COMMUNICATIONS AND INTRODUCTION TO NURSING

ANITA CATLIN, DNScANITA CATLIN, DNSc

KATHLEEN ROCKET, MSNKATHLEEN ROCKET, MSN

FALL 2003FALL 2003

PLAN FOR DAY

Read article in classRead article in class Discuss what is a nurseDiscuss what is a nurse Communication ToolCommunication Tool Discuss confidentialityDiscuss confidentiality Do nursing interview on classmateDo nursing interview on classmate View Video on American Oncology View Video on American Oncology

NursesNurses

Who Can I Think of as a Mentor?

DEFINITION OF NURSINGHENDERSON, 1939

Nursing is primarily helping people (sick or well) in the performance of those activities contributing to health, or its recovery (or to a peaceful death) that they would perform unaided if they had the necessary strength, will, or knowledge. It is likewise the function of nurses to help people gain independence as rapidly as possible.

Virginia Henderson, Definition of NursingInternational Council of Nurses, 1960

Nursing is primarily assisting individuals Nursing is primarily assisting individuals (sick or well) in the performance of those (sick or well) in the performance of those activities contributing to health, or its activities contributing to health, or its recovery (or to a peaceful death) that they recovery (or to a peaceful death) that they would perform unaided if they had the would perform unaided if they had the necessary strength, will, or knowledge. necessary strength, will, or knowledge. Nursing is a process through which care Nursing is a process through which care is provided to individuals, families, or is provided to individuals, families, or community groups.community groups.

WEIDENBACH, 1964Delineation between medicine and nursing:

The physician’s role is to treat The physician’s role is to treat the patient’s primary condition.the patient’s primary condition.

The nurse’s role is to treat the The nurse’s role is to treat the patient’s response to this patient’s response to this condition.condition.

ANA CODE OF ETHICS Last written in 1985Last written in 1985 10 years of discussion10 years of discussion Brought to nurse ethicists for reviewBrought to nurse ethicists for review Input from nationInput from nation Revised in 2001Revised in 2001

Compassion and respect, regardless Compassion and respect, regardless and unrestrictedand unrestricted

Commitment to patient; individual, Commitment to patient; individual, family, group, communityfamily, group, community

Advocates for health, safety, and rights Advocates for health, safety, and rights of patientof patient

Responsible and accountableResponsible and accountable Maintains moral self respect and Maintains moral self respect and

competencecompetence

Maintains health care environmentMaintains health care environment Advances profession by maintaining Advances profession by maintaining

standards and active involvementstandards and active involvement Collaborates with other health care Collaborates with other health care

professionals, local and worldwideprofessionals, local and worldwide Promotes nursing values and social Promotes nursing values and social

reformreform

NURSES TRAINED TO SEE OUTSIDE THE BED

HistorySociologyEthnicity

Social EconomicsFamily Dynamics

SpiritualityLoveHope

Imogene King, 1981MUTUAL INTERACTION MODEL

ExplorationExplorationInformation and AnalysisInformation and Analysis

Mutual Goal SettingMutual Goal SettingStrategiesStrategies

Implementation of AlternativesImplementation of AlternativesEvaluationEvaluation

DEFINITION OF CARING IN NURSING

Swanson, 1983Swanson, 1983KnowingKnowingBeing WithBeing WithDoing ForDoing ForEnablingEnablingMaintaining BeliefMaintaining Belief

Caring for patients with community Caring for patients with community prevention or in tertiary settings, living or prevention or in tertiary settings, living or dying, throughout the lifespandying, throughout the lifespan

THOUGHTFUL DELIBERATION Fostering critical thinkingFostering critical thinking Using the nursing processUsing the nursing process Socratic method helpful Socratic method helpful Purposeful conversationPurposeful conversation

ACCOUNTABILITY

Using critical thinking before taking Using critical thinking before taking actionsactions

Being responsible for your actionsBeing responsible for your actions Entering the professional roleEntering the professional role Working at the level of your peersWorking at the level of your peers Using the nursing processUsing the nursing process

MEDICAL EDUCATION Science basedScience based Cellular/molecular understanding of Cellular/molecular understanding of

disease processdisease process Medical school, internship, Medical school, internship,

residency, fellowship; all honed to residency, fellowship; all honed to specific understandingspecific understanding

““War” against disease War” against disease Death is the “enemy”Death is the “enemy”

GOALS OF MEDICINE Promotion of health and prevention of diseasePromotion of health and prevention of disease Relief of symptoms, pain and sufferingRelief of symptoms, pain and suffering Cure of diseaseCure of disease Preventing untimely deathPreventing untimely death Improvement of functional status or maintenance Improvement of functional status or maintenance

of compromised statusof compromised status Education and counseling of patients regarding Education and counseling of patients regarding

their condition and its progresstheir condition and its progress Avoid harm to the patient in the course of careAvoid harm to the patient in the course of care

AMERICAN MEDICAL ASSOCIATIONPRINCIPLES OF MEDICAL ETHICS, 1997

Physician shall have competency, compassion Physician shall have competency, compassion and respect for human dignityand respect for human dignity

Shall be honest and expose those engaging in Shall be honest and expose those engaging in fraud or deficient characterfraud or deficient character

Respect the law and work to change law that is Respect the law and work to change law that is bad for patient carebad for patient care

Respect the rights and confidences of othersRespect the rights and confidences of othersContinue to study, use consultation, advance Continue to study, use consultation, advance

scientific knowledgescientific knowledgeFreedom to choose own patients and own Freedom to choose own patients and own

practice environmentpractice environmentParticipate in improving the communityParticipate in improving the community

PHYSICIAN DESCRIPTIONCatlin study, 1998

I think if you really want the truth on the whole, you I think if you really want the truth on the whole, you are asking somebody who is medically trained to are asking somebody who is medically trained to wear more hats than that of a physician. You are wear more hats than that of a physician. You are asking them to be a physician; you are asking asking them to be a physician; you are asking them to be ethicist; you are asking them to be an them to be ethicist; you are asking them to be an economist; you are asking them to be a minister of economist; you are asking them to be a minister of religion; you are asking them to be a judge and religion; you are asking them to be a judge and jury and it is a big mantle of responsibility. And jury and it is a big mantle of responsibility. And peer pressure, family pressure, societal pressure, peer pressure, family pressure, societal pressure, and fear of litigation all play a role in the decisions and fear of litigation all play a role in the decisions that are being made.that are being made.

GOALS OF MEDICINE WORK GROUP, 1997-1999 Germany Germany HungaryHungary ScotlandScotland USAUSA Slovak RepublicSlovak Republic SpainSpain ChileChile

ItalyItaly SwedenSweden Czech RepublicCzech Republic DenmarkDenmark IndonesiaIndonesia The NetherlandsThe Netherlands ChinaChina

MOVING TOWARDS EACH OTHER Physicians learning “context”Physicians learning “context” Advanced practice nurses Advanced practice nurses

accepting medical model of accepting medical model of diagnosis and treatmentdiagnosis and treatment

Palliative care has entered into Palliative care has entered into medical practice: initiated for medical practice: initiated for adults, less so for childrenadults, less so for children

MARTHA ROGERS, NURSE THEORIST

““When an apple is cut, When an apple is cut, others see seeds in the apple. others see seeds in the apple. We, as nurses, see apples in We, as nurses, see apples in the seeds.”the seeds.”

STUDENT NURSES’ CODE OF ETHICSCode of Academic and Clinical ConductCode of Academic and Clinical Conduct Similar to American Nurses AssociationSimilar to American Nurses Association Additional discussion on:Additional discussion on:

impairment in clinicalimpairment in clinicalnot performing skills that haven’t been not performing skills that haven’t been

taught yettaught yetCollaborate with instructors who have Collaborate with instructors who have

your best interests at heartyour best interests at heart

HEALTH

According to the World Health According to the World Health Organization is well-being in these Organization is well-being in these domains:domains:EmotionalEmotionalPhysicalPhysicalSocialSocialSpiritualSpiritual

HEALTH ILLNESS CONTINUUM View of each person of where he or View of each person of where he or

she sits on the health illness scaleshe sits on the health illness scale The patient’s opinion may be The patient’s opinion may be

different than oursdifferent than ours Ours may be different than the Ours may be different than the

patient’s patient’s It is a dynamic processIt is a dynamic process

HIGH LEVEL WELLNESS

Mental healthMental health Physical healthPhysical health Social healthSocial health Family healthFamily health Community healthCommunity health

HOLISTIC HEALTH

Interaction ofInteraction ofmindmindbodybodyspiritspirit

Nursing care is based on thisNursing care is based on this

PATIENT ADVOCACY

Expressing and defending the Expressing and defending the cause of anothercause of another

InformingInforming SupportingSupporting MediatingMediating Ensuring accessEnsuring access

PATIENT’S BILL OF RIGHTS

Considerate and respectful careConsiderate and respectful care Complete, current, and necessary Complete, current, and necessary

informationinformation Informed consent prior to procedureInformed consent prior to procedure Right to refuse treatmentRight to refuse treatment Confidentiality of recordsConfidentiality of records PrivacyPrivacy

PATIENT’S BILL OF RIGHTS

Response to request for servicesResponse to request for services Involvement in transferInvolvement in transfer Information about hospital and staff Information about hospital and staff

relationshipsrelationships Knowledge of research and right to refuseKnowledge of research and right to refuse Continuity of careContinuity of care Bill explanationBill explanation Hospital rules and regulationsHospital rules and regulations

CONFIDENTIALITY Patient has the right to privacyPatient has the right to privacy Patients entrust in us and we have earned that trustPatients entrust in us and we have earned that trust Especially in small towns as we practice inEspecially in small towns as we practice in No discussion other than those who need to knowNo discussion other than those who need to know Patients will need to disclose private dataPatients will need to disclose private data Discussion with your instructor is acceptableDiscussion with your instructor is acceptable Use patient initials on your work and notesUse patient initials on your work and notes No talking in cafeteria, hallways, elevatorsNo talking in cafeteria, hallways, elevators

LEVELS OF CARE

Primary CarePrimary CareHealth promotionHealth promotionPreventionPreventionOutpatientOutpatientFirst line of careFirst line of care

LEVELS OF CARE

Secondary CareSecondary CareSurgerySurgerySpecialistsSpecialistsOB/GYNOB/GYNLocal hospital treatmentLocal hospital treatment

LEVELS OF CARE

Tertiary CareTertiary Care Regional medical careRegional medical care Regionalized expertiseRegionalized expertise Medical schoolMedical school Advanced diagnosticsAdvanced diagnostics Away from homeAway from home May be done by telehealthMay be done by telehealth

CONTINUITY OF CARE

Care that begins with maintaining Care that begins with maintaining health, treats someone with an acute health, treats someone with an acute illness, and follows to home care for illness, and follows to home care for recovery or stabilizationrecovery or stabilization

A goal of good nursingA goal of good nursing Rehabilitation begins with admissionRehabilitation begins with admission

TYPES OF NURSING CARE

Curative: Return to level of healthCurative: Return to level of health Preventive: Prevent disease process Preventive: Prevent disease process

from occurringfrom occurring Restorative/Rehabilitation: Restore Restorative/Rehabilitation: Restore

function after diseasefunction after disease Supportive: Care for emotional aspectsSupportive: Care for emotional aspects Holistic: Body, mind, spiritHolistic: Body, mind, spirit Palliative: Care for dying patientPalliative: Care for dying patient

ILLNESS

AcuteAcute ChronicChronic RemissionRemission ExacerbationExacerbation

INDEPENDENT NURSING FUNCTIONS

Licensed to initiate based on knowledge Licensed to initiate based on knowledge and skillsand skills

Physical carePhysical care Gathering health information Gathering health information Support and comfortSupport and comfort Teaching, counselingTeaching, counseling Environmental supportEnvironmental support ReferralsReferrals

DEPENDENT/COLLABORATIVE NURSING FUNCTIONS Under physician ordersUnder physician orders Under protocolsUnder protocols Decisions under parametersDecisions under parameters Student reports to faculty memberStudent reports to faculty member

METHODS OF CARE DELIVERY

FunctionalFunctional Team NursingTeam Nursing Primary Care NursingPrimary Care Nursing Nurse PractitionerNurse Practitioner Independent Nursing PracticeIndependent Nursing Practice Private Duty NursingPrivate Duty Nursing Home Care NursingHome Care Nursing

HEALTH CARE PERSONNEL

Physician: Medical diagnosis and treatment, Physician: Medical diagnosis and treatment, cure oriented, often given more leadership cure oriented, often given more leadership than trained forthan trained for

Nurse Practitioner: MSN, Advanced practice, Nurse Practitioner: MSN, Advanced practice, can Dx and Txcan Dx and Tx

Clinical Nurse Specialist: Advanced role in Clinical Nurse Specialist: Advanced role in acute care settingsacute care settings

Nurse: LVN, ADN, BSN, PHN, MSN, PhD, Nurse: LVN, ADN, BSN, PHN, MSN, PhD, DNSc, JDDNSc, JD

Midwife: Advanced Practice, MSNMidwife: Advanced Practice, MSN

HEALTH CARE PERSONNEL

Dietician: Trained in nutrition and food Dietician: Trained in nutrition and food servicesservices

Physical Therapist: Muscular-skeletal Physical Therapist: Muscular-skeletal focusfocus

Pharmacist: Preparation/Dispensing Pharmacist: Preparation/Dispensing MedsMeds

Respiratory Therapist: Management of Respiratory Therapist: Management of airway, lung, and ventilator issuesairway, lung, and ventilator issues

HEALTH CARE PERSONNEL Social Worker: College degree, support Social Worker: College degree, support

and counsel patients and staff, transfers and counsel patients and staff, transfers and placementand placement

Hospital chaplain: Issues of spirituality Hospital chaplain: Issues of spirituality and death and dyingand death and dying

Occupational therapist: Fine motor Occupational therapist: Fine motor training and activities of daily livingtraining and activities of daily living

Speech therapy: Speech and swallowing Speech therapy: Speech and swallowing Paramedical technologist: Skills blood Paramedical technologist: Skills blood

draw, EKGdraw, EKG

HEALTH CARE FINANCING

Employment linked insuranceEmployment linked insurance Prepaid insurance policiesPrepaid insurance policies Federally and state funded programsFederally and state funded programs Millions of Americans uninsuredMillions of Americans uninsured

CONSUMER INFLUENCE & SOCIAL CHANGES

IMPACT ON HEALTH CARE Women’s movement led to improved Women’s movement led to improved

access to birth control access to birth control Consumers demanded that families be Consumers demanded that families be

present at deliveriespresent at deliveries Men’s movement made prostate cancer Men’s movement made prostate cancer

more discussedmore discussed Breast cancer activists have increased Breast cancer activists have increased

attention to this diseaseattention to this disease

FUTURE CHALLENGES

Nursing shortageNursing shortage Increased telehealth careIncreased telehealth care Increased use of life extending Increased use of life extending

technologiestechnologies Increased training in pain control and Increased training in pain control and

end of life comfortend of life comfort