Fundamentals of Nursing Practice - Lecture

BS
S NURSING / FIRST YEAR
TUDENT ACTIVITY SHEET
Session # 2

LESSON TITLE: CONCEPT OF NURSING Materials:

Pen and notebook
LEARNING OUTCOMES:

Upon completion of this lesson, you can:

1. Discuss the development of Nursing as a
profession;
2. Outline the standards of professional Reference:
performance and code of ethics for nurses; Potter, P. A., Perry, A.G., et al. (2021).
3. Describe the roles and career opportunities for Fundamentals of nursing (10th ed.). Singapore:
nurses; and, Elsevier.
4. Discuss the influence of social, historical,
political, and economic changes on nursing practices.

LESSON PREVIEW/REVIEW
Answer the following questions in your SAS based on your understanding. You may use the back sheet of this page for
your answers. Here are the questions as follow:
1. What is nursing as a science?

2. What is nursing as an art?

3. What is nursing as a profession?

MAIN LESSON
You will study the contents of this lesson and read your book, if available.

• Nursing is an art and a science.

• As a professional nurse you will learn to deliver care artfully with compassion, caring, and respect for each
patient’s dignity and personhood.
• As a science, nursing practice is based on a body of knowledge that is continually changing with new discoveries
 and innovations.
• When you integrate the art and science of nursing into your practice, the quality of care you provide to your
patient is at a level of excellence that benefits patients and their families.
• Because nursing is both an art and a science, nursing practice requires a blend of the most current knowledge
and practice standards with an insightful and compassionate approach to patient care. Your patients’ health care
needs are multidimensional and constantly changing.
• Thus your care will reflect the needs and values of society and professional standards of care and performance,
meet the needs of each patient, and integrate evidence-based findings to provide the highest level of care. Nursing
has a specific body of knowledge; however, it is essential that you socialize within the profession and practice to
fully understand and apply this knowledge and develop professional expertise.

Nursing as a Profession
• Patient-centered care
• Professionalism
◻ Administer quality care
◻ Be responsible and accountable
• Health care advocacy groups
◻ Robert Wood Johnson Foundation (RWJF) Future of Nursing: Campaign for Action
◻ Institute of Medicine (IOM) publication on The Future of Nursing
Science and Art of Nursing Practice
• Nursing requires • Benner’s stages of nursing proficiency:
◻ Current knowledge and practice ◻ Novice
standards ◻ Advanced beginner
◻ Insightful and compassionate ◻ Competent
approach ◻ Proficient
◻ Critical thinking ◻ Expert

Scope and Standards of Practice

• Nursing definitions by American Nurses
Association (ANA) and The International
Council of Nurses
• Nursing: Scope and Standards of Practice
◻ 1960: Documentation began
◻ Standards of Practice
◻ Standards of Professional Performance
• Goal
◻ To improve the health and well-being of all
individuals, communities, and populations
through the significant and visible
contributions of registered nursing using
standards-based practice

Standards of Practice
• Six standards of practice:
◻ Assessment
◻ Diagnosis
◻ Outcomes identification
◻ Planning
◻ Implementation
◻ Evaluation

• The nursing process is the foundation of clinical

decision making and includes all significant
actions taken by nurses in providing care to
patients.
 Standards of Professional
Performance

Ethics Quality of Practice Professional Practice Evaluation

Education Communication Resources
Evidence-Based Practice & Leadership
Collaboration Environmental Health
Research

• The ANA has identified 10 Standards of Professional Performance.

• These standards serve as objective guidelines for nurses to follow.

Code of Ethics
• A code of ethics is the philosophical ideals of right and wrong that define principles used to provide care.
• It is important for you to incorporate your own values and ethics into your practice.
• It will be important to incorporate the ANA code of ethics, as well as your personal values and ethics, into your
nursing practice.
• The ANA has a number of publications that address ethics and human rights in nursing. The Code of Ethics for
Nurses with Interpretive Statements is a guide for carrying out nursing responsibilities that provide quality nursing
care; it also outlines the ethical obligations of the profession.

Professional Roles
Autonomy and Educator
Accountability
Caregiver Communicator
Advocate Manager

• You are responsible for obtaining and maintaining specific knowledge and skills for a variety of professional roles
and responsibilities.
◻ Autonomy is an essential element of professional nursing that involves the initiation of independent nursing
interventions without medical orders. Accountability means that you are responsible professionally and
legally for the type and quality of nursing care provided.
◻ As a caregiver, you help patients maintain and regain health and find their maximum level of independent
function through the healing process. A patient’s health care needs include the patient’s emotional, spiritual,
and social well-being.
◻ As a patient advocate you protect your patient’s human and legal rights and help patients assert those
rights when needed.
◻ As an educator, your teaching can be formal or informal. Always use teaching methods that match your
patient’s capabilities and needs, and incorporate other resources, such as the family, in teaching plans.
◻ Your effectiveness as a communicator is central to the nurse—patient relationship. It allows you to know
your patients, including their strengths, weaknesses, and needs. You will routinely communicate with
patients and families, other nurses and health care professionals, resource people, and the community.
◻ As a manager, you will establish an environment for collaborative patient-centered care to provide safe,
quality care with positive patient outcomes.

Career Development
Nursing provides an opportunity for you to commit to lifelong learning and career development.
• Provider of care
• Advanced practice registered nurses
◻ Clinical nurse specialist
o An APRN who is an expert clinician in a specialized area of practice, such as a population (e.g.,
geriatrics), a setting (e.g., critical care), a disease specialty (e.g., diabetes), a type of care (e.g.,
rehabilitation), or a type of problem (e.g., pain).
◻ Certified nurse practitioner
o An APRN who provides health care to a group of patients, usually in an outpatient, ambulatory
care, or community-based setting. NPs provide care for patients with complex problems and a more
holistic approach than physicians.
◻ Certified nurse midwife
 o An APRN who is also educated in midwifery and is certified by the American College of Nurse-
Midwives. The practice of nurse-midwifery involves providing independent care for women during
normal pregnancy, labor, and delivery and care for the newborn.
◻ Certified registered nurse anesthetist
o An APRN with advanced education from a nurse anesthesia–accredited program. Nurse
anesthetists provide surgical anesthesia under the guidance and supervision of an anesthesiologist
who is a physician with advanced knowledge of surgical anesthesia.
• Nurse educator
◻ Works primarily in schools of nursing, staff development departments of health care agencies, and patient
education departments.
• Nurse administrator
◻ Manages patient care and the delivery of specific nursing services within a health care agency.
• Nurse researcher
◻ Investigates problems to improve nursing care and further define and expand the scope of nursing practice.
The nurse research often works in an academic setting, hospital, or independent professional or community
service agency.

Historical Influences
• Nurses:
◻ Respond to needs of patients
◻ Actively participate in determining best practices
• Knowledge of the history of the nursing profession increases your ability to
understand the social and intellectual origins of the discipline.

Florence Nightingale
• First practicing epidemiologist
• Organized first school of nursing
• Improved sanitation in battlefield hospitals
• Practices remain a basic part of nursing today

Civil War to the Beginning of the Twentieth Century

• Clara Barton - founder of the American Red Cross, tended soldiers on the battlefields.
• Mother Bickerdyke - organized ambulance services and walked abandoned battlefields at night, looking
for wounded soldiers.
• Harriet Tubman - a prominent female in the Underground Railroad movement to free slaves.
• Mary Mahoney - the first professionally trained African-American nurse. She was concerned with the
relationship between cultures and races; and as a noted nursing leader she brought forth an awareness of
cultural diversity and respect for the individual, regardless of background, race, color, or religion.
• Lillian Wald and Mary Brewster - opened the Henry Street Settlement, which focused on the health needs of
poor people who lived in tenements in New York City.

The Twentieth Century

• Movement toward scientific, research-based practice and defined body of knowledge
• Nurses assumed expanded and advanced practice roles
◻ 1906: Mary Adelaide Nutting, first nursing professor at Columbia Teachers College
◻ Army and Navy Nurse Corps established
◻ 1920s: Nursing specialization began

Twenty-First Century
• Changes in curriculum
• Advances in technology and informatics
• New programs address current health concerns
• Leadership role in developing standards and policies

Contemporary Influences
• Importance of nurses’ self-care
 ◻ Compassion fatigue, secondary traumatic stress, and burnout impact the health and wellness of
nurses and the quality of care provided to patients.
• Changes in society lead to changes in
nursing: ◻ Demographic changes
◻ Affordable Care Act (ACA) ◻ Medically underserved
◻ Rising health care costs

Trends in Nursing

• Evidence-based practice
◻ Your practice needs to be based on current evidence, not just according to your education and
experiences and the policies and procedures of health care facilities.
• Quality and Safety Education for Nurses (QSEN)
◻ QSEN addresses the challenge to prepare nurses with the competencies needed to continuously improve
the quality of care in their work environments.
• Impact of emerging technologies
◻ Many emerging technologies have the potential to rapidly change nursing practice. Some of these help
nurses use noninvasive, more accurate assessment tools; implement evidence-based practices; collect
and trend patient outcome data; and use clinical decision support systems.
• Genomics
◻ A newer term that describes the study of all the genes in a person and interactions of these genes with
one another and with that person’s environment.
• Public perception of nursing
◻ As frontline health care providers, nurses practice in all health care settings and constitute the largest
number of healthcare professionals. When you care for patients, recognize how your approach to
care influences public opinion. Always act in a competent professional manner.
• Impact of nursing on politics and health policy
◻ Nurses are becoming more politically sophisticated and, as a result, are able to increase the influence
nursing has on health care policy and practice.

Professional Registered Nurse Education

• Registered nurse education
◻ 2-year associate’s degree
◻ 4-year baccalaureate degree
• Graduate education
◻ Master’s degree, advanced practice RN
◻ Doctoral degrees
• Continuing and in-service education
◻ Involves formal, organized educational programs offered by universities, hospitals, state
nurses’ associations, professional nursing organizations, and educational and health care
institutions.

CASE SCENARIO :

Mrs. Lopez is in the hospital recovering from hip replacement surgery. Her surgery involved insertion of a new type of hip
replacement prosthesis and newer postsurgical care. The certified nurse practitioner is preparing her discharge medication and
rehabilitation prescriptions. The clinical nurse specialist is preparing to transfer Mrs Lopez to a rehabilitation facility. The nurse
educator is conducting bedside rounds to explain the new prosthesis and related postoperative care.

Discuss the roles of the certified nurse practitioner, clinical nurse specialist and nurse educator.
What is the educational preparation for each role?

CHECK FOR UNDERSTANDING

You will answer and rationalize this by yourself. This will be recorded as your quiz. One (1) point will be given to the correct
answer and another one (1) point for the correct ratio. Superimpositions or erasures in your answer/ratio is not allowed.

1. A nurse is caring for a patient with end-stage lung disease. The patient wants to go home on oxygen and be comfortable.
The family wants the patient to have a new surgical procedure. The nurse explains the risk and benefits of the surgery
to the family and discusses the patient's wishes with them. The nurse is acting as the patient's:
a. Educator.
b. Advocate.
c. Caregiver.
d. Case
manager. ANSWER:
RATIO:
2. The nurse spends time with the patient and family reviewing the dressing change procedure for the patient's wound.
The patient's spouse demonstrates how to change the dressing. The nurse is acting in which professional role?
a. Educator
b. Advocate
c. Caregiver
d. Case manager
ANSWER:
RATIO:

3. Contemporary nursing requires that the nurse has knowledge and skills for a variety of professional roles and
responsibilities. Which of the following are examples? (Select all that apply.)
a. Caregiver
b. Autonomy
c. Patient advocate
d. Manager
ANSWER:
RATIO:

4. You are preparing a presentation for your classmates regarding the clinical care coordination conference for a patient
with terminal cancer. As part of the preparation you have your classmates read the Nursing Code of Ethics for
Professional Registered Nurses. Your instructor asks the class why this document is important. Which of the following
statements best describes this code?
a. Improves self–health care
b. Protects the patient's confidentiality
c. Ensures identical care to all patients
d. Defines the principles of right and wrong to provide patient care
ANSWER:
RATIO:

5. The nurses on an acute care medical floor notice an increase in pressure ulcer formation in their patients. A nurse
consultant decides to compare two types of treatment. The first is the procedure currently used to assess for pressure
ulcer risk. The second uses a new assessment instrument to identify at-risk patients. Given this information, the nurse
consultant exemplifies which career?
a. Clinical nurse specialist c. Nurse educator
b. Nurse administrator ANSWER: d. Nurse researcher

RATIO:

6. Nurses in an acute care hospital are attending a unit-based education program to learn how to use a new pressure-
relieving device for patients at risk for pressure ulcers. This is which type of education?
a. Continuing education
 b. Graduate education
c. Professional Registered Nurse Education
d. All of the above
ANSWER:
RATIO:

7. An 18-year-old woman is in the emergency department with fever and cough. The nurse obtains her vital signs, listens
to her lung and heart sounds, determines her level of comfort, and collects blood and sputum samples for analysis.
Which standard of practice is performed?
a. Diagnosis
b. Evaluation
c. Assessment
d. Implementation
ANSWER:
RATIO:

8. A patient in the emergency department has developed wheezing and shortness of breath. The nurse gives the
ordered medicated nebulizer treatment now and in 4 hours. Which standard of practice is performed?
a. Planning
b. Evaluation
c. Assessment
d. Implementation
ANSWER:
RATIO:

9. Who established the Red Cross in the United States in

1882? c. Jane Addams
a. Clara Barton d. Florence Nightingale
b. Dorothe
a Dix ANSWER:

RATIO:

10. Which of the following is used by the nurse to identify the patient’s healthcare needs and strengths and to establish
and carry out a plan of care to meet those needs?
a. Nursing standards c. Nurse practice acts
b. Nursing orders ANSWER: d. Nursing process

RATIO:

RATIONALIZATION ACTIVITY
The instructor will now provide you the rationalization to these questions. You can now ask questions and debate among
yourselves. Write the correct answer and correct/additional ratio in the space provided.

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LESSON WRAP-UP

You will now mark (encircle) the session you have finished today in the tracker below. This is simply a visual to help you
track how much work you have accomplished and how much work there is left to do.

You are done with the session! Let’s track your progress.

AL Activity: CAT 3-2-1

This strategy provides a structure for you to record your own comprehension and summarize your learning.

Three things you learned:

1.
2.
 3.

Two things that you’d like to learn more about:

1.
2.

One question you still have:

1.