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CH. 4 Professional Nursing Practice by Mary Koloroutis. Key Constructs to Professional Nursing The nurse-patient is the cornerstone The two major H.C. drivers can negatively impact Professional Nursing Financial decisions Technology issues - PowerPoint PPT Presentation
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CH. 4 Professional Nursing Practiceby Mary Koloroutis
Key Constructs to Professional Nursing The nurse-patient is the cornerstone The two major H.C. drivers can
negatively impact Professional Nursing Financial decisions Technology issues
Magnet Status is positively related to Professional Nursing
Key Constructs to Professional Nursing continued
Aiken Study (1994) > + P. N. Facilitate professional autonomy Nursing control over their practice Positive nurse-physician relations
P.N. numbers/mix impact + patient outcomes by 3-12% (Needleman, 2001) Provides compassionate care to clientsOJT does not normally meet the requirements of a professional occupation.
What is a Profession?
Abraham Flexner (1910) Intellectual vs physical (care plan vs IV) Based on an assessable body of
knowledge Is practical rather than theoretical Can be taught through professional Ed Has a strong internal organization of
members Has practitioners motivated by altruism
Explore the Meaning of a Professional vs. Technical
Practice
Describe the similarities or differences between the chef at the Brown Palace & the cook at the Village Inn?
Chef
Cook
Professional vs. Technicalfor all practice areas
Professional PracticesHave a culture that supports professional activities: frameworks, CE, researchHas a defined body of knowledge gained by formal educationIs a discipline with peer review and a code of ethicsAutonomy in practice with legislative and legal sanctionsIs an organized system of practice-society recognized
Technical PracticesAre more likely to have more OJT than formal education. Are skill focusedHave trade journals or technique trainingsDo not focus on what advances the practiceDevelop through certificationsWant less accountability
Professional vs. TechnicalThinking and Valuing
Professional thinking More is best Specialization in depth
and breadth Evidence-based education Invests energy beyond the
work-associations, research, reading
Expects self accountability Resilient with change and
believes change is valuable
Technical Thinking Least is best Specialization in depth Experience is the
primary educator Conserves energy
beyond the workday Prefers others be
accountable Enjoys consistency and
believes change is disruptive
Professional vs. TechnicalNursing Competencies
Professional Technical
Imagine Nursing as Never Changing-Flat Line
Completely controlled Impact on patient
outcomes Impact on new
nurses Impact on
physicians Impact on quality Impact on staff
What Would it Look Like with Fluctuation and Change?
How is Fluctuation & Change different from Random Chaos?What are the Benefits of Fluctuation and Change?Called Cybernetics II
(as system in constant change—shaping toward improvements)
Imagine Minimal Change
Professionals believe there are: Mind and Body Failures
Limited knowledgeInformation processing barriersEnvironmental barriersMotivational (internal) barriersEmotional barriersPerceptual barriersIntellectual barriersCultural barriers (bias)
KEY RESPONSES ARE:More people need to be
stepping up to critical decisions with
Shared GovernanceWe need practice
theories to keep us on track and tell us when we are lost
We need to practice in an evidence-based care environment
Conceptual Frameworks-Theory Allow You To Organize Your Thinking and Connect it to
PrinciplesIt helps to know what we believe and whyThese are the the building blocks of our knowledge and beliefsThis allows us to move into new territory as if we have a map for the unknown We have less surprises, and then react less stressedIt is an external support for our faulty thinking
Imagine Nursing as Random Practice—Not a Discipline
Inconsistent carePatient confusionEvidence based practices are not encouragedThere is confusion and constant conflictNo accountability
MetaparadigmsBroadest consensus of a disciplineHave general parameters & creates boundariesHave a distinctive domain and cover all of itMost theories include these components Person (humans) Environment (context) Health (ideas of health) Nursing (nursing as a discipline) Caring Quality
Propositions: Linkages & Relationships
Belief regarding person to their own healthBelief regarding person to environmentBelief regarding health to nursing practiceBelief regarding the connection of person, environment, health , and the practice of nursing
Beliefs about caring, quality and practice
The Focus of One’s PracticeImpacts the practice and workplace
Client focusedFamily focusedPerson-environment focusedNursing therapeutic focusedHumanistic focusedSpiritually focusedProcess focused
Models Give you a Picture of How the Parts are Related
A Philosophy Has Your Key Values Presented for Others
Advocacy through Caring
About Quality
Nursing Practice
Patients are the reason we exist and our caring shows that we advocate for them
Quality is the combination of clinical competency and the art of caring
Nursing is at the forefront of our excellence
Other TheoriesImpact the practice and the workplace
Growth and development (Erikson, Piaget)Adult development (Kohlberg, Gilligan, Rest)Aging and death (Kubler-Ross)Chronic Disease (Geriatric Theories)Human Intelligence (Gardner)Psychological development (Psych. Theories)Cause and Effect & Multifactorial (Medicine)Potentiality, Consciousness & Reality (Q.M.)
Definitions of Nursing (ANA)
Provision of a caring relationship that facilitates health and healingAttention to the range of human responses to health and illness, the physical and social environmentsIntegrates objective data and subjective experience.Apply scientific knowledgeAdvance knowledge through scholarly inquiryInfluence social and public policy for social justice
Definition of Nursing (ANA)
“Nursing is the protection, promotion, and optimization of health and abilities, prevention of illness and injury, alleviation of suffering through the diagnosis and treatment of human response, and advocacy in the care of individuals, families, communities, and populations.”
The Scope of Nursing Practice
Dependent on their educational preparationTheir experienceTheir roleAnd the nature of the patient populationPractice within recognized standards of professional nursing practice (varies with education, experience
Three Realms of Practice
Delegated RNs carry out medical plans of action RN is responsible to confirm safety, and
appropriateness of the order
Independent Focus is on the patients response to actual
or potential health problems
Interdependent Interdisciplinary care, planning, and services
Entry & Levels of Nursing Today
Certified Nursing Assist.Licensed Practical Nurse
PN, LPN, LVN
Professional Entry AD, BSN, (Dip), ND
Advanced Practice Nurses
NP, CNS, ND
Terminal Degrees Ed.D., Ph.D., DNSc, DNP,
DScN,
Creating Boundaries for Practical Nursing:
What is in the Domain of
NOT Practical Nursing
Practical Nursing
Quiz # 1 Name: Date
Beyond LPN
List four things that are in the domain of practical nursing &four things that are beyond the scope of practical nursing
Within LPN
Creating Boundaries for Nursing:What is the Discipline?
What is in the domain
And what is not
NOT NURSINGNURSING
Evaluating the boundaries of Nursing
1. Distinctions between human and non-human (not nursing), 2. Distinctions between living and nonliving (not nursing),3. Nature of environments and human-environmental interactions from cellular to societal levels,4. Illness versus health and well-being5. What you do to or for your clients
Academic Training for RNsAll NursingAssessmentDiagnosisOutcomes IdentifiedPlanningImplementation
Coordination of Care Health teaching,
Promotion Consultation Prescriptive Authority
Evaluation
Professional NursingQuality of PracticeEducationProfessional Prac. Eval.Collegiality /CollaborationEthicsResearchResource UtilizationLeadership
Roles of Professional Nursing
Have a “Voice of Agency”1. Sentry (Watch over, protect others)2. Healer (Care for another’s body, mind, spirit)3. Guide (Leads another through unfamiliar territory)4. Teacher (Imparts knowledge)5. Collaborator (Works with others)6. Leader (Has authority to act on behalf of others)
Essential Functions of Nursing Practice
Assessment of needs through data collection, clinical assessment, plan, implement, & evaluateManage and deliver the care required for the patient’s condition and individual human responseCommunication and coordinate care with others who are interacting with the patientCoordinate the patient transfer or discharge
Benner’s “Novice to Expert” (1984)
NoviceAdvanced BeginnerCompetentProficientExpert
“Quotes” form Ch. 4
There must be a relationship with the patient to know their strengths, weaknesses, hopes and fears… our challenge is to balance tasks with relationship. (Manthey)Within the dominant, modern, Western mindset, the caring-healing practices of nursing have been on the margins—have been repressed and silenced. (Watson)