Chapter 1 Professional Nursing Practice KEY POINTS PROFESSIONAL Nursing practice • Nursing is the (1) protection, promotion, and optimization of health and abilities; (2) prevention of illness and injury; (3) alleviation of suffering through the diagnosis and treatment of human response; and (4) advocacy in the care of individuals, families, communities, and populations. • Nurses offer skilled care to those recuperating from illness or injury, advocate for patients’ rights, teach patients to manage their own health, support patients and caregivers at critical times, and help them navigate the complex health care system. • A number of nursing organizations offer certification in nursing specialties, such as critical care, geriatric, emergency, psychiatric and mental health, and community health nursing. • Entry-level nurses with an associate or baccalaureate degree in nursing are prepared to function as generalists. With additional preparation, nurses can assume roles such as clinical nurse specialist and nurse practitioner. INFLUENCES ON PROFESSIONAL NURSING PRACTICE • Rapidly changing technology and dramatically expanding knowledge are adding to the health care environments. Changes in the structure and financing of health care systems, Copyright © 2020 by Elsevier, Inc. All rights reserved. ever-changing laws and regulations, and the increasing voice that patients have in their care influence the health care environment. • Because nurses play such a vital role in providing safe care, major nursing organizations promote research into the causes of errors, develop strategies to prevent future errors, and address nursing work environments that affect patient safety. PATIENT-CENTERED CARE • Nursing care is delivered using a variety of models. The nurse’s role in most cases is one of interdependence and co-participation with the patient and other health care team members. • Complex health care environments require that you use critical thinking to make decisions that lead to the best patient outcomes. These include applying the cognitive skills of analyzing, applying standards, discriminating, information seeking, logical reasoning, predicting, and transforming knowledge. • The five elements of the nursing process are assessment, diagnosis, planning, implementation, and evaluation. Standard nursing languages are often used to document the nursing process. Using standard languages helps professional nursing practice and provides the nurse with a consistent way to communicate nursing knowledge. Teamwork and Collaboration • To collaborate effectively with members of the interprofessional team, you must be aware of the knowledge and skills of other team members and be able to communicate effectively with them. Copyright © 2020 by Elsevier, Inc. All rights reserved. • Delegation of nursing interventions to licensed practical nurses/licensed vocational nurses (LPN/VNs) and unlicensed assistive personnel (UAP) is an important function of the professional nurse. • Assignment is the distribution of work that each staff member is responsible for during a given work period. Assignments are often performed when the nurse directs other nurses, LPN/VN, and UAP to perform care that is within their scope of practice. • Supervision includes guidance and direction, oversight, evaluation, and follow-up by the RN. When you delegate, you are responsible for supervision of UAP or LPN/VNs. Safety • By implementing various procedures and systems to improve communication and health care delivery to meet safety goals, health care systems create a culture of safety that minimizes the risk of harm to the patient. • Nurses are a vital part of promoting this culture of safety by providing care in a manner that reduces errors and actively promotes patient safety. Quality Improvement • The nurse’s role in quality improvement is to coordinate the complex aspects of patient care, including the care delivered by others, and identify and correct issues associated with poor quality and unsafe care. • The National Database of Nursing Quality Indicators provides data on nursing-sensitive patient outcomes. Patient outcomes are nursing sensitive if they improve with a greater quantity or quality of nursing care. Copyright © 2020 by Elsevier, Inc. All rights reserved. Informatics • All nurses use informatics every day in practice. Information technology has changed how you obtain and review diagnostic information, make clinical decisions, communicate with patients and health care team members, document, and provide care. • As a nurse, you must be able to help patients access and use appropriate health information and to evaluate information as it relates to your own practice. Evidence-Based Practice • Evidence-based practice (EBP) is a problem-solving approach to clinical decision making that involves the use of the best available evidence in combination with clinician expertise and patient preferences and values to achieve desired patient outcomes. • EBP is a process that involves finding, examining, and using research conducted by others in efforts to answer a specific clinical question. Copyright © 2020 by Elsevier, Inc. All rights reserved.
