Nursing and Health Care

HISTORY OF NURSING
1. In 1200 B.C., the ill were treated with a mixture of physical, prayer, and magic spells. Temples were health centers. From the 1st-10th century initial care was at the local bishop’s house. They had deacons and deaconesses. In the 19th century, nurses cared for patients while at the risk of exposure to disease. Nursing in hospitals expanded in the 19th century, but nursing the communities did not increase significantly until 1893 when the Henry Street Settlement opened and focused on the health needs of poor people who lived in tenements in New York City.
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3. 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.
4. She saw the role of nursing as having “charge of somebody’s health” based on the knowledge of “how to put the body in such a state to be free of disease or to recover from disease.” She was the first nurse epidemiologist who connected poor sanitation with cholera and dysentery.
5. There were no standards to help control disease. Nursing was not a distinct profession.
6. Florence Nightingale-implemented methods to improve battlefield sanitation, which ultimately reduced illness, infection, and mortality. Clara Barton- 1st woman to gain employment in the federal government and is the founder of the American Red Cross and tended to soldiers on the battlefield, cleansing their wounds, meeting their basic needs and comforting them in death. Dorothea Lynde Dix-School teacher, founded schools, advocate for the mentally ill, formed an army nursing corps, and organized hospitals and ambulatory services. Mary Eliza Mahoney- 1st African-American RN in the USA, concerned with relationships between cultures and races, Cofounder of The National Association of Colored People. Isabel Hampton Robb- founder of modern ANA and American nursing theory, established nursing standards, develop a grading policy, author of nursing textbooks. Lillian Wald and Mary Brewster opened the Henry Street Settlement.
7. Theories are designed to explain a phenomenon such as self-care or caring. A nursing theory is a conceptualization of some aspect of nursing that describes, explains, predicts, or prescribes nursing. It helps to identify the focus, means, and goals of practice. Theories give us perspective for assessing our patients’ situations and organizing data and methods for analyzing and interpreting information. Integration of theory into practice is the basis for professional nursing.

PROFESSIONALISM
1. Caring, Competence, Collaboration, Critical thinking, Commitment to Holistic care, Integrity, Responsibility, and Accountability.
2. A profession requires a basic liberal foundation and an extended education of its members, it has a theoretical body of knowledge leading to defined skills, abilities, and norms, it provides a specific service, members of a profession have autonomy in decision making and practice, and the profession as a whole has a code of ethics for practice.
3. LPN
Associate Degree in Nursing (ADN)- 2 year program that focuses on the basic sciences and theoretical and clinical courses related to the practice of nursing.
Bachelor of Science in Nursing (BSN)- 4 year programs that focuses on the basic sciences; theoretical and clinical courses; and courses in the social sciences, arts, and humanities to support the nursing theory
Master’s Degree- is important for the roles of a nurse educator and nurse administrator, and it is required for an advanced practice registered nurse
Doctoral
* Doctor of Philosophy (PhD)- Emphasize more basic research and theory and research-oriented * Doctor of Nursing Practice (DNP)- practice-focused and provides skills in obtaining expanded knowledge through the formulation and interpretations of evidence-based practice
4. Caregiver- help patients maintain and regain health, manage disease and symptoms, and attain a maximal level function and independence through the healing process.
Advocate- protect your patient’s human and legal rights and provide assistance in asserting these rights if the need arises.
Educator- explain concepts and facts about health, describe the reason for routine care activities, demonstrate procedures such as self-care activities, reinforce learning or patient behavior, and evaluate the patient’s progress in learning.
Communicator- it allows you to know your patients’ strengths, weaknesses, and their needs. Without it you cannot give comfort and emotional support, make decisions with patients and families, give care effectively, protect patients from threats to well-being, coordinate and manage patient care, assist in patient rehabilitation, or provide patient education.
Manager- uses appropriate leadership styles to create a nursing environment for the patients and staff that reflect the mission and values of the health care organization.
5. Licensure- Must pass NCLEX to receive license. This provides a standard minimized knowledge base for nurses.
6. Certified by national nursing organizations in about 20 specific areas of nursing practice. After passing an exam, maintain certification by completing CEU’s.
7. According to Benner, an expert nurse passes through five levels of proficiency when acquiring and developing generalist or specialized nursing skills. Novice-beginning nursing student learns via a specific set of rules or procedures. Advanced Beginner-Nurse has had some level of experience, may be observational, but is able to identify meaningful aspects or principles of nursing care. Competent- establish long-range goals, and has been in the same position for 2-3 years with an understanding of organization and specific care required by the type of patient. Proficient- Same clinical position for 2-3 years, focuses on managing care, and is able to assess an entire situation and can readily transfer knowledge gained from multiple previous experiences to a situation. Expert-can focus on multiple dimensions of a situation and has an intuitive grasp of an existing or potential clinical problem. Skilled at identifying patient-centered problems and problems related to the health care system.
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9. Advanced Practice Nurse-most independent nurse, has master’s degree in nursing; advanced education in pathophysiology, pharmacology, and physical assessment; and certification and expertise in a specialized area of practice-clinical nurse specialist, certified nurse practitioner, certified nurse midwife, and certified RN anesthetist.
Nurse Educator-works primarily in schools of nursing, staff development department of health care agencies, and patient education departments. Must have experience in clinical practice to provide them with practical skills and theoretical knowledge.
Nurse Administrator- manages patient care and the delivery of specific nursing services within a health care agency. Examples: assistant nurse manager, nurse manager, house supervisor, director of nursing, and chief nurse executive or vice president.
Nurse Researcher- investigates problems to improve nursing care and further define and expand the scope of nursing practice.
10. National League for Nursing-advances excellence in nursing education to prepare nurses to meet the needs of a diverse population in a changing health care environment.
American Nurses Association- improves standards of health and availability of health care, to foster high standards for nursing, and to promote the professional development and general and economic welfare of nurses.
International Council of Nursing- promote national associations of nurses, improving standards of nursing practice, seeking higher status for nurses, and providing an international power base for nurses.
National Student Nurses Association/ Student Nurse Association of PA- consider issues of importance to nursing students such as career development and preparation for licensing.
Specialty Organizations- seek to improve the standards of practice, expand nursing roles, and foster the welfare of nurses within specialty areas. Publish journals and present educational programs.
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12. Problem-solving approach to clinical practice that involves the conscientious use of current best evidence, along with clinical expertise and patient preferences and values in making decisions about patient care.
13. Ask a clinical question that is problem focused. Collect the most relevant and best evidence. Critically appraise the evidence you gather. Integrate all evidence with one’s clinical expertise and patient preferences and values in making a practice decision or change. Evaluate the practice decision or change. Share knowledge.
LEGAL ISSUES IN NURSING PRACTICE
1. Statutory Law- written by state legislature and U.S. Congress-may be a civil or criminal offense. Civil laws protect the rights of individuals within our society and provide for fair and equitable treatment when civil wrongs or violations occur. Fines or community service and examples are malpractice or negligence. Criminal laws protect society as a whole and provide punishment for crimes, which are defined as municipal, state, and federal legislation-felony or misdemeanor. Administrative Law (Regulatory Law)-reflects decisions made by administrative bodies such as State Boards of Nursing when they pass rules and regulations. Common Law-results from judicial decision made in courts when individual legal cases are decided-informed consent, patients right to refuse treatment, negligence, and malpractice.
2. Federal laws- body of laws that were created by the federal government of the country. Emergency Medical Treatment and Active Labor Law (EMTALA)- when patient comes to emergency department an appropriate medical screening occurs within the capacity of the hospital- cannot discharge or transfer patient until they are stable. The Health Care Quality Improvement Act of 1986. Patient Bill of Right- became patient care partnership given out to patients. The Americans with Disabilities Act (ADA)- prohibits discrimination and ensures for persons with disabilities equal opportunities in employment, state and local government services, public accommodations, commercial facilities, and transportation. People with HIV do not have to disclose their disability. Patient Self-Determination Act (PSDA)-requires health care institutions to provide written information to patients concerning their right under state law to make decisions including the right to refuse treatment and formulate advance directives. Patients records need to document whether or not the patient has signed an advance directive. For living wills or durable powers of attorney for health care to be enforceable, the patient must be legally incompetent or lack to the capacity to make decisions regarding health care treatment. Health Insurance Portability and Accountability Act (HIPAA)-protects individuals from losing their health care insurance when changing jobs by providing portability. These rules create patient rights to consent to the use and disclosure of their protected health information, to inspect and copy one’s medical record, and to amend mistaken or incomplete information.
State Laws-Mandatory Reporting Laws-communicable diseases, school immunizations, suspected neglect and abuse, legal immunity provided to the reporter, may face civil or criminal action if nor reported. Good Samaritan Laws-limit liability and offer legal immunity if a nurse helps at the scene of an accident. Nurse Practice Act- describe and define the legal boundaries of nursing practice within each state. Scope of Practice-perform a procedure in which you have training for, distinguishes between nursing and malpractice.
3. RN-licensed and educated in nursing process and critical thinking; responsible for who you delegate to. LPN- licensed but does not cover assessment of patient. Can collect data but must give to nurse. NA/PCT- not licensed
4. Standards of care are set by ANA and are the legal requirements for nursing practice that describe the minimum acceptable nursing care. Nurse practice act defines scope of nursing practice, distinguishing between nursing and medical practice and establishing education and licensure requirements for nurses. Internal-Standards defined within hospital. External- developed by ANA and TJC-accredited body of the hospital-health department.
5. Established to help accredited organizations address specific areas of concern in regards to patient safety. Identify patients correctly. Improve staff communication. Use medicines safely. Prevent infection. Identify patient safety risks. Prevent mistakes in surgery.
6. Advance directive include living wills, health care proxies, and durable powers of attorney for health care. They are based on values of informed consent, patient autonomy over end-of-life decisions, truth telling, and control over the dying process.
7. Living wills represent written documents that direct treatment in accordance with a patient’s wishes in the event of a terminal illness or condition. The patient is able to declare which medical procedures he or she wants or does not want when terminally ill or in a vegetative state. Durable Power of Attorney for health care is a legal document that designates a person or persons of one’s choosing to make health care decisions when the patient is no longer able to make decisions on his or her own behalf.
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10. Negligence is conduct that falls below a standard of care. Courts define negligence cases as the degree of care that an ordinarily careful and prudent person would use under the same or similar circumstances.
11. Malpractice is a type of negligence and is often referred to as professional negligence. When nursing care falls below a standard of care, nursing malpractice occurs.
12. Assault- any action that places a person in apprehension of a harmful or offensive contact without consent. Battery-any intentional touching without consent. False Imprisonment-unjustified restraint of a person without legal warrant and requires the patient be aware of confinement. Defamation of Character- publication of false statements that result in damage to a persons’ reputation. Invasion of Privacy- the release of a patient’s medical information to an unauthorized person such as a member of the press, the patient’s employer, or the patient’s family. Breach of Confidentiality-