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Profesionalismo en enfermeria

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Descripción de los métodos de profesionalizacion de enfermeria.

Descripción de los métodos de profesionalizacion de enfermeria.

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  • 1. Professionalism in NursingProfessionalism in Nursing Nurses WeekNurses Week 20042004 ByBy Cheryl Donelan, R.N. BSNCheryl Donelan, R.N. BSN
  • 2. Professionalism in NursingProfessionalism in Nursing Learning ModuleLearning Module  Purpose: Upon completion of this learningPurpose: Upon completion of this learning module, the nurse will have an overview ofmodule, the nurse will have an overview of nursing professionalism in practice. Thisnursing professionalism in practice. This activity will explore what nursingactivity will explore what nursing professionalism is, how it impacts nursingprofessionalism is, how it impacts nursing practice, and how to advancepractice, and how to advance professionalism in the community. Theprofessionalism in the community. The module includes information on the Kansasmodule includes information on the Kansas State Board of Nursing’s definition ofState Board of Nursing’s definition of incompetence, The Code of Ethics from theincompetence, The Code of Ethics from the Kansas State Nurses Association andKansas State Nurses Association and accountability within the profession.accountability within the profession.
  • 3.  Objectives: Upon completion of the learningObjectives: Upon completion of the learning module, the nurse should be able to:module, the nurse should be able to: – Define the meaning of nursingDefine the meaning of nursing professionalism.professionalism. – Describe three factors which enhanceDescribe three factors which enhance professionalism.professionalism. – Describe situations reflective ofDescribe situations reflective of accountability in the nursing profession.accountability in the nursing profession.
  • 4. Nurses Week 2004Nurses Week 2004  The nursing profession began with aThe nursing profession began with a genuine desire to serve and care for others,genuine desire to serve and care for others, combined with a sense of compassion andcombined with a sense of compassion and commitment. Nurses are special people. Itcommitment. Nurses are special people. It is with awe and reverence that the nationis with awe and reverence that the nation pauses this week to celebrate and thank allpauses this week to celebrate and thank all those in the nursing profession for thethose in the nursing profession for the tireless hours of giving and care bestowedtireless hours of giving and care bestowed upon the suffering.upon the suffering.
  • 5.  To be a nurse is a calling and difficultTo be a nurse is a calling and difficult to describe in words. Who can say whyto describe in words. Who can say why a person would want to do a nursesa person would want to do a nurses work, but those who do will tell youwork, but those who do will tell you there is nothing as fulfilling orthere is nothing as fulfilling or rewarding. Nurses stay by the side ofrewarding. Nurses stay by the side of those they serve through the worstthose they serve through the worst times and celebrate with patients andtimes and celebrate with patients and families in the best times.families in the best times.
  • 6.  There is an intimacy nurses andThere is an intimacy nurses and patients share which is understood.patients share which is understood. The essence of nursing is anThe essence of nursing is an unconditional love for mankind. Tounconditional love for mankind. To be called a nurse is an honor – abe called a nurse is an honor – a profession of the highest realm.profession of the highest realm.
  • 7. Founder of NursingFounder of Nursing  Florence Nightingale is called the mother ofFlorence Nightingale is called the mother of modern secular nursing. Born in 1820 inmodern secular nursing. Born in 1820 in Florence, Italy, this intelligent, upper-classFlorence, Italy, this intelligent, upper-class woman made dramatic and universalwoman made dramatic and universal changes in health care. At age 16,changes in health care. At age 16, Nightingale was called by God to minister toNightingale was called by God to minister to the sick.the sick.
  • 8.  With her social connections she was able toWith her social connections she was able to secure an appointment as a healthcaresecure an appointment as a healthcare professional at a hospital for women inprofessional at a hospital for women in London in 1853. Nightingale was asked toLondon in 1853. Nightingale was asked to bring nurses to care for the wounded Britishbring nurses to care for the wounded British soldiers in Scutari during the Crimea War insoldiers in Scutari during the Crimea War in 1854.1854.
  • 9.  Nightingale viewed nursing as an art as well as aNightingale viewed nursing as an art as well as a science.science.  ““Nursing is an art, and, if it is to be made an art,Nursing is an art, and, if it is to be made an art, requires as exclusive a devotion, as hard arequires as exclusive a devotion, as hard a preparation, as any painter’s or sculptor’s work; forpreparation, as any painter’s or sculptor’s work; for what is the having to do with dead canvas or coldwhat is the having to do with dead canvas or cold marble, compared with having to do with the livingmarble, compared with having to do with the living body- the temple of God’s spirit? It is one of thebody- the temple of God’s spirit? It is one of the fine Arts; I had almost said, the finest of the Finefine Arts; I had almost said, the finest of the Fine Arts” (Nightingale,1868).Arts” (Nightingale,1868).
  • 10. The Florence Nightingale PledgeThe Florence Nightingale Pledge  I solemnly pledge myself before GodI solemnly pledge myself before God and in the presence of this assembly toand in the presence of this assembly to pass my life in purity and to practice mypass my life in purity and to practice my profession faithfully.profession faithfully.  I will abstain from whatever isI will abstain from whatever is deleterious and mischievous and will notdeleterious and mischievous and will not take or knowingly administer anytake or knowingly administer any harmful drug.harmful drug.
  • 11. (continued)(continued)  I will do all in my power to maintain andI will do all in my power to maintain and elevate the standard of my professionelevate the standard of my profession and will hold in confidence all personaland will hold in confidence all personal matters committed to my keeping and allmatters committed to my keeping and all family affairs coming to my knowledge infamily affairs coming to my knowledge in the practice of my calling.the practice of my calling.  With loyalty will I endeavor to aid theWith loyalty will I endeavor to aid the physician in his work and devote myselfphysician in his work and devote myself to the welfare of those committed to myto the welfare of those committed to my carecare (Nightingale,1860).(Nightingale,1860).
  • 12.  In 1859, Florence Nightingale wrote: “NoIn 1859, Florence Nightingale wrote: “No man, not even a doctor, ever gives anyman, not even a doctor, ever gives any other definition of what a nurse should beother definition of what a nurse should be than this – “devoted and obedient” “ Thisthan this – “devoted and obedient” “ This definition would do just as well for a porter.definition would do just as well for a porter. It might even do for a horse. It would not doIt might even do for a horse. It would not do for a policeman” (Nightingale, 1860).for a policeman” (Nightingale, 1860).
  • 13.  Nursing has come a long way in 145 years.Nursing has come a long way in 145 years. Nightingale established the fundamentals ofNightingale established the fundamentals of patient management, care, and cleanlinesspatient management, care, and cleanliness that has been taught in nursing schools everthat has been taught in nursing schools ever since. Her true legacy is far greater, as shesince. Her true legacy is far greater, as she elevated nursing to a higher degree ofelevated nursing to a higher degree of respectability and professionalism than everrespectability and professionalism than ever before. As we celebrate Nurse’s Week, Maybefore. As we celebrate Nurse’s Week, May 6-12, 2004 let us reflect on what6-12, 2004 let us reflect on what professional nursing is and our vision for theprofessional nursing is and our vision for the future.future.
  • 14. Definition of Professional NursingDefinition of Professional Nursing The Kansas State Board of Nursing provides this definitionThe Kansas State Board of Nursing provides this definition on professional nursing:on professional nursing: (1) The practice of professional nursing as performed by a(1) The practice of professional nursing as performed by a registered professional nurse for compensation orregistered professional nurse for compensation or gratuitously means the process in which substantialgratuitously means the process in which substantial specialized knowledge derived from the biological,specialized knowledge derived from the biological, physical, and behavioral sciences is applied to: the care,physical, and behavioral sciences is applied to: the care, diagnosis, treatment, counsel and health teaching ofdiagnosis, treatment, counsel and health teaching of persons who are experiencing changes in the normalpersons who are experiencing changes in the normal health processes or who require assistance in thehealth processes or who require assistance in the maintenance of health or the prevention or management ofmaintenance of health or the prevention or management of illness, injury or infirmity; administration, supervision orillness, injury or infirmity; administration, supervision or teaching of the process as defined in this section; and theteaching of the process as defined in this section; and the execution of the medical regimen as prescribed by aexecution of the medical regimen as prescribed by a person licensed to practice medicine and surgery or aperson licensed to practice medicine and surgery or a person licensed to practice dentistry (KSBN, 2003).person licensed to practice dentistry (KSBN, 2003).
  • 15. Definition of Licensed PracticalDefinition of Licensed Practical NurseNurse (2) The practice of nursing as a licensed practical(2) The practice of nursing as a licensed practical nurse means the performance for compensation ornurse means the performance for compensation or gratuitously of tasks and responsibilities defined ingratuitously of tasks and responsibilities defined in part (1) which tasks and responsibilities are basedpart (1) which tasks and responsibilities are based on acceptable educational preparation within theon acceptable educational preparation within the framework of supportive and restorative careframework of supportive and restorative care under the direction of a registered professionalunder the direction of a registered professional nurse, a person licensed to practice medicine andnurse, a person licensed to practice medicine and surgery or a person licensed to practice dentistrysurgery or a person licensed to practice dentistry (KSBN,2003).(KSBN,2003).
  • 16. A profession is defined as a calling orA profession is defined as a calling or vocation, especially one that involves somevocation, especially one that involves some branch of advanced learning or science. Thebranch of advanced learning or science. The essence of professionalism is both having aessence of professionalism is both having a unique or special knowledge and the self-unique or special knowledge and the self- imposed obligation to serve the community.imposed obligation to serve the community.
  • 17. Until recently this has been an unwrittenUntil recently this has been an unwritten contract. For these reasons, society holdscontract. For these reasons, society holds the professional in higher esteem than itthe professional in higher esteem than it does a technician, blue-collar worker, ordoes a technician, blue-collar worker, or businessman, people who traditionally arebusinessman, people who traditionally are interested in the benefits of theirinterested in the benefits of their employment rather than the occupationemployment rather than the occupation itself.itself.
  • 18. Professionals are expected to show aProfessionals are expected to show a degree of special attainment, altruism, anddegree of special attainment, altruism, and self-sacrifice in their dealings with the rest ofself-sacrifice in their dealings with the rest of the community and in return receivethe community and in return receive privileges both in the workplace and at largeprivileges both in the workplace and at large (Bryan-Brown, et al. 2003).(Bryan-Brown, et al. 2003).
  • 19.  In order to emphasize professionalismIn order to emphasize professionalism within nursing, each nurse needs towithin nursing, each nurse needs to understand the opportunities,understand the opportunities, responsibilities and concerns that areresponsibilities and concerns that are integral to the nursing profession. Theintegral to the nursing profession. The Kansas State Nurses Association, 2003,Kansas State Nurses Association, 2003, Code of Ethics for Nurses with InterpretiveCode of Ethics for Nurses with Interpretive StatementsStatements defines these concepts:defines these concepts:
  • 20. ANA Code Of EthicsANA Code Of Ethics Provision 7Provision 7  The nurse participates in theThe nurse participates in the advancement of the profession throughadvancement of the profession through contributions to practice, education,contributions to practice, education, administration, and knowledgeadministration, and knowledge development.development. 7.1 Advancing the profession through7.1 Advancing the profession through active involvement in nursing and inactive involvement in nursing and in healthcare policyhealthcare policy..
  • 21.  Nurses should advance their profession byNurses should advance their profession by contributing in some way to the leadership,contributing in some way to the leadership, activities, and the viability of their professionalactivities, and the viability of their professional organizations. Nurses can also advance theorganizations. Nurses can also advance the profession by serving in leadership or mentorshipprofession by serving in leadership or mentorship roles or on committees within their places ofroles or on committees within their places of employment. Nurses who are self-employed canemployment. Nurses who are self-employed can advance the profession by serving as role modelsadvance the profession by serving as role models for professional integrity. Nurses can also advancefor professional integrity. Nurses can also advance the profession through participation in civicthe profession through participation in civic activities related to health care or through local,activities related to health care or through local, state, national, or international initiatives.state, national, or international initiatives.
  • 22.  Nurse educators have a specificNurse educators have a specific responsibility to enhance students’responsibility to enhance students’ commitment of professional and civiccommitment of professional and civic values. Nurse administrators have avalues. Nurse administrators have a responsibility to foster an employmentresponsibility to foster an employment environment that facilitates nurses’ ethicalenvironment that facilitates nurses’ ethical integrity and professionalism, and nurseintegrity and professionalism, and nurse researchers are responsible for activeresearchers are responsible for active contribution to the body of knowledgecontribution to the body of knowledge supporting and advancing nursing practice.supporting and advancing nursing practice.
  • 23. 7.2 Advancing the profession by7.2 Advancing the profession by developing, maintaining, and implementingdeveloping, maintaining, and implementing professional standards in clinical,professional standards in clinical, administrative, and educational practice.administrative, and educational practice.  Standards and guidelines reflect theStandards and guidelines reflect the practice of nursing grounded in ethicalpractice of nursing grounded in ethical commitments and a body of knowledge.commitments and a body of knowledge. Professional standards and guidelines forProfessional standards and guidelines for nurses must be developed by nurses andnurses must be developed by nurses and reflect nursing’s responsibility to society.reflect nursing’s responsibility to society.
  • 24.  It is the responsibility of nurses to identifyIt is the responsibility of nurses to identify their own scope of practice as permitted bytheir own scope of practice as permitted by professional practice standards andprofessional practice standards and guidelines, by state and federal laws, byguidelines, by state and federal laws, by relevant societal values, and by the Code ofrelevant societal values, and by the Code of Ethics.Ethics.
  • 25.  The nurse as administrator or managerThe nurse as administrator or manager must establish, maintain, and promotemust establish, maintain, and promote conditions of employment that enableconditions of employment that enable nurses within that organization ornurses within that organization or community setting to practice in accord withcommunity setting to practice in accord with accepted standards of nursing practice andaccepted standards of nursing practice and provide a nursing and health care workprovide a nursing and health care work environment that meets the standards andenvironment that meets the standards and guidelines of nursing practice.guidelines of nursing practice.
  • 26.  Professional autonomy and self regulationProfessional autonomy and self regulation in the control of conditions of practice arein the control of conditions of practice are necessary for implementing nursingnecessary for implementing nursing standards and guidelines and assuringstandards and guidelines and assuring quality care for those whom nursing serves.quality care for those whom nursing serves.
  • 27.  The nurse educator is responsible forThe nurse educator is responsible for promoting and maintaining optimumpromoting and maintaining optimum standards of both nursing education and ofstandards of both nursing education and of nursing practice in any settings wherenursing practice in any settings where planned learning activities occur. Nurseplanned learning activities occur. Nurse educators must also ensure that only thoseeducators must also ensure that only those students who possess the knowledge, skills,students who possess the knowledge, skills, and competencies that are essential toand competencies that are essential to nursing graduate from their nursingnursing graduate from their nursing programs.programs.
  • 28. 7.3 Advancing the profession through7.3 Advancing the profession through knowledge development, dissemination,knowledge development, dissemination, and application to practiceand application to practice  The nursing profession should engage inThe nursing profession should engage in scholarly inquiry to identify, evaluate, refine,scholarly inquiry to identify, evaluate, refine, and expand the body of knowledge thatand expand the body of knowledge that forms the foundation of its discipline andforms the foundation of its discipline and practice.practice.
  • 29.  In addition, nursing knowledge is derivedIn addition, nursing knowledge is derived from the sciences and from the humanities.from the sciences and from the humanities. Ongoing scholarly activities are essential toOngoing scholarly activities are essential to fulfilling a profession’s obligations to society.fulfilling a profession’s obligations to society. All nurses working alone or in collaborationAll nurses working alone or in collaboration with others can participate in thewith others can participate in the advancement of the profession through theadvancement of the profession through the development, evaluation, dissemination,development, evaluation, dissemination, and application of knowledge in practice.and application of knowledge in practice.
  • 30.  However, an organizational climate andHowever, an organizational climate and infrastructure conducive to scholarly inquiryinfrastructure conducive to scholarly inquiry must be valued and implemented for this tomust be valued and implemented for this to occur.occur.
  • 31.  The nursing profession is characterized byThe nursing profession is characterized by the continuing pursuit of knowledge, athe continuing pursuit of knowledge, a sense of responsibility for human concerns,sense of responsibility for human concerns, preparation through higher education, peerpreparation through higher education, peer accountability, autonomy, and altruism.accountability, autonomy, and altruism.
  • 32.  Nursing theory provides knowledge toNursing theory provides knowledge to improve practice by describing, explaining,improve practice by describing, explaining, predicting, and controlling phenomena.predicting, and controlling phenomena. Theory provides professional autonomy byTheory provides professional autonomy by guiding the practice, education, andguiding the practice, education, and research functions of the profession. Theoryresearch functions of the profession. Theory also helps develop analytical skills,also helps develop analytical skills, challenge thinking, clarify values andchallenge thinking, clarify values and assumptions, and determine purposes forassumptions, and determine purposes for nursing practice, education, and researchnursing practice, education, and research (Tomey, 2002).(Tomey, 2002).
  • 33.  Career trajectory, in systems thinking, refers toCareer trajectory, in systems thinking, refers to the series of successive states through which athe series of successive states through which a system or career proceeds over time. It may besystem or career proceeds over time. It may be said to represent the long-term behavior of thesaid to represent the long-term behavior of the system. Nursing is often referred to as a youngsystem. Nursing is often referred to as a young profession, in that it is around 150 years old. Aprofession, in that it is around 150 years old. A review of nursing’s history clearly shows growth inreview of nursing’s history clearly shows growth in theory, evidence-based practice, image andtheory, evidence-based practice, image and autonomy.autonomy.
  • 34. VCRMC Survey on ProfessionalismVCRMC Survey on Professionalism  In the winter of 2003, a random survey ofIn the winter of 2003, a random survey of licensed nurses was conducted at Vialicensed nurses was conducted at Via Christi Regional Medical Center. The surveyChristi Regional Medical Center. The survey asked nurses throughout the organization toasked nurses throughout the organization to name three characteristics that expressedname three characteristics that expressed what professionalism was to them.what professionalism was to them.
  • 35. Click here to start video
  • 36. The top eight responses of over 300The top eight responses of over 300 surveys were as follows:surveys were as follows: ProfessionalProfessional PersonalPersonal  Knowledge (78) Respect for others (51)Knowledge (78) Respect for others (51)  Competence (53)Competence (53) Integrity (35)Integrity (35)  Appearance (48)Appearance (48) Positive Attitude (28)Positive Attitude (28)  Teamwork (27)Teamwork (27) Compassion (18)Compassion (18)
  • 37.  The following discussion will focus on theThe following discussion will focus on the results and how nurses can build on theresults and how nurses can build on the characteristics identified by peers tocharacteristics identified by peers to exemplify professional nursing.exemplify professional nursing.
  • 38. KnowledgeKnowledge  Participants in the Via Christi studyParticipants in the Via Christi study indicated that knowledge and continuingindicated that knowledge and continuing education were very important to them. Theeducation were very important to them. The desire to continue learning is relevant to thedesire to continue learning is relevant to the nurse’s ability to develop competence andnurse’s ability to develop competence and professionalism in the provision of nursingprofessionalism in the provision of nursing care. With knowledge acquired, nurses cancare. With knowledge acquired, nurses can focus on the quality and performance offocus on the quality and performance of nursing care rather than merely successfulnursing care rather than merely successful completion of tasks.completion of tasks.
  • 39. Several factors enhance the utilization andSeveral factors enhance the utilization and acquisition of knowledge. These factors are:acquisition of knowledge. These factors are:  OrientationOrientation  Preceptor/co-worker supportPreceptor/co-worker support  In-house educational programsIn-house educational programs  Advanced certificationAdvanced certification  Research evidence-based practice.Research evidence-based practice.
  • 40. Click here to start video
  • 41. OrientationOrientation  Orientation generally includes a briefOrientation generally includes a brief employee orientation about the hospital’semployee orientation about the hospital’s mission, vision and values as well asmission, vision and values as well as organizational policies and procedures.organizational policies and procedures. Further orientation for licensed personnel isFurther orientation for licensed personnel is focused on patient care policies and issues.focused on patient care policies and issues.
  • 42.  Specific orientation programs for varyingSpecific orientation programs for varying lengths of time are developed to addresslengths of time are developed to address skills and expectations for patient care inskills and expectations for patient care in each department. Some nurses may requireeach department. Some nurses may require a longer orientation time than othersa longer orientation time than others because learning is individualized.because learning is individualized.
  • 43. Preceptoring/ Co-worker SupportPreceptoring/ Co-worker Support  Mentoring or precepting is a crucial activityMentoring or precepting is a crucial activity that enhances the development ofthat enhances the development of professionals. Experienced practicingprofessionals. Experienced practicing nurses mentor others by being competentnurses mentor others by being competent role models and by providing a safety net asrole models and by providing a safety net as nurses attempt to master new skills.nurses attempt to master new skills.
  • 44. MentorsMentors  Strong mentors provide a positiveStrong mentors provide a positive introduction to the nursing profession and,introduction to the nursing profession and, depending on their beliefs, can fosterdepending on their beliefs, can foster professionalism among those they guideprofessionalism among those they guide (Cameron-Jones & O’Hara, 1996; Ehrich,(Cameron-Jones & O’Hara, 1996; Ehrich, Tennent, & Hansford, 2002; Lo & Brown,Tennent, & Hansford, 2002; Lo & Brown, 2000).2000).
  • 45. MentorsMentors  Mentoring involves two parties and occursMentoring involves two parties and occurs when the senior person in terms of maturitywhen the senior person in terms of maturity and experience- the mentor- providesand experience- the mentor- provides information, advice, and emotional supportinformation, advice, and emotional support for the junior person – the “mentee” orfor the junior person – the “mentee” or protégé. Mentors are people with advancedprotégé. Mentors are people with advanced job-related experience, knowledge, andjob-related experience, knowledge, and power in their organizations.power in their organizations.
  • 46. MentorsMentors  The beliefs of altruism, self-sacrifice,The beliefs of altruism, self-sacrifice, advanced learning and above all elseadvanced learning and above all else honesty are required in order to be ahonesty are required in order to be a mentor and serve as a role-model for thementor and serve as a role-model for the profession of nursing. To find a goodprofession of nursing. To find a good mentor look for someone with a positivementor look for someone with a positive attitude and caring approach to others. Theattitude and caring approach to others. The individual should be a good communicatorindividual should be a good communicator and someone trustworthy (Restifo, 2004).and someone trustworthy (Restifo, 2004).
  • 47. PreceptorsPreceptors Preceptors are key elements in thePreceptors are key elements in the success of a nurse’s professionalsuccess of a nurse’s professional development. Alspach (2000) published adevelopment. Alspach (2000) published a Preceptor’s Bill of Rights which follows.Preceptor’s Bill of Rights which follows. Preceptors have the right to:Preceptors have the right to: – A clear definition of their role.A clear definition of their role. – A clearly stated set of expectations forA clearly stated set of expectations for their performance.their performance.
  • 48. – A clear delineation of their responsibilitiesA clear delineation of their responsibilities to the preceptee.to the preceptee. – A clear distinction for their responsibilitiesA clear distinction for their responsibilities in relation to others who are involved inin relation to others who are involved in the orientation program.the orientation program.
  • 49. – A clear statement of all expectedA clear statement of all expected outcomes for the orientation program.outcomes for the orientation program. – Valid and reliable evaluation tools toValid and reliable evaluation tools to appraise preceptee performance.appraise preceptee performance. – The resources necessary to fulfill theirThe resources necessary to fulfill their responsibilities.responsibilities.
  • 50. – Continuing and responsive supportContinuing and responsive support systems for fulfillment of theirsystems for fulfillment of their responsibilities.responsibilities. – Adequate preparation for integration ofAdequate preparation for integration of the preceptor role.the preceptor role. – Adequate training in the knowledge, skills,Adequate training in the knowledge, skills, and attitudes necessary to fulfill theirand attitudes necessary to fulfill their responsibilities (Alspach, 2000).responsibilities (Alspach, 2000).
  • 51. Preceptor Development Classes andPreceptor Development Classes and programs help define and support theprograms help define and support the preceptor role. With the increasedpreceptor role. With the increased complexity of healthcare systems thiscomplexity of healthcare systems this clearly is an identified need for the nursingclearly is an identified need for the nursing profession.profession.
  • 52.  Students and new nurses working closelyStudents and new nurses working closely with experienced staff nurses have thewith experienced staff nurses have the opportunity for role socialization as well asopportunity for role socialization as well as increasing clinical skills, knowledge,increasing clinical skills, knowledge, competence, and confidence.competence, and confidence.
  • 53. Precepting student nurses and graduatePrecepting student nurses and graduate nurses has shown to be effective innurses has shown to be effective in reducing lengthy and costly orientationreducing lengthy and costly orientation programs, enhancing recruitment andprograms, enhancing recruitment and increasing retention.increasing retention.
  • 54. In-house Educational ProgramsIn-house Educational Programs  Nurses are required to maintain andNurses are required to maintain and develop their professional knowledge anddevelop their professional knowledge and competence in the many years of practicecompetence in the many years of practice that may follow registration. They arethat may follow registration. They are expected to have knowledge,expected to have knowledge, communication skills and the ability to offercommunication skills and the ability to offer effective, safe, evidence-based nursing ineffective, safe, evidence-based nursing in their field of practice.their field of practice.
  • 55.  In order to facilitate and encourage this levelIn order to facilitate and encourage this level of professionalism, in-house educationalof professionalism, in-house educational programs should be offered. Accordingly,programs should be offered. Accordingly, higher education, certification in advancedhigher education, certification in advanced practice, support for professionalpractice, support for professional organizations and research should beorganizations and research should be supported.supported.
  • 56. Nursing CompetencyNursing Competency Nursing competency ranked second inNursing competency ranked second in the Via Christi survey. Some key features ofthe Via Christi survey. Some key features of nursing competency are as follow:nursing competency are as follow:  The ability to recognize common factors thatThe ability to recognize common factors that contribute to, and adversely affect, thecontribute to, and adversely affect, the physical, mental and social well-being ofphysical, mental and social well-being of patients and clients, and be able to takepatients and clients, and be able to take appropriate action.appropriate action.
  • 57.  The use of relevant literature and researchThe use of relevant literature and research to inform the practice of nursing.to inform the practice of nursing.  An appreciation of the influence of social,An appreciation of the influence of social, political and cultural factors in relation topolitical and cultural factors in relation to health care.health care.
  • 58.  An understanding of the ethics of healthAn understanding of the ethics of health care and the nursing profession and thecare and the nursing profession and the responsibilities these impose on the nurse’sresponsibilities these impose on the nurse’s professional practice.professional practice.
  • 59.  The ability to identify the physical,The ability to identify the physical, psychological, social and spiritual needs ofpsychological, social and spiritual needs of the patient or client.the patient or client.  The use of appropriate channels of referralThe use of appropriate channels of referral for matters not within the nurse’s sphere offor matters not within the nurse’s sphere of competencecompetence
  • 60. Click here to start video
  • 61. Professional Incompetence DefinedProfessional Incompetence Defined  Professional Incompetence is defined inProfessional Incompetence is defined in the Kansas Nurse Practice Act (2004) 65-the Kansas Nurse Practice Act (2004) 65- 11201120  e. Professional incompetence defined;e. Professional incompetence defined; As used in this section, “professionalAs used in this section, “professional incompetence” means:incompetence” means:  1) one or more instances involving failure1) one or more instances involving failure to adhere to the applicable standard of careto adhere to the applicable standard of care to a degree which constitutes grossto a degree which constitutes gross negligence, as determined by the board;negligence, as determined by the board;
  • 62.  2) repeated instances involving failure to2) repeated instances involving failure to adhere to the applicable standard of care toadhere to the applicable standard of care to a degree which constitutes ordinarya degree which constitutes ordinary negligence, as determined by the board; ornegligence, as determined by the board; or  3) a pattern of practice or other behavior3) a pattern of practice or other behavior which demonstrates a manifest incapacitywhich demonstrates a manifest incapacity or incompetence to practice nursing.or incompetence to practice nursing.
  • 63.  It is every nurses responsibility toIt is every nurses responsibility to understand the definition of incompetentunderstand the definition of incompetent proactice. In addition, it is the responsibilityproactice. In addition, it is the responsibility of those within the profession to monitor andof those within the profession to monitor and report acts of incompetence.report acts of incompetence.
  • 64.  A standard is an authoritative statementA standard is an authoritative statement defined and promoted by the profession bydefined and promoted by the profession by which the quality of practice, service, orwhich the quality of practice, service, or education can be evaluated.education can be evaluated.  These standards are used by Peer ReviewThese standards are used by Peer Review Committees to evaluate peer practice andCommittees to evaluate peer practice and determine if certain situations meet thedetermine if certain situations meet the criteria of a reportable incident according tocriteria of a reportable incident according to the Kansas Risk Management laws.the Kansas Risk Management laws.
  • 65.  The Kansas State Board of NursingThe Kansas State Board of Nursing provides standard of care determinationsprovides standard of care determinations which are based on the following criteria:which are based on the following criteria:
  • 66. Standard of Care DeterminationsStandard of Care Determinations  Level I Standard of care metLevel I Standard of care met  Level II Standard of care not met, butLevel II Standard of care not met, but no reasonable probability ofno reasonable probability of causing injurycausing injury  Level III Reportable; standard of careLevel III Reportable; standard of care not met, with injury occurringnot met, with injury occurring or reasonable probable.or reasonable probable.  Level IV Reportable; grounds forLevel IV Reportable; grounds for disciplinary action by thedisciplinary action by the appropriate licensing agencyappropriate licensing agency
  • 67. AppearanceAppearance  The nursing survey identified appearanceThe nursing survey identified appearance as important as professionalism. The issueas important as professionalism. The issue of appearance and attire is important inof appearance and attire is important in creating a positive perception andcreating a positive perception and communicating an attitude of competencecommunicating an attitude of competence and professionalism (Huber, 2000).and professionalism (Huber, 2000).
  • 68. Research has shown that consumersResearch has shown that consumers prefer white uniforms with a skirt and a capprefer white uniforms with a skirt and a cap as a nurse’s uniform. This has possiblyas a nurse’s uniform. This has possibly occurred because of the persistence ofoccurred because of the persistence of traditional views and images of nursing. Astraditional views and images of nursing. As the health care field becomes morethe health care field becomes more competitive some institutions may begin tocompetitive some institutions may begin to implement dress codes which capitalize onimplement dress codes which capitalize on the preference of “the customer”.the preference of “the customer”.
  • 69.  While caps and white starched uniforms areWhile caps and white starched uniforms are not functional, nurses must realize that thenot functional, nurses must realize that the way one dresses symbolizes role identity,way one dresses symbolizes role identity, authority, professional image, andauthority, professional image, and confidence - as well as the way the nurseconfidence - as well as the way the nurse feels about themselves (Mangum, et al.,feels about themselves (Mangum, et al., 1991).1991).
  • 70. Clothing is a form of nonverbalClothing is a form of nonverbal communication that stimulates judgmentalcommunication that stimulates judgmental responses from others and as aresponses from others and as a professional nurse it is inappropriate toprofessional nurse it is inappropriate to dress casual, soiled, disheveled ordress casual, soiled, disheveled or seductive. Dressing with a professionalseductive. Dressing with a professional image in mind is a simple act which carriesimage in mind is a simple act which carries the power to advance professionalism.the power to advance professionalism.
  • 71. An institutional policy on nursing dress codeAn institutional policy on nursing dress code is as follows:is as follows:  Nurses are asked to set an example ofNurses are asked to set an example of neatness and cleanliness in personalneatness and cleanliness in personal appearance during work hours/shifts. Dailyappearance during work hours/shifts. Daily grooming and appropriate appearance aregrooming and appropriate appearance are essential and set the image of the hospital.essential and set the image of the hospital.
  • 72.  Nurses customarily dress in uniformNurses customarily dress in uniform specified by the departments. Hair, beards,specified by the departments. Hair, beards, and sideburns must be neatly groomed,and sideburns must be neatly groomed, clean and present a professionalclean and present a professional appearance. Excessive use of cosmetics,appearance. Excessive use of cosmetics, fragrances and other accessories should befragrances and other accessories should be avoided. Facial jewelry, such as eye, nose,avoided. Facial jewelry, such as eye, nose, lip or tongue jewelry is prohibited.lip or tongue jewelry is prohibited.
  • 73. Other attire consideredOther attire considered inappropriateinappropriate includes:includes:  Stained, wrinkled, tight, frayed, or revealingStained, wrinkled, tight, frayed, or revealing clothingclothing  JeansJeans  ShortsShorts  Leggings, stretch pants, or caprisLeggings, stretch pants, or capris  Sweatpants/tops or wind suitsSweatpants/tops or wind suits
  • 74.  T-shirts, tank tops, tube tops, crop tops orT-shirts, tank tops, tube tops, crop tops or halter topshalter tops  HatsHats  Sleeveless clothingSleeveless clothing  Shirts with inappropriate slogans and/orShirts with inappropriate slogans and/or designs.designs.  Artificial nailsArtificial nails  Open-toed shoesOpen-toed shoes
  • 75. Click here to start video
  • 76. TeamworkTeamwork  The last characteristic identified through toThe last characteristic identified through to 2003 survey relates to teamwork. Nurses2003 survey relates to teamwork. Nurses work in multidisciplinary professional teamswork in multidisciplinary professional teams with doctors and therapists. The goal ofwith doctors and therapists. The goal of these teams is to promote and providethese teams is to promote and provide treatments which improve patient outcomes.treatments which improve patient outcomes. Nurses have been working with doctors forNurses have been working with doctors for many years attempting to strengthen mutualmany years attempting to strengthen mutual understanding of each otherunderstanding of each other professionalism and ability.professionalism and ability.
  • 77. Definition of TeamworkDefinition of Teamwork  Teamwork in nursing practice refers toTeamwork in nursing practice refers to interdisciplinary practice or collaborationinterdisciplinary practice or collaboration defined as a joint decision-making anddefined as a joint decision-making and communication process with the goal ofcommunication process with the goal of satisfying the needs of the patient. Thissatisfying the needs of the patient. This includes respecting the unique abilities ofincludes respecting the unique abilities of each professional involved in the care.each professional involved in the care.
  • 78.  Today’s best integrated health deliveryToday’s best integrated health delivery systems are evolving toward a model ofsystems are evolving toward a model of care in which interdisciplinary teams ofcare in which interdisciplinary teams of providers manage the care of complexproviders manage the care of complex patients.patients.
  • 79.  As nurses have expanded their roles inAs nurses have expanded their roles in the community, it is important to understandthe community, it is important to understand the contributions of unlicensed assistivethe contributions of unlicensed assistive personnel. As the nursing shortage loomspersonnel. As the nursing shortage looms upon us, the nursing profession may needupon us, the nursing profession may need to divide labor with unlicensed staff,to divide labor with unlicensed staff, particularly in non-acute care where teamparticularly in non-acute care where team working has existed for many years.working has existed for many years.
  • 80.  As professionals, nurses must not forget theAs professionals, nurses must not forget the greatest consideration – that of the patientgreatest consideration – that of the patient rather than the provider. We cannot functionrather than the provider. We cannot function without our unlicensed assistants and owewithout our unlicensed assistants and owe them mutual respect and courtesy. Their jobthem mutual respect and courtesy. Their job is also to provide comfort, care, love andis also to provide comfort, care, love and compassion to the sick.compassion to the sick.
  • 81. Teamwork Improves SafetyTeamwork Improves Safety  As stated in theAs stated in the Hallmarks of theHallmarks of the Professional Nursing Practice EnvironmentProfessional Nursing Practice Environment (2002), in 1999, the Institute of Medicine(2002), in 1999, the Institute of Medicine (IOM) issued a comprehensive report,(IOM) issued a comprehensive report, ToTo Err is Human; Building a Safer HealthErr is Human; Building a Safer Health System,System, summarizing problems of patientsummarizing problems of patient safety in the U.S. health system (IOM,safety in the U.S. health system (IOM, 1999).1999).
  • 82.  One important recommendation was toOne important recommendation was to create improved safety systems insidecreate improved safety systems inside health care through implementation of safehealth care through implementation of safe practices at the delivery level, includingpractices at the delivery level, including interdisciplinary clinical practice amonginterdisciplinary clinical practice among health professionals.health professionals.
  • 83.  Attributes of interdisciplinary collaborationAttributes of interdisciplinary collaboration include trust, knowledge, mutual respect,include trust, knowledge, mutual respect, good communication, cooperation,good communication, cooperation, coordination, share responsibility, andcoordination, share responsibility, and optimism.optimism.
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  • 85. The Fear FactorThe Fear Factor The Institute for Safe Medication PracticesThe Institute for Safe Medication Practices recently released a report on a surveyrecently released a report on a survey concerning the role that intimidation plays in theconcerning the role that intimidation plays in the safe administration of medications.safe administration of medications. 75% of the survey participants were nurses.75% of the survey participants were nurses. The questions were inquiring of how frequentlyThe questions were inquiring of how frequently problems were encountered regardingproblems were encountered regarding intimidating behaviors:intimidating behaviors:
  • 86.  >Reluctance or refusal to answer your questions,>Reluctance or refusal to answer your questions, return phone calls or pages: 39% three to 10return phone calls or pages: 39% three to 10 times, and 21% more than 10 times.times, and 21% more than 10 times.  >Condescending language or voice intonation:>Condescending language or voice intonation: 40% three to 10 times, and 30% more than 1040% three to 10 times, and 30% more than 10 times.times.  >Impatience with questions: 42% three to 10>Impatience with questions: 42% three to 10 times, and 27% more than 10 times.times, and 27% more than 10 times.  >”Just give what I ordered”: 24% three to 10 times,>”Just give what I ordered”: 24% three to 10 times, and 10% more than 10 times (Ulrich, 2004).and 10% more than 10 times (Ulrich, 2004).
  • 87.  This data identifies the problem ofThis data identifies the problem of intimidating behavior in regard to clarifyingintimidating behavior in regard to clarifying orders and answering questions. Manyorders and answering questions. Many professional education programs forprofessional education programs for medical, nursing, and allied health studentsmedical, nursing, and allied health students now require curricula that supportnow require curricula that support interdisciplinary practice in a variety ofinterdisciplinary practice in a variety of clinical settings.clinical settings.
  • 88.  These programs should emphasizeThese programs should emphasize teamwork, conflict resolution, and the use ofteamwork, conflict resolution, and the use of informatics to promote collaboration ininformatics to promote collaboration in patient care planning and implementationpatient care planning and implementation (Wakefield & O’Grady, 2000).(Wakefield & O’Grady, 2000).
  • 89. AccountabilityAccountability  Though problems of intimidation exist, theThough problems of intimidation exist, the registered nurse is personally accountableregistered nurse is personally accountable for his/her own practice – not a seniorfor his/her own practice – not a senior member of staff, physician or other healthmember of staff, physician or other health care professional. Remember the sayingcare professional. Remember the saying “but he/she told me to do it” is never“but he/she told me to do it” is never justification for poor practice.justification for poor practice.
  • 90.  Nurses cannot blame anyone else forNurses cannot blame anyone else for mistakes – they are accountable,mistakes – they are accountable, answerable, and liable for their own actions,answerable, and liable for their own actions, the completion of the assigned task, andthe completion of the assigned task, and acts of delegation.acts of delegation. Accountability cannotAccountability cannot be delegated.be delegated.
  • 91.  Past studies of environments that supportPast studies of environments that support collaboration among physicians, nurses and alliedcollaboration among physicians, nurses and allied health professionals have shown evidence ofhealth professionals have shown evidence of improved outcomes for both acutely andimproved outcomes for both acutely and chronically ill patients. The professional nursechronically ill patients. The professional nurse should always remain calm and respectful ofshould always remain calm and respectful of others. Perhaps the best advice is to rememberothers. Perhaps the best advice is to remember the golden rule “do unto others as you would havethe golden rule “do unto others as you would have them do unto you.”them do unto you.”
  • 92.  The most common dilemma regardingThe most common dilemma regarding accountability is created by the assignment ofaccountability is created by the assignment of responsibility and the granting of authority. Someresponsibility and the granting of authority. Some common examples of a mismatch of authority tocommon examples of a mismatch of authority to responsibility is when nurses are placed in whatresponsibility is when nurses are placed in what they consider inadequate staffing situations,they consider inadequate staffing situations, disagreements with physician orders which maydisagreements with physician orders which may not reflect best practice or instructions to carry outnot reflect best practice or instructions to carry out tasks outside the scope of practice or the nurses’tasks outside the scope of practice or the nurses’ competency base.competency base.
  • 93.  Suggestions for avoiding the mismatch ofSuggestions for avoiding the mismatch of authority to responsibility include clear andauthority to responsibility include clear and explicit communication, coupled withexplicit communication, coupled with negotiation strategies (Huber, 2000). Everynegotiation strategies (Huber, 2000). Every nurse has a responsibility to know the chainnurse has a responsibility to know the chain of command and the person to turn to whenof command and the person to turn to when these occasions occur.these occasions occur.
  • 94. Respect, Integrity and PositiveRespect, Integrity and Positive AttitudeAttitude  Respect for others, integrity and a positiveRespect for others, integrity and a positive attitude also ranked high in the nursingattitude also ranked high in the nursing survey. This finding is not surprising, as itsurvey. This finding is not surprising, as it correlates to Gallup’s 2003 annual survey incorrelates to Gallup’s 2003 annual survey in which nurses were on the top for honestywhich nurses were on the top for honesty and ethics among various professions,and ethics among various professions, followed by other medical professionals likefollowed by other medical professionals like doctors, pharmacists, veterinarians anddoctors, pharmacists, veterinarians and dentists.dentists.
  • 95.  Americans, in the November 14-16, 2003Americans, in the November 14-16, 2003 CNN/USA Today/Gallup Poll, were asked toCNN/USA Today/Gallup Poll, were asked to rate the honesty and ethical standards ofrate the honesty and ethical standards of people in 23 different professions as verypeople in 23 different professions as very high, high, average, low, or very low.high, high, average, low, or very low.
  • 96.  As has been the case in four out of the fiveAs has been the case in four out of the five times they have been included in the poll,times they have been included in the poll, nurses ranked higher than any othernurses ranked higher than any other profession, with 83% of respondents sayingprofession, with 83% of respondents saying honesty and ethical standards of nurses arehonesty and ethical standards of nurses are “very high” or “high” (Carroll, 2003).“very high” or “high” (Carroll, 2003).
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  • 98. Future of NursingFuture of Nursing  As nurses embrace the future, what is yourAs nurses embrace the future, what is your vision for the nursing profession? Thisvision for the nursing profession? This author believes it will be interactions thatauthor believes it will be interactions that nourish our human spirits in the places wenourish our human spirits in the places we live and work. Nurses must be deliberatelive and work. Nurses must be deliberate with time, energy and resources as thewith time, energy and resources as the profession works toward the goal of qualityprofession works toward the goal of quality nursing care.nursing care.
  • 99.  New modalities of delivering care are yetNew modalities of delivering care are yet to be envisioned and coordinated – not onlyto be envisioned and coordinated – not only for patients being served, but for each other.for patients being served, but for each other. Fundamental to the nursing professions’Fundamental to the nursing professions’ future is our ability to honor, respect andfuture is our ability to honor, respect and value each other, as well as the inter-value each other, as well as the inter- personal and inter-professionalpersonal and inter-professional relationships.relationships.
  • 100.  To know even one life has breathedTo know even one life has breathed easier because you have lived – thiseasier because you have lived – this is to have succeededis to have succeeded ((unknown authorunknown author).).  Happy Nurses Week!Happy Nurses Week!
  • 101. ReferencesReferences • Alspach, J. G., (2000). The Preceptor’s Bill of Rights. AACN, CriticalAlspach, J. G., (2000). The Preceptor’s Bill of Rights. AACN, Critical Care Publications, CA.Care Publications, CA. • Bryan-Brown, C. & Dracup, K., (2003). Professionalism,Bryan-Brown, C. & Dracup, K., (2003). Professionalism, AmericanAmerican Journal of Critical CareJournal of Critical Care, 12(5), 394., 12(5), 394. • Carroll, J., (2003) Public Rates Nursing as Most Honest and EthicalCarroll, J., (2003) Public Rates Nursing as Most Honest and Ethical Profession.Profession. The Gallup Organization,The Gallup Organization, Princeton, NJ.Princeton, NJ. • Corlett, J., (2000) The Perceptions of Nurse Teacher, Student NursesCorlett, J., (2000) The Perceptions of Nurse Teacher, Student Nurses and Preceptors of the Theory-Practice Gap in Nurse Education.and Preceptors of the Theory-Practice Gap in Nurse Education. NurseNurse Education Today.Education Today. 20, 499-505.20, 499-505. • Cvetak, S., (1999) Professionalism and Professionalization in NursingCvetak, S., (1999) Professionalism and Professionalization in Nursing Care Within the Changing Context of Healthcare.Care Within the Changing Context of Healthcare. Obzornik-Obzornik- Zdravstvene-Nege,Zdravstvene-Nege, 33 (1/2), 19-2333 (1/2), 19-23..
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