Chapter 1
Nursing Foundations
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Nursing Origins
• Youngest profession but oldest art
• During the Middle Ages in Europe
• Schism between King Henry VIII and the
Catholic Church
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The Nightingale Reformation
• The Crimean War
• Nightingale’s contributions
– Training people for future work
– Selecting those with upstanding character
– Improving sanitary conditions for sick and
injured
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The Nightingale Reformation (cont’d)
• Nightingale’s contributions (cont’d)
– Reducing death rate of British soldiers
– Providing classroom assistance and
clinical teaching
– Advocating nursing education should be
lifelong
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Question
• Is the following statement true or false?
Florence Nightingale advocated that nursing
education should be lifelong.
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Answer
True.
Florence Nightingale advocated that nursing
education should be lifelong due to continual
technological advances, to demonstrate
competence and ensure the public’s
confidence, and to facilitate practice
consistent with current nursing standards.
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Nursing in the United States
• U.S. nursing schools:
– Differences between the Nightingale
Training Schools and U.S. Training Schools
• Expanding horizons of practice
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Nursing in the United States (cont’d)
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Contemporary Nursing
• Combining nursing art with science
• Integrating the nursing theory
– Nursing theories and application
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Contemporary Nursing (cont’d)
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Contemporary Nursing (cont’d)
• Defining nursing
– Nursing definitions by:
o Florence Nightingale
o Virginia Henderson
o American Nurses Association
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The Educational Ladder
• Basic educational options available:
– Practical (vocational) nursing
– Registered nursing
• Factors that influence choice of nursing
program:
– Career goals
– Geographic location of schools
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The Educational Ladder (cont’d)
• Factors that influence choice of nursing
program (cont’d):
– Costs involved
– Length of program
– Reputation and success of graduate
– Flexibility of course scheduling
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The Educational Ladder (cont’d)
• Factors that influence choice of nursing
program (cont’d):
– Opportunity for part-time versus full-time
employment
– Ease of movement into next level of
education
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The Educational Ladder (cont’d)
• Practical/vocational nursing
– Abbreviated nursing program created
during World War II
– Length: average between 12 and 18
months
– Shortest, most economical program
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The Educational Ladder (cont’d)
• Registered nurse
– Works under direction of physician or
dentist
– Manages or provide direct care to client
– Educates clients and the public re:
Medical conditions
– Delegates client care to LPN and UAP
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The Educational Ladder (cont’d)
• Registered nurse (cont’d)
– Three paths
o Hospital-based diploma program
 Traditional route for nurse
 Lowest number of diploma
programs compared to other basic
nursing educational programs
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The Educational Ladder (cont’d)
• Registered nurse (cont’d)
– Hospital-based diploma program (cont’d)
o Reasons for decline
 Movement to increase
professionalism in nursing
 Hospitals no longer financially able
to subsidize schools of nursing
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The Educational Ladder (cont’d)
• Registered nurse (cont’d)
– Associate degree program
o Aimed at shortening nursing education
o Originally-proposed title of “technical
nurse”
o Would not be expected to work in a
management position
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The Educational Ladder (cont’d)
• Registered nurse (cont’d)
– Baccalaureate program
o Greatest flexibility in qualifying for
nursing positions
o Preferred in areas requiring substantial
independent decision making
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The Educational Ladder (cont’d)
• Registered nurse (cont’d)
– Graduate nursing program
o Master’s-prepared nurses: Clinical
specialist, nurse practitioner,
administrator, educator
o Doctoral degree: Conduct research;
advise, administer, and instruct nurses
pursuing graduate and undergraduate
degrees
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The Educational Program (cont’d)
• Registered nurse (cont’d)
– Continuing education
o Planned learning experience beyond
the basic nursing program
o Rationale for acquiring continuing
education
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The Educational Program (cont’d)
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Question
• Is the following statement true or false?
The geographic location of a school does not
have any implication in the choice of a
nursing program.
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Answer
False.
Geographic location of a school is one of the
factors that influences the selection of a
nursing program.
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Future Trends
• Factors contributing to nursing shortage:
– Retirement rate exceeds replacement
– Increased aging population requires
health care
– Disappointing salaries with longevity
employment
– Job dissatisfaction
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Future Trends (cont’d)
• Factors contributing to nursing shortage
(cont’d):
– Heavier workloads and sicker clients
– Publicity about mandatory overtime
– Downsizing nursing staff from dwindling
revenues and managed care policies
– Negative stereotypes
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Future Trends (cont’d)
• Governmental response
– Loan repayment programs and
scholarships for nursing students
– Funding for public service announcements
– Career ladder programs
– Establishment of nurse retention and
client safety enhancement grants
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Future Trends (cont’d)
• Governmental response (cont’d)
– Grants to incorporate gerontology into
nursing curricula
– Loan repayment programs for nursing
students who agree to teach following
graduation
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Future Trends (cont’d)
• Proactive strategies
– Pursuing post-licensure education
– Training for advanced practice roles
– Becoming cross-trained
– Learning more about multicultural
diversity
– Supporting legislative efforts toward
national health insurance
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Future Trends (cont’d)
• Proactive strategies (cont’d)
– Promoting wellness: home health and
community-based programs
– Helping clients with chronic diseases
– Referring clients with health problems
– Coordinating nursing services across
health care settings
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Future Trends (cont’d)
• Proactive strategies (cont’d)
– Developing and implementing clinical
pathways, standardized multidisciplinary
plans for a specific diagnosis or procedure
– Participating in quality assurance
– Concentrating on knowledge and skills:
manage health needs of older Americans
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Question
Which of the following is a factor
contributing to nursing shortage?
a. Job dissatisfaction
b. Geographic location of schools
c. Length of programs
d. Reputation and success of graduate
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Answer
a. Job dissatisfaction
Job dissatisfaction is a factor that has
contributed to nursing shortage. Geographic
location of schools, length of programs, and
reputation and success of graduate are
factors that influence the selection of a
nursing program.
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Unique Nursing Skills
• Assessment skills
– Following activities requires use of
assessment:
o Interviewing, observing, examining
client and family; reviewing client’s
medical record; obtaining facts from
other health care workers
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Unique Nursing Skills (cont’d)
• Caring skills
– Assisting with ADLs
– Safe care of clients who require invasive
or highly technical equipment
– Helping client become self-reliant
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Unique Nursing Skills (cont’d)
• Counseling skills
– Communicating with client
– Actively listening
– Offering pertinent health teaching
– Providing emotional support
– Using therapeutic communication
techniques
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Unique Nursing Skills (cont’d)
• Counseling skills (cont’d)
– Use active listening
– Clarify client’s perspective
– Teach clients: promote healing processes,
staying well, preventing illness, and
carrying out ADLs
– Use empathy
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Unique Nursing Skills (cont’d)
• Comforting skills
– Provide stability and security during a
health-related crisis
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