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問題一覧
1
Clinical judgment
a process; consists of recognizing and analyzing the cues, prioritizing hypotheses, generating solutions, taking actions, and evaluating outcomes
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Reflective thinking
consists of collecting and analyzing info and carefully considering options for action
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Problem-solving
considers an issue and attempts to find a satisfactory outcome
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ANA: 1980: The ANA defined nursing as:
“The diagnosis and treatment of human responses to actual and potential health problems.”
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ANA 2010: - - - - -
Nursing practice is individualized, Nurses care by establishing partnerships , Caring is central to the practice of the RN, RNs use the nursing process to plan and provide individualized care to the healthcare consumers, A strong link exists between the professional work environment and the RN’s ability to provide quality healthcare and achieve optimal outcomes
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ANA 2015:
“Nursing is the protection, promotion, and optimization of health and abilities, prevention of illness and injury, facilitation of healing, alleviation of suffering through the diagnosis and treatments of human responses, and advocacy in the care of individuals, families, groups, communities, and populations.”
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Why Define Nursing?
Helps public understand value of nursing, Helps differentiate activities of nursing from those of medicine, Helps students understand what’s expected of them
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Important Qualities for Nurses
Critical-thinking skills, Caring and compassionate, Detail-oriented, Organizational skills, Speaking skills, Listening skills, Patience, Competence, Emotional stability, Physical stamina
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Nursing Profession:
Technical and scientific knowledge; be evaluated by a community of peers; have a service orientation and a code of ethics (Starr, 1982)
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Nursing Occupation:
Nursing is often described as an occupation or job, 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
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Nursing Discipline:
Nursing is the scientifically based and self-governed profession that focuses on the ethical care of others, Nursing is a discipline, driven by aspects of theory and practice, Nursing demands mastery of both theoretical knowledge and clinical skills
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How Can Nursing Improve its Recognition as a Perfection?
Standardizing education requirements, Uniform continuing educational requirements , Increased participation of nurses in professional organizations, Educating the public about the true nature of nursing practice
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Nursing Education (RN, BSN, MSN, DNP, PHD, DSN)
Diploma programs (3-year program, hospital-based), Associate degree programs (2-year program, community college), Baccalaureate degree programs (8 semesters, colleges, and universities), RN to BSN program (Associate degree to BSN degree), Master’s (2 years, must have baccalaureate degree first), Doctorate
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Continuing Edu (CE)
Professional strategy to maintain current clinical knowledge, Many states require CE courses for renewal of a nursing license
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In-Service Edu
Programs offered at the worksite
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Phases of Nursing (Benner, 1984)
Novice, Advanced beginner, Competent, Proficient, Expert
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Regulation of Nursing Practice
Nurse practice acts, State board of nursing, Standards of practice
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Professional Organizations
American Nurses Association (ANA), National League for Nursing (NLN), International Council of Nurses (ICN), National Student Nurses’ Association (NSNA), Sigma Theta Tau International (STTI), Specialty
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Recipients of Nursing Care
Individuals (referred to as patients, clients, persons), Groups, Families, Communities, Types of care (Direct and Indirect)
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Purpose of Nursing Care
Health promotion, Illness prevention, Health restoration, End-of-Life care
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Case method
one to one care, used in intensive care units, labor delivery, and private duty
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Functional nursing
each task assigned to a staff member with the appropriate knowledge and skills
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Team nursing
licensed nurse, paired with a nursing assistant or assistive personal assigned to a group of clients
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Primary nursing
one nurse manages to care for a group of clients
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Differentiated practice
individual nurses with specific and similar expertise are put together to take care of clients
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Healthcare Delivery System
acute care (the goal is to prevent deterioration and restore health), long-term support services (encompass “human assistance, assistive technologies and devices, environmental modifications, care and service coordination” on a regular or intermittent basis, Hospitals, Extended care facility (assisted living facilities and rehabs), Ambulatory care centers, Home healthcare agencies, Community or public health centers
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• Primary - -
primary healthcare providers, clinics, diagnostic centers, preventing illness and promoting illness prevention activities
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• Secondary - -
surgery centers, offices, outpatient centers, early diagnosis and treatment of illness, disease, and injury
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• Tertiary - -
home, outpatient settings, rehab, hospice, long term rehab or care for dying
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Inter professional Healthcare Team
Physicians (MDs or DOs), Advanced practice nurses (APNs)/nurse practitioners (NPs), Physician assistants (PAs), RNs and LPNs, Unlicensed assistive personnel (UAPs), Pharmacists, Therapists
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8 Types of Ambulatory Care Settings
Smartphones, computers, and the internet, Mobile care units, Convenience care and retail clinics, Urgent care, Freestanding emergency departments, Work-based clinics, Primary care clinics, Specialty care and high-tech centers
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Financing Healthcare
Individual, Individual private insurance, Employment-based private insurance, Government (Medicare/DRGs and Medicaid), Charitable organizations
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Managed Care
Health maintenance organizations (HMOs), Preferred provider organizations (PPOs), Point of service (POS), Integrated delivery systems (IDNs)
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Ensuring Quality Care Continuous quality improvement programs:
Process reviews, Outcome reviews, Structure reviews
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Societal Trends That Influence Nursing Practice
National economy, Growing proportion of older adults in the U.S., Changes in healthcare consumer, Legislation, Women’s movement, Collective bargaining
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Trends in Nursing Practice
Increased use of complementary and alternative medicine (CAM), Expanded variety of care locations, Interprofessional collaboration, Expanded career roles for nurses, Increased use of unlicensed assistive personnel, Influence of nurses on health policy, Divergence between high-tech and high-touch