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NURSING DEFINED

1850’S: Florence Nightengale

“To engage in care that helps prevent, or helps recovery from illness and injury” “Nursing is putting individuals in the best possible condition for nature to restore and preserve health”

NURSING DEFINED

1966: Virginia Henderson

“The unique function of the nurse is to assist the individual, sick or well, in the performance of those activities contributing to health or recovery (or to a peaceful death) that he would perform unaided if he had the necessary strength, will or knowledge – in such a way as to gain independence rapidly.”

1966 Definition continued

Virginia Henderson’s definition of “Nursing” was adopted by the International Council of Nurses in 1966. This definition added Health Promotion, not just Illness Care.

NURSING DEFINED

1980: American Nursing Association

“The diagnosis and treatment of human responses to actual or potential health problems”

1980 Definition continued

ANA position added “besides nursings’ traditional dependent and interdependent functions, there is also an INDEPENDENT area of practice for using nursing skills (NANDA).

NURSING: ART & SCIENCE

ART: Ability to perform an act skillfully.

SCIENCE: Body of knowledge unique

to a particular subject

INTEGRATING NURSING THEORY

THEORY: (Greek word meaning vision) An opinion, belief, or view that explains a process.

NURSING THEORY: Proposal on what is involved in the process called nursing.

HEALTH DEFINED

Defining health is difficult because each person has a personal concept of health. Health is not acquired scientific knowledge; nor is it a thing, part of the body, or a function of the body. Health is a state of being that people define in relation to their own value system. (No longer defined as “merely the absence of illness.)

Health Definition continued

Nurses can differ on their definitions of health. They plan patient care on their individual definition of “health” AND accepted standards of health care

HOLISTIC CARE DEFINED

A philosophy based on the belief that, in health care, individuals/patients/clients function as a complete unit/body and cannot be reduced to the sum of their parts.

HOLISTIC HEALTH DEFINED

An ongoing state of wellness that involves taking care of the physical self, expressing emotions appropriately and effectively, using the mind constructively, being creatively involved with others, and becoming aware of higher levels of consciousness (1981).

CURATIVE CARE DEFINED

A course of treatment designed to restore health.

Medical Model vs Nursing Model

CURE vs CARE

HEALTH PROMOTION AND PREVENTIVE CARE

Activities involving “health promotion” help clients maintain or enhance their present levels of health (motivate people to act positively to reach goals).

Activities for “illness prevention” protect clients from actual or potential threats to health (motivate people to avoid declines in health/functional levels).

PREVENTIVE CARE DEFINED

Primary Prevention: True prevention; it precedes disease or dysfunction and is applied to clients considered physically and emotionally healthy. It does not use therapeutic treatments and does not involve symptom identification (health educ/immunizations/nutrition)


Secondary Prevention: Focuses on individuals who are experiencing health problems or illnesses and who are at risk for developing complications or worsening conditions. Activities are directed at diagnosis and prompt interventions to reduce severity and help client return to normal “health”.


Tertiary Prevention: Occurs when a defect or disability is permanent and irreversible. Involves minimizing the effects of the disease/disability by interventions directed at preventing complication and deterioration (Prior to 1994 was called Supportive Care).

ILLNESS DEFINED

Illness is a state in which a person’s physical, emotional, intellectual, social, developmental, or spiritual functioning is diminished or impaired compared with that person’s previous experience.

ACUTE ILLNESS DEFINED

Symptoms of relatively short duration that are usually severe and may affect functioning in any dimension.

Clients with acute illnesses are likely to seek health care and comply readily with recommended therapies.

CHRONIC ILLNESS DEFINED

Chronic illnesses persist, usually longer than 6 months, and can affect functioning in any dimension.

Chronically ill clients may become less actively involved in their care, may experience greater frustration, and may comply less readily with health care.

HEALTH-ILLNESS CONTINUUM DEFINED

A dynamic state that continuously alters as a person adapts to changes in the internal and external environments to maintain a state of physical, emotional, intellectual, social, developmental, and spiritual well-being

EVOLUTION OF THE HEALTH CARE DELIVERY

SYSTEMAt the turn of the century, only a few urban hospitals existed in the USA. These institutions served the poor, whereas the affluent and middle-class members of the population were treated at home (early hospitals primarily financed by voluntary processes).

HEALTH CARE EVOLUTION

1920’s: Third Party Payment for hospital care was introduced (because of the very high losses faced by hospitals from non-paying patients). Hospital insurance plans quickly developed, and the cost of health care has grown ever since.


Mid 1920s to mid 1930s: Governmental discussion regarding costs of medical care heightened.

1935: Social Security Act – facilitated public assistance to blind, elderly, and dependent children.


1938: First major national health care conference resulting in the first national discussion of a national health care program for the USA. General consensus emerged about principles for improving the nation’s health, but no agreement about the costs division and distribution (Fed/State). This unresolved discussion continues today.


1945 (post WWII): Hill-Burton Act –Provided money for hospital construction, expansion or improvement. This resulted in an explosion of hospital construction and the emergence of research and teaching facilities.


1965 Social Security Act included the passage of the Medicare and Medicaid Amendments. National and state health insurance programs for certain segments of the population

MEDICARE

A program that provides health insurance for persons who are over 65 years of age or disabled. It is regulated through different eligibility requiremments and benefits across states. Beginning in 1972 additional changes were instituted to control costs. 1977 HCFA (Health Care Financing Admin) created to run Medicare/Caid.

MEDICAID

A program providing joint federal and state health insurance for low-income persons in specific groups (FDC, elderly, blind/disabled, and persons who cannot afford medical care). Benefits vary between states. Since 1977, HCFA manages these monies as well.


1978: Rural Health Clinics Act represented the USA government’s willingness to allow nurse practitioners to deliver primary health care. It allowed for Medicare/Medicaid reimbursement for care provided by nurses. (A trend to expand nurses’ roles was established).


1970’s: Research instituted to identify similarities and differences between hospitals (Utilization Review completed by Yale University and Feds HCFA in 1983). 1983 introduced DRG’s (Diagnosis-related groups). This prospective payment system has been one of the most significant factors affecting the USA health care system.


1973: Health Maintenance Organization Act established. To provide comprehensive preventive and treatment services to a specific group of voluntarily enrolled persons under a fixed, prepaid plan. Thus began the concept of “Managed Care”.


1990’s: The Unions in the USA began a strong push to move their working constituents from “Fee for Service” insurance plans to “HMO” plans.

RISING HEALTH CARE COSTS

Technology advancements

Higher Labor Costs

Emphasis on Treatment & Individuals

Convenience implementations

Frivalous Law Suits

Growing and Aging Populations

Cost Shifting (public to private sectors)

HEALTH CARE SYSTEM DEFINED

An organized system that manages and provides treatments and preventive services for healthy, sick, and injured. Elements include physicians and their assistants, dentists and their associates, nurses and their surrogates, and the various levels of health care facilities, services, and management.

FUNDING HEALTH CARE

Private Insurance Plans: Can be obtained by an individual or through a group plan offered by employers. These programs pay for some, most, or all of the expenses of health care for the client. Such payments are called “Third Party Reimbursements”. (HMO/Managed Care/Fee for Service/Long-Term Insurance)

FUNDING HEALTH CARE

USA Government Insurance Plans (Public Insurance Plans): Medicare, Medicaid, and Catastrophic Health Insurance plans.

HEALTH CARE AGENCIES

OUTPATIENT AGENCIES: Primary Provider Offices, Clinics, Ambulatory Care Centers.

INPATIENT AGENCY/INSTITUTION: Hospitals, Subacute Care, Extended Care Facilities, Psychiatric Facilities, Rehabilitation Centers

HEALTH CARE AGENCIES

COMMUNITY-BASED AGENCIES: Adult Day-Care Centers, Home Health Care Agencies, Rural Hospitals, Crisis Intervention Centers.SUPPORT GROUPSVOLUNTEER AGENCIESHOSPICESGOVERNMENT AGENCIES (VA)

HEALTH CARE TEAM DEFINED

Organization of trained people who work together to give total patient care (Physicians, Nurses, Unlicensed assistive personnel, PT, OT, Dietary, Social Services, BioMedical, Lab, Pharmacy Services, Housekeeping, Grounds/Maintenance, Volunteers, etc, etc, etc).

NURSING BRANCHES and ROLES & PREPARATION

CNA/PCT/ERT (Unlicensed Assistants)

LPN: Educated in basic nursing techniques and direct patient care. Practices under the supervision of an RN or MD. Generally receives 1 year of education/training in a hospital, community or technical college, or other agency.

NURSING (continued)

Associate Degree RN: A 2 year program usually offered by a college or junior college. Program focuses on basic sciences and the theoretical and clinical courses related to the practice of nursing.

NURSING (continued)

Diploma RN: A 2 or 3 year program usually associated with a hospital. Also focus on the basic sciences and on theoretical and clinical courses related to nursing practice. Some programs are affiliated with colleges/universities which grant credits for non-nursing courses. These schools are declining in the USA

NURSING (continued)

Baccalaureate RN: Encompasses 4 yrs of study in a college or university. Focuses on the basic sciences and on theoretical and clinical courses, as well as courses in the social sciences, arts, and humanities to support nursing theory.

NURSING (continued)

Graduate/Advanced Practice RN: Available at both the master’s and doctoral levels. Master’s-prepared nurses fill roles as clinical specialists, nurse practitioners, administrators, and educators. Doctoral-prepared nurses conduct research, advise, administer, and instruct nurses pursuing undergraduate and graduate degrees.

HISTORICAL DEVELOPMENT OF LPNSDuring WWII, many RNs enlisted in the military, leaving civilian health care systems understaffed. To fill the void as expeditiously as possible, abbreviated programs in practical nursing were developed across the country to teach essential nursing skills.

HISTORICAL ROLE OF LPN (continued)

LPN goal was to prepare graduates to care for the health needs of well infants, children, and adults who were mildly or chronically ill or convalescing so that RNs could be used more effectively to care for acutely ill patients.


After the war, the need for LPN’s continued because many RNs opted for part-time employment or resigned to become homemakers. The LPN role was fulfilling a necessary health care need, and it became obvious that the LPN would not be a temporary position.


Thus, the National Association for Practical Nurse Education and Service, Inc was established to standardize practical nurse education and to facilitate licensure of graduates. By 1945, 8 states had approved LPN programs. In 1995, 1,107 LPN programs existed (58,000 students).


1999: The Bureau of Labor Statistics predicted “Job opportunities in the nursing profession are expected to rise faster than the norm over the next decade and will continue to make nursing an attractive career choice…replacement due to attrition & retirement will provide # job openings.

NURSING ARTICULATION OPPORTUNITIES

Articulation Defined: A process that provides academic/educational movement (a ladder) from entry levels of nursing to higher levels of nursing. Some colleges have “combined” nursing programs. Others offer “bridge” programs or Bachelor Degree to RN/MSN options.

HISTORICAL NURSING LEADERS

The Nursing Profession is new, but nursing is as old as medicine. Thru out history, nursing & medicine have been interdependent. During the era of Hippocrates, medicine was practiced without nursing, and during the Middle Ages, nursing was practiced without medicine.

NURSING HISTORY (continued)

Historically, men and women have held the role of nurse. Prior to the Crimean War (1854-1856), the majority of nurses were men. Today, 6% of the nurse population is male (Only 1% of Washington State nurses are male).

HISTORY: FLORENCE NIGHTINGALE

1854-1856: Crimean War: Nightingale brought about major reforms in hygiene, sanitation, and nursing practice, and reduced the mortality rate at the Barracks Hospital in Scutari, Turkey from 42.7% to 2.2% in a 6 month period of time with only 38 volunteer nurses.

HISTORY: FLORENCE NIGHTINGALE (cont’d)

1860: Nightingale wrote Notes on Nursing: What It Is and What It Is Not for the lay person. During this same year, she developed the first organized program of training for nurses in London. (It was not until after the USA Civil War that American Schools of Nursing began to model the academic framework established by Nightingale).

HISTORY: CLARA BARTON

Civil War (1860-1865). Barton, founder of the American Red Cross, tended soldiers on the battlefields, cleansing their wounds, meeting their basic needs, and comforting them in death. The American Red Cross was ratified by congress in 1882, after 10 yrs of lobbying by Barton.

HISTORY: DOROTHEA DIX

Civil War (1860-1865). As superintendent of the female nurses of the Union Army, Dix organized hospitals, appointed nurses, and oversaw and regulated supplies to the troops.

HISTORY: MOTHER BICKERDYKE

Civil War (1860-1865). Mother Bickerdyke organized ambulance services, supervised nurses, and walked abandoned battlefields at night looking for wounded soldiers.

HISTORY: LILLIAN WALD & MARY BREWSTER

1893: Community nursing increased significantly when Wald and Brewster opened the Henry Street Settlement, which focused on the health needs of poor people who lived in tenements in New York City.

HISTORY: HENRY STREET SETTLEMENT

Nurses working this this settlement had greater responsibility for their clients than nurses working in hospitals because they frequently encountered situations requiring action independent of a physician’s orders.

HISTORY: HENRY STREET SETTLEMENT

In addition to the treatment of illness, these poor people needed nursing therapies aimed at restoring nutrition, providing shelter, and maintaining hygiene. Wald authored 2 books about her experiences – The House on Henry Street (1915) and Windows on Henry Street (1934)

HISTORY OF NURSING (continued)

1923: Rockefeller Foundation funded a survey of nursing education, the Goldmark Report. It concluded that nursing education needed increased financial support and suggested that the money be given to university schools of nursing (Yale & Vanderbilt expansions set the example for other universities).

HISTORY OF NURSING (continued)

1901: Army Nurse Corps established

1908: Navy Nurse Corps established

1920s: Graduate nurse-midwifery programs established

1950s: Specialty nursing organizations established (OR, CCU, Oncology)

HISTORY: LYSAUGHT REPORT

1965: The Nat’l Commission of Nursing and Nursing Education explored issues that included the supply of and demand for nurses, clarification of nursing roles and functions, education of nurses, and career opportunities available to nurses. It called for clarification of nursing roles & responsibilities in relation to other health care professionals.

HISTORY: TODAY’S CHALLENGES

Today the profession is faced with greater challenges. Nurses and nurse educators are revising nursing practice and curricula to meet the ever-changing needs of society. Advances in technology, rising acuity of clients, and the early discharge of clients from health care institutions require nurses to have a strong & current knowledge base from which to practice.

HISTORY: TODAY’S CHALLENGES (cont’d)

Nursing practice is moving toward more community-based settings, and the challenge is to prepare professional nurses to deliver complex, multifaceted care in the client’s home or community based outreach facility.

NURSING MANAGEMENT PATTERNS

FUNCTIONAL NURSING: Each nurse on a patient unit is assigned specific tasks (Medication Nurse, Treatment Nurse, Admission Nurse, Etc.)


CASE METHOD: A method in which one nurse manages all the care a patient needs for a designated period of time (not the same as managed care). The method is most often used in home health and public health nursing.


TEAM NURSING: A method in which nursing personnel divide the patients into groups and complete their care together. It is organized and directed by a nurse called the “team leader” All team members report to the team leader, who is responsible for evaluating whether the goals of the patient care were met.


PRIMARY CARE NURSING: A method in which the admitting (or chosen) nurse assumes responsibility for planning patient care and evaluating the progress of the patient. Care may be delegated to another nurse, but all changes must be approved by the assigned primary nurse until the patient is discharged.


NURSE-MANAGED CARE: A method in which a nurse manager plans the care of patients based on their type of case or medical diagnosis. Another name for this time of nursing is CASE MANAGEMENT. This is a new method of patient management. (Nursing Pathways)

pvr module 1

Health & Medicine