CH. 4
Professional Nursing Practice
by Mary Koloroutis
Key Constructs to Professional Nursing
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The nurse-patient is the cornerstone
The two major H.C. drivers can negatively
impact Professional Nursing
 Financial decisions
 Technology issues
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Magnet Status is positively related to
Professional Nursing
Key Constructs to Professional Nursing
continued
Aiken Study (1994) > + P. N.
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Facilitate professional autonomy
Nursing control over their practice
Positive nurse-physician relations
P.N. numbers/mix impact + patient outcomes
by 3-12% (Needleman, 2001)
Provides compassionate care to clients
OJT does not normally meet the requirements
of a professional occupation.
What is a Profession?
Abraham Flexner (1910)
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Intellectual vs physical (care plan vs IV)
Based on an assessable body of knowledge
Is practical rather than theoretical
Can be taught through professional Ed
Has a strong internal organization of
members
Has practitioners motivated by altruism
Explore the Meaning of a
Professional vs. Technical Practice
Describe the similarities
or differences between
the chef at the Brown
Palace & the cook at
the Village Inn?
Cook
Chef
Professional vs. Technical
for all practice areas
Professional Practices
Have a culture that supports
professional activities:
frameworks, CE, research
Has a defined body of
knowledge gained by formal
education
Is a discipline with peer
review and a code of ethics
Autonomy in practice with
legislative and legal sanctions
Is an organized system of
practice-society recognized
Technical Practices
Are more likely to have more
OJT than formal education.
Are skill focused
Have trade journals or
technique trainings
Do not focus on what
advances the practice
Develop through certifications
Want less accountability
Professional vs. Technical
Thinking and Valuing
Professional thinking
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More is best
Specialization in depth and
breadth
Evidence-based education
Invests energy beyond the
work-associations,
research, reading
Expects self accountability
Resilient with change and
believes change is valuable
Technical Thinking
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Least is best
Specialization in depth
Experience is the primary
educator
Conserves energy beyond
the workday
Prefers others be
accountable
Enjoys consistency and
believes change is
disruptive
Professional vs. Technical
Nursing Competencies
Professional
Technical
Imagine Nursing as Never
Changing-Flat Line
Completely
controlled
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Impact on
outcomes
Impact on
nurses
Impact on
Impact on
Impact on
patient
new
physicians
quality
staff
What Would it Look Like with
Fluctuation and Change?
How is Fluctuation &
Change different from
Random Chaos?
What are the Benefits
of Fluctuation and
Change?
Called Cybernetics II
(as system in constant
change—shaping
toward improvements)
Imagine Minimal Change
Professionals believe there are:
Mind and Body Failures
Limited knowledge
Information processing
barriers
Environmental barriers
Motivational (internal)
barriers
Emotional barriers
Perceptual barriers
Intellectual barriers
Cultural barriers (bias)
KEY RESPONSES ARE:
More people need to be
stepping up to critical
decisions with
Shared Governance
We need practice theories
to keep us on track and
tell us when we are lost
We need to practice in an
evidence-based care
environment
Conceptual Frameworks-Theory
Allow You To Organize Your Thinking
and Connect it to Principles
It helps to know what we
believe and why
These are the the building
blocks of our knowledge and
beliefs
This allows us to move into
new territory as if we have a
map for the unknown
We have less surprises, and
then react less stressed
It is an external support for
our faulty thinking
Imagine Nursing as Random
Practice—Not a Discipline
Inconsistent care
Patient confusion
Evidence based
practices are not
encouraged
There is confusion
and constant conflict
No accountability
Metaparadigms
Broadest consensus of a discipline
Have general parameters & creates
boundaries
Have a distinctive domain and cover all of it
Most theories include these components
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Person (humans)
Environment (context)
Health (ideas of health)
Nursing (nursing as a discipline)
Caring
Quality
Propositions: Linkages & Relationships
Belief regarding person to their own health
Belief regarding person to environment
Belief regarding health to nursing practice
Belief regarding the connection of person,
environment, health , and the practice of
nursing
Beliefs about caring, quality and practice
The Focus of One’s Practice
Impacts the practice and workplace
Client focused
Family focused
Person-environment focused
Nursing therapeutic focused
Humanistic focused
Spiritually focused
Process focused
Models Give you a Picture of
How the Parts are Related
A Philosophy Has Your Key
Values Presented for Others
Advocacy
About Quality
through Caring
Patients are
the reason we
exist and our
caring shows
that we
advocate for
them
Nursing
Practice
Quality is the Nursing is at
combination of the forefront of
clinical
our excellence
competency
and the art of
caring
Other Theories
Impact the practice and the workplace
Growth and development (Erikson, Piaget)
Adult development (Kohlberg, Gilligan, Rest)
Aging and death (Kubler-Ross)
Chronic Disease (Geriatric Theories)
Human Intelligence (Gardner)
Psychological development (Psych. Theories)
Cause and Effect & Multifactorial (Medicine)
Potentiality, Consciousness & Reality (Q.M.)
Definitions of Nursing (ANA)
Provision of a caring relationship that
facilitates health and healing
Attention to the range of human responses to
health and illness, the physical and social
environments
Integrates objective data and subjective
experience.
Apply scientific knowledge
Advance knowledge through scholarly inquiry
Influence social and public policy for social
justice
Definition of Nursing (ANA)
“Nursing is 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.”
The Scope of Nursing Practice
Dependent on their educational
preparation
Their experience
Their role
And the nature of the patient
population
Practice within recognized standards of
professional nursing practice (varies
with education, experience
Three Realms of Practice
Delegated
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RNs carry out medical plans of action
RN is responsible to confirm safety, and
appropriateness of the order
Independent
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Focus is on the patients response to actual or
potential health problems
Interdependent
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Interdisciplinary care, planning, and services
Entry & Levels of Nursing Today
Certified Nursing Assist.
Licensed Practical Nurse
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PN, LPN, LVN
Professional Entry
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AD, BSN, (Dip), ND
Advanced Practice Nurses
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NP, CNS, ND
Terminal Degrees
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Ed.D., Ph.D., DNSc, DNP,
DScN,
Creating Boundaries for Practical
Nursing:
What is in the
Domain of
Practical
Nursing
NOT Practical Nursing
Quiz # 1
Name:
Date
List four things that are in the domain of practical nursing &
four things that are beyond the scope of practical nursing
Within LPN
Beyond LPN
Creating Boundaries for Nursing:
What is the Discipline?
What is in the
domain
And what is not
NURSING
NOT NURSING
Evaluating the boundaries of Nursing
1. Distinctions between human and non-
human (not nursing),
2. Distinctions between living and nonliving
(not nursing),
3. Nature of environments and humanenvironmental interactions from cellular to
societal levels,
4. Illness versus health and well-being
5. What you do to or for your clients
Academic Training for RNs
All Nursing
Professional Nursing
Assessment
Diagnosis
Outcomes Identified
Planning
Implementation
Quality of Practice
Education
Professional Prac. Eval.
Collegiality /Collaboration
Ethics
Research
Resource Utilization
Leadership
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Coordination of Care
Health teaching, Promotion
Consultation
Prescriptive Authority
Evaluation
Roles of Professional Nursing
Have a “Voice of Agency”
1. Sentry (Watch over, protect others)
2. Healer (Care for another’s body, mind,
spirit)
3. Guide (Leads another through unfamiliar
territory)
4. Teacher (Imparts knowledge)
5. Collaborator (Works with others)
6. Leader (Has authority to act on behalf of
others)
Essential Functions of Nursing
Practice
Assessment of needs through data collection,
clinical assessment, plan, implement, &
evaluate
Manage and deliver the care required for the
patient’s condition and individual human
response
Communication and coordinate care with
others who are interacting with the patient
Coordinate the patient transfer or discharge
Benner’s “Novice to Expert” (1984)
Novice
Advanced Beginner
Competent
Proficient
Expert
“Quotes” form Ch. 4
There must be a relationship with the patient
to know their strengths, weaknesses, hopes
and fears… our challenge is to balance tasks
with relationship. (Manthey)
Within the dominant, modern, Western
mindset, the caring-healing practices of
nursing have been on the margins—have
been repressed and silenced. (Watson)