Meet the Nguyens
T
hroughout this text, you will be applying what you have learned as you care for the
Nguyen family. In Chapter 1, you will meet Nam Nguyen, a construction work supervisor,
who arrives at the Family Medicine Center for his first physical exam in 10 years. It is
Mr. Nguyen’s knee pain that causes him to seek help because it affects his work. But as you
will see, Mr. Nguyen will discover he has other serious health problems that require him to
be more vigilant about his health. As you read and work through the exercises in Caring for
the Nguyens, you will also get to know Nam’s wife, Yen Nguyen, his grandchild Kim Phan,
other members of his extended family, and his friends, as they deal with health issues and
life changes.
Your experience in caring for the Nguyens will show you that patients come to you with
symptoms, but each person brings unique values, lifestyle, and relationships to the encounter.
From the Nguyens, you will learn what it means to care for the whole person and how to be a
full-spectrum nurse.
Mr. Nam Nguyen
is a new patient at the Family Medicine Center. He arrives at
the center for a scheduled physical exam and completes the following admission
questionnaire.
Please list your current medications and dosages. Also list over-the-counter and herbal products you use regularly.
Ben-Gay Balm on knees
Ibuprofen
MultiVitamin 1 per day
Acetaminophen
Nam Nguyen
Yen
Construction supervisor
Daycare teacher
The Diagnosis
During the visit, the clinic nurse records the following
information in Mr. Nguyen’s chart:
Height
5 ft 4 in.
Weight
165 lb (75 kg)
BP
162/94 mm Hg
Pulse
84 beats/min
RR
20 breaths/min
Temp
98.2°F oral
Pr e s e n t i n g C o m p l a i n t : Patient states he is here to
become established as a patient at the center and
that he has not had a physical exam in over 10 years.
Wife accompanies. He is currently experiencing bilateral
knee pain that is affecting his work performance. “I am
a building inspector. To check on things, I have to climb
up and down ladders, lift things, and crawl around
a lot.” Has not missed any work but has been using
increasing amounts of acetaminophen and ibuprofen
“to get through the day.” The medications provide only
limited relief. States pain occurs daily even if not at
work. Describes the pain as “achy” and “dull.” Feels best
when he is off his feet. Desires pain relief and checkup.
Explains that both parents had heart disease. Wife
expressing worry that he may be developing heart
problems “because he’s so tired after work and he
gets short of breath easy.”
The nurse explains to Mr. Nguyen that he will be seen
by the nurse practitioner shortly. She asks Mr. Nguyen if
he would like his wife to be present for the exam. He
answers yes.
Zach Jackson, MSN, FNP, is on duty at the center today.
Zach worked as an RN for more than 10 years in the
local emergency department and urgent care clinic. He has
been a family nurse practitioner (FNP-BC) for more than
5 years. Zach enters the room and introduces himself to the
Nguyen couple. To begin the exam, Zach reviews the
information Nam supplied on the admission form, and
then asks him about his family history.
Zach:
“Are your parents still living?”
Nam:
“Yes, they’re both alive. My father is
80 years old and my mother is 76.”
Zach:
“I’d like to hear a little more about your
family history. Tell me about your father’s
cancer. How old was he when he was first
diagnosed? Has he had treatment?”
Nam:
“He was probably about 60 when he first
found out about it. I know he had some
kind of surgery and takes medicines but
I don’t know the details. He seems all right
though.”
Zach:
“Your father also has high blood pressure and
heart disease. Please tell me a little more
about that.”
Nam:
“My father and mother both have high blood
pressure and heart disease. They both
take medicines for their blood pressure.
My father had a small heart attack about
10 years ago. My mother has never had a
heart attack that I know of, but she
sometimes has chest pain.”
Jordan:
“Your mother also has diabetes?”
Nam:
“She’s had that for a long time. A lot of
people in his family, especially on my
father’s side, have diabetes but nobody in
my mother’s family. Yet my mother is the
one with the diabetes!”
Yen:
“A lot of people in my family have diabetes
too. But so far I’m OK, I think.
Zach:
“Have you had a health exam lately,
Mrs. Nguyen?”
Yen:
“Not in about a year, but I’m going to
schedule an appointment here.”
The Nguyen couple and Zach continue to review the
health information. After reviewing the history and
discussing current complaints, Zach performs a complete
physical exam.
1
Nursing Past & Present
2
Critical Thinking & the Nursing Process
3
Nursing Process: Assessment
4
Nursing Process: Diagnosis
5
Planning Outcomes
6
Planning Interventions
7
Implementation & Evaluation
8
Theory, Research, & Evidence-Based Practice
unit
1
C H A P T E R
1
Nursing Past & Present
➤Describe the role of religion in thedevelopment of nursing.
➤Identify the factors that led to the change of nursing from a vocation of both men and women to a
predominantly female profession.
➤Explain the role of the military in the development of the nursing profession.
➤Define nursing in your own words.
➤Discuss the transitions that nursing education has undergone in the last century.
➤Differentiate among the various forms of nursing education.
➤Explain how nursing practice is regulated.
➤Give four examples of influential nursing organizations.
➤Name and recognize the four purposes of nursing care.
➤Delineate the forces and trends affecting contemporary nursing practice.
If you were assigned readings in the
Expanded Discussion on DavisPlus, you
should also be able to demonstrate the
following outcomes:
➤Describe the healthcare delivery system in the United States, including sites for care, types of workers, regulation, and financing of healthcare.
➤Name nine expanded roles for nursing.
➤Discuss issues related to healthcare reform.
Learning Outcomes
After completing this chapter, you should be able to:
5
Key Concepts
Nursing Nursing image
Contemporary nursing education Contemporary nursing practice
Related Concepts
See the Concept Map at the end of this chapter.
Caring for the Nguyens
This feature allows you to practice the kind of thinking you will use as a full-spectrum nurse. There is usually more than one correct answer to a critical thinking question, so we do not provide answers for these features. It is more important to develop your nursing judgment than to “cover content.” Discuss the questions with your peers. If you are still unsure, consult your instructor.
Review the opening scenario in the front of the book. On
the preliminary visit of Nam Nguyen at the Family Medicine
Center, he is examined by Zach Jackson, MSN, FNP-BC.
A.
How would you respond to Nam’s concern that he was
examined by someone who is “just a nurse”?
B.
What factors might be causing Mr. Nguyen to question
care by “a male nurse”?
Go to
Caring for the Nguyens Response Sheet on
DavisPlus.
ThinkLike a Nurse
1-1
The Quality and Safety Education for Nurses (QSEN) project and the Institute of Medicine (IOM) have identified quality and safety competencies for nurses: (1) patient-centered care, (2) teamwork and collaboration, (3) evidence-based practice, (4) quality improvement, (5) safety, and (6) informatics (Cronenwett, Sherwood, Barnsteiner, et al., 2007). Which
of these did Florence Nightingale demonstrate? Explain your thinking.
ABOUT THE KEY CONCEPTS
The overarching concept for this chapter is the definition of nursing. As you come to understand other key concepts (i.e., nursing images, contemporary nursing education, and
Nurses Make a Difference . . .
Then & Now
Time: 1854, Üsküdar (now part of Istanbul, Turkey)
in the Crimea
The hospital tent is set up away from the battlefield.
The injured and dying soldiers are lying on the bare
earth, soiled and covered with crusted blood. The rank
odor of disease and death are inescapable in the stifling
hospital tent. Scanning the scene, Florence Nightingale
and her staff of 38 nurses review the environment in
the tent, the health problems of the soldiers, and the
supplies and equipment they have. First, they open the
tent to allow in fresh air. Then they clean the tent, bathe
the wounded, and provide clean bedding. They assess
and dress the wounds, feed the soldiers a nutritious meal,
and comfort those who are dying or are in pain. They
offer encouragement and emotional care to the healthier
soldiers and help them to write letters home. Within a
brief period of time, the mortality rate drops from 47%
to 2% and morale improves immeasurably.
Time: 2014, Your Local Hospital
While standing at the bedside mixing an antibiotic
solution, Susan listens to the ventilator cycle. She notes
that her patient has begun to trigger breaths on his
own. In the background she hears the cardiac monitor
sounds, which have become more irregular over the past
hour. She mentally runs through her patient assessment.
“Why is his heart so irritable?” she wonders. She calls
the lab for the morning blood work results. When the
lab technician e-mails the results, Susan notes that
the potassium level is low at 2.9 mEq/L. She notifies
the physician of the test results and the cardiac irritability.
Susan says, “The patient’s potassium is low from the
diarrhea he’s had since we began the antibiotics.”
Together they develop a plan to raise the potassium
level and check it every 8 hours. Susan administers
intravenous (IV) potassium chloride. Several hours later
she documents that the ectopy (irregular heartbeat) has
decreased to less than 2 beats/min.
Time: 2030, A Local
Home
Yesterday, Mr. Samuels
under-went cardiac surgery. He
was discharged home this
morning. As a home health
nurse, your role is to assess
his condition; provide skilled
care; teach Mr. Samuels how
to care for himself; instruct
his family about his care; and
coordinate any required
addi-tional services. Mrs. Samuels
greets you at the front door.
She tells you that her
husband is in a lot of pain and
that the chest drainage
system is full. She looks
frightened as she says,
“When my father had cardiac
surgery 25 years ago, he
spent 4 days in the hospital.
I don’t understand why my
husband got sent home so
quickly.” You explain that
changes in technology and
the healthcare system allow
you to take care of clients
in the home who would
previously have been in the hospital. As you begin your
assess-ments, you tell Mrs. Samuels, “After I’ve gathered more
information, we’ll make a plan for his care that will make all
of us more comfortable.”
In each of these scenarios, the nurses engaged in
full-spectrum nursing; that is, they used their minds and their
hands to improve the client’s comfort and condition. As the
scenarios illustrate, nursing roles have changed over time. Yet
nursing remains a profession dedicated to care of the client.
contemporary nursing practice), you will grasp how the image of nursing and actual nursing practice have changed over time.
NURSING IMAGES THROUGHOUT
HISTORY
An understanding of the past can give insight into the present. Throughout history, artwork, television, popular stories, ad-vertisements, and greeting cards have all portrayed nurses in many ways. Whether the images are flattering or demeaning, accurate or inaccurate, they influence how people view nurs-ing. Some of these images may have, in either a positive or negative way, influenced your decision to become a nurse.
Common Images of Nurses
In the next few pages you will see how nursing has been portrayed in art and popular culture at different periods in history, and relate the truth and fiction of those images to the practice of contemporary nursing. This will help you appre-ciate the rich traditions of nursing and the forces that have shaped nursing as it is today. Pay close attention to the rate of change in recent years, and keep in mind that nursing and healthcare are likely to change even more rapidly in the future.
When you think of nursing, what images do you think of? As you reflect on each of the three scenarios at the opening of this chapter, what pictures come into your mind? Is this the same image you get when you imagine yourself as a nurse? In the following sections we explore four common nursing stereotypes.
The Angel of Mercy
Images of the angel-nurse are usually serene and content, with a halo or other religious symbol. This image grew out of the in-fluence of religion and the risks inherent to the practice of nursing.
Influence of Religion.
The strong link between nursing and religious orders can be traced back to ancient cultures. In Egypt, Greece, and Rome, temples were health centers as well as places of worship. Priests and priestesses treated the ill with a combination of physical care, prayer, and magic spells. In Asia, some of the earliest writings about a distinct nursing occupation are included in the Vedas, the ancient sa-cred books of the Hindu faith (circa 1200 BCE). The nurses included in these texts were always men who were part of a priestly order and who possessed knowledge of the prepara-tion, compounding, and administration of drugs; wisdom; purity; and devotion to the patient. In later centuries, lay deacons and deaconesses in the early Christian church vis-ited the sick in their homes and functioned as nurses until the first hospitals were established in the first century. The oldest continuously existing hospital, Hôtel Dieu, in France, was founded in 542 (Fig. 1-1). In the United States, all train-ing programs for nurses were affiliated with religious orders until well after the Civil War.Today, many nursing programs, universities, colleges, and healthcare institutions are affiliated with religious groups. Ex-amples include the University of Notre Dame, the Seventh Day Adventist hospital system, and the American Baptist nursing home system.
Effect of the Protestant Reformation.
Christianity gradually lost influence in general society over the 15th tothe 19th centuries. Catholic religious orders were often per-secuted, and many monasteries were closed during the Protestant Reformation (16th and 17th centuries CE), forcing many nurses to flee in order to avoid imprisonment or death. Medicine in this period moved to the universities, with major advances in theoretical knowledge of anatomy, physiology, and communicable disease. After the 19th cen-tury, religious groups gradually regained influence, and many modern nursing programs, universities, colleges, and healthcare institutions are affiliated with religious groups. Although most of these organizations have mission state-ments that incorporate charitable values, such as compas-sion and caring, they no longer require religious dedication from their nursing students.
Risks Involved in Patient Care.
Another reason for the association between nursing and spirituality is the in-herent risks involved in patient care, especially in the recent past. Before the development of microscopes and tech-niques for culturing microorganisms in the 19th century, people who entered nursing placed themselves at risk for exposure to diseases that were poorly understood and often could not be cured. Even as recently as the 1950s, antibiotics were not readily available, and the chief cause of mortality (death) was infectious disease. Providing care in spite of these risks was considered self-sacrificing, much like the call to serve in religious life.ThinkLike a Nurse
1-2
Which aspects of the nurse-as-angel concept appeal to you most when you think about the way you will practice nursing? Why?
The Handmaiden
The validity of this image has changed over time. While the nurse’s role was initially limited, nurses now collaborate with all members of the healthcare team, planning and providing care not only at the direction of physicians but also along with them. Many activities that nurses now do independently were once performed only by physicians, including taking vital signs, performing physical assessments, and administering IV and other injectable medications (Table 1-1). Nevertheless, while nurses perform these and other critical and complex
CHAPTER 1 Nursing Past & Present
7
FIGURE 1-1
Hôtel Dieu in France, the oldest continuously
existing hospital.
tasks, the physician remains the final decision maker for most patient care.
■ Physicians derive much of their power from legal and
financial authority. Early physicians from wealthy and educated classes wrote and lobbied for legislation that awarded them extensive power and ensured control of healthcare. Now it is very difficult to change these laws to accommodate the expanded role of modern nurses (Quadagno, 2004; Rockwell, 1994; Safriet, 1994).
■ Without physicians, the institution does not generate
in-come.Most patients—or their insurers—directly pay the facility to provide care that is prescribed by the physician. In contrast, nurses, with the exception of advanced care nurses, are often employees of healthcare institutions. Therefore, they are considered an expense because they cannot bill for the services they provide. To learn more about circumstances that have made it difficult to expand the role of nursing,
Go to Chapter 1,
Reading More About Nursing
Past and Present, on DavisPlus.
■ In the past, not all nurses considered themselves to
be subservient to physicians. The letters and writings of Florence Nightingale (Fig. 1-2), the founder of modern nursing, indicate that she considered nurses the colleagues of physicians rather than their servants. She stated at one time that the standard description of nurses as “devoted and obedient . . . would do well for a porter” and “[i]t might even do well for a horse” (Chambers, 1958, p. 130).
Despite the protests of her wealthy, upper-class family, Nightingale went on to study nursing in Germany at the
age of 24. She became a field nurse during the Crimean War, where she became known as “the Lady of the Lamp” because of her nighttime care to the wounded. Upon her return to England, she used her experience in the Crimea to immediately lobby politicians and physicians about the importance of nursing and the need for public health reform. Nightingale’s major contributions include the following:
The establishment of nursing as a distinct profession Introduction of a broad-based liberal education for nurses Major reform in the delivery of care in hospitals
The introduction of standards to control the spread of disease in hospitals
Major reforms in healthcare for the military
If you would like more information about other historical nursing leaders,
Go to Chapter 1,
Supplemental Materials: Nursing
Leaders, on DavisPlus.
■ The employment status of most nurses is another factor
that must be considered when looking at the validity of the handmaiden image.As we said earlier, most nurses work for healthcare institutions rather than directly for physicians. If nurses have indeed been handmaidens, perhaps it has been to the institutions that employ them. Nurses are actively working to combat the handmaiden stereotype; for instance, they have formed unions to improve their working conditions and benefits and to advocate for patient safety. The increased number of advance practice nurses and nurse entrepreneurs further rebukes the validity of the hand-maiden image. It is interesting that with changes in the healthcare system, more physicians are becoming employees of healthcare institutions as well—and some, like nurses, are forming unions. The increasing costs of healthcare, coupled with decreasing reimbursement for health services, appear to be driving these changes.
Table 1-1
➤
Examples of Nursing Activities
DEPENDENT INDEPENDENT
ACTIVITIES
ACTIVITIES
Administering prescribed medication
Assisting with a diagnostic test (e.g., opening trays, handing instruments to the physician)
Administering IV fluids
Ensuring that the patient receives the prescribed diet
Evaluating the patient’s response to medication and withholding the next dose if the patient has a negative reaction Teaching the patient what
to expect from the diagnostic test; preparing the patient for the test (e.g., shaving a site); supporting the patient during the test Evaluating the patient’s
response to treatment; monitoring the flow rate; evaluating the site for redness or leakage Teaching a pregnant
woman about additional nutrients needed in her diet
ThinkLike a Nurse
1-3
What similarities or differences do you see between the angelic and handmaiden images of nursing?
The Battle-Ax
The image of the nurse as a battle-ax is in direct opposition to the image of the angel of mercy, but these opposing images have coexisted for centuries. Charles Dickens created an early ver-sion of the abusive nurse in his 1844 novel Martin Chuzzlewit, in the character of Sairey Gamp. Mrs. Gamp personified the view of nurses that many people held at that time: She was corrupt, harsh, and frequently intoxicated. In the 1975 film One Flew
Over the Cuckoo’s Nest, Nurse Ratched personifies the
contempo-rary image of the nurse as the battle-ax or torturer, treating her patients with cruelty and disdain. How did these negative images come about? And why does this image persist? Again, history may provide insight.
Fading Influence of Christianity.
Before the 14th century, religious-affiliated nursing orders provided most of the care for the sick. However, as science and philosophy grew more so-phisticated and popular, religious orders for nursing became less common, and much of the devotion and knowledge of car-ing for the sick was lost. Municipal authorities took over hospi-tals and began to sentence criminals to care for the sick in the hospitals—to assume the nursing role. Forced to care for large numbers of patients without training, supplies, assistance, or time off, these criminals often managed their workload by treat-ing patients harshly and drinktreat-ing alcohol while on duty. Most patients who entered such hospitals died there. Such practices persisted until the 1860s in Europe and until after the Civil War in the United States. It is no wonder, then, that the battle-ax image of nurses endured so long.Perception of Nursing Activities.
Nurses give injec-tions, clean and dress wounds, draw blood, and start intra-venous lines—such activities are performed to improve the patient’s health, but they may cause significant pain, contribut-ing to the persistence of the battle-ax image. Unfortunately, the association with pain helps to perpetuate the image of nurses as unfeeling. Aware of the power of this image, nurses on pedi-atric units typically wear colorful uniforms with child-friendly patterns, such as cartoon characters or cuddly animals, to avoid frightening children who may associate “nurse” with “pain.” Providers in many pediatric and outpatient facilities deliver care in street clothes without white lab coats in order to reduce patient anxiety.The Naughty Nurse
The image of the sexy, risqué nurse arose in the early part of the 20th century with burlesque shows and persists in popular culture today. In many television programs such as
Nightin-gales, M*A*S*H, and more recently Grey’s Anatomy, nurses are
portrayed as sexy, mindless, irrelevant, or simply potential dates for bright and talented surgeons. Get-well cards often portray nurses in short skirts, fishnet stockings, high heels, and cap, as do paperback novels, comic books, CDs, and other print media. An Internet search yields links to legitimate sites with realistic pictures of nurses, but also a large number of car-toons, greeting cards, and pornographic Web sites featuring women who are supposedly nurses. Their role is implied through props—a nursing cap, a stethoscope, or a uniform—in the background.
Why is this so? What gives this image its power? As trusted health professionals, nurses frequently provide care that
involves exposing the patient’s body, contact with bare skin, and discussion of intimate aspects of the client’s life. In addition, hospitalized patients are in a weakened, vulnerable state, and the nurse may seem quite powerful by contrast. Thus, despite the fact that nurse–patient contact is profes-sional and does not involve sexual intimacy, the “naughty nurse” stereotype may express a forbidden desire for intimate contact with a stranger in a position of power. In addition, the traditionally female nurse’s collaboration with traditionally male physicians may reinforce the stereotype of the nurse in a sexual role. The “naughty nurse” stereotype may be popular, but it is not founded on truth.
ThinkLike a Nurse
1-4
■ How do the images of the nurse as a battle-ax or sex object
affect your view of nursing?
■ As a nurse, what can you do to counteract these images?
The Military Image
Nursing imagery is often military, both in the general public and within the profession itself. Throughout the past century, nurses were frequently portrayed in uniform providing sup-port at the battlefield, and nurses are still often characterized as warriors fighting disease. What is the history of these two military images?
Nurses on the Battlefield
Nurses’ involvement in the military dates from 27 BCE, as the Roman Empire began to consolidate its dominion. Because the Roman Empire relied on the success of military excursions to extend its domain, the well-being of its soldiers was critical. Thus, one of the great contributions of the Roman Empire was the development of the military hospital and the practice of providing first aid on the battlefield.
During the Middle Ages, the two largest influences on nursing were the military and religion. These two threads fused in the Crusaders, soldiers who went to battle to conquer Islamic lands and spread Christianity throughout the world. Among the Crusaders were hospitalers, specialized soldiers who at the end of battle returned to the outposts to care for the sick and injured (Fig. 1-3). The hospitaler order known as
CHAPTER 1 Nursing Past & Present
9
the Knights of St. John of Jerusalem established men’s and women’s branches throughout Europe—one of which still exists in England as the Order of Malta.
Nursing presence on the battlefield continued during the Civil War. The U.S. government established the Army Nursing Service in 1861, and its role was to organize nurses and hospitals and coordinate supplies for the soldiers. Many trained nurses joined the Army Nursing Service from reli-gious orders. Thousands of laypersons also volunteered, in-cluding the following:
■ Clara Barton. Among the lay nurses was Clara Barton, who
organized her own nursing efforts. Rather than providing care in base hospitals, far removed from the battlefield, Barton and her volunteers provided care in tents set up close to the fighting. Barton did not discriminate when giving care, nursing soldiers from both the North and South, black and white. When the war was over, Barton continued this universal care through the establishment of the American Red Cross.
■ Other laypersons. Other notable figures who served as
nurses include Harriet Tubman, who helped slaves escape to freedom on the Underground Railroad; the poet Walt Whitman; the author Louisa May Alcott; and Dorothea Dix, the Union’s Superintendent of Female Nurses during the Civil War.
Nurses also served in World War I, World War II, the Korean and Vietnam wars (Fig. 1-4), the Gulf War, and the conflicts in Iraq and Afghanistan. In these wars the nurses were all for-mally trained. Formal training for nurses became widespread in Europe in the 1860s after the widely publicized success of Nightingale in the Crimea. In the United States the first formal training program was established in 1873.
Nurses Fighting Disease
A second military image portrays nurses as warriors in the fight against disease. This image is common in public aware-ness campaigns against infectious diseases.
■ Florence Nightingale. Florence Nightingale’s
contribu-tions in public health and epidemiology (the study of the distribution and origins of disease) were among the first
nursing efforts to fight disease. In her Notes on Hospitals (1863), Nightingale stated that air, light, nutrition, and ade-quate ventilation and space assist the patient to recuperate. The hospitals she designed to incorporate these ideas were associated with decreased mortality, decreased length of hospital stay, and decreased rate of nosocomial infection (an infection associated with a healthcare facility and now more commonly called healthcare-associated infection).
■ Lillian Wald and Mary Brewster.Another notable event in
the fight against disease occurred in 1893 when Lillian Wald and Mary Brewster founded the Henry Street Settle-ment in New York to improve the health and social condi-tions of poor immigrants. This is considered the start of public health nursing in the United States. Since then, nurses have played an important role in improving health and preventing illness by promoting safe drinking water, adequate sewage facilities, and proper sanitation measures in communities.
In spite of the historical association of nursing with the mil-itary, currently only a small percentage of licensed U.S. nurses work in the armed services. Similarly, despite the powerful image of the nurse fighting diseases, only approximately 8% of nurses work in community and public health agencies, which includes school and public health departments (Health Resources and Services Administration [HRSA], 2010).
Caucasian Women
Historically, images of nurses have been of Caucasian women. Rarely are the images of various ethnicity or men of any race. To a degree, this reflects reality. About 83% of RNs in the United States are Caucasian, and only about 9% of nurses in the United States are men (HRSA, 2010). Male nurses make up a higher percentage in other countries (12.5% in Great Britain, for example); nevertheless, men are a minority of the total nursing population worldwide (Fig. 1-5) (Pullen, 2006). This is ironic considering that many ancient nursing orders were exclusively male. In early Christianity, deacons provided nurs-ing care to parish men while deaconesses provided care to women, and even today the majority of medics and hospital corpsmen who provide battlefront first aid are men.
The trend in the United States now is toward a slightly more diverse workforce. In 2008, 16.8% of nurses were other than Caucasian—an increase from 12.2% in 2004. The percent-age will likely increase, because RNs from racial and ethnic
FIGURE 1-4
Women’s Memorial for the Vietnam War.
(Copyright 1993, Vietnam Women’s Memorial Foundation, Inc. Glenna Goodacre, sculptor.)
FIGURE 1-5
The roles of men in nursing are now as varied as
those for women, and the opportunities for personal and
professional fulfillment are as great.
CHAPTER 1 Nursing Past & Present
11
These actions are intertwined with the nursing process stages of assessing, diagnosing, and evaluating.Critical thinkingis a reflective thinking process that in-volves collecting information, analyzing the adequacy and ac-curacy of the information, and carefully considering options for action. Nurses use critical thinking in every aspect of nurs-ing care. Critical thinknurs-ing is discussed at length in Chapter 2 and applied in every chapter in this text.
Problem-solvingis a process by which nurses consider an issue and attempt to find a satisfactory solution to achieve the best outcomes. You will often use problem-solving in your pro-fessional life. The nursing process (see Chapters 2 through 7) is one type of problem-solving process.
ThinkLike a Nurse
1-6
In the three scenarios of Nurses Make a Difference . . . Then & Now, what image of nursing predominates: thinking or doing?
CONTEMPORARY NURSING: EDUCATION,
REGULATION, AND ORGANIZATION
As a student about to enter your new professional life, you need a realistic understanding of the nature and demands of your chosen career. To help you to better acquaint yourself with nursing today, the remainder of this chapter discusses the current state of nursing, nursing education, and the trends affecting nursing.
How Is Nursing Defined?
As you have seen, there are many perceptions of nursing. These images are only loosely based on fact and sometimes they con-flict. They make it difficult for the public to know the reality of nursing—and they are also confusing to nurses and other mem-bers of the healthcare team. In addition, the constantly changing nature of nursing, healthcare, and society further complicates the definition of nursing. Therefore, it is important for nurses to articulate clearly what nursing is and what nurses do. The fol-lowing are the views of three important nursing organizations with regard to the question, “What is nursing?”
International Council of Nurses Definition
In 1973 the International Council of Nurses (ICN), an organi-zation representing nurses throughout the world, defined
nursing according to the beliefs of respected theorist Virginia
Henderson:
The unique function of the nurse is to assist the individual, sick or well, in the performance of those activities contributing to health or its recovery (or to peaceful death) that he would perform unaided if he had the necessary strength, will or knowledge. (Henderson, 1966, p. 15) In the decades since the adoption of this definition, nursing throughout the world has changed. Advances in healthcare have altered the type of care required by clients. To reflect these changes, the ICN has revised its definition of nursing, as follows:
Nursing encompasses autonomous and collaborative care of individ-uals of all ages, families, groups and communities, sick or well and in all settings. Nursing includes the promotion of health, prevention of illness, and the care of ill, disabled and dying people. Advocacy, pro-motion of a safe environment, research, participation in shaping health policy and in patient and health systems management, and education are also key nursing roles. (International Council of Nurses [ICN], 2007)
Table 1-2
➤
Racial and Ethnic Distribution
Upon Graduation From Initial
Nursing Education
WHITE, NON-WHITE
GRADUATION YEAR
NON-HISPANIC
OR HISPANIC
1980 or earlier 87.7% 12.3% 1981–1985 88.0% 12.0% 1986–1990 82.4% 17.6% 1991–1995 80.5% 19.5% 1996–2000 79.4% 20.6% 2001–2004 78.5% 21.5% 2005–2008 77.5% 22.5%
Source: Compiled from the U. S. Dept. of Health and Human Services,
Health Resources and Services Administration (HRSA). (September 2010). The registered nurse population. Findings from the 2008 National
Sample Survey of Registered Nurses. Retrieved January 6, 2011, from
http://bhpr.hrsa.gov/healthworkforce/rnsurvey/2008/nssrn2008.pdf
minority groups represent a larger portion of recent nursing school graduates than in earlier years (see Table 1-2).
It is encouraging for diversity that more men are being re-cruited into nursing. For example, in 2006, 8.3% of nursing stu-dents in the United States were men (Pullen, 2006). During 2008–2009 the proportion of men increased to 13.8% (National League for Nursing, n. d.). However, it is important that prac-ticing nurses embrace these changes and welcome others into the field.
ThinkLike a Nurse
1-5
In your opinion, what efforts, if any, should nursing organizations take to recruit a more diverse workforce?
Full-Spectrum Nurse
Nurses have often been shown actively caring for the patient— dressing wounds, bathing, giving medications—but the intellec-tual or thinking side of nursing is rarely portrayed. The angel of mercy and military stereotypes reinforce the idea that nursing is a duty and that nurses are carrying out orders. The naughty nurse, battle-ax, and handmaiden images suggest a woman who is quick to act but may not carefully consider her actions. In real-ity, a large portion of the nursing role involves thinking.
To be safe providers, nurses must carefully consider their
ac-tions and think carefully about the patient, the treatment plan, the
healthcare environment, the patient’s support system, the nurse’s
support system, resources, and safety.
Full-spectrum nursing involves clinical judgment, critical thinking, and problem-solving. You will learn more about this in Chapter 2.
Clinical judgment involves observing, comparing, con-trasting, and evaluating the client’s condition to determine whether change has occurred. It also involves careful consid-eration of the client’s health status in light of what is expected based on the client’s condition, medications, and treatment.
Profession.
Although the term profession is freely used, Starr (1982) said that a group must meet certain criteria to be considered a profession (see Table 1-4). Nursing appears to meet all criteria of a profession as defined by Starr.Discipline.
To be considered a discipline, a profession must have a domain of knowledge that has both theoretical and practical boundaries. The theoretical boundaries of a profession are the questions that arise from clinical practice and are then investigated through research. The practicalboundariesare the current state of knowledge and research in the field—the facts that dictate safe practice (Meleis, 1991). A case can be made that nursing is both a profession and a discipline:
■ It is a scientifically based and self-governed profession that
focuses on the ethical care of others.
■ It is a discipline, driven by aspects of theory and practice. It
demands mastery of both theoretical knowledge and clinical skills.
Occupation.
In spite of meeting criteria for both designa-tions (profession and discipline), nursing is often described as an occupation, or job. Unlike physicians, most of whom are in control of their practice environment, working conditions, and schedule, most nurses are hourly wage earners. The employer, not the nurse, decides the conditions of practice and the nature of the work. Nurse practice acts do not prevent nurses from functioning more autonomously, however.Rather than continuing to develop arguments to “prove” that nursing is a profession, the following actions might do more to improve the status of nursing:
■ Standardizing the educational requirements for entry into
practice
ThinkLike a Nurse
1-7
Look at the three scenarios of Nurses Make a Difference . . . Then & Now. What nursing actions did the nurses perform that are represented in the International Council of Nurses (ICN) definition of nursing?
American Nurses Association Definition
You can see similar changes in the approach of the American Nurses Association (ANA). In 1980, the ANA defined nursing as “the diagnosis and treatment of human responses to actual and potential health problems” (p. 2). Attempts to refine this definition have been difficult. Nurses are a heterogeneous group of people with varying skills who perform activities de-signed to provide care ranging from basic to complex in a growing number of settings. It is very difficult to describe the boundaries of the profession.
In 2010, the ANA acknowledged five characteristics of reg-istered nursing:
1. Nursing practice is individualized.
2. Nurses coordinate care by establishing partnerships (with persons, families, support systems, and other providers).
3. Caring is central to the practice of the registered nurse.
4. Registered nurses use the nursing process to plan and pro-vide individualized care to their healthcare consumers.
5. A strong link exists between the professional work environ-ment and the registered nurse’s ability to provide quality health care and achieve optimal outcomes. (pp. 4–5) The ANA now defines professional nursing as the following: 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. (American Nurses Association [ANA], 2010)
Importance of a Definition
You may wonder why there has been so much emphasis on creating a definition. Nursing organizations and leaders have pushed for accurate definitions to (1) help the public under-stand the value of nursing, (2) describe what activities and roles belong to nursing versus other health professions, and (3) help students and practicing nurses understand what is expected of them within their role as nurses. Undoubtedly nursing will continue to change as nursing knowledge in-creases and society changes. Box 1-1 lists several additional definitions of nursing for you to consider.
As a student entering nursing, you can use definitions and descriptions to understand what is expected of you. To aid you in this task, Table 1-3 reviews the essential components of the nursing role. While in the clinical setting, you will observe nurses functioning in each of these capaci-ties. Nursing is a flexible career that requires you to move effortlessly among these various roles to meet the needs of the patient.
Knowledge
Check 1-1
■ What factors make it difficult to define nursing?
■ Based on the ICN definition of nursing, what does a nurse do?
Is Nursing a Profession, a Discipline,
or an Occupation?
One strategy used to describe a field of work is to categorize it as a profession, a discipline, or an occupation.
■ I use the word nursing, for want of a better. It has been
limited to signify little more than the administration of medicines and the application of poultices. It ought to signify the proper use of fresh air, light, warmth, cleanliness, quiet, and the proper choosing and giving of diet—all at the least expense of vital power to the patient (Nightingale, 1876, p. 5).
■ Events that give rise to higher degrees of consideration
for those who are helpless or oppressed, kindliness and sympathy for the unfortunate and for those who suffer, tolerance for those of differing religion, race, color, etc.—all tend to promote activities like nursing which are primarily humanitarian (Dock & Stewart, 1938, p. 3).
■ Nursing has been called the oldest of the arts and the
youngest of the professions. As such, it has gone through many stages and has been an integral part of societal movements. Nursing has been involved in the existing culture—shaped by it and yet helping to develop it (Donahue, 1985, p. 3).
■ Nurses provide care for people in the midst of health,
pain, loss, fear, disfigurement, death, grieving, challenge, growth, birth, and transition on an intimate front-line basis. Expert nurses call this the privileged place of nursing (Benner & Wrubel, 1989, p. xi).
■ Nursing: The care and nurturing of healthy and ill people,
individually or in groups and communities [Taber’s also includes as a part of the definition the ANA “essential features” involving holism, use of subjective and objective data, application of scientific knowledge, and provision of a caring relationship.] (Venes, D., 2009).
CHAPTER 1 Nursing Past & Present
13
Table 1-3
➤
Roles and Functions of the Nurse
ROLE
FUNCTION
EXAMPLES
Direct care provider
Communicator Client/family educator Client advocate Counselor Change agent Leader Manager Case manager Research consumer
Assessing the client Giving medications Patient teaching Counseling a client
Discussing unit staffing needs at a meeting
Providing pregnancy prevention education at a local school Preoperative teaching Prenatal education for siblings Community classes on nutrition
Helping a client explain to his family that he does not want to have further chemotherapy
Counseling a client on weight-loss strategies
Working to improve the nutritional quality of the lunch program at a preschool
Florence Nightingale Walt Whitman Harriet Tubman
Charge nurse on a hospital unit (e.g., assigns patients and work to staff nurses)
Coordinator of services for clients with tuberculosis Reading journal articles Attending continuing education;
seeking additional education Addressing the physical, emotional, social, and spiritual
needs of the client
Using interpersonal and therapeutic communication skills to address the needs of the client, to facilitate communication in the healthcare team, and to advise the community about health promotion and disease prevention
Assessing and diagnosing the teaching needs of the client, group, family, or community. Once the diagnosis is made, nurses plan how to meet these needs, implement the teaching plan, and evaluate its effectiveness.
Supporting clients’ right to make healthcare decisions when they are able to voice their opinions and protecting clients from harm when they are unable to make decisions
Using therapeutic communication skills to advise clients about health-related issues
Advocating for change on an individual, family, group, community, or societal level that enhances health. The nurse may use counseling, communication, and educator skills to accomplish this change. Inspiring others by setting an example of positive
health, assertive communication, and willingness to improve
Coordinating and managing the activities of all members of the team
Coordinating the care delivered to a client
Applying evidence-based practice to provide the most appropriate care, to identify clinical problems that warrant research, and to protect the rights of research subjects
■ Enacting uniform continuing education requirements ■ Encouraging the participation of more nurses in professional
organizations
■ Educating the public about the true nature of nursing
practice
ThinkLike a Nurse
1-8
Evaluate the status of nursing. Is nursing a respected profession? Give examples to support your opinion.
How Do Nurses’ Educational Paths
Differ?
The transition into the nursing profession involves the con-cepts of formal and informal processes. Formal education consists of completing the initial and continuing education
required for licensure. Informal education involves a gradual progression in skill and clinical judgment that allows the nurse to advance in the profession.
Formal Education
When the patient calls out “Nurse!” who can respond? To legally use the title nurse, a person must be a graduate of an ac-credited nursing education program and have successfully passed a licensure exam. Students may enter nursing through two paths: as a practical nurse or a registered nurse. Other per-sonnel may respond to the patient’s call, but they cannot legally be considered nurses.
Practical and Vocational Nursing Education
Practical nursing education prepares nurses to provide bedside care to clients. Practical nurses are known as licensed practical nurses (LPNs) or licensed vocational nurses (LVNs).
In the United States a student who wishes to become an LPN/LVN may attend one of approximately 1,200 approved programs given at technical schools and community colleges. Educational programs for LPN/LVNs offer both classroom and clinical teaching and usually last 1 year. After complet-ing the practical nurscomplet-ing education program, the student must pass the NCLEX-PN® exam. Practical nurses work
under the direction of the registered nurse (RN) or the pri-mary care provider.
Registered Nursing Entry Education
Currently, five educational pathways lead to licensure as a registered nurse (RN). Graduates of all these programs must suc-cessfully complete the NCLEX-RN®exam to practice as RNs.
■ Diploma. Until the 1960s, diploma programs were the
main-stay of nursing education. These programs are usually associ-ated with a hospital. The typical program lasts 3 years and focuses on clinical experience in direct patient care. Since the 1960s the number of diploma programs has steadily decreased. In 2004, only about 4% of nursing schools were diploma pro-grams; in 2008, about 20% of U.S. RNs reported their initial education was in a diploma program (HRSA, 2010).
■ Associate degree. Most associate degree (AD) programs
are offered in community colleges. Although the nursing component typically lasts 2 years, students are required to take numerous other courses in liberal arts and the sci-ences. In 2008, 45% of U.S. RNs reported their initial educa-tion was in an AD program (HRSA, 2010). ADN students are prepared to provide direct patient care.
■ Baccalaureate degree. Students in baccalaureate programs
pursue a course of study like that of other undergraduate students. The course of study lasts at least eight semesters. Students are prepared to provide direct patient care, to work
Table 1-4
➤
Nursing: Is It a Profession?
STARR CRITERION
EXAMPLES IN NURSING
The knowledge of thegroup must be based on technical and scientific knowledge.
The knowledge and competence of members of the group must be evaluated by a community of peers.
The group must have a service orientation and a code of ethics.
■ Entry-level nursing education
requires coursework in basic and social sciences as well as humanities, arts, and general education.
■ Nursing education and
practice are increasingly based on research from nursing and related fields.
■ State or provincial regulatory
bodies have defined the criteria that nurses must meet to practice, and they monitor members for adherence to standards.
■ Nursing is clearly focused
on providing service to others.
■ The major professional
organizations have developed ethical guidelines to guide the practice of nursing.
in community care, to use research, and to enter graduate education (Bureau of Labor Statistics, 2009). In 2008, BSN graduates accounted for 34% of U.S. RNs (HRSA, 2010). Many AD graduates enter RN-to-BSN (or RN “completion”) programs to obtain a baccalaureate degree in nursing. The length of time required to complete the BSN varies according to the program and the number of credits each student can transfer.
■ Master’s entry. The typical student in these programs has a
baccalaureate degree in another field and has entered nurs-ing as a second career. Programs usually are completed in 3 years of full-time study. At the completion, the student is eligible to take the licensing exam and is awarded a master’s degree in nursing.
■ Doctoral entry. This is the most unusual entry pathway into
nursing. The nursing doctorate (ND) path parallels the path-way through which physicians enter the healthcare field. This entry path has very limited enrollment.
For several decades, nursing leaders have debated about the most appropriate educational pathway for entry into the profession. For an overview of this debate,
Go to Chapter 1,
Supplemental Materials:
Entry-into-Practice Debate, on DavisPlus.
Graduate Nursing Education
Graduate education prepares the RN for advanced practice, expanded roles, or research. Master’s degree programs pre-pare RNs to function in a more independent role, for example, as advanced practice nurses (APNs) or educators. Programs typically last 2 years or longer. Doctoral programs in nursing offer professional degrees. Typically the student has com-pleted a baccalaureate and master’s degree before entry into a doctoral program. Degrees awarded are usually the DNS (doc-tor of nursing science) or PhD (doc(doc-tor of philosophy). The DNS program prepares the nurse for advanced clinical prac-tice. The PhD is a research degree. For additional discussion on expanded nurse roles,
Go to Chapter 1,
Supplemental Materials: Expanded
Career Roles, on DavisPlus.
Other Forms of Formal Education
To stay current with advances in healthcare after graduat-ing, you must participate in ongoing education.
■ Continuing educationprograms are intended to ensure
that nurses keep up with current clinical knowledge. These programs are available at work sites, at colleges and universities, through privately operated educational groups, on the Internet, and in professional journals. In 23 states, renewal of the nursing license requires success-ful completion of a specified number of continuing educa-tion courses. When you receive your initial nursing license, your state board of nursing (SBN) will notify you about continuing education requirements, if any. Thereafter, the SBN will notify you of any changes in the requirements—regulations change frequently. For an overview of the continuing education requirements for license renewal in the United States,
Go to Chapter 1,
Supplemental Materials: Continuing
Education Requirements for Nurses, on DavisPlus.
■ Inservice educationis another form of ongoing education. It
toward meeting the continuing education requirement for license renewal. For instance, inservice education might focus on the use of new equipment or the introduction of new policies in an institution, or it may resemble traditional continuing education programs.
Informal Education
In addition to formal programs of study, education also re-quires socialization into the profession. Socialization is the informal education that occurs as you move into your new profession. It is the knowledge gained from direct experience, observation in the real world, and informal discussion with peers and colleagues. Professional socialization begins when you enter the educational program and continues as you gain expertise throughout your career. Informal education comple-ments formal education to create clinical competence.
Benner’s Model
Patricia Benner (1984) described the process by which a nurse acquires clinical skills and judgment. Expertise is not merely demonstration of skilled application of knowledge, but rather a personal integration of knowledge that requires technical skill, thoughtful application, and insight. That is what we mean in this text when we use the term full-spectrum
nursing. Expertise requires thinking, doing, and caring.
Ben-ner’s process occurs in stages:
Stage 1: Novice. This phase begins with the onset of educa-tion. The novice is typically receptive to education and is “learning the rules” of the profession.
Stage 2: Advanced beginner. After considerable exposure to clinical situations, nurses improve in performance and, through repeated experiences or mentoring, begin to recognize the elements of a situation. The nurse func-tioning at this level begins to use more facts and is more sophisticated with use of the rules. A new graduate usu-ally functions at this level.
Stage 3: Competence. Nurses achieve competence after a few years of practice. Competent performers have gained additional experience and wrestle with more complex concerns. They are able to handle their pa-tient load and prioritize situations. They are also more involved in their caregiving role and may be emotion-ally involved in the clinical choices made. Although competent nurses manage clinical care with mastery, they often do not fully grasp the overall scope and most important aspects.
Stage 4: Proficient. Proficient nurses are a resource for less experienced nurses. They are able to see the “big picture” and can coordinate services and forecast needs. They are much more flexible and fluent with their role and able to adapt to nuances of various patient situations. Proficient nurses plan intuitively as well as consciously.
Stage 5: Expert. Expert nurses are able to see what needs to be achieved and how to do it. They trust in and use their intuition while operating with a deep understanding of a situation. They have expert skills and are often con-sulted when others need advice or assistance.
Benner’s model deals with the development of clinical wis-dom and competence. Nurses do not automatically move through the stages as they gain experience. Instead, this model assumes that, to improve in skill and judgment, you must also be attuned to each clinical situation. This requires an ability to take in information from a variety of sources and to notice subtle variations. Although expertise (stage 5) is a goal, not everyone can achieve this level of skill.
Nursing Organization Guidelines
The ANA and other organizations also help nurses to con-tinue to improve their practice (e.g., by setting standards and articulating nursing values). For example, in the Code for Nurses, the ANA provides guidelines for nurses to conduct themselves in their day-to-day practice. These guidelines de-scribe behaviors and values that help improve practice and participation in the profession. Box 1-2 presents some values and behaviors associated with nursing. See Chapter 42 for fur-ther discussion of nursing values and the ANA Code for Nurses.
Knowledge
Check 1-2
■ Compare and contrast formal and informal education. ■ Name and describe five educational pathways leading to
licensure as an RN.
How Is Nursing Practice Regulated?
Nurse Practice Acts.
Nurse practice acts are laws that regulate nursing practice. In the United States, each state en-acts its own nurse practice act. The state board of nursing is the agency responsible for regulating nursing practice. Although there are minor variations, each board of nursing is responsi-ble for the following:■ Defining the practice of nursing
■ Establishing criteria that allow a person to be considered a
registered nurse (RN) or licensed practical or vocational nurse (LPN/LVN)
■ Determining activities that are in the scope of practice of
nursing: that nurses may perform (and by implication, those they may not); and those that may be performed only by li-censed nurses
■ Enforcing the rules that govern nursing
To practice nursing, an individual must be licensed as a nurse. Licenses are issued by the state. All states require gradu-ation from an approved nursing program and successful com-pletion of the National Council Licensure Exam (NCLEX®).
To receive licensure in another state, the nurse simply applies for reciprocity. For further details about licensing and the regu-lation of nursing practice, see Chapter 43.
Standards of Practice.
Nursing is also guided bystan-dards of practice,which “describe a competent level of nurs-ing practice and professional performance common to all registered nurses. . . . They are authoritative statements of the duties that all registered nurses, regardless of role, popula-tion, or specialty, are expected to perform competently” (ANA, 2010, p. 2). Standards are used by individual nurses, employers of nurses, professional organizations, and other professions.
As a student of nursing, you may use the ANA standards of nursing practice to get a better understanding of nursing (Table 1-5). Practicing nurses use the standards to judge their
CHAPTER 1 Nursing Past & Present
15
■ The nurse’s primary concern is the good of the patient. ■ Nurses ought to be competent.
■ Nurses demonstrate a strong commitment to service. ■ Nurses believe in the dignity and worth of each person. ■ Nurses constantly strive to improve their profession. ■ Nurses work collaboratively within the profession.
Table 1-5
➤
American Nurses Association: Scope and Standards of Clinical Nursing Practice
Standards of Care Standard 1 Standard 2 Standard 3 Standard 4 Standard 5 Standard 5A Standard 5B Standard 5C Standard 5D Standard 6Standards of Professional Performance Standard 7 Standard 8 Standard 9 Standard 10 Standard 11 Standard 12 Standard 13 Standard 14 Standard 15 Standard 16
Source: American Nurses Association (2010). Nursing: Scope and standards of practice (2nd ed.). Silver Spring, MD: Nursebooks.org.
The registered nurse collects comprehensive data pertinent to the healthcare consumer’s health and/or the situation.
The registered nurse analyzes the assessment data to determine the diagnoses or the issues.
The registered nurse identifies expected outcomes for a plan individualized to the healthcare consumer or situation.
The registered nurse develops a plan that prescribes strategies and alternatives to attain expected outcomes.
The registered nurse implements the identified plan. The registered nurse coordinates care delivery.
The registered nurse employs strategies to promote health and a safe environment.
The graduate-level prepared specialty nurse or advanced practice registered nurse provides consultation to influence the identified plan, enhance the abilities of others, and effect change.
The advanced practice registered nurse uses prescriptive authority, procedures, referrals, treatments, and therapies in accordance with state and federal laws and regulations.
The registered nurse evaluates progress toward attainment of outcomes.
The registered nurse practices ethically.
The registered nurse attains knowledge and competence that reflects current nursing practice.
The registered nurse integrates evidence and research findings into practice.
The registered nurse contributes to quality nursing practice. The registered nurse communicates effectively in all areas of
practice.
The registered nurse demonstrates leadership in the professional practice setting and the profession.
The registered nurse collaborates with healthcare consumer, family, and others in the conduct of nursing practice.
The registered nurse evaluates her or his own nursing practice in relation to professional practice standards and guidelines, relevant statutes, rules, and regulations.
The registered nurse utilizes appropriate resources to plan and provide nursing services that are safe, effective, and financially responsible.
The registered nurse practices in an environmentally safe and healthy manner. Assessment Diagnosis Outcome Identification Planning Implementation Coordination of Care Health Teaching and
Health Promotion Consultation Prescriptive Authority and Treatment Evaluation Ethics Education Evidence-Based Practice and Research Quality of Practice Communication Leadership Collaboration Professional Practice Evaluation Resource Utilization Environmental Health
own performance, develop an improvement plan, and under-stand what employers expect of them. Employers incorporate the standards into annual evaluation tools at hospitals and health facilities. Professional organizations use the standards to educate the public about nursing, to plan for continuing education programs for nurses, and to guide their efforts at lobbying and other activities that advocate for nurses. Finally, other professions read the standards of practice to examine the boundaries between nursing and other health professions.
ThinkLike a Nurse
1-9
What additional information have you learned about nursing from your review of the American Nurses Association (ANA) and Canadian Nurses Association (CNA) standards of practice?
What Are Some Important Nursing
Organizations?
Numerous organizations are involved in the profession of nursing. Some of the most influential are discussed here.
American and Canadian Nurses Associations
The ANA and the CNA are the official professional organiza-tions for nurses in their respective countries. Both of these organizations were formed in 1911 from an organization pre-viously known as the Nurses’ Associated Alumnae of the United States and Canada.
Originally, these organizations focused on establishing stan-dards of nursing to promote high-quality care and work toward licensure as a means of ensuring adherence to the standards. Representatives are elected from the local branches of the state organizations to bring their concerns to the national level. As such, they track healthcare legislation, serve as liaisons with national government representatives to inform them of how current and proposed legislation will affect nursing, and de-velop and sponsor legislation that will have a positive effect on nursing and on patient care. The ANA publishes educational materials on nursing news, issues, and standards.
National League for Nursing
Originally founded as the American Society of Superintend-ents of Training Schools for Nurses in 1893, the National League for Nursing (NLN) was the first nursing organization with a goal to establish and maintain a universal standard of education. The NLN sets standards for and evaluates all types of nursing education programs, studies the nursing work-force, lobbies and participates with other major healthcare organizations to set policy for the nursing workforce, aids fac-ulty development, funds research on nursing education, and publishes the journal Nursing Education Perspectives.
International Council of Nursing
The International Council of Nursing (ICN) represents nurs-ing on a global level. It is composed of a federation of national nursing organizations from more than 120 nations. The ICN aims to ensure quality nursing care for all, supports global health policies that advance nursing and improve worldwide health, and strives to improve working conditions for nurses throughout the world.
National Student Nurses Association
The National Student Nurses Association (NSNA) represents nursing students in the United States. It is the student coun-terpart of the ANA. Like the ANA, this association is made up
of elected volunteers who advocate on behalf of student nurses. The NSNA sponsors yearly conventions to address student concerns. Local chapters are usually organized at in-dividual schools. The NSNA also publishes Image, a journal dedicated to nursing student issues. In Canada, the Canadian University Student Nurses Association serves in the same ca-pacity as the NSNA.
Sigma Theta Tau International
Sigma Theta Tau International (STTI) is the national honor society for nursing. Members are sought from the clinical, educator, and researcher nursing communities as well as from senior-level baccalaureate and graduate programs. The goal of this organization is to foster nursing scholarship, leadership, and research.
Specialty Organizations
Numerous specialty organizations have developed around clinical specialties, group identification, or similarly held values. The following are some examples:
■ Clinical specialty.Association of Operating Room Nurses
(AORN); Association of Nurses in AIDS Care (ANAC); Emergency Nurses Association (ENA)
■ Group identification.National Organization for Associate
Degree Nursing (NOADN), National Association of Hispanic Nurses (NAHN), American Assembly for Men in Nursing (AMN)
■ Similar values.Nurses Christian Fellowship (NCF),
Nurs-ing Ethics Network (NEN)
Web sites of a variety of nursing organizations are identi-fied on DavisPlus.
Go to Chapter 1,
Resources for Caregivers and Health
Professionals, on DavisPlus.
CONTEMPORARY NURSING: CARING
FOR CLIENTS
Look again at the definitions of nursing you have read in this chapter (e.g., Box 1-1). Notice that they all agree that nursing is about caring for clients. Recent studies show that when the percentage of RNs increases in an agency, quality of care rises, death and infection rates drop (Potera, 2007), and length of stay is shorter by at least 30% (Kane, Shamliyan, Mueller, et al., 2007).
Who Are the Recipients of Nursing
Care?
The recipients of nursing care may be individuals, groups, families, or communities. They can be referred to as patients, clients, or persons. Direct care involves personal interaction between the nurse and clients (e.g., giving medications or teaching a client about a treatment). Nurses deliver indirect
carewhen they work on behalf of clients to improve their health status (e.g., restocking a resuscitation cart or arrang-ing unit staffarrang-ing). A nurse may use independent judgment to determine the care needed or may work under the direct order of a primary care provider.
As a nurse, you should not view patients as passive recipi-ents of care. On the contrary, nurses should actively encourage patients’ involvement in decisions about their care, and facili-tate their participation as collaborative members of the health-care team (e.g., by being informed and speaking up about their concerns).
