Chapter 1
Professional Nursing Practice
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Nursing Defined
Florence Nightingale (1858): The goal of nursing is
“to put patient in best condition for nature to act
upon him.”
American Nurses Association Social Policy statement
(2010): 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.”
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Healthy People 2030
Goals that, if reached, could have major impacts on
improving the nation’s health and overall well-being
Need to collaborate more effectively with diverse
agencies to optimize health and well-being across
developmental life stages
Emphasis on reducing health disparities and
improving health equity and literacy
 http://www.healthypeople.gov
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Health
 The World Health Organization (WHO, 2006) defines
health in the preamble to its constitution: “state of
complete physical, mental, and social well-being and not
merely the absence of disease and infirmity.”
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Wellness
Wellness: has been defined as equivalent to health
Hood (2018): wellness has four components:
o Capacity to perform to the best of ability
o Ability to adjust and adapt to varying situations
o Reported feeling of well-being
o Feeling that “everything is together” and
harmonious
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Cultural Diversity
By the year 2030 racial and ethnic minority
populations will triple in the United States
Five distinct races as classified by 2019 census:
White, Black or African American, Asian, Native
American, Native Hawaiian/Pacific Islander (Hispanic
population is classified primarily under White race)
Asian race had the largest growth
Hispanic population accounted for half of increased
population growth
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Changing Patterns of Disease and
Wellness
Chronic disease account for 7 out of 10 leading
causes of death (CDC, 2019)
Cardiovascular, cancer, diabetes, chronic lung
disease
Nearly half of all adults have one diagnosed chronic
condition
60 million have two or more (CDC, 2019)
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Major Health Concerns
Tobacco use
Substance use
Poor physical activity and nutrition habits
Obesity
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Health Informatics
Health Information Technology (HIT)
Technology Informatics Guiding Education Reform
(TIGER)
International Classification of Diseases (ICD-10)
Electronic Health Record (EHR) Incentive Program
Telehealth
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Health Promotion
Increased emphasis on:
o Health
o Health promotion
o Wellness
o Self-care
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Health Promotion and Technology
Websites
Chat groups
Social Media
Computer technology and informatics
(e.g., Fitbit™ and Carb Manager)
 Mobile health apps
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Evidence-Based Practice
Best practices derived from valid and reliable
research studies
Take into consideration the health care setting,
patient preferences and values, and clinical
judgment
Identify and evaluate current literature and research
and incorporate these findings into patient care
(Melnyk & Fineout-Overholt, 2018)
Evidence-Based Practice Bundles measurably
improve patient outcomes
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Quality and Safety Education for Nurses
(QSEN)
KSAs—Knowledge, Skills, Attitudes:
Patient-centered care
Teamwork and collaboration
EBP
Safety
Informatics
(QSEN, 2020)
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Basic Needs: Maslow’s Hierarchy
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Interprofessional Collaborative Practice
Core Competencies for Interprofessional
Collaborative Practice
Multiple health professionals working together with
patients, families, and communities to deliver best
practices
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Interprofessional Collaborative Practice
Domains
Interprofessional Collaboration Competency Domain.
Interprofessional Education Collaborative. (2016b). Core
competencies for interprofessional collaborative practice:
2016 update. Washington, DC: Author. All rights reserved.
Reproduced with permission.
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Critical Thinking
Metacognition
Deliberate and outcome oriented
Occurs through inquiry
Examination/analysis of data
Formulation of conclusions/alternatives
“Inquisitive truth seekers”
Developed over time
Used in clinical reasoning
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Critical Thinking Skills
Interpretation
Analysis
Inference
Explanation
Evaluation
Self-reflection
Self-regulation
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Components of Critical Thinking
Identify priorities
Gather and validate information
Analyze the information
Draw on past experience and knowledge
Maintain flexibility
Consider alternatives
Formulate decisions
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Critical Thinking in Nursing Practice
“Critical thinking is the foundation of the process of
clinical reasoning and clinical judgment” (AlfaroLeFevre, 2017)
Used in all practice settings
Decision making includes cognitive and
metacognitive skills and logical reasoning
Development involves experiential learning and
practice
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Question #1
Which of the following is an example of using critical
thinking when providing genetics-related nursing
care?
A. Call the family and set up an appointment for
genetic screening
B. Assess and analyze family history data for genetic
risks
C. Obtain blood samples for genetic screening
D. Follow up with the family after the screening
appointment
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Answer to Question #1
B. Assess and analyze family history data for genetic
risks
Rationale: Critical thinking is the process of gathering
information, analyzing, and drawing conclusions. This
is what the nurse will be doing when assessing and
analyzing family history data. Answers A, C, and D
were not examples of critical thinking but rather
examples of care being provided.
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The Nursing Process #1
Assessment
Diagnosis
Planning
Implementation
Evaluation
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The Nursing Process #2
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Assessment
Health history
Physical assessment
“Ongoing”
Relevant information from family, health care team,
medical record
Recording data
o Electronic health record (EHR)
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Diagnoses
Included in ANA’s Scope and Standards of Practice
(2015)
NANDA International (NANDA-I)
Based on collection and analysis of assessment data
Actual or potential health problems
NOT medical diagnosis
Collaborative problems
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Differentiating Nursing Diagnosis and
Collaborative Problems
Redrawn with permission from Carpenito, L. J. (2017). Nursing diagnosis:
Application to clinical practice (15th ed., p. 25). Philadelphia, PA:
Lippincott Williams & Wilkins.
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Planning
Prioritization
o Maslow hierarchy
Establish expected outcomes
o Attainable and quantifiable
Establish goals: immediate, intermediate, long-term
Determine nursing action: planned interventions
Standardized interventions: NIC system
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Implementation
Carry out the plan of care
Nurse assumes responsibility
Goals are used as a focus
“Ongoing” assessment
Make revisions when necessary
All interventions should be patient focused and
outcome directed!
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Evaluation
Allows nurse to determine patient’s response to
interventions
Have outcomes been met?
Document
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Question #2
Assessment begins with initial patient contact. Which
nursing activity is included during this component of
the nursing process?
A. Interviewing and obtaining a nursing history
B. Choosing a nursing diagnosis
C. Establishing expected outcomes
D. Determining nursing actions
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Answer to Question #2
A. Interviewing and obtaining a nursing history
Rationale: The initial or baseline assessment is a
systematic process of collecting predetermined data
during the first contact with the patient, which
includes interviewing and obtaining a nursing history.
Choosing a nursing diagnosis is included during the
diagnosis component of the nursing process.
Establishing expected outcomes and determining
nursing actions are included during the planning
component of the nursing process.
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Individualized Nursing Care Plan
Refer to Chart 1-5
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Ethics and Morality in Nursing
Ethics: formal systematic study of moral beliefs to
understand right and wrong
Morality: specific values, characters, or actions
whose outcomes are examined through systematic
ethical analysis
Often used interchangeably
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Ethics Theories
Teleologic/consequentialism
o Focuses on the end or consequences of actions
o Utilitarianism: “the greatest good for the
greatest number”
Deontologic/formalist
o Ethical standards/principles exist independently
of the consequences
o “Sense of duty”
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Approaches to Ethics
Meta-ethics: analysis of the concept of informed
consent
o When a nurse questions if the patient was truly
informed
Applied ethics: addresses implications of actions or
practices in terms of moral permissibility
o Nursing ethics is a form of applied ethics
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Moral Situations
Dilemmas: a clear conflict exists between two or
more principles
Problems: competing moral claims or principles
when one is clearly dominant
Uncertainty: when one cannot define what the moral
situation is or what moral principles apply
Distress: one is aware of the correct course of action
but institutional constraints are a barrier
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Nursing Ethical Standards
International Council of Nurses (ICN) Code of Ethics
for Nurses 2012
American Nurses Association (ANA) Code of Ethics
for Nurses
ANA sponsors the Center for Ethics and Human
Rights which contains a repository of position
statements (Refer to Chart 1-9)
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Most Common Ethical Issues
Confidentiality
Use of restraints
Truth-telling
Refusing to provide care
End-of-life decisions and palliative care
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Question #3
What is the most appropriate way to establish trust
with a patient?
A. Only provide necessary information to the patient
related to procedures and diagnosis
B. Do not communicate the patient’s request to the
family
C. Use a compassionate and caring disposition when
discussing diagnosis with the patient and family
D. Administer placebos to prevent side effects of
narcotics
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Answer to Question #3
C. Use a compassionate and caring disposition when
discussing diagnosis with the patient and family
Rationale: A compassionate and caring disposition
helps to convey respect toward others and may help
ease emotional distress. You should provide the
patient all information about the care provided. With
the patient’s consent, you should also inform the
family of the patient’s request. Nurses should never
administer placebos.
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Patient Self-Determination
The Patient Self-Determination Act, 1991
o Advanced directives
o Living will
o Identification of a health care representative
o Physician orders for life-sustaining treatment
(POLST)
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Ethical Decision Making
Ethical dilemmas are common and diverse
No clear solutions
Fundamental philosophical principles
Approach to ethical decision making—Nursing
Process
Ethical analysis (Refer to Chart 1-10)
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