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)