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Introduction into Nursing

Part Two

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NursingAn ART and SCIENCE

• Caring: nursing is caring for and about people

• Individualized: nursing is adapting to each persons needs

• Holistic: nursing views the ENTIRE person including physical, spiritual, social, psychological and economic needs

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NursingAn ART and SCIENCE

• Interpersonal: nursing involves individuals, families, groups - each interrelated

• Reasoning: nursing is a science that requires critical thinking

• Comprehensive: nursing involves health promotion, disease prevention, health restoration and care of the dying

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Code of Ethics

• The Code of Ethics for Nurses was developed as a guide for carrying out nursing responsibilities in a manner consistent with quality in nursing care and the ethical obligations of the profession.

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Code of ethics at KSA

• http://www.moh.gov.sa/depts/NursingDepts/Ethics/Pages/default.aspx

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CODE OF ETHICSAmerican Nurses Association

1. The nurse provides services with respect for human dignity and the uniqueness of the client unrestricted by considerations of social or economic status, personal attributes, or the nature of health problems.2. The nurse safeguards the client’s right to privacy by judiciously protecting information of a confidential nature.3. The nurse acts to safeguard the client and the public when health care and safety are affected by the incompetent, unethical, or illegal practice of any person.4. The nurse assumes responsibility and accountability for individual nursing judgments and actions.5. The nurse maintains competence in nursing.

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CODE OF ETHICSAmerican Nurses Association

6. The nurse participates in activities that contribute to the ongoing development of the profession’s body of knowledge.7. The nurse participates in the profession’s efforts to implement and improve standards of nursing.8. The nurse participates in the profession’s efforts to establish and maintain conditions of employment conducive to high-quality nursing care.9. The nurse participates in the profession’s effort to protect the public from misinformation and misrepresentation and to maintain the integrity of nursing.10. The nurse collaborates with members of the health professions and other citizens in promoting community and national efforts to meet the health needs of the public.

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Challenges of the past

• Chronic shortage employed nurses• Negative practice environment • Education service gap• Evidence based practice• Heavy administration/ workload• Weak management • Poor work forces planning

Dr.Mirellina kingma, ICN

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Health Care System

• Complex of facilities, organizations, and trained personnel engaged in providing health care within a geographical area.

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Nursing and health care system

– With more than 3 million members, the nursing profession is the largest segment of the nation’s health care workforce.

– Working on the front lines of patient care, nurses can play a vital role in helping realize the objectives.

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Current Trends & Issues in Healthcare

• Nursing Shortage• Patient Satisfaction • Transcultural Nursing• National Patient Safety Initiatives• Evidence-Based Practice• Genetics• Globalization of Health• Aging Population• Legal & Ethical Issues• Terrorism/Bioterrorism/Disaster Nursing

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Types of Health Care Services

• Primary prevention– Focus on health promotion and illness prevention

• Childhood obesity/nutrition• Physical activity across lifespan• Dental/oral health• Tobacco use/smoking cessation• Health screening recommendations

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Types of Health Care Services, continued

• Secondary prevention– Focus on early disease detection, treatment– Prevent progression of disease– Early detection provided through screening

• Tertiary prevention– Focus on restoring function, decreasing disease-

related complications of already established disease

– Includes rehabilitation and palliative care

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Nursing Theory

• Theory helps provide knowledge to improve practice

• Theoretical knowledge provides nurses with increased power

• Theory provides autonomy• Theory helps develop critical thinking

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Health and Wellness

• Traditionally health and illness were viewed as two separate entities

• WHO (World Health Organization) defines health as “the state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity”

• Currently viewed as: Health-Illness Continuum

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Health - Illness Continuum

• Measures a person’s perception of health• Constantly changing state• High level wellness at one end, normal health

in the center and illness-death at the opposite end

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Stress and Adaptation

• Stressors = disruptive forces• Adaptations = reactions to stress and stressors • Nursing acts to develop interventions to

reduce or prevent stressors

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What IS Critical Thinking?

• is a process for identifying underlying assumptions and variables in order to draw conclusions and make decisions.

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What IS Critical Thinking?

• Critical thinking involves the use of several concepts, including: exploring, analyzing, prioritizing, explaining, deciding, and evaluating to identify solutions and determine a course of action to solve patient care problems.

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What IS Critical Thinking?

• Exploring encourages you to identify all the variables within a situation.

• Analyzing is the process of studying each variable to understand its meaning and its relationship to the other variables.

• Prioritizing requires you to weigh the relative importance of each variable to the others, at a given point in time.

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What IS Critical Thinking?

• Explaining the variables involves the exercise of amplifying each variable to understand its meaning in the situation and to the involved parties.

• Deciding means to choose a specific course of action.

• Evaluating requires the thinker to assess how correct the thinking process was, and if further action is needed.

Exercise

• Mrs. A , a 67-year old patient who suffers from COPD has been admitted to your unit. Upon admission you note her to be alert, oriented and appropriate. She provides you with information to complete her history. After completing & charting your assessment, you leave her to see to your other patients. An hour later when you return, you note that Mrs. A does not seem as alert, and appears to be confused.

• On each of the 5 components of critical thinking, write down what could be going on with your patient.

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Mrs. A

• Exploring: what could be causing this previously alert woman to be so suddenly confused?

• Hypoxia• Hypotension• Fatigue• Infection• Medications• Unfamiliar Surroundings• Stroke

Mrs. A

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Mrs. A

• Analyzing: what other information can I gather to help me narrow down the possible causes of her confusion?

• Vital Signs• Oxygen Saturation/ ABG• Medications taken & last dose time• Further assessment of confusion level• Previous history of confusion?• Potential infection sites & their appearance

Mrs. A

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Mrs. A

• Prioritizing/Deciding: is this change significant to this patient, and do I need to even look further? This also includes the decision that is made whether to inform the physician of the change in their patient’s status. What would you say?

• Considering that Mrs. A is a new patient, and that this is a sudden change, it is potentially clinically significant, and should be investigated thoroughly, and reported to the Physician right away.

Mrs. A

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Mrs. A

• Evaluating: after reporting the alteration to the patient’s Physician, he orders the following:

• STAT ABG & STAT Portable CXR• Blood Cultures• Urine & Sputum Cultures• Head CT in the morning if confusion doesn’t resolve• Discontinue all medications that could cause

confusion• At this point, the Physician’s orders indicate to you

that he is thinking along the same lines as you did, and your thinking process was complete

Mrs. A

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Mrs. A

• Now the next time you have a patient who suddenly presents with confusion, you have a “history” with that experience, and have a knowledge base to draw from.

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Side-by-Side

NURSING PROCESS

CRITICAL THINKING

Assessment Exploring

Diagnosis Analyzing

Planning Prioritizing/decision making

Implementation Prioritizing and deciding

Evaluation Evaluating

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References

• http://www.rn4cast.eu/attachments/Challenges%20-%20MKingma.pdf

• http://www.moh.gov.sa/depts/NursingDepts/Ethics/Pages/default.aspx