nursing

  • Nursing = Care of Others

  • Blend of Art and Science


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History of Nursing

  • Ancient Civilizations through the Renaissance

    • Illness had supernatural causes

    • Women delivered custodial care to family

    • Medicine men treated disease

    • As civilizations grew priests were seen as physicians

    • Under Christianity educated and wealthy women dedicated themselves to care of the sick

    • Phoebe became the 1st Deaconess

    • During the Crusades all-male military orders flourished and all-female religious orders declined

    • During the Renaissance medicine moved into the University

    • Male nurses vanished from profession

    • Home major locality for nursing care

    • Only poor hospitalized, cared for by prostitutes and female criminals


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History of Nursing

  • Colonialism and Revolution

    • Physicians not required to have license

    • Hospital care only available in cities

    • Mentally ill “warehoused”

    • More soldiers died in Revolutionary War due to disease than wounds


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History of Nursing

  • Industrialization

    • Population explosion

    • Increased incidence illness, injury, and early mortality

    • Hospitals opened

    • Schools of nursing started: Sisters of Charity, Kaiserworth school of nursing in Germany 1836, Dr Joseph Warrington in Philadelphia 1839


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History of Nursing

  • Influence of War

    • Crimean war, notable for Florence Nightingale

    • American Civil War, emergence of early nursing leaders

    • Training for nurses more apprenticeship than education, hospital-based schools of nursing

    • WWI, female nurses under control of male hospital administrators and physicians

    • WWII, large # women working outside home

    • Increased need for nurses

    • Move into university and college settings


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History of Nursing

  • Influence of War

    • Korean War, growth of AD programs in community colleges

    • Vietnam War, expansion civilian hospitals, advancement of specialization

    • Concept of nursing diagnosis

    • Masters and PhD programs in nursing


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Current Trends in Nursing

  • Change in education, disappearance of hospital based schools of nursing

  • Nursing shortage

  • Evidence-based practice

  • Decreased hospital length of stay

  • Community based nursing

  • Aging population

  • Increase in chronic health conditions

  • Culturally competent nursing care

  • Increase costs of health care/managed care


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Major Factors to Evolution of Nursing

  • Industrial revolution

  • Wars

  • Closure of diploma programs

  • Nursing shortage

  • Movement from inpatient to outpatient

  • Increasing costs of health care


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Florence Nightingale

  • Wealthy well-educated

  • In Crimean War reduced soldiers mortality from 42.7% to 2.2% in 6 months

  • Established training school for nurses

  • Wrote books about healthcare and nursing education “Notes on Nursing”


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Florence Nightingale

  • 1st Nursing Theorist

  • Nursing is separate and distinct from medicine

  • All women are natural nurses

  • Emphasized importance of environment: fresh air, cleanliness, nutrition

  • Maintained accurate records, 1st Nursing Researcher


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Is Nursing a Profession?

  • Well-defined body of specific and unique knowledge that undergoes continual growth through research

  • Services provided are vital to human beings and the welfare of society

  • Practitioners have autonomy and control their own policies and activities

  • Practitioners are motivated by the service they provide and consider their work important to their lives (altruism)

  • Practitioners decisions and conduct are guided by a code of ethics

  • Professional organization sets standards

  • Practitioners receive education in institutions of higher learning


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Registered Nursing Education

  • Diploma in Nursing

  • Associate Degree in Nursing

  • Baccalaureate in Nursing

  • Direct entry Masters Degree in Nursing

  • Advanced practice Masters in Nursing

  • PhD in Nursing


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Physical Sciences

A & P Biology Microbiology Chemistry

Pathophysiology

Food & Nutrition

Humanities

Ethics Literature

History

Philosophy

Pharmacology

NURSING

Abnormal Psychology

Psychology Sociology

Growth & Development

Social Sciences

Research

Mathematics & Statistics

Writing & Composition

Liberal Arts & Nursing


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Professional Nursing Organizations

  • American Nurses Association (ANA): establishes standards of practice, encourages research to advance nursing practice, and represents nursing for legislative actions

  • National Student Nurses’ Association (NSNA)

    • OSNA


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Professional Nursing Organizations

  • National League for Nursing (NLN): foster development and improvement of nursing education; voluntary accreditation

  • American Association of Colleges of Nursing (AACN): national accreditation for collegiate nursing programs

  • International Council of Nurses (ICN)

  • Specialty Nursing Organizations: Sigma Theta Tau International Honor Society of Nursing


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Professional Organizations and Nursing Process

  • Term 1st used in 1955

  • ANA Standards of Nursing Practice

  • Canadian Nurses Association standard of effective use of nursing process

  • Joint Commission of Accreditation of Healthcare Organizations requires care documentation according to nursing process

  • ANA recommends educational programs incorporate nursing process


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Nursing Process and Critical Thinking

  • Nursing process provides a framework for critical thinking


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CRITICAL THINKING

  • Abstract concept

  • Learned thinking skills

  • Has a purpose

  • Considers evidence, context, past knowledge, alternatives, creativity


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WHY CRITICALLY THINK?

  • Nursing is an applied discipline

  • Nursing draws on knowledge from other fields

  • Nurses deal with change in stressful environments

  • Nurses make frequent, varied, and important decisions


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CRITICAL THINKING

  • SKILLS

    • Objectively gather information

    • Recognize need for more info

    • Recognize gaps in own knowledge

    • Listen carefully; read thoroughly

    • Separate relevant from irrelevant data

    • Group info in meaningful way

    • Draw tentative conclusions


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  • SKILLS (cont)

    • Integrate findings with previous knowledge

    • Identify potential solutions

    • Evaluate each potential solution

    • Choose best solution

    • Carry out intervention

    • Evaluate credibility and usefulness of sources of info

Sound like the problem-solving or scientific method?


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CRITICAL THINKING

  • ATTITUDES

    • Independent thinking

    • Intellectual curiosity

    • Intellectual humility

    • Intellectual courage

    • Intellectual perseverance

    • Fair-mindedness


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STAGES OF SKILL ACQUISITION

  • Novice

    • Rule-governed, limited, inflexible

    • Total recall mode

  • Advanced Beginner

    • Notes recurrent aspects

    • Beginning development of professional habits

  • Competent

    • Able to recognize own thinking

    • Able to analyze problems

    • Lacks speed and flexibility of proficient nurse

    • 2-3 years in setting


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BENNER (cont)

  • Proficient

    • Perceives each situation as a whole

    • Long-term goals

    • Advanced level of critical thinking

    • 3-5 years in setting

  • Expert

    • Intuitive grasp of situation

    • 5-15 years in setting

Patricia Benner: From Novice to Expert


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OBSTACLES

  • Overuse of habit with questioning “We’ve always done it that way”

  • Anxiety

  • Working under deadlines

  • Biases, own as well as patient

  • Lack of confidence in own thinking


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NURSING PROCESS

  • Structure for critical thinking


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NURSING PROCESS

  • Assessment

  • Nursing Diagnosis

  • Planning (expected outcomes)

  • Nursing Intervention

    • Implementation of plan

  • Evaluation


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NURSING PROCESS

Nursing

Diagnosis

Assessment

Standards of

Professional

Practice

ANA code of Ethics

Evidence-Based

Practice

Planning

Evaluation

Intervention