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NURS285 Lectures Notes for Midterm 1.docx

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NURS 285
Sandi Hirst

NURS 285  What’s CNA? - Canadian Nursing Association  What legislation influences your practice? – criminal code, Canada Health Act  What roles will I demonstrate as a registered nurse? – Communication, verbally as well as non- verbally, advocating for what is correct  What challenges will face me in my current and emerging nursing practice? – changes What is nursing?  Promoting comfort and alleviating suffering  Expert health assessment and monitoring  Technical skills  A focus on maximizing recovery and self care  Coordinating health care teams  Health promotion and education  Developing and implementing health care policy/lobbying ICN – International Council of Nursing What are some of the roles o the RN?  Caregiver  Advocate  Educator  Communicator  Manager  Researcher Types of Nursing Care  Curative: return to level of health  Preventive: prevent disease process of occurring  Restorative/rehabilitation: restore function after disease  Supportive: care for emotional aspects  Holistic: body, mind, spirit  Palliative: care for dying patient Core Values  Altruism: concern for well-being of others before self  Autonomy: right to self-determination  Human dignity: respect for inherent worth uniqueness of individuals  Integrity: acting ethically and in accordance with established standard  Social Justice: “upholding moral, legal, and humanistic principles”, values of common good Core Knowledge  Health promotion, risk reduction, and disease prevention  Illness and disease management  Information and health care technologies  Ethics  Human diversity  Global health care  Health care systems and policy Core Competencies  Critical thinking, communication, assessment, technical skills Nursing is a practical science Discipline vs. Profession  A discipline is normally associated with following a standard way of doing things  Encompasses the knowledge in  A professions typically has regulations and frameworks/theories that are part of our licensing requirements nursing paradigm  Consists of persons educated in the discipline according to monitored standards Professions – an occupation requiring specialized knowledge and skills Flexner’s Criteria for defining a Profession  Based on intellectual action and personal responsibility  Practice based on knowledge  Practical application Characteristics of a Profession  Higher education and specialized knowledge  Social value – competency and commitment  Legislative legitimacy and self regulation – autonomous leadership and decision making  Code of ethics  Professional identity AUTONOMY – the client is independent and self-governing in decision-making ACCOUNTABILITY – professionally & legally for type & quality of care provided September 24, 2013 Nursing Practice Standards  Developing and implementing nursing practice standards  Practice standards represent acceptable requirements for determining the quality of nursing care a patient receives  These standards are developed to… o Regulate, guide, direct, and promote practice o Evaluate practice o Enable judgment of adequacy of care o Provide guidelines for identifying and exploring relationships between nursing practice and patient care outcomes o Support and facilitate safe, competent, and ethical practice o Guidelines for setting objectives in educational programs o Framework for developing specialty nursing standards o Facilitate articulation of the role of nursing  5 assumptions of Nursing Practice Standards o Apply at all times to all RN’s regardless of role o Provide guidelines to assist RN’s in decision making o Support registered nurses by outlining practice expectations of the procession o Inform the public and others about what they can expect from practicing registered nurses o Are used as legal reference for reasonable and prudent practice  5 Areas of Nursing Practice Standards o professional responsibility o Knowledge0based practice o Ethical practice o Provision of service to the public o Self-regulation  Continuing Competence Program o CARNA CCP is based on a reflective practice model o Reflective practice involves the review of one’s nursing practice to determine learning needs and incorporate learning to improve one’s practice (keeping up the date) o Based upon the nursing practice standards Professional Organizations  Why belong? o Empowering nurses in practice o Facilitates networking with colleagues  What’s available? o College and Association of Registered Nurses o Canadian Nurses Association o Canadian Association of Schools of Nursing o Canadian Gerontological Nursing Association Factors influencing our Profession  National Nursing shortage, especially in specialty areas  Patient Satisfaction – media surveys, patients like family, Healthcare is a business  Transcultural Nursing – being aware of cultural sensitivity  Evidence-Informed Practice – understanding what the research is and basing our practice on that, goal is to achieve cost-effective, high quality patient care based on scientific inquiry, clinical journals  Information Age – technology is changing, consumers could possibly be more informed than health care worker  Globalization of Health – healthcare as a global issue, diseases can travel, RNs need to understand the issues pertaining to global health  Agining Population – our population is aging, growing concers regarding the unique needs of the elderly  Legal & Ethical Issues – Health Professions Act o Standards of Professional Practice o Personal Care Directives o Licensure o Good Samaritan Laws o Public Health Laws o Physician-Assisted Suicide  Terrorism/Bioterrorism/Disaster Nursing – 9/11 terrorist attacks have heightened attention to the growing threats of terrorism, need to be aware of consequences of terrorism and use of biological agents RN’s: Our Past Image – the power of images: the ability to exert an influence propaganda/advertising  Self-Image of Nursing – set of beliefs we hold as true about ourselves o Continually being developed, influences our behavior and performance, and affects how we think and act. People’s perception is influenced by their interaction and experiences with nurses. Healers have existed in every culture & civilization o Shaman, herbalists, midwives, spiritual healers Nursing in Primitive Societies  Impossible to describe nursing practice or the role of the nurse prior to historical timelines  Religious beliefs and muths were the ofundations for medical practice in early civilizations  It is known that midwives care for the mother and infant during birthing and care for children of wealthy damilies – these were often filled by female slaves  Both men and women have worked as nurses throught the ages o First nursing school was in India in 250 B.C. – only men were considered pure enough to become nurses Nursing in Early Christian Era  Women began nursing as an expression of Christianity (acts of mercy)  Phoebe considered the first Deaxoness and visiting nurse  Fabiola started the 1 public hospital 11 and 12 Centuries  Male nurses serves the battlefields of the Crusades  Sickness was often thought to be punishment from God, so it was common to seek healing through religious intervention  Nuns & monks of various religious orders ministers to the ill.  Female healers & midwives were common Crusades 1096 A.D.  Deplorable sanitary conditions  More and more hospitals being built The Holy Wars and the Further Development of Nursing  Hospital of St. John built for ill knights  Male nurses accompanied Knights into battle  Male nurses dominated the order of Hospitalers  Humilitay and love became the foundation of nursing 11 and 12 Centuries  Physicians began to organize into guilds and emphasizes university training, excluding most women 1347-1351 The Black Plague  More than 20 million people died – spread by the bacillus Yersinia pestis  There was no effective treatment, they did know quarantine was effective th th Witch Hunts 14 -17 Centuries  Church, state, and physicians conspired to eliminate women healers  1484 – Papal decree Malleus Maleficarum  women healers were accused of being under the influence of the devil Renaissance and Reformation th  2 great movements that began in the 16 century  Renaissance – intellectual rebirth and scientific revolution began a new era “Dark Period of Nursing”  Conditions were at their worst 1550-1850  Care in hospitals provided by criminals, patients, drunks Canada Protected From the “Dark Age of Nursing”  Canada first settles by the French…Catholic monks were also somewhat medically trained Marguerite d’Youville – 18 Century Canada  Resorted to inventive fundraising, shifting healthcare to a business model (away from the nuns)  Beginning healthcare as a private enterprise, in a caring manor Victorian Era 1837-1901  Nurses were predominantly women – patriarchy  Reform focused on establishing standards for nursing education and practice Florence Nightingale st  Founder of modern nursing, established 1 nursing philosophy based on health maintenance and restoration  1 practicing nurse epidemiologist, 1 nurse researcher Florence Nightingale in 19 C. Britain  Nursing in Britain affected by Henry VIII’s renunciation of the Catholic Church – nurses were expelled from hospitals (“the Dark Age of Nursing”)  Nightingale advocated, she volunteered her services to the British army to help men suffering from disease in the Crimea. She was given permission to take a group of 38 nurses to Turkey. The ‘Crimean War’ began in 1854 (it lasted two years) Mary Seacole  Cured people suffering of Cholera and Typhoid with herbal remedies  Florence Nightigale refused Mary permission to help because she was back… Mary went anyways Late 1800’s North America  Proliferation of modern hospitals and hospital schools of nursing st  1874 – St. Catherine’s Training School was the 1 in Canada following Nightingale’s model Social Context 1900-1950  Infectious diseases remained a leading cause of death until mid 1950’s (pneumonia, tetanus, diphtheria, staph, and strep infections)  Increased emphasis on public health, sanitation, public education to prevent spread of disease  Expansions of hospitals as a major site of medical services  1910-1922 – Legislation governing nursing registration  Advent of antibiotics  Beginning of women’s movement “suffragettes” Canadian Hospitals 1900-1950  Many continues to be managed by nuns affiliated with religious organizations  Most people received nursing care n their homes  Nurses assisted the ill, did laundry, prepared meals, etc.  1910-1922 Provincial legislation passed governing nursing registration  1919 – UBC established first university baccalaureate program for nurses in the British empire  1920 – Canadian Red Cross sponsored certificate programs in public health nursing  1924 – Establishment of Canadian Nurses Association  1950-2000 Influences in Canada  Increased access to university education  Public demanding more and better health care  Illness care as an international industry  1950-present  Illness care, increasingly invasive diagnostics & treatments  Reduction of length of hospital stay, increasing prevalence of chronic illness th  20 C.  Evolved toward a scientific, research based knowledge and practice, expanded and advanced practice roles, nursing specializations evolved, specialty organizations were formed October 1, 2013 Values & Ethics – quite heavily on the Mid-Term exam Ethics – (the study of morals) a branch of philosophy that focuses on critical reflection of :  Actions and events that consider right and wrong  What ought and ought not to be done in respect to values and behaviors between people Morality – personal standards or beliefs of what is right or wrong in conduct, character and attitude. Morality is concerned with what “out to be” (end goal = moral mandate) Nurse as a Moral Agent  Moral identities are dialogical, relational and contextual  Being sensitive to moral moments  Ability to discern the “good” action to take and willingness to accept the responsibility of the action taken  Beneficence – understanding ethical action  Relational Ethics – understanding the ethical situation  Utilitarianism - justice  Virtue – understanding shared ethical communication  Legislation  Kantianism – autonomy  Code of Ethics Values – at the heart of ethic  They influence how we treat each other, they influence the systems we create to provide care  Values are individual – based on our personal needs and experiences  Values are share – based on cultural and social background and relationships CAN Code of Ethics (2008) – organized in two parts:  Part I “Nursing Values and Ethical Responsibilities”  Part II Issues of Social Justice  7 Primary Values  Providing safe, compassionate, competent & ethical care  Promoting heath & well-being  Promoting and respecting informed decision making  Preserving dignity  Maintaining privacy and confidentiality  Promoting justice  Being accountable Bioethical Principles  Autonomy – “self-determination,” the right of people to choose for themselves what they think is best for them. Influenced by legal doctrine of informed consent.  Individual autonomy vs. relational autonomy  Beneficence – taking steps to help others, to do or promote good. Protecting and defending the rights of others, preventing harm, removing conditions that may be harmful. Nursing has “fiduciary duty” to act in the best interests of patients.  Nonmaleficence – “to do no harm,” physical harm, emotional harm . Weighing the risks of potentially harmful/beneficial treatments.  Justice – fairness in determining what someone or some group is owed, merits, deserves or is otherwise entitles to need, equality, utility, liberty & restitution. Non-discrimination in provision of care, fair decision in allocation of time and resources.  Veracity – Relational Ethics: The Nursing Perspective  Our ethical understandings are formed in, and emerge from relationships with others.  Relational ethics puts relationships, rather than principles, virtues or problems in the foreground of analysis.  What is “right” is always contextual situated in the unique station.  Core Elements of Relational Ethics:  Building Trust  Mutual Respect (Relational Knowing)  Embodied Knowledge  Recognition of Interdependent Environment  Moral Significance of Relational Knowing  Ethical practice is situated in relationships  Autonomy are Relational  Recognizing that we both have knowledge to offer each situation  Engagement  Connecting in an authentic and mutual respectful way while honoring complexity and ambiguity  Building trust in that relationship  Moral Significance of Embodied Knowing  Moral understanding we feel within ourselves as nurses when we touch or feel someone’s pain  Touch can affect healing and offer a sense of moral worth for both nurse and patient  Ethic that considers interpersonal commitments while recognizing environmental influences that impact our attentiveness and responsiveness  Nurses with Addictions: What are the ethical issues?  Should such misconduct be punished?  Assessing the ethics of the situation  Analyzing available options  Making the best decision possible  Reflecting and reviewing ethical action October 8, 2013 What is CNA?  Canadian Nursing Association – Framework for the practice of registered nurses in Canada  Regulates our professional practice on a national scale What are the elements listed under professional practice?  Maintaining confidentiality, professionally administering surveys What are the entry to practice competencies?  CARNA’s Entry-to-Practice Competencies for the Registered Nurse  Mental well-bing fit to practice Context for our Roles  Different educational focuses, depth, detail of knowledge, thinking patterns, study and credentials  Registered Nurses  Licensed Practical Nurses  Registered Psychiatric Nurses CARNA – College and Association of Registered Nurses of Alberta  Body of regulation in which we work under  2006 version has been revised to 2013 Scope of Practice  “Scope of practice is the care which you are competent, educated and authorized to provide.”  Activities that RN’s are educated and authorized to perform are set out in legislation and complemented by standards, guidelines and policy positions of provincial, territorial nursing bodies  In 2020… RN’s are…  Health professionals & knowledge workers who provide nursing care and lead nursing and health services in all kinds of settings  Prepared to provide direct care, lead nursing, health & social services, collaborate with and lead teams, educate nursing students, mentor new nurses, develop healthy policy, serve as administrators: … most RN’s work in interprofessional teams  Champion self-care & facilitate its’ integration across all settings  Recognize and incorporate into their practice knowledge of the impact of determinants of health  Support clients by enabling through building health public policy, creating supportive environments, developing personal skills and strengthening community action  Assist clients to navigate the system and to increase control over and improve or maintain their health  Provide direct clinical care when health care needs are acute, complex, rapidly changing, and when outcomes are unpredictable  Are health educators directing clients to credible sources and assisting them to develop health literacy  Provide care in all settings that is responsive to changing demographics such as aging, diverse populations, aboriginal  Assess, plan, implement care directed to mental health needs  Partner with family physicians in family practice to follow families across all stages of growth & development, wellness & illness  Community health nurses, in much greater #’s than today, play key roles in diverse practice focuses in the community  Continue to work in established roles and move into new roles to assess, diagnose and treat specific health conditions such as providing contraception, ordering medications, radiology & lab tests  In advanced practice roles move into new roles to meet population health needs, improve quality of care provided and reduce wait times  Develop and evaluate evidence and research for best practice  Continue to demonstrate positive nurse sensitive outcomes for the client and the health care system as a whole  Roles of a RN: caregiver, communicator, advocate, counselor, leader, manager, teacher, coordinator, rehabilitator Caregiver  The chief goal of an RN in this role is to convey understanding about what is important and to provide support  The RN supports the client by attitudes and actions that show concern for client’s welfare and acceptance of the client as a person, not merely a m
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