NURS 402 | Fundamentals of Nursing | Week 1 Week 1 Lecture Outline and Topics Paradigm of Nursing Scope and standards of practice Code of ethics Foundations of Nursing practice acts Professional Nursing process Nursing Nursing theory Practice Health and wellness Model of health promotion and illness prevention Never Events HIPAA “Nursing is the protection, promotion, and optimization of health and abilities, prevention of illness and injury, facilitation of healing, alleviation of suffering through the diagnosis and treatment of human response, and advocacy in the care of individuals, families, groups, communities, and population” -The American Nurses Association (ANA) Care vs. Cure “The patient can google doctors, but cannot google nurses” Dr. J.P Paradigm of Nursing Four elements 1.Person (physical, emotional, social, and spiritual dimensions) 2.Environment 3.Health 4.Nursing Nursing Roles in All Settings •Caregiver •Communicator •Teacher/educator •Counselor •Leader •Researcher •Advocate •Collaborator “The Lady of the Lamp” Florence Nightingale Nightingale’s contributions: The Birth of Modern Nursing •Identifying the personal needs of the patient and the role of the nurses in meeting those needs •Establishing standards for hospital management •Establishing a respected occupation for women •Establishing nursing education •Recognizing the two components of nursing: health and illness •Believing that nursing is separate and distinct from medicine •Recognizing that nutrition is important of health •Instituting occupational and recreational therapy for sick people •Stressing the need for continuing education for nurses •Maintaining accurate records, recognized as the beginning of nursing research Leaders in American Nursing Growth of Nursing in the US: •Clara Barton (1821-1912)- founded American Red Cross •Linda Richards (1841-1930)- First American trained nurse. Developed nurse’s notes •Mary Mahoney (1845-1926)- First African American Professional Nurse •Lillian Wald (1867-1940)-Founder of public health nursing. Henry St. Settlement •Lavinia Dock (1858-1956)- Women’s rights; campaigned for legislation to allow nurses to control their own practice. •Margaret Sanger (1879-1966)- Public health nurse in NY, founder of Planned Parenthood •Mary Breckinridge (1881-1965)- established Frontier Nursing Service Development of Nursing The 20th century: The 21th century: •Movement toward scientific, research-based practice •Nursing Code of Ethics and defined body of knowledge •Changes in curriculum •Nursing in multiple care settings Historical Perspective Highlights Nurses: •Respond to needs of clients •Actively participate in policy •Respond and adapt to challenges Societal Influences on Nursing •Demographic changes •Women’s health care issues •Human rights •Medically underserved •Cultural diversity •Health promotion •Threat of bioterrorism and a global pandemic Nursing as a Profession A profession has characteristics: •Requires an extended education •Requires a body of knowledge •Provides a specific service •Has autonomy •Incorporates a Code of Ethics The 5 Core Professional Nursing Values -The American Association of Colleges of Nursing (AACN) •Human Dignity •Integrity •Autonomy •Altruism •Social Justice Code of Ethics •Developed as a guide for carrying out nursing responsibilities in a manner consistent with quality in nursing care and the ethical obligations of the profession. •As a nursing student you are held to the American Nurses Association (ANA) code of ethics. ANA Scope and Standards of Practice •Provides parameters for practice •It contains 17 national standards of Practice and performance which define the Who, What, Where, When, Why, and How of nursing practice. •It outlines key aspects of nursing’s professional role and practice for any level, setting, population focus, or specialty. Nurse Practice Acts •Nurses, like other licensed professionals, are regulated by various state laws. •Nursing practice acts originated to protect the public from unsafe and unlicensed practice, by regulating nursing practice and nursing education. • Nursing practice acts define nursing, set standards for the nursing profession and give guidance regarding scope of practice issues. As such, the state nursing practice act is the single most important piece of legislation affecting nursing practice. •Nursing practice acts are not checklists. They contain general statements of appropriate professional nursing actions. Professional Licensure New York State Registered Professional Nurse (RN) may: •diagnose and treat a patient’s unique responses to diagnosed health problems; •perform health assessments to identify new symptoms of possibly undiagnosed conditions or complications, •teach and counsel patients about maintenance of health and prevention of illness or complications; •execute medical regimens as prescribed by licensed physicians, dentists, nurse practitioners, physician assistants, and podiatrists, and, •contribute as members of an interdisciplinary health care team and as consultants on health related committees to plan and implement the health care needs of consumers. Interprofessional Collaborative Practice Why do we need interprofessional collaboration? World Health Professions Alliance: - Interprofessional Collaborative Practice https://www.whpa.org/activities/interprofessional-collaborative-practice World Health Organization: - Framework for action on interprofessional education & collaborative practice https://www.who.int/publications/i/item/framework-for-action-on-interprofessional-education-collaborative-p ractice Week 1 assignment: Discussion - Understanding & Promoting Interprofessional Practice & Collaboration The Nursing Process Purpose: a nurse follows the nursing process to organize and deliver nursing care. •Use of this process allows the nurse to integrate elements of critical thinking to make judgment and take actions based on reason. •The nursing process is client-centered and goal oriented. •The nursing process is a variation of scientific reasoning that allows nurses to organize and systematize nursing practice. Steps of Nursing Process 1.Assessment (what is the situation?) 2.Nursing Diagnosis (what is the problem?) 3.Planning (how to fix the problem?) 4.Implementation (putting the plan into action) 5.Evaluation (did the plan work?) Nursing Theory •Provides nurse with a distinct health care identity when collaborating with other healthcare professionals •Informs nursing practice •Ensures consistent and constancy of professional nursing practice across clinical settings •Nursing theory builds upon theories in other disciplines i.e. psychology, sociology •Nursing theories are; - Central focus of nursing is the client - Goal of nursing is to promote and maintain health Nursing Theory Development Florence Nightingale (the first nurse theorist) (1820-1910) •Creating a supportive environment •to aid healing process •Nurse’s function was to put the patient in the best condition for nature to act upon him/her •Nursing is based on knowledge of the patient and his/her surroundings •Nursing knowledge distinct from medical knowledge 1950’s nursing began to develop, articulate and test nursing theory. Levels of Nursing Theory Nursing Theory, Research, Education, and Practice Selected Nursing Theorist: Grand Theory Sister Callista Roy: Adaptation Model •Four adaptive modes: - Physiological - Self-concept-group identity - Role function mode - Interdependence mode •Identifying types of demands placed on the client, assessing adaptation to demands, helping client to adapt. Dorothea Orem: Self Care Deficit Theory •Theory of self care: How and why people care for themselves •Theory of self care deficit: Why people can be helped through nursing •Self-care is a human need; self-care deficits require nursing actions - Nursing is a human service, and nurses design interventions to provide or to manage self-care actions for sustaining health or recovering from illness or injury Middle-Range Theory: Example Theory of Chronic Sorrow: Georgene Gaskill Eakes •The theory was developed to help analyze individual response of people experiencing ongoing disparity due to chronic illness, caregiving responsibilities, loss of child, or bereavement. •The sorrow is cyclic or recurrent and brings to mind a person’s losses, disappointments, or fears. oAntecedent to chronic sorrow is experience of a significant loss. - The loss is ongoing with no predictable end. oDisparity is created when the reality is different from the idealized. - Trigger events (e.g., milestones, situations, and conditions that create negative disparity) exacerbate the experience of disparity. Practice-Level Theory: Examples •Theory of Asian Immigrant Women’s Menopausal Symptom Experience in the U.S.: Eun-Ok Im •Theory of Transition Shock: Judy Dechscher Practice-Level Theory is; 1.Low level of abstraction, 2.Reflection of specific nursing phenomena, 3.Context, 4.Connection to research and/or practice, 5.Incorporation of diversities, and 6.Limits in generalization Evidence Based Practice The conscientious use of current best evidence in making decisions about the care of patients •Informed, collaborative, and patient-centered Four components 1.Best practices-derived from consensus statements from experts (clinicians and researchers) 2.Evidence-from scientific findings in research studies 3.Clinical expertise of professional nurses 4.Preferences and values of patients and families Concept of Health and Wellness Health is a state of complete physical, mental, and social well-being, not merely the absence of disease or infirmity (Word Health Organization, 1974) Disease vs. Illness: •Disease is a medical term, referring to pathologic changes in the structurer/function of the body or mind. (See page 57, Box3-1: Common causes of diseases) •Illness is the response of the person to a disease. •Acute illness vs. Chronic illness Disparities in Health Care A health disparities: Particular type of health difference that is closely linked with social, economic, and/or environmental disadvantage. (Healthy People 2020, Disparities) Social determinants of health: The conditions in the environments in which people are born, live, learn, work, play, worship, and age that affect a wide range of health, functioning, and quality of life outcomes and risks. •Economic stability, Neighborhood and physical environment, Education, Food, Community and social context, Healthcare system (See page 60, figure 3-3) Health Promotion and Illness Prevention Level Topic Primary Weight loss, Diet, Exercise, Smoking cessation, Immunization, Family safety, Safer sex practices, Prevent alcohol and illicit drugs, etc. Secondary Screening (blood pressure, cholesterol, HIV, glaucoma, skin cancer), Pap smears, Mammograms, Family counseling, etc. Tertiary Medication, Medical therapy, Surgical treatment, Rehabilitation, Physical/occupational therapy, etc. Restorative Care and Continuing Care •Serves clients recovering from an acute or chronic illness/disability •Helps individuals regain maximal function and enhance quality of life •Promotes patient independence and self-care ability •Requites multidisciplinary approach •For people who are disabled, functionally dependent, or suffering a terminal disease •Available within institutional settings or in the home Issues in Health Care Delivery •Nursing-sensitive outcomes - Nursing-sensitive Care: http://www.qualityforum.org/Publications/2004/10/National_Voluntary_Consensus_Standards_for_Nursin g-Sensitive_Care__An_Initial_Performance_Measure_Set.aspx •Client satisfaction Example: The HCAHPS (Hospital Consumer Assessment of Healthcare Providers and Systems) survey - HCAHPS: Patients' Perspectives of Care Survey: https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/HospitalQualityInits/Hos pitalHCAHPS •Technology in health care •Globalization of health care Never Events (NQF) Serious Reportable Events: extremely rare medical errors that should never happen to a patient. ØList of 29 events by the National Quality Forum (2011): https://www.qualityforum.org/Topics/SREs/List_of_SREs.aspx The SREs focus on 7 areas (full list posted on Classes) 1.Surgical or invasive procedure events 2.Products or device events 3.Patient protection events 4.Care management events 5.Environmental events 6.Radiologic events 7.Potential criminal events Never Events (CMS) Center for Medicare and Medicaid Services (CMS) stopped reimbursement to the hospitals for 8 never events (2008) 1.Vascular catheter associated infection 2.Pressure injuries (ulcers) 3.Surgical site infections (mediastinitis after CABG) 4.Hospital acquired injuries (falls, fractures, burns) 5.Objects left in surgery (sponges, towels, needles) 6.Blood incompatibility 7.Air embolism 8.Cather associated urinary tract infection HIPAA (see p. 151 Box 7-2) HIPAA: Health Insurance Portability and Accountability Act (2002) •The HIPAA Privacy Rule provides federal protections for individually identifiable health information held by covered entities and their business associates •The HIPAA Privacy Rule provides patients an array of rights with respect to that information. •The Privacy Rule is balanced so that it permits the disclosure of health information needed for patient care and other important purposes. •The Security Rule specifies a series of administrative, physical, and technical safeguards for covered entities and their business associates to use to assure the confidentiality, integrity, and availability of electronic protected health information. PHI: “Individually identifiable health information” is information, including demographic data, that relates to: •the individual’s past, present or future physical or mental health or condition, •the provision of health care to the individual, or •the past, present, or future payment for the provision of health care to the individual, •and that identifies the individual or for which there is a reasonable basis to believe it can be used to identify the individual. •Individually identifiable health information includes many common identifiers (e.g., name, address, birth date, Social Security Number) What Happens if You Violate HIPAA? •The HHS Office for Civil Rights (OCR) enforces the HIPAA Privacy, Security, and Breach Notification •Violations may result in the imposition of civil monetary penalties. In some cases, criminal penalties may apply, enforced by the Department of Justice. Maintaining Patient Privacy •When discussing medical information with the patient, doing so in an unused room whenever possible •Speaking quietly when discussing the patient's condition with him or the family when in a semi private room •By avoiding the use of patients' names in public hallways and elevators, and posting signs to remind employees to protect patient confidentiality •By isolating or locking file cabinets or records room; or •By providing additional security, such as passwords, on computers maintaining personal information. •When using medical records they are not to be left unattended in areas where others can see them. This is important at nursing stations, public areas, and locations of heavy traffic. •Medical information or records should not be visible on an unattended computer monitor. •When discarding paper patient information, assure that information is shredded and located in a secure place.
