lecture 1: SBN + professional practice

an occupation who core element is work based upon mastery of body of knowledge and skills

knowledge is used in the service of others

governed by a code of ethics

altruism, autonomy, caring + compassion, commitment, competence, confidentiality, insight, openness, presence, respect for dignity/autonomy/resilience

ensuring the protection of the public

regulating and overseeing practice of profession

fostering development of profession

OIIQ - ordre des infirmières + infirmiers du Quebec

student + nursing permits

entry to practice exam

investigate complaints

education programs

create standards of practice

the practice of nursing consists in assessing a person's state of health, determining and carrying out of the nursing care and treatment plan, providing nursing + medical care and treatment in order to maintain or restore health and prevent illness, as well as provide palliative care

lists activities in the practice of nursing that are reserved to nurses (nurse's scope of practice)

guides our practice and defines our responsibilities toward protecting the public

knowledge - we have the responsibility for generating its own body of knowledge and it requires research

4 central concepts and the relationships between them

environment, nursing, person, health

indivisible, unique and evolving entity who acts in accordance with his choices, values, beliefs and to the best of his abilities. persons interrelate with other persons, the family, group, community, environment

dynamic + continuous process in which a person aspires state of equilibrium that fosters well-being and QOL

involves adaptation to multiple environmental factors, a learning process and commitment on the part of person and society

all components in persons surroundings with which that person interacts

includes physical (living environment), psychosocial (support), political and economic (laws), spiritual (values), cultural (ethnic origin) and organizational

dynamic process to maintain restore and improve health well-being + QOL, prevent illness, accidents, social problems, promote rehab.

process encompasses assessment + monitoring of persons physical/mental health, determination of therapeutic nursing plan, nursing care + treatment plan, information + professional advice

distinct belief/value system about nursing and its practice

address phenomena identified by metaparadigm

ONLY 1 metaparadigm but MANY theories

provide us with framework

guides practice: assessment, intervention, evaluation

guides curriculum + research

provides language: common terminology to use

enhances professional identity

NEEDS

person: humans have variety of NEEDS

environment: immediate physical surroundings

nursing: meeting NEEDS

health: linked to 14 fundamental needs

ADAPTATION

person: adapting to stimuli present as a result of their position on health-illness continuum

environment: constantly changing stimuli to which person adapts

nursing: promotion of client adaptation

health: way in which beings interact with + adapt to environment

theories

evidence informed knowledge

research

clinical guidelines

human interactions

caring

empirical - data from science

personal - relational (ability to relate/engage) + knowing oneself

aesthetic - understanding person's experience with illness + nurse actions tailored to person uniqueness + therapeutic relationship

ethical - adhering to code of ethics, knowing right/wrong, taking responsibility for actions

emancipatory - awareness of social problems, considers SDoH, taking action to create social change

efforts aimed at increasing peoples control over the things that affect their health

includes health education, nutrition, sanitation, advocacy, community participation + prevention of disease

help develop skills to improve and maintain their own health and well-being

build healthy public policy: unemployment insurance, child daycare

create supportive environments: safe living/working conditions, stimulating, enjoyable

strengthen community actions: empowerment of communities (social support + self-help)

developing personal skills: enable to learn, prepare themselves, to cope

reorienting health services: responsibility is shared among individuals, community groups, health pros, governments

universal access to care + coverage on basis of need

commitment to health equity as part of development oriented to social justice

community participation in defining and implementing health agendas

intersectional approaches to health

primary care: healthcare provided by pros (physician, nurse, NP); early detection, routine care, health promotion, prevention

secondary: usually in hospital, specialists (cardiologist, dermatologist...)

tertiary: more complex pathologies, teaching hospitals

nursing mandates: laws, code of ethics, standards

nursing theories/approaches/conceptual models

education background

nurse's beliefs, assumptions and values

work and life experience

work environment

approach to nursing guided by 8 core values

collaborative + strength based approach

approach that considers whole person

- focuses on what is working

- focuses on what person does best

- focuses on resources available to person

focus on what is working

avoid labels

uses strengths to build confidence to deal

person involved in choosing solutions

positive language

collaborative partnership

values subjective + objective info

knowledge created through experience and reflection

plan of care built on person strengths

person + family determines outcome

place person at centre of own care (person-centred care)

empowers ppl to achieve their own goals (empowerment)

encourages to take charge and be responsible of their own health recovery and healing (health promotion, prevention + self care)

collaborative relationship between pt + healthcare provider (collaborative partnership)

works with persons strengths to help them deal + meet goals

person/family entered care

empowerment

relational care

innate health and healing

providing care that is respectful of and responsive to pt preferences, needs and values, and ensuring the pt values guide clinical decisions

place pt at centre of care

pt is engaged + involved in decision making

pt beliefs + values respected

pt given opportunity to talk about his experience living w/health issue

care is tailored to unique needs/concerns

health challenges understood within person context

a social process of recognizing, promoting, and enhancing peoples abilities to meet their own needs, solve their own problems, and mobilize the necessary resources in order to feel in control of their life

by working with strengths, uncovering new strengths, helping turn deficits into strengths, the nurse helps person experience greater control over their health + helps them attain their health goals

ppl are born w/capacities, potential to heal, grow and thrive

innate abilities include the ability to form relationships, emotional regulation, curiosity, need to learn

abilities develop over lifespan, they help adapt, develop and cope with adversity

nurses promote support, supplement restore and help develop persons capacities and natural healing processes (inner strengths)

everything a nurse sees, does and experiences arises from relationship with pt

SBN values nurse-pt relationship

holism and embodiement

reality and created meaning

self determination

learning/readiness/timing

collaborative partnership

health and healing

uniqueness

environement

nurses promote health and healing and alleviate suffering

health = being in state of balance/harmony, NOT absence of illness, encompasses ones physical, psychological, spiritual well-being

when person not in state of equilibrium, they are healing their state of harmony

ex: how would u describe your health? what kind of things do you do to feel better?

nurses respect + acknowledge persons uniqueness by getting to know the pt in their care

curious to know what makes a person who they are, what is diff apt their experience, what Sx are like for them, how they have responded in the past

ex: how do you usually respond to this Tx?

nurses address the persons environment in order to provide quality care: the internal, physical cultural and social environments are all considered

the quality of ones environment will affect ones health and healing; people thrive when there is a goodness of fit between them and their environment

ex: how is your family affected by your illness?

nurses view person as a whole, they explore all aspects of individuals health challenge - how it impacts their psychological and physical states - because nurses recognize mind-body connection

ex: how is your health concern affecting your mood?

nurses look at persons objective data + subjective reality and meaning they have created to understand situation

must explore persons understanding of his experience to create complete picture of person + provide care in a sensitive/meaningful/responsive way

ex: what do you think is contributing to your health concern

nurses value the pt's choices and believe the decisions are best made when pt + families are well informed

ex: what info would help u make ur decision?

nurses recognize that learning is essential for a person to navigate his environment + to live to their fullest

nurses need to know their pt to be able to determine when an intervention is most likely to be successful; readiness to learn is linked to timing

ex: is this a good time to find ways to address this health concern?

nurses view the nurse-pt relationship as collaborative: both involved in setting goals, developing plan + evaluating outcomes

nurses learn from patients + other way around

each partner brings own knowledge skill + experiences to relationship and is open to learning from each other; built on mutual respect + trust

ex: tell me how I can help

cooperation = planning + working together in a helpful way: person can be unassertive, passive but be cooperating

collaboration = cooperation but also assertiveness and active involvement

sharing power

open + respectful

being non judgemental

living with ambiguity

being self aware and reflective

the heart of a collaborative partnership

both partners set agenda + determine plan

both partners share responsibility

info and knowledge flow in both directions

willingness to develop a relationship with each other

willing to share info, ideas + perspectives

willing to experiment, change + learn

respects knowledge, skill, experience, expertise of other

honouring differences + looking for common ground to manage differences

showing tolerance for others beliefs, values, behaviours and perspectives

try to understand other persons perspectives

there are 2 drivers

not clear to either partner how situation will unfold

both must be able to tolerate uncertainty and unpredictability

both must be flexible and adaptable

requires both self awareness + awareness from other

need to be aware of dynamics + impact of ones behaviour having on other

using reflection