09/16 20:4709/16 20:47
St Paul's University St Paul's University
artart
As a professional nurse youAs a professional nurse you
will learn to deliver care as anwill learn to deliver care as an
______ with compassion,______ with compassion,
caring, and respect for eachcaring, and respect for each
patient's dignity andpatient's dignity and
personhood.personhood.
When you integrate the art andWhen you integrate the art and
science of nursing into yourscience of nursing into your
practice, the quality of care youpractice, the quality of care you
provide to your patients is at aprovide to your patients is at a
level of excellence that benefitslevel of excellence that benefits
patients and their families.patients and their families.
sciencescience
As a _______, nursingAs a _______, nursing
practice is based on a body ofpractice is based on a body of
knowledge that is continuallyknowledge that is continually
changing with new discoverieschanging with new discoveries
and innovations.and innovations.
individuals, families,individuals, families,
communities.communities.
The patient is the center ofThe patient is the center of
your practice. Your patientyour practice. Your patient
includes: _________,includes: _________,
__________, and/or__________, and/or
________________________
Robert Wood JohnsonRobert Wood Johnson
Foundation (RWJF) Future ofFoundation (RWJF) Future of
Nursing: Campaign for ActionNursing: Campaign for Action
This program is a multifacetedThis program is a multifaceted
campaign to transform healthcampaign to transform health
care through nursing, and it iscare through nursing, and it is
a response to the Institute ofa response to the Institute of
Medicine (IOM) publication onMedicine (IOM) publication on
The Future of Nursing.The Future of Nursing.
fivefive
According to Benner (1984), anAccording to Benner (1984), an
expert nurse passes throughexpert nurse passes through
_______ levels of proficiency_______ levels of proficiency
when acquiring andwhen acquiring and
developing generalist ordeveloping generalist or
specialized nursing skillsspecialized nursing skills
novice, advanced beginner,novice, advanced beginner,
competent, proficient, expertcompetent, proficient, expert
The five Benner levels ofThe five Benner levels of
proficiencyproficiency
novicenovice
Beginning nursing student orBeginning nursing student or
any nurse entering a situationany nurse entering a situation
in which there is no previousin which there is no previous
level of experience (e.g., anlevel of experience (e.g., an
experienced operating roomexperienced operating room
nurse chooses to now practicenurse chooses to now practice
in home health).in home health).
The learner learns via aThe learner learns via a
specific set of rules orspecific set of rules or
procedures, which are usuallyprocedures, which are usually
stepwise and linear.stepwise and linear.
Advanced BeginnerAdvanced Beginner
A nurse who has had someA nurse who has had some
level of experience with thelevel of experience with the
situation. This experience maysituation. This experience may
only be observational inonly be observational in
nature, but the nurse is able tonature, but the nurse is able to
identify meaningful aspects oridentify meaningful aspects or
principles of nursing care.principles of nursing care.
CompetentCompetent
A nurse who has been in theA nurse who has been in the
same clinical position for 2 to 3same clinical position for 2 to 3
years. This nurse understandsyears. This nurse understands
the organization and specificthe organization and specific
care required by the type ofcare required by the type of
patients (e.g., surgical,patients (e.g., surgical,
oncology, or orthopediconcology, or orthopedic
patients). He or she is apatients). He or she is a
practitioner who is able topractitioner who is able to
anticipate nursing care andanticipate nursing care and
establish long-range goals. Inestablish long-range goals. In
this phase the nurse hasthis phase the nurse has
usually had experience with allusually had experience with all
types of psychomotor skillstypes of psychomotor skills
required by this specific grouprequired by this specific group
of patients.of patients.
ProficientProficient
A nurse with more than 2 to 3A nurse with more than 2 to 3
years of experience in the sameyears of experience in the same
clinical position. This nurseclinical position. This nurse
perceives a patient's clinicalperceives a patient's clinical
situation as a whole, is able tosituation as a whole, is able to
assess an entire situation, andassess an entire situation, and
can readily transfer knowledgecan readily transfer knowledge
gained from multiple previousgained from multiple previous
experiences to a situation. Thisexperiences to a situation. This
nurse focuses on managingnurse focuses on managing
care as opposed to managingcare as opposed to managing
and performing skills.and performing skills.
ExpertExpert
A nurse with diverse experienceA nurse with diverse experience
who has an intuitive grasp ofwho has an intuitive grasp of
an existing or potential clinicalan existing or potential clinical
problem. This nurse is able toproblem. This nurse is able to
zero in on the problem andzero in on the problem and
focus on multiple dimensionsfocus on multiple dimensions
of the situation. He or she isof the situation. He or she is
skilled at identifying bothskilled at identifying both
patient-centered problems andpatient-centered problems and
problems related to the healthproblems related to the health
care system or perhaps thecare system or perhaps the
needs of the novice nurse.needs of the novice nurse.
Critical thinkingCritical thinking
______ _________ skills are______ _________ skills are
essential to nursing. Whenessential to nursing. When
providing nursing care, youproviding nursing care, you
need to make clinicalneed to make clinical
judgments and decisions aboutjudgments and decisions about
your patients' health careyour patients' health care
needs based on knowledge,needs based on knowledge,
experience, critical-thinkingexperience, critical-thinking
attitudes, and standards ofattitudes, and standards of
care. Providing the patientcare. Providing the patient
with the best of the science andwith the best of the science and
art of nursing care.art of nursing care.
Nursing (ANA)Nursing (ANA)
The protection, promotion, andThe protection, promotion, and
optimization of health andoptimization of health and
abilities, prevention of illnessabilities, prevention of illness
and injury, alleviation ofand injury, alleviation of
suering through the diagnosissuering through the diagnosis
and treatment of humanand treatment of human
response, and advocacy in theresponse, and advocacy in the
care of individuals, families,care of individuals, families,
communities, and populations.communities, and populations.
Nursing definition by theNursing definition by the
American Nurses AssociationAmerican Nurses Association
(ANA)(ANA)
Nursing (INC)Nursing (INC)
Nursing encompassesNursing encompasses
autonomous and collaborativeautonomous and collaborative
care of individuals of all ages,care of individuals of all ages,
families, groups, andfamilies, groups, and
communities, sick or well, andcommunities, sick or well, and
in all settings. Nursing includesin all settings. Nursing includes
the promotion of health;the promotion of health;
prevention of illness; and theprevention of illness; and the
care of ill, disabled, and dyingcare of ill, disabled, and dying
people. Advocacy, promotion ofpeople. Advocacy, promotion of
a safe environment, research,a safe environment, research,
participation in shaping healthparticipation in shaping health
policy and in patient andpolicy and in patient and
health systems management,health systems management,
and education are also keyand education are also key
nursing roles.nursing roles.
Standards of Practice andStandards of Practice and
Standards of ProfessionalStandards of Professional
PerformancePerformance
Usually set by the ANA, It isUsually set by the ANA, It is
important to know for eachimportant to know for each
school/hospital. The scope andschool/hospital. The scope and
standards of practice guidestandards of practice guide
nurses to make significant andnurses to make significant and
visible contributions thatvisible contributions that
improve the health andimprove the health and
well-being of all individuals,well-being of all individuals,
communities, and populationscommunities, and populations
ANA Standards of NursingANA Standards of Nursing
PracticePractice
1. Assessment1. Assessment
2. Diagnosis2. Diagnosis
3. Outcomes Identification3. Outcomes Identification
4. Planning4. Planning
5. Implementation5. Implementation
6. Evaluation6. Evaluation
( ANA)Standards of( ANA)Standards of
Professional PerformanceProfessional Performance
1. Ethics1. Ethics
2. Education2. Education
3. Evidence-Based Practice and3. Evidence-Based Practice and
ResearchResearch
4. Quality of Practice4. Quality of Practice
5. Communication5. Communication
6. Leadership6. Leadership
7. Collaboration7. Collaboration
8. Professional Practice8. Professional Practice
EvaluationEvaluation
9. Resources utilization9. Resources utilization
10. Environmental Health10. Environmental Health
11. Culturally congruent care11. Culturally congruent care
code of ethicscode of ethics
The philosophical ideals ofThe philosophical ideals of
right and wrong that defineright and wrong that define
the principles you will use tothe principles you will use to
provide care to your patients.provide care to your patients.
The Code of Ethics for NursesThe Code of Ethics for Nurses
With Interpretive StatementsWith Interpretive Statements
A guide for carrying outA guide for carrying out
nursing responsibilities thatnursing responsibilities that
provide quality nursing care; itprovide quality nursing care; it
also outlines the ethicalalso outlines the ethical
obligations of the professionobligations of the profession
Professional responsibilitiesProfessional responsibilities
and roles as a nurseand roles as a nurse
Autonomy, Accountability,Autonomy, Accountability,
Caregiver, Advocate, Educator,Caregiver, Advocate, Educator,
Communicator, ManagerCommunicator, Manager
AutonomyAutonomy
An essential element ofAn essential element of
professional nursing thatprofessional nursing that
involves the initiation ofinvolves the initiation of
independent nursingindependent nursing
interventions without medicalinterventions without medical
orders.orders.
AccountabilityAccountability
This means that you areThis means that you are
responsible professionally andresponsible professionally and
legally for the type and qualitylegally for the type and quality
of nursing care provided. Youof nursing care provided. You
must remain current andmust remain current and
competent in nursing andcompetent in nursing and
scientific knowledge andscientific knowledge and
technical skills.technical skills.
caregivercaregiver
As a ________ you helpAs a ________ you help
patients maintain and regainpatients maintain and regain
health, manage disease andhealth, manage disease and
symptoms, and attain asymptoms, and attain a
maximal level of function andmaximal level of function and
independence through theindependence through the
healing process. You providehealing process. You provide
healing through psychomotorhealing through psychomotor
and interpersonal skills. Youand interpersonal skills. You
help patients and families sethelp patients and families set
realistic goals and meet them.realistic goals and meet them.
patient advocatepatient advocate
As a ________As a ________
_________you protect your_________you protect your
patient's human and legalpatient's human and legal
rights and provide assistance inrights and provide assistance in
asserting these rights if theasserting these rights if the
need arises. You act on behalfneed arises. You act on behalf
of your patient and secure yourof your patient and secure your
patient's health care rightspatient's health care rights
educatoreducator
As an ________ you explainAs an ________ you explain
concepts and facts aboutconcepts and facts about
health, describe the reason forhealth, describe the reason for
routine care activities,routine care activities,
demonstrate procedures suchdemonstrate procedures such
as self-care activities, reinforceas self-care activities, reinforce
learning or patient behavior,learning or patient behavior,
and evaluate the patient'sand evaluate the patient's
progress in learning.progress in learning.
Your eectiveness as aYour eectiveness as a
________ is central to the________ is central to the
nurse-patient relationship. Itnurse-patient relationship. It
allows you to know yourallows you to know your
patients, including theirpatients, including their
strengths, weaknesses, andstrengths, weaknesses, and
needs. It is essential for allneeds. It is essential for all
nursing roles and activities.nursing roles and activities.
You will routinely use this withYou will routinely use this with
patients and families, otherpatients and families, other
nurses and health carenurses and health care
professionals, resource people,professionals, resource people,
and the community.and the community.
Without it, it is impossible toWithout it, it is impossible to
advocate for your patients or toadvocate for your patients or to
give comfort and emotionalgive comfort and emotional
support, give care eectively,support, give care eectively,
make decisions with patientsmake decisions with patients
and families, protect patientsand families, protect patients
from threats to well-being,from threats to well-being,
coordinate and managecoordinate and manage
patient care, assist patients inpatient care, assist patients in
rehabilitation, or providerehabilitation, or provide
patient educationpatient education
managermanager
A ________ coordinates theA ________ coordinates the
activities of members of theactivities of members of the
nursing sta in deliveringnursing sta in delivering
nursing care and hasnursing care and has
personnel, policy, andpersonnel, policy, and
budgetary responsibility for abudgetary responsibility for a
specific nursing unit or agency.specific nursing unit or agency.
They use appropriateThey use appropriate
leadership styles to create aleadership styles to create a
nursing environment fornursing environment for
patients and sta that reflectspatients and sta that reflects
the mission and values of thethe mission and values of the
health care organizationhealth care organization
They need to establish anThey need to establish an
environment for collaborativeenvironment for collaborative
patient-centered care topatient-centered care to
provide safe, quality care withprovide safe, quality care with
positive patient outcomes.positive patient outcomes.
hospitalhospital
Today the majority of nursesToday the majority of nurses
practice in _________practice in _________
settings, followed bysettings, followed by
community-based care,community-based care,
ambulatory care, and nursingambulatory care, and nursing
homes/extended care settings.homes/extended care settings.
homehome
Most nurses provide directMost nurses provide direct
patient care in an acute carepatient care in an acute care
setting. However, as changes insetting. However, as changes in
health care services andhealth care services and
reimbursement continue, therereimbursement continue, there
will be an increase in the directwill be an increase in the direct
care activities provided in thecare activities provided in the
_______ care setting and an_______ care setting and an
increased need forincreased need for
community-based healthcommunity-based health
promotion activities.promotion activities.
Advanced practice registeredAdvanced practice registered
nurse (APRN)nurse (APRN)
The most independentlyThe most independently
functioning nurse. They havefunctioning nurse. They have
advanced education inadvanced education in
pathophysiology,pathophysiology,
pharmacology, and physicalpharmacology, and physical
assessment and certificationassessment and certification
and expertise in a specializedand expertise in a specialized
area of practicearea of practice
clinical nurse specialist (CNS),clinical nurse specialist (CNS),
certified nurse practitionercertified nurse practitioner
(CNP), certified nurse midwife(CNP), certified nurse midwife
(CNM), and certified RN(CNM), and certified RN
anesthetist (CRNA)anesthetist (CRNA)
There are four core roles forThere are four core roles for
the APRN:the APRN:
adult-gerontology, pediatrics,adult-gerontology, pediatrics,
neonatology, women's health/neonatology, women's health/
gender related, family/gender related, family/
individual across the life span,individual across the life span,
and psychiatric mental healthand psychiatric mental health
The educational preparationThe educational preparation
for the four roles of the APRN isfor the four roles of the APRN is
in at least one of the followingin at least one of the following
six populations:six populations:
Clinical Nurse Specialist (CNS)Clinical Nurse Specialist (CNS)
an APRN who is an expertan APRN who is an expert
clinician in a specialized areaclinician in a specialized area
of practiceof practice
population, setting, disease,population, setting, disease,
care, problemcare, problem
The specialty of a CNS may beThe specialty of a CNS may be
identified by a _______ (e.g.,identified by a _______ (e.g.,
geriatrics), a _______ (e.g.,geriatrics), a _______ (e.g.,
critical care), a _______critical care), a _______
specialty (e.g., diabetes), a typespecialty (e.g., diabetes), a type
of _______ (e.g.,of _______ (e.g.,
rehabilitation), or a type ofrehabilitation), or a type of
________ (e.g., pain)________ (e.g., pain)
palliativepalliative
relieving or soothing therelieving or soothing the
symptoms of a disease orsymptoms of a disease or
disorder without eecting adisorder without eecting a
curecure
nurse practitioner (NP)nurse practitioner (NP)
An APRN who provides healthAn APRN who provides health
care to a group of patients,care to a group of patients,
usually in an outpatient,usually in an outpatient,
ambulatory care orambulatory care or
community-based setting.community-based setting.
They provide care for patientsThey provide care for patients
with complex problems and awith complex problems and a
more holistic approach thanmore holistic approach than
physicians. They providephysicians. They provide
comprehensive care, directlycomprehensive care, directly
managing the nursing andmanaging the nursing and
medical care of patients whomedical care of patients who
are healthy or who haveare healthy or who have
chronic conditionschronic conditions
Certified Nurse-MidwifeCertified Nurse-Midwife
(CNM)(CNM)
An APRN who is also educatedAn APRN who is also educated
in midwifery and is certified byin midwifery and is certified by
the American College ofthe American College of
Nurse-Midwives. The practiceNurse-Midwives. The practice
of nurse-midwifery involvesof nurse-midwifery involves
providing independent care forproviding independent care for
women during normalwomen during normal
pregnancy, labor, and deliverypregnancy, labor, and delivery
and care for the newborn. Itand care for the newborn. It
includes some gynecologicalincludes some gynecological
services such as routineservices such as routine
Papanicolaou (Pap) smears,Papanicolaou (Pap) smears,
family planning, andfamily planning, and
treatment for minor vaginaltreatment for minor vaginal
infections.infections.
Certified Registered NurseCertified Registered Nurse
Anesthetist (CRNA)Anesthetist (CRNA)
An APRN with advancedAn APRN with advanced
education from a nurseeducation from a nurse
anesthesia-accreditedanesthesia-accredited
program. Before applying to aprogram. Before applying to a
nurse anesthesia program, anurse anesthesia program, a
nurse must have at least 1 yearnurse must have at least 1 year
of critical care or emergencyof critical care or emergency
experience. Nurse anesthetistsexperience. Nurse anesthetists
provide surgical anesthesiaprovide surgical anesthesia
under the guidance andunder the guidance and
supervision of ansupervision of an
anesthesiologist who is aanesthesiologist who is a
physician with advancedphysician with advanced
knowledge of surgicalknowledge of surgical
anesthesia.anesthesia.
nurse educatornurse educator
A _____ _________ worksA _____ _________ works
primarily in schools of nursing,primarily in schools of nursing,
sta development departmentssta development departments
of health care agencies, andof health care agencies, and
patient education departments.patient education departments.
Nurse educators needNurse educators need
experience in clinical practiceexperience in clinical practice
to provide them with practicalto provide them with practical
skills and theoreticalskills and theoretical
knowledge.knowledge.
nurse administratornurse administrator
A _______ _________A _______ _________
manages patient care and themanages patient care and the
delivery of specific nursingdelivery of specific nursing
services within a health careservices within a health care
agency. Nursingagency. Nursing
administration begins withadministration begins with
positions such as clinical carepositions such as clinical care
coordinators. Experience andcoordinators. Experience and
additional educationadditional education
sometimes lead to asometimes lead to a
middle-management positionmiddle-management position
such as nurse manager of asuch as nurse manager of a
specific patient care area orspecific patient care area or
house supervisor or to anhouse supervisor or to an
upper-management positionupper-management position
such as an associate director orsuch as an associate director or
director of nursing services.director of nursing services.
Nurse administrators oftenNurse administrators often
have advanced degrees such ashave advanced degrees such as
a master's degree in nursinga master's degree in nursing
administration, hospitaladministration, hospital
administration (MHA), publicadministration (MHA), public
health (MPH), or an MBA.health (MPH), or an MBA.
budgeting, stang, strategicbudgeting, stang, strategic
planning of programs andplanning of programs and
services, employee evaluation,services, employee evaluation,
and employee development.and employee development.
Vice presidents of nursing orVice presidents of nursing or
chief nurse executives oftenchief nurse executives often
have responsibilities for allhave responsibilities for all
clinical functions within theclinical functions within the
hospital. This may include allhospital. This may include all
ancillary personnel whoancillary personnel who
provide and support patientprovide and support patient
care services. The nursecare services. The nurse
administrator needs to beadministrator needs to be
skilled in business andskilled in business and
management and understandmanagement and understand
all aspects of nursing andall aspects of nursing and
patient care. Functions ofpatient care. Functions of
administrators includeadministrators include
______,_______, _______,______,_______, _______,
_______, ______________, _______
nurse researchernurse researcher
conducts evidence-basedconducts evidence-based
practice and research topractice and research to
improve nursing care andimprove nursing care and
further define and expand thefurther define and expand the
scope of nursing practice. Shescope of nursing practice. She
or he often works in anor he often works in an
academic setting, hospital, oracademic setting, hospital, or
independent professional orindependent professional or
community service agency. Thecommunity service agency. The
preferred educationalpreferred educational
requirement is a doctoralrequirement is a doctoral
degree, with at least a master'sdegree, with at least a master's
degree in nursing.degree in nursing.
directdirect
There is a direct link betweenThere is a direct link between
_______ care by an RN and_______ care by an RN and
positive patient outcomes,positive patient outcomes,
reduced complication rates,reduced complication rates,
and a more rapid return of theand a more rapid return of the
patient to an optimalpatient to an optimal
functional statusfunctional status
diminishdiminish
Professional nursingProfessional nursing
organizations predict that theorganizations predict that the
number of nurses will continuenumber of nurses will continue
to __________to __________
rushedrushed
Your patients should never feelYour patients should never feel
____________. They need to____________. They need to
feel that they are importantfeel that they are important
and are involved in decisionsand are involved in decisions
and that their needs are met. Ifand that their needs are met. If
a certain aspect of patient carea certain aspect of patient care
requires 15 minutes of contact,requires 15 minutes of contact,
it takes you the same time toit takes you the same time to
deliver organized anddeliver organized and
compassionate care as it does ifcompassionate care as it does if
you rushed through youryou rushed through your
nursing care.nursing care.
researchersresearchers
Nurse ___________ areNurse ___________ are
leaders in expandingleaders in expanding
knowledge in nursing andknowledge in nursing and
other health care disciplines.other health care disciplines.
Their work provides evidenceTheir work provides evidence
for practice to ensure thatfor practice to ensure that
nurses have the best availablenurses have the best available
evidence to support theirevidence to support their
practicespractices
historyhistory
Knowledge of the ________Knowledge of the ________
of the nursing professionof the nursing profession
increases your ability toincreases your ability to
understand the social andunderstand the social and
intellectual origins of theintellectual origins of the
discipline.discipline.
Florence NightingaleFlorence Nightingale
English nurse remembered forEnglish nurse remembered for
her work during the Crimeanher work during the Crimean
War (1820-1910)War (1820-1910)
Notes on Nursing: What It IsNotes on Nursing: What It Is
and What It Is Notand What It Is Not
This established the firstThis established the first
nursing philosophy based onnursing philosophy based on
health maintenance andhealth maintenance and
restoration.restoration.
the Nightingale Trainingthe Nightingale Training
School for NursesSchool for Nurses
An independent, secular schoolAn independent, secular school
of nursing unaliated withof nursing unaliated with
anyany
religious body; established inreligious body; established in
London in 1860. (St. ThomasLondon in 1860. (St. Thomas
Hospital)Hospital)
epidemiologistepidemiologist
Nightingale was the firstNightingale was the first
practicing nursepracticing nurse
___________. Her statistical___________. Her statistical
analyses connected pooranalyses connected poor
sanitation with cholera andsanitation with cholera and
dysentery.dysentery.
choleracholera
an acute intestinal infectionan acute intestinal infection
caused by ingestion ofcaused by ingestion of
contaminated water or foodcontaminated water or food
dysenterydysentery
inflammation of the largeinflammation of the large
intestineintestine
lady with the lamplady with the lamp
Florence Nightingale wasFlorence Nightingale was
known as "_____ ____known as "_____ ____
_____ ____"_____ ____"
sanitationsanitation
The sanitary, nutrition, andThe sanitary, nutrition, and
basic facilities in the battlefieldbasic facilities in the battlefield
hospitals were poor at best.hospitals were poor at best.
Eventually FlorenceEventually Florence
Nightingale was tasked withNightingale was tasked with
organizing and improving theorganizing and improving the
quality of ________ facilities.quality of ________ facilities.
As a result, the mortality rateAs a result, the mortality rate
at the Barracks Hospital inat the Barracks Hospital in
Scutari, Turkey, was reducedScutari, Turkey, was reduced
from 42.7% to 2.2% in 6from 42.7% to 2.2% in 6
monthsmonths
Clara BartonClara Barton
The Civil War (1860 to 1865)The Civil War (1860 to 1865)
stimulated the growth ofstimulated the growth of
nursing in the United States.nursing in the United States.
__________ ________,__________ ________,
founder of the American Redfounder of the American Red
Cross, tended soldiers on theCross, tended soldiers on the
battlefields, cleansing theirbattlefields, cleansing their
wounds, meeting their basicwounds, meeting their basic
needs, and comforting them inneeds, and comforting them in
death.death.
Mother BickerdykeMother Bickerdyke
During the civil war,During the civil war,
________ __________________ __________
organized ambulance servicesorganized ambulance services
and walked abandonedand walked abandoned
battlefields at night, lookingbattlefields at night, looking
for wounded soldiers.for wounded soldiers.
Mary MahoneyMary Mahoney
The first professionally trainedThe first professionally trained
African-American nurse wasAfrican-American nurse was
___________ _________.___________ _________.
She was concerned with theShe was concerned with the
eect culture had on healtheect culture had on health
care, and as a noted nursingcare, and as a noted nursing
leader she brought forth anleader she brought forth an
awareness of cultural diversityawareness of cultural diversity
and respect for the individual,and respect for the individual,
regardless of background, race,regardless of background, race,
color, or religion.color, or religion.
nineteenthnineteenth
Nursing in hospitals expandedNursing in hospitals expanded
in the late _________in the late _________
century.century.
Henry Street SettlementHenry Street Settlement
Nursing in the community didNursing in the community did
not increase significantly untilnot increase significantly until
1893, when Lillian Wald and1893, when Lillian Wald and
Mary Brewster opened theMary Brewster opened the
______ ________________ __________
______, which focused on the______, which focused on the
health needs of poor peoplehealth needs of poor people
who lived in tenements in Newwho lived in tenements in New
York CityYork City
twentiethtwentieth
In the early ___________In the early ___________
century a movement towardcentury a movement toward
developing a scientific,developing a scientific,
research-based defined bodyresearch-based defined body
of nursing knowledge andof nursing knowledge and
practice evolved. Nurses beganpractice evolved. Nurses began
to assume expanded andto assume expanded and
advanced practice roles.advanced practice roles.
Mary Adelaide NuttingMary Adelaide Nutting
(1858-1947)(1858-1947)
The first nursing professor atThe first nursing professor at
Columbia Teacher's College inColumbia Teacher's College in
1906, was instrumental in1906, was instrumental in
moving nursing education intomoving nursing education into
universitiesuniversities
specializationspecialization
As nursing educationAs nursing education
developed, nursing practicedeveloped, nursing practice
also expanded, and the Armyalso expanded, and the Army
and Navy Nurse Corps wereand Navy Nurse Corps were
established. By the 1920sestablished. By the 1920s
nursing _________ began.nursing _________ began.
Graduate nurse-midwiferyGraduate nurse-midwifery
programs began; in the lastprograms began; in the last
half of the centuryhalf of the century
specialty-nursingspecialty-nursing
organizations were created.organizations were created.
aging population,aging population,
bioterrorism, emergingbioterrorism, emerging
infections, disasterinfections, disaster
managementmanagement
Nurses and nurse educators areNurses and nurse educators are
revising nursing practice andrevising nursing practice and
school curricula to meet theschool curricula to meet the
ever-changing needs ofever-changing needs of
society, including ansociety, including an
_________ ________,_________ ________,
_______, _____________, ______
_________, and __________________, and _________
____________________
compassion fatiguecompassion fatigue
Frequent, intense, or prolongedFrequent, intense, or prolonged
exposure to grief and lossexposure to grief and loss
places nurses at risk forplaces nurses at risk for
developing ________developing ________
_________. It is a term used_________. It is a term used
to describe a state of burnoutto describe a state of burnout
and secondary traumaticand secondary traumatic
stress. It occurs withoutstress. It occurs without
warning and often results fromwarning and often results from
giving high levels of energygiving high levels of energy
and compassion over aand compassion over a
prolonged period to those whoprolonged period to those who
are suering, often withoutare suering, often without
experiencing improved patientexperiencing improved patient
outcomesoutcomes
Secondary traumatic stressSecondary traumatic stress
the trauma that health carethe trauma that health care
providers experience whenproviders experience when
witnessing and caring forwitnessing and caring for
others suering trauma.others suering trauma.
Examples include an oncologyExamples include an oncology
nurse who cares for patientsnurse who cares for patients
undergoing surgery andundergoing surgery and
chemotherapy over the longchemotherapy over the long
term for their cancer or aterm for their cancer or a
spouse who witnesses his wifespouse who witnesses his wife
deteriorating over the yearsdeteriorating over the years
from Alzheimer's diseasefrom Alzheimer's disease
BurnoutBurnout
The condition that occurs whenThe condition that occurs when
perceived demands outweighperceived demands outweigh
perceived resources. It is a stateperceived resources. It is a state
of physical and mentalof physical and mental
exhaustion that often aectsexhaustion that often aects
health care providers becausehealth care providers because
of the nature of their workof the nature of their work
environment.environment.
social, self-caresocial, self-care
Burnout often occurs inBurnout often occurs in
situations in which there is asituations in which there is a
lack of ______ support,lack of ______ support,
organizational pressuresorganizational pressures
influencing stang, and theinfluencing stang, and the
inability of the nurse toinability of the nurse to
practice _____-_____.practice _____-_____.
Compassion fatigueCompassion fatigue
Typically results in feelings ofTypically results in feelings of
hopelessness, a decrease in thehopelessness, a decrease in the
ability to take pleasure fromability to take pleasure from
previously enjoyable activities,previously enjoyable activities,
a state of hypervigilance, anda state of hypervigilance, and
anxiety.anxiety.
It impacts the health andIt impacts the health and
wellness of nurses and thewellness of nurses and the
quality of care provided toquality of care provided to
patients. Nurses experiencepatients. Nurses experience
changes in job performancechanges in job performance
and in their personal lives,and in their personal lives,
increased demands, and aincreased demands, and a
desire to leave the professiondesire to leave the profession
or their specialty. In addition,or their specialty. In addition,
these factors aect an agency'sthese factors aect an agency's
ability to maintain a caring,ability to maintain a caring,
competent sta and patientcompetent sta and patient
satisfaction.satisfaction.
improveimprove
When health care agenciesWhen health care agencies
develop interventions to helpdevelop interventions to help
nurses manage compassionnurses manage compassion
fatigue, nurse retention andfatigue, nurse retention and
job satisfaction rates _______job satisfaction rates _______
validate, talkvalidate, talk
Agency-based programs thatAgency-based programs that
provide opportunities toprovide opportunities to
______ the caregiver's______ the caregiver's
experiences and an opportunityexperiences and an opportunity
to ______ about theto ______ about the
challenges of the type of carechallenges of the type of care
nurses give are basicnurses give are basic
interventions to begin tointerventions to begin to
manage these factors and theirmanage these factors and their
implication for professionalimplication for professional
nursing care.nursing care.
More complex interventionsMore complex interventions
include specific programs thatinclude specific programs that
teach nurses how to moreteach nurses how to more
eectively cope with theeectively cope with the
challenges of care to oset thechallenges of care to oset the
stress related to the carestress related to the care
disengagesdisengages
When a nurse experiencesWhen a nurse experiences
ongoing stressful patientongoing stressful patient
relationships, he or she oftenrelationships, he or she often
___________. This can also___________. This can also
occur when perceived stressoccur when perceived stress
comes from nurse-physician orcomes from nurse-physician or
nurse-nurse relationships. It isnurse-nurse relationships. It is
not uncommon for nurses whonot uncommon for nurses who
are experiencing compassionare experiencing compassion
fatigue to become angry orfatigue to become angry or
cynical and have dicultycynical and have diculty
relating with patients andrelating with patients and
co-workersco-workers
lateral violencelateral violence
Occurs in nurse-nurseOccurs in nurse-nurse
interactions and includesinteractions and includes
behaviors such as withholdingbehaviors such as withholding
information, making snideinformation, making snide
remarks, and demonstratingremarks, and demonstrating
nonverbal expressions ofnonverbal expressions of
disapproval such as raisingdisapproval such as raising
eyebrows or making faces.eyebrows or making faces.
New graduates and nurses newNew graduates and nurses new
to a unit are most likely to faceto a unit are most likely to face
problems with lateral orproblems with lateral or
horizontal violencehorizontal violence
Afordable Care ActAfordable Care Act
Mandate for all Americans toMandate for all Americans to
have health insurance:have health insurance:
It aects how health care isIt aects how health care is
paid for and delivered. Therepaid for and delivered. There
will be greater emphasis onwill be greater emphasis on
health promotion, diseasehealth promotion, disease
prevention, and illnessprevention, and illness
management in the future.management in the future.
community-based carecommunity-based care
The ACA impacts how andThe ACA impacts how and
where nursing care is provided.where nursing care is provided.
More nursing services will beMore nursing services will be
in _________-__________in _________-__________
_______ settings. As a result,_______ settings. As a result,
more nurses will be needed tomore nurses will be needed to
practice inpractice in
__________-___________________-_________
_______ centers, schools, and_______ centers, schools, and
senior centers. This will requiresenior centers. This will require
nurses to be better able tonurses to be better able to
assess for resources, identifyassess for resources, identify
service gaps, and help patientsservice gaps, and help patients
adapt to safely return to theiradapt to safely return to their
community.community.
6565
The U.S. Census Bureau (2014)The U.S. Census Bureau (2014)
continues to predict acontinues to predict a
continuing rise in thecontinuing rise in the
population, with an increase inpopulation, with an increase in
the population over _____the population over _____
unemployment,unemployment,
underemployment,underemployment,
low-paying jobs, mentallow-paying jobs, mental
illness, homelessness, andillness, homelessness, and
rising health care costsrising health care costs
Things contributing to theThings contributing to the
medically underservedmedically underserved
population:population:
social, political, economicsocial, political, economic
Caring for the medicallyCaring for the medically
underserved population is aunderserved population is a
global issue; the ________,global issue; the ________,
_________, and_________, and
__________ factors of a__________ factors of a
country aect both access tocountry aect both access to
care and resources to providecare and resources to provide
and pay for these servicesand pay for these services
evidenceevidence
Your practice needs to be basedYour practice needs to be based
on current _______, NOT juston current _______, NOT just
according to your educationaccording to your education
and experiences and theand experiences and the
policies and procedures ofpolicies and procedures of
health care facilitieshealth care facilities
Magnet Recognition ProgramMagnet Recognition Program
The only national designationThe only national designation
built on and evolving throughbuilt on and evolving through
nursing research that isnursing research that is
designed to recognize nursingdesigned to recognize nursing
excellence of healthcareexcellence of healthcare
organizations through aorganizations through a
self-nominating, appraisalself-nominating, appraisal
process.process.
Quality and Safety EducationQuality and Safety Education
for Nurses (QSEN)for Nurses (QSEN)
Addresses the challenge toAddresses the challenge to
prepare nurses with theprepare nurses with the
competencies needed tocompetencies needed to
continuously improve thecontinuously improve the
quality of care in their workquality of care in their work
environments (sponsored byenvironments (sponsored by
RWJF).RWJF).
The _QSEN_____ initiativeThe _QSEN_____ initiative
encompasses the competenciesencompasses the competencies
of patient-centered care,of patient-centered care,
teamwork and collaboration,teamwork and collaboration,
evidence-based practice,evidence-based practice,
quality improvement, safety,quality improvement, safety,
and informaticsand informatics
IOMIOM
Institute of MedicineInstitute of Medicine
Knowledge, skills, and abilitiesKnowledge, skills, and abilities
(KSA)(KSA)
Elements that are integrated inElements that are integrated in
a nursing prelicesnsurea nursing prelicesnsure
program. For each competencyprogram. For each competency
that QSEN addresses there arethat QSEN addresses there are
targeted _______, _______,targeted _______, _______,
___ ________.___ ________.
Teamwork and CollaborationTeamwork and Collaboration
(QSEN)(QSEN)
QSEN: __________ ___QSEN: __________ ___
____________________
Function eectively withinFunction eectively within
nursing and interprofessionalnursing and interprofessional
teams, fostering openteams, fostering open
communication, mutualcommunication, mutual
respect, and shared decisionrespect, and shared decision
making to achieve qualitymaking to achieve quality
patient care.patient care.
evidence-based practiceevidence-based practice
(QSEN)(QSEN)
QSEN:QSEN:
________-_________________-_________
______________
Integrate best current evidenceIntegrate best current evidence
with clinicalwith clinical
expertise and patient/familyexpertise and patient/family
preferences and values forpreferences and values for
delivery of optimal health care.delivery of optimal health care.
Examples: DemonstrateExamples: Demonstrate
knowledge of basic scientificknowledge of basic scientific
methods. Appreciate strengthsmethods. Appreciate strengths
and weaknesses of scientificand weaknesses of scientific
bases for practice. Appreciatebases for practice. Appreciate
the importance of regularlythe importance of regularly
reading relevant journals.reading relevant journals.
Quality Improvement (QSEN)Quality Improvement (QSEN)
QSEN: ___________QSEN: ___________
____________________
Use data to monitor theUse data to monitor the
outcomes of care processes andoutcomes of care processes and
use improvement methods touse improvement methods to
design and test changes todesign and test changes to
continuously improve thecontinuously improve the
quality and safety of healthquality and safety of health
care systems.care systems.
Examples: Use tools such asExamples: Use tools such as
flow charts and diagrams toflow charts and diagrams to
make process of care explicit.make process of care explicit.
Appreciate how unwantedAppreciate how unwanted
variation in outcomes aectsvariation in outcomes aects
care. Identify gaps betweencare. Identify gaps between
local and best practices.local and best practices.
Safety (QSEN)Safety (QSEN)
QSEN: _________QSEN: _________
Minimize risk of harm toMinimize risk of harm to
patients and providers throughpatients and providers through
both system eectiveness andboth system eectiveness and
individual performance.individual performance.
Examples: Examine humanExamples: Examine human
factors and basic safety designfactors and basic safety design
principles and commonly usedprinciples and commonly used
unsafe practices. Value ownunsafe practices. Value own
role in preventing errors.role in preventing errors.
InformaticsInformatics
QSEN: _________QSEN: _________
Use information andUse information and
technology to communicate,technology to communicate,
manage knowledge, mitigatemanage knowledge, mitigate
error, and support decisionerror, and support decision
making.making.
Examples: Navigate anExamples: Navigate an
electronic health record.electronic health record.
Protect confidentiality ofProtect confidentiality of
protected health informationprotected health information
in electronic health records.in electronic health records.
PICO questionPICO question
Patient, Intervention,Patient, Intervention,
Comparison, OutcomComparison, Outcom
electronic health recordelectronic health record
The ______ _______ _____The ______ _______ _____
(EHR) oers an ecient(EHR) oers an ecient
method to record and managemethod to record and manage
patient health carepatient health care
informationinformation
computerized physician/computerized physician/
provider order entry (CPOE)provider order entry (CPOE)
___________ _________/___________ _________/
________ _____________ _____
_________ (CPOE) is a key_________ (CPOE) is a key
patient safety initiativepatient safety initiative
1. use technology to facilitate1. use technology to facilitate
mobility, communication, andmobility, communication, and
relationships 2. develop anrelationships 2. develop an
expertise to acquire andexpertise to acquire and
distribute knowledge 3.distribute knowledge 3.
understand and use genomicsunderstand and use genomics
Three skills sets are needed toThree skills sets are needed to
respond to these emergingrespond to these emerging
technologiestechnologies
GenomicsGenomics
the study of all the genes in athe study of all the genes in a
person and interactions ofperson and interactions of
these genes with one anotherthese genes with one another
and with that person'sand with that person's
environmentenvironment
Hospital Consumer AssessmentHospital Consumer Assessment
of Healthcare Providers andof Healthcare Providers and
Systems (HCAHPS)Systems (HCAHPS)
Helps consumers obtain validHelps consumers obtain valid
comparisons about patientcomparisons about patient
perspectives across allperspectives across all
hospitals. This information ishospitals. This information is
intended to allow consumers tointended to allow consumers to
make "apples to apples"make "apples to apples"
comparisons to support theircomparisons to support their
choicechoice
To Err Is HumanTo Err Is Human
Describe strategies forDescribe strategies for
government, health caregovernment, health care
providers, industry, andproviders, industry, and
consumers to reduceconsumers to reduce
preventable medical errors.preventable medical errors.
Note hereNote here
Notes-NotebookNotes-Notebook
