Definition of NursingDefinition of Nursing

• Nursing is the protection, promotion, Nursing is the protection, promotion, and optimization of health and and optimization of health and abilities, prevention of illness and abilities, prevention of illness and injury, alleviation of suffering through injury, alleviation of suffering through diagnosis and treatment of human diagnosis and treatment of human response, and advocacy in the care response, and advocacy in the care of individuals, families, communities, of individuals, families, communities, and populations (ANA, 2003)and populations (ANA, 2003)

Definition of NursingDefinition of Nursing

• Nursing encompasses autonomous and Nursing encompasses autonomous and collaborative care of individuals of all collaborative care of individuals of all ages, families, groups, and ages, families, groups, and communities, sick or well in all communities, sick or well in all settings. Nursing includes the settings. Nursing includes the promotion of health, prevention of promotion of health, prevention of illness, and the care of ill, disabled, and illness, and the care of ill, disabled, and dying people (International Council of dying people (International Council of Nurses, 2002).Nurses, 2002).

Definition of NursingDefinition of Nursing

• Advocacy, promotion of a safe Advocacy, promotion of a safe environment, research, participation environment, research, participation in shaping health policy and in in shaping health policy and in patient and health systems patient and health systems management, and education are also management, and education are also key nursing roles (ICN, 2002).key nursing roles (ICN, 2002).

Definition of NursingDefinition of Nursing

• Nursing = Care of OthersNursing = Care of Others

• Blend of Art and ScienceBlend of Art and Science

History of NursingHistory of Nursing

• Ancient Civilizations through the RenaissanceAncient Civilizations through the Renaissance– Illness had supernatural causesIllness had supernatural causes– Women delivered custodial care to familyWomen delivered custodial care to family– Medicine men treated diseaseMedicine men treated disease– As civilizations grew priests were seen as physiciansAs civilizations grew priests were seen as physicians– Under Christianity educated and wealthy women dedicated Under Christianity educated and wealthy women dedicated

themselves to care of the sickthemselves to care of the sick– Phoebe became the 1Phoebe became the 1stst Deaconess Deaconess– During the Crusades all-male military orders flourished and all-During the Crusades all-male military orders flourished and all-

female religious orders declinedfemale religious orders declined– During the Renaissance medicine moved into the UniversityDuring the Renaissance medicine moved into the University– Male nurses vanished from professionMale nurses vanished from profession– Home major locality for nursing careHome major locality for nursing care– Only poor hospitalized, cared for by prostitutes and female Only poor hospitalized, cared for by prostitutes and female

criminalscriminals

History of NursingHistory of Nursing

• Colonialism and RevolutionColonialism and Revolution– Physicians not required to have licensePhysicians not required to have license– Hospital care only available in citiesHospital care only available in cities– Mentally ill “warehoused”Mentally ill “warehoused”– More soldiers died in Revolutionary War More soldiers died in Revolutionary War

due to disease than woundsdue to disease than wounds

History of NursingHistory of Nursing

• IndustrializationIndustrialization– Population explosionPopulation explosion– Increased incidence illness, injury, and Increased incidence illness, injury, and

early mortalityearly mortality– Hospitals openedHospitals opened– Schools of nursing started: Sisters of Schools of nursing started: Sisters of

Charity, Kaiserworth school of nursing in Charity, Kaiserworth school of nursing in Germany 1836, Dr Joseph Warrington in Germany 1836, Dr Joseph Warrington in Philadelphia 1839Philadelphia 1839

History of NursingHistory of Nursing

• Influence of WarInfluence of War– Crimean war, notable for Florence NightingaleCrimean war, notable for Florence Nightingale– American Civil War, emergence of early American Civil War, emergence of early

nursing leadersnursing leaders– Training for nurses more apprenticeship than Training for nurses more apprenticeship than

education, hospital-based schools of nursingeducation, hospital-based schools of nursing– WWI, female nurses under control of male WWI, female nurses under control of male

hospital administrators and physicianshospital administrators and physicians– WWII, large # women working outside homeWWII, large # women working outside home– Increased need for nursesIncreased need for nurses– Move into university and college settingsMove into university and college settings

History of NursingHistory of Nursing

• Influence of WarInfluence of War– Korean War, growth of AD programs in Korean War, growth of AD programs in

community collegescommunity colleges– Vietnam War, expansion civilian Vietnam War, expansion civilian

hospitals, advancement of specializationhospitals, advancement of specialization– Concept of nursing diagnosisConcept of nursing diagnosis– Masters and PhD programs in nursingMasters and PhD programs in nursing

Current Trends in NursingCurrent Trends in Nursing

• Change in education, disappearance of hospital Change in education, disappearance of hospital based schools of nursingbased schools of nursing

• Nursing shortageNursing shortage• Evidence-based practiceEvidence-based practice• Decreased hospital length of stayDecreased hospital length of stay• Community based nursingCommunity based nursing• Aging populationAging population• Increase in chronic health conditionsIncrease in chronic health conditions• Culturally competent nursing careCulturally competent nursing care• Increase costs of health care/managed careIncrease costs of health care/managed care

Major Factors to Evolution of Major Factors to Evolution of NursingNursing

• Industrial revolutionIndustrial revolution

• WarsWars

• Closure of diploma programsClosure of diploma programs

• Nursing shortageNursing shortage

• Movement from inpatient to Movement from inpatient to outpatientoutpatient

• Increasing costs of health careIncreasing costs of health care

Florence NightingaleFlorence Nightingale

• Wealthy well-educatedWealthy well-educated

• In Crimean War reduced soldiers In Crimean War reduced soldiers mortality from 42.7% to 2.2% in 6 mortality from 42.7% to 2.2% in 6 monthsmonths

• Established training school for nursesEstablished training school for nurses

• Wrote books about healthcare and Wrote books about healthcare and nursing education “Notes on Nursing”nursing education “Notes on Nursing”

Florence NightingaleFlorence Nightingale

• 11stst Nursing Theorist Nursing Theorist• Nursing is separate and distinct from Nursing is separate and distinct from

medicinemedicine• All women are natural nursesAll women are natural nurses• Emphasized importance of Emphasized importance of

environment: fresh air, cleanliness, environment: fresh air, cleanliness, nutritionnutrition

• Maintained accurate records, 1Maintained accurate records, 1stst Nursing ResearcherNursing Researcher

Is Nursing a Profession?Is Nursing a Profession?

• Well-defined body of specific and unique knowledge that Well-defined body of specific and unique knowledge that undergoes continual growth through researchundergoes continual growth through research

• Services provided are vital to human beings and the Services provided are vital to human beings and the welfare of societywelfare of society

• Practitioners have autonomy and control their own policies Practitioners have autonomy and control their own policies and activitiesand activities

• Practitioners are motivated by the service they provide and Practitioners are motivated by the service they provide and consider their work important to their lives (altruism)consider their work important to their lives (altruism)

• Practitioners decisions and conduct are guided by a code of Practitioners decisions and conduct are guided by a code of ethicsethics

• Professional organization sets standardsProfessional organization sets standards• Practitioners receive education in institutions of higher Practitioners receive education in institutions of higher

learninglearning

Registered Nursing Registered Nursing EducationEducation• Diploma in NursingDiploma in Nursing

• Associate Degree in NursingAssociate Degree in Nursing

• Baccalaureate in NursingBaccalaureate in Nursing

• Direct entry Masters Degree in NursingDirect entry Masters Degree in Nursing

• Advanced practice Masters in NursingAdvanced practice Masters in Nursing

• PhD in NursingPhD in Nursing

Liberal Arts & NursingLiberal Arts & Nursing

NURSING

Physical Sciences

A & P Biology Microbiology Chemistry

Pathophysiology Food & Nutrition

Abnormal Psychology

Psychology SociologyGrowth & Development

Social Sciences

Humanities

Ethics Literature

HistoryPhilosophy

Pharmacology

Writing & Composition

Research

Mathematics & Statistics

Professional Nursing Professional Nursing OrganizationsOrganizations

• American Nurses Association (ANA): American Nurses Association (ANA): establishes standards of practice, establishes standards of practice, encourages research to advance encourages research to advance nursing practice, and represents nursing practice, and represents nursing for legislative actionsnursing for legislative actions

• National Student Nurses’ Association National Student Nurses’ Association (NSNA)(NSNA)– OSNAOSNA

Professional Nursing Professional Nursing OrganizationsOrganizations

• National League for Nursing (NLN): foster National League for Nursing (NLN): foster development and improvement of nursing development and improvement of nursing education; voluntary accreditationeducation; voluntary accreditation

• American Association of Colleges of American Association of Colleges of Nursing (AACN): national accreditation for Nursing (AACN): national accreditation for collegiate nursing programscollegiate nursing programs

• International Council of Nurses (ICN)International Council of Nurses (ICN)• Specialty Nursing Organizations: Sigma Specialty Nursing Organizations: Sigma

Theta Tau International Honor Society of Theta Tau International Honor Society of NursingNursing

Professional Organizations and Professional Organizations and Nursing ProcessNursing Process

• Term 1Term 1stst used in 1955 used in 1955• ANA Standards of Nursing PracticeANA Standards of Nursing Practice• Canadian Nurses Association standard of Canadian Nurses Association standard of

effective use of nursing processeffective use of nursing process• Joint Commission of Accreditation of Joint Commission of Accreditation of

Healthcare Organizations requires care Healthcare Organizations requires care documentation according to nursing documentation according to nursing processprocess

• ANA recommends educational programs ANA recommends educational programs incorporate nursing processincorporate nursing process

Nursing Process and Critical Nursing Process and Critical ThinkingThinking

• Nursing process provides a Nursing process provides a framework for critical thinkingframework for critical thinking

CRITICAL THINKINGCRITICAL THINKING

• Abstract conceptAbstract concept

• Learned thinking skillsLearned thinking skills

• Has a purposeHas a purpose

• Considers evidence, context, Considers evidence, context, past knowledge, alternatives, past knowledge, alternatives, creativitycreativity

WHY CRITICALLY THINK?WHY CRITICALLY THINK?

• Nursing is an applied disciplineNursing is an applied discipline

• Nursing draws on knowledge Nursing draws on knowledge from other fieldsfrom other fields

• Nurses deal with change in Nurses deal with change in stressful environmentsstressful environments

• Nurses make frequent, varied, Nurses make frequent, varied, and important decisionsand important decisions

CRITICAL THINKINGCRITICAL THINKING

• SKILLSSKILLS– Objectively gather informationObjectively gather information– Recognize need for more infoRecognize need for more info– Recognize gaps in own knowledgeRecognize gaps in own knowledge– Listen carefully; read thoroughlyListen carefully; read thoroughly– Separate relevant from irrelevant dataSeparate relevant from irrelevant data– Group info in meaningful wayGroup info in meaningful way– Draw tentative conclusionsDraw tentative conclusions

• SKILLS (cont)SKILLS (cont)– Integrate findings with previous Integrate findings with previous

knowledgeknowledge– Identify potential solutionsIdentify potential solutions– Evaluate each potential solutionEvaluate each potential solution– Choose best solutionChoose best solution– Carry out interventionCarry out intervention– Evaluate credibility and usefulness of Evaluate credibility and usefulness of

sources of infosources of infoSound like the problem-solving or scientific method?

CRITICAL THINKINGCRITICAL THINKING

• ATTITUDESATTITUDES– Independent thinkingIndependent thinking– Intellectual curiosityIntellectual curiosity– Intellectual humilityIntellectual humility– Intellectual courageIntellectual courage– Intellectual perseveranceIntellectual perseverance– Fair-mindednessFair-mindedness

STAGES OF SKILL STAGES OF SKILL ACQUISITIONACQUISITION• NoviceNovice

– Rule-governed, limited, inflexibleRule-governed, limited, inflexible– Total recall modeTotal recall mode

• Advanced BeginnerAdvanced Beginner– Notes recurrent aspectsNotes recurrent aspects– Beginning development of professional habitsBeginning development of professional habits

• CompetentCompetent– Able to recognize own thinkingAble to recognize own thinking– Able to analyze problemsAble to analyze problems– Lacks speed and flexibility of proficient nurseLacks speed and flexibility of proficient nurse– 2-3 years in setting2-3 years in setting

BENNER (cont)BENNER (cont)

• ProficientProficient– Perceives each situation as a wholePerceives each situation as a whole– Long-term goalsLong-term goals– Advanced level of critical thinkingAdvanced level of critical thinking– 3-5 years in setting3-5 years in setting

• ExpertExpert– Intuitive grasp of situationIntuitive grasp of situation– 5-15 years in setting5-15 years in setting

Patricia Benner: From Novice to Expert

OBSTACLESOBSTACLES

• Overuse of habit with questioning Overuse of habit with questioning “We’ve always done it that way”“We’ve always done it that way”

• AnxietyAnxiety

• Working under deadlinesWorking under deadlines

• Biases, own as well as patientBiases, own as well as patient

• Lack of confidence in own thinkingLack of confidence in own thinking

NURSING PROCESSNURSING PROCESS

• Structure for critical thinkingStructure for critical thinking

NURSING PROCESSNURSING PROCESS• AssessmentAssessment

• Nursing DiagnosisNursing Diagnosis

• Planning (expected Planning (expected outcomes)outcomes)

• Nursing InterventionNursing Intervention– Implementation of planImplementation of plan

• EvaluationEvaluation

NURSING PROCESSNURSING PROCESS

Assessment

Nursing Diagnosis

Planning

Intervention

Evaluation

Standards ofProfessional

PracticeANA code of Ethics

Evidence-BasedPractice