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Conceptual Foundations of
NursingPeggy Korman, CNM
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How would you define Nursing?
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3
Nursing
• Caring
• Commitment
• Dedicated to meeting the health needs of people
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Florence Nightingale
• Environmental theory
• A person’s surroundings such as clean air, water, and lighting can play a part in their healing process and their quality of care
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Virginia Henderson “first lady of nursing”
• “Definition of Nursing”
• Nurses should help a client regain as much independence as quickly as possible with a holistic approach
• Treat each client as an individual, include them in the plan of care and assist them with a quick and healthy recovery
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Jean Watson• Philosophy and Science
of Caring
• Supports humanistic and holistic care; focus on “caring” promoting health and preventing illness.
• Focus on the importance of the “caring “ relationship and communication in an individual’s health
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Patricia Benner• Nurses move through
stages of expertise and skill as they practice nursing; defines a set of competencies from novice to expert nurse
• Made nursing aware of effects of clinical skills on client care and client outcomes.
• Made community more aware of nursing as a responsible and caring practice
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Dorothea Orem• Self-Care Deficit theory
of nursing
• Nurses assist clients to their highest level of self-care
• Made nurses more aware of individualized client care, their participation in the plan of care and return to their highest possible level of self-care
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Madeline Leninger• “Margaret Mead of
Nursing”: pioneer nurse-anthropologist
• Encourages nurses to gain an awareness of the uniqueness of each culture to meet the individual needs of each client
• Culturally specific care is provided in a caring manner
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Betty Neuman• Systems Model
• Wholistic approach to client care, addresses homeostasis of the client and the environment
• Focus on primary prevention
• Wholistic approach to assessment and client-centered care
• Encourages continued research
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Hildagard Peplau• Client-nurse relationships
use interpersonal skills and knowledge gained through previous research from other disciplines
• You must understand your own behavior before you can help someone else understand his behavior
• Used in mental-health field to develop therapeutic communication
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What did you see???
• Yes we provide care and comfort to the sick
• We function independently and collaboratively
• Must haves: assertiveness, knowledge, ability to make sound judgments, ability to communicate in the written and oral form, spirit of collegiality with other team members.
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Becoming A Caring Nurse at DSN
Nursing, Person, Environment, Wellness, RBC Values
Benners stages of Development:Novice-Advanced Beginner-Competent-
Proficient-Expert
The Nurse:Patient Advocate, Care-Giver, Educator,
Change Agent,Leader, User of RBC Values/Practice
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Nurses deal with the whole person
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Marjory Gordon’s Functional Patterns
• Helps us organize information about patients
• Consistent with human needs
• Health perception, Activity & Exercise, Nutrition, Elimination, Sleep & Rest, Cognition & Perception, Coping & Stress, Sexuality
• Welcome to NRS 320!!!!
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All this and more….
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Health, Wellness, Illness
• Health is “a state of complete physical, mental and social well-being, not merely the absence of disease or infirmity” (WHO, 1948)
• Holism
• Disease: a state of disharmony of mind, body, emotions, and spirit.
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Illness Prevention
• Primary prevention:
• Secondary prevention:
• Tertiary prevention:
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Complimentary and Alternative
Therapies
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Definitions
• Complementary therapy:• Used with conventional treatment
• Alternative therapy:• Used in place of conventional treatment
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Complementary/Alternative Medicine (CAM)
• Factors contributing to popularity:
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National Center for CAM
• Established in 1998 at National Institutes of Health (NIH)
• Rigorous research on CAM
• Training CAM researchers
• Disseminating information to public and professionals
• Integrative medicine
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Benefits of CAM
• Emphasizes maintenance of wellness and prevention of illness
• Utilizes a holistic approach
• May be less expensive
• May be more accessible
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Risks of CAM
• Lack of standardization
• Lack of regulation and research
• Inadequate training and certification of some healers
• Financial and health risks of unproven methods
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Traditional Chinese MedicineEnsures a balance of energy
Chi is invisible flow of energy in the body.Chi flows along pathways or meridians.
Yin and yang:Opposing pathways that form the whole
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Quigong
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Ayurveda
• Five elements:• Ether, wind, fire, water,
and earth
• Three tendencies, called doshas:• Vata, pitta, and kapha
• The goal is to balance the doshas
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HomeopathyHealing system that uses like to cure like
Remedies are minute dilutions of substances
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Reiki
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Therapeutic Touch
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YOGA
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Reflexology
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Massage
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Meditation
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Herbal Remedies
• Nutritive value of foods
• Dietary supplements
• Herbal medicine
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Manipulative and Body-Based Therapies
• Chiropractic medicine
• Hydrotherapy
• Exercise
• Massage therapy
• Hatha Yoga
• Reflexology
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Acupressure/Acupuncture
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More Mind-Body Therapies
• Hypnosis
• Biofeedback
• Visualization
• Guided imagery
• Meditation
• Prayer
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Healthcare in the community and Home
• The design, delivery and evaluation of healthcare services in the community.
• Community= workplace, school district, geographic area, managed-care enrollees, the HOME.
• Discharge planning “a coach”: helps pt move from one level of care to another within or outside the current healthcare facility. Referrals. Assessment. Pt education. Advocacy. Holistic care. Know the community resources.
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Cultural Awareness, Sensitivity and Competence
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A Culturally Competent Professional
….performs in a manner that meets the expectations of a particular cultural group, and acknowledges that group’s values, beliefs and practices.
“Indeed nursing itself, is a largely cultural phenomenon”
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Specific to Nursing…
“Culturally competent care occurs when the nurse adjusts attitudes and behaviors to work effectively in cross-cultural situations.”
(Cross, Bazron, Dennis, & Issacs, 1989)
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Who says we need cultural sensitivity
• WHO
• US HHS
• The Bureau of Nursing
• CDC
• JCAHO
• Healthy People 2020
• Be honest, you do too!
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Iceberg
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“Awareness” a better word
• Be very cautious with generalizations
• Learn to ask questions and listen to the answer
• Be prepared to get a different answer to what you believe to be the same question
• Be flexible
• Laugh: culture can become very political, be more lighthearted
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Watch Translation
• Medical words
• What the pt hears
• Could be completely different
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Stategies to Achieve Cultural Competence
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Strategies….
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How do you ask about Cultural Wishes or Needs???
• Don’t be shy
• Let the patient and family know that you CARE!
• Approach in a non-judgmental manner
• Express an interest in their culture and traditions
• Keep a resource book or current articles available on your unit
• Document any preferences so the next shift will be able to provide continuity
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Use Translation Services
• Availabililty of translator (NOT family or friends) is now required by Federal payers
• Lay workers are NOT adequate for medical translation
• 1-800-At & T Translation Line!!!!! 1-800-874-9426
• Many local advocacy groups offer assistance
• Internet translation available
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Plan for “Cultural Transformation”
• Review JCAHO Standards regarding patient care
• Seek resources for written materials with diverse ethnic representation
• Consider a “Cultural Nursing Rounds” format for education of staff
• Develop contacts in your community with various ethnic groups
• Be a cultural Change Agent
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100 Questions and Answers About Arab Americans
• www.allied-media.com/Arab-American/100%20questions%20about%20arab%20americans.htm
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DSN Video
• Jane’s School Video
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Communication and Nursing Practice
• A lifelong process for nurses
• An essential attribute of professional practice
• Builds relationships with clients, families, and multidisciplinary team members
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Nonverbal Communication
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Communication and Interpersonal Relationships
• The means to establish helping and healing relationships.
• The ability to relate to others is important for interpersonal communication.
• Developing communication skills requires both an understanding of the communication process and of one’s own communication experience
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Levels of Communicationmatching exercise
1. Intrapersonal A. One-to-one interaction between two people
2. Interpersonal B. Occurs within an individual
3. Transpersonal C. Interaction with an audience
4. Small Group D. Interaction within a person’s spiritual domain
5. Public E. Interactions with a small group of people
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Professional Nursing Relationships
• Nurse-client helping relationships
• Nurse-family relationships
• Nurse-health team relationships
• Nurse-community relationships
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Elements of Professional Communication
Appearance, Demeanor, and Behavior
Courtesy
Use of Names Trustworthiness
Autonomy and responsibility Assertiveness
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Therapeutic Communication
• Seeking Clarification:
• Sharing Observation:
• Silence:
• Summarization:
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Therapeutic Communication
• Open Question:
• Paraphrasing:
• Reflection:
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Therapeutic Communication
• Acknowledgement:
• Closed Question:
• Focused Question:.
• Giving information:
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Blockers
• False Reassurance:
• Giving Advice or Opinions:
• Showing Approval or Disapproval:
• Sidestepping the Topic:
• Stereotyped Responses:
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Blockers
• Asking “Why” Question:
• Changing the topic:
• Defensive Responses:
• Failure to listen: