CH. 4 Professional Nursing Practice by Mary Koloroutis

1. 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

2. 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 clients • OJT does not normally meet the requirements of a professional occupation.

3. 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

4. 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? Cook Chef

5. Professional Practices Have a culture that supports professional activities: frameworks, CE, research Has a defined body of knowledge gained by formal education Is a discipline with peer review and a code of ethics Autonomy in practice with legislative and legal sanctions Is an organized system of practice-society recognized Technical Practices Are more likely to have more OJT than formal education. Are skill focused Have trade journals or technique trainings Do not focus on what advances the practice Develop through certifications Want less accountability Professional vs. Technicalfor all practice areas

6. 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. TechnicalThinking and Valuing

7. Professional Technical Professional vs. TechnicalNursing Competencies

8. 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

9. 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)

10. Imagine Minimal Change

11. Limited knowledge Information processing barriers Environmental barriers Motivational (internal) barriers Emotional barriers Perceptual barriers Intellectual barriers Cultural barriers (bias) KEY RESPONSES ARE: More people need to be stepping up to critical decisions with Shared Governance We 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 Professionals believe there are: Mind and Body Failures

12. Conceptual Frameworks-Theory Allow You To Organize Your Thinking and Connect it to Principles • It helps to know what we believe and why • These are the the building blocks of our knowledge and beliefs • This allows us to move into new territory as if we have a map for the unknown • We have less surprises, and then react less stressed • It is an external support for our faulty thinking

13. Imagine Nursing as Random Practice—Not a Discipline • Inconsistent care • Patient confusion • Evidence based practices are not encouraged • There is confusion and constant conflict • No accountability

14. Metaparadigms • Broadest consensus of a discipline • Have general parameters & creates boundaries • Have a distinctive domain and cover all of it • Most theories include these components • Person (humans) • Environment (context) • Health (ideas of health) • Nursing (nursing as a discipline) • Caring • Quality

15. Propositions:Linkages & Relationships • Belief regarding person to their own health • Belief regarding person to environment • Belief regarding health to nursing practice • Belief regarding the connection of person, environment, health , and the practice of nursing • Beliefsabout caring, quality and practice

16. The Focus of One’s PracticeImpacts the practice and workplace • Client focused • Family focused • Person-environment focused • Nursing therapeutic focused • Humanistic focused • Spiritually focused • Process focused

17. Models Give you a Picture of How the Parts are Related

18. A Philosophy Has Your Key Values Presented for Others

19. 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.)

20. Definitions of Nursing (ANA) • Provision of a caring relationship that facilitates health and healing • Attention to the range of human responses to health and illness, the physical and social environments • Integrates objective data and subjective experience. • Apply scientific knowledge • Advance knowledge through scholarly inquiry • Influence social and public policy for social justice

21. 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.”

22. The Scope of Nursing Practice • Dependent on their educational preparation • Their experience • Their role • And the nature of the patient population • Practice within recognized standards of professional nursing practice (varies with education, experience

23. 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

24. 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,

25. Creating Boundaries for Practical Nursing: What is in the Domain of NOT Practical Nursing Practical Nursing

26. Quiz # 1 Name:Date List four things that are in the domain of practical nursing & four things that are beyond the scope of practical nursing Beyond LPN Within LPN

27. Creating Boundaries for Nursing:What is the Discipline? What is in the domain And what is not NOT NURSING NURSING

28. 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-being • 5. What you do to or for your clients

29. All Nursing Assessment Diagnosis Outcomes Identified Planning Implementation Coordination of Care Health teaching, Promotion Consultation Prescriptive Authority Evaluation Professional Nursing Quality of Practice Education Professional Prac. Eval. Collegiality /Collaboration Ethics Research Resource Utilization Leadership Academic Training for RNs

30. 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)

31. Essential Functions of Nursing Practice • Assessment of needs through data collection, clinical assessment, plan, implement, & evaluate • Manage and deliver the care required for the patient’s condition and individual human response • Communication and coordinate care with others who are interacting with the patient • Coordinate the patient transfer or discharge

32. Benner’s “Novice to Expert” (1984) • Novice • Advanced Beginner • Competent • Proficient • Expert

33. “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)