perspectives of nursing


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perspectives of nursing

  2. 2. NURSING 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. -American Nurses Association
  3. 3.  Nursing includes the promotion of health, prevention of illness, and the care of ill, disabled and dying people. Advocacy, promotion of a safe environment, research, participation in shaping health policy and in patient and health systems management, and education are also key nursing roles. - International Council of Nurses
  4. 4.  The unique function of the nurse is to assist the individual, sick or well, in the performance of those activities contributing to health or its recovery (or to peaceful death) that he would perform unaided if he had the necessary strength, will or knowledge. -Virginia Avenel Henderson
  5. 5. PROFESSION  Profession is a classic piece of educational literature that provided the impetus for the much needed reform of medical education. –Abraham Flexner (1910)  Professionalism involves the application of knowledge and skills, high standards of practice, leadership, self regulation, professional commitment, social values and self directed activity. - Muller (1998)
  6. 6. Richard H Hall identified 5 indicators of individuals’ attributes towards professionalism (1968):  Use of a professional organization as a primary point of reference.  Belief in the value of public service.  Belief in self regulation.  Commitment to a profession that goes beyond economic incentives.  A sense of autonomy in practice.
  7. 7. Characteristics of a Profession  A profession requires an extended education of its     members, as well as a basic liberal foundation. A profession has a theoretical body of knowledge leading to defined skills, abilities and norms. A profession provides a specific service. Members of a profession have autonomy in decision making and practice. The practice as a whole has a code of ethics.
  8. 8. Criteria of Nursing Profession 1. 2. 3. 4. 5. 6. 7. Specialized Education Body of Knowledge Service Orientation Ongoing Research Code of Ethics Autonomy Professional Organizations
  9. 9. Two terms related to Profession  Professionalism: It refers to the professional character, spirit or methods. It is a set of attributes, a way of life that implies responsibility and commitment.  Professionalization: It is the process of becoming professional, that of acquiring characteristics considered being professional.
  10. 10. Nursing: Occupation vs Profession  Occupation is defined as “What occupies or engages one’s time; business; employment” - Webster (1996)  Profession is defined as “A calling, vocation or form of employment that provides a needed service to society, possesses expertise, autonomy, long academic preparation, commitment, & responsibility” -Huber(2000)
  11. 11. Professional Preparation Five core competencies:  Provide patient-centered care  Work in interdisciplinary teams  Employ EBP  Apply quality improvement principles  Utilize informatics -IOM Summit in 2003
  12. 12. Professional Commitment  Professional Commitment to their profession is strong. They deliver much of their personal identity from their work and consider it as an integral part of their life.
  13. 13. Characteristics of Profession vs. Occupation Profession Occupation College/university preparation On the job, trade school, community college preparation Usually 4 or more years Shorter preparation time Values, beliefs, ethics always present (code of ethics) Values, beliefs, ethics not always present Commitment & personal ID always present (mentoring) Commitment & personal ID not always present Independent, autonomous Supervised by others Work stable, rarely change profession Often change jobs Individual accountability Accountability usually rests with employer
  14. 14. Nursing Pathway to Professionalism Nursing pathway to professionalism has not been smooth. For decades an ongoing subject for discussion in nursing circles has been the following question “is nursing a profession”.  Bixler’s Criteria  Kelly’s Criteria  Miller’s Wheel of Professionalism in Nursing
  15. 15. Bixler’s Criteria  A profession utilizes in its practice a well defined and well organized body of specialized knowledge which is on the intellectual level of higher learning.  A profession constantly enlarges the body of knowledge, its uses and improves its techniques of education and service by the use of scientific method.  A profession entrusts the education of its practitioners to institutions of higher education.
  16. 16. Bixler’s Criteria…….  A profession functions autonomously in the formulation of professional policies and in the control of professional activity there by.  A profession applies its body of knowledge in practical services which are vital to human and social welfare.  A profession attracts individuals of intellectual personal qualities who exalt service above personal gain and who recognize their chosen occupation as a life work.  A profession strives to compensate its practitioners providing freedom of action, opportunity for continuous professional growth and economic security.
  17. 17. Kelly’s Criteria  Services provided vital to humanity/society  There is a Specialized knowledge that continuously enlarged       with research The services involve Intellectual activities, accountability: individual responsibility is a great feeling. Education in higher learning institution Autonomy - Practitioners are independent, control own policies and activities Altruism - Practitioners are motivated by service and consider their work as an important part of their lives There is a Code of ethics to guide decisions and conduct There is an organization (association) that encourages and supports high standards of practice
  18. 18. Miller’s Wheel of Professionalism in Nursing  Center represents the essential foundation of nursing education  Eight spokes  Competence and Continuing       Education Adherence to the code of ethics Participation in professional organization Community Service Publication and Communication Theory and research development and utilization Self-regulation and autonomy
  19. 19. Professional Nursing Practice  Nurse Practice Acts  It regulates the licensure and practice of nursing.  The nurse practice act of each state defines the practice of nursing within that area.  The board of nursing in each states sets requirements for licensure.
  20. 20. Professional Nursing Practice…..  Standards of Practice  As nursing became an independent profession, it began to develop its own standards of practice.  It serves as a guideline for providing and evaluating nursing care and serves as criteria in legal questions of whether adequate care was given.
  21. 21. STANDARDS OF PROFESSIONAL NURSING PRACTICE American Nurses Association (ANA) 2010 1. ANA Standards of Care 2. ANA Standards of Professional Performance
  22. 22. ANA Standards of Care  Standard I: Assessment The registered nurse collects comprehensive data pertinent to the healthcare consumer’s health or the situation.  Standard II: Diagnosis The registered nurse analyzes the assessment data to determine the diagnoses or issues.  Standard III: Outcome Identification The registered nurse identifies expected outcomes for a plan individualized to the healthcare consumer or the situation.
  23. 23.  Standard IV: Planning The registered nurse develops a plan of care that prescribes strategies and interventions to attain expected outcomes.  Standard V: Implementation The nurse implements the interventions identified in the plan. Standard 5A - Coordination of Care Standard 5B - Health Teaching and Health Promotion Standard 5C - Consultation (Graduate Prepared Specialty or Advanced Practice Nurse) Standard 5D - Prescriptive Authority and Treatment (Advanced Practice Nurse)  Standard VI: Evaluation The registered nurse evaluates progress toward attainment of outcomes.
  24. 24. ANA Standards of Professional Performance  Standard VII: Ethics The registered nurse practices ethically.  Standard VIII: Education The registered nurse attains knowledge and competence that reflects current nursing practice.  Standard IX: Evidence-Based Practice and Research The registered nurse integrates evidence and research findings into practice.  Standard X : Quality of Practice The registered nurse contributes to quality nursing practice.  Standard XI: Communication The registered nurse communicates effectively in a variety of formats in all areas of practice.
  25. 25.  Standard XII: Leadership The registered nurse demonstrates leadership in the professional practice setting and the profession.  Standard XIII: Collaboration The registered nurse collaborates with the healthcare consumer, family and others in the conduct of nursing practice.  Standard XIV: Professional Practice Evaluation The registered nurse evaluates her or his own nursing practice in relation to professional practice standards and guidelines, relevant statutes, rules and regulations.  Standard XV: Resource Utilization The registered nurse utilizes appropriate resources to plan and provide nursing services that are safe, effective and financially responsible.  Standard XVI: Environmental Health The registered nurse practices in an environmentally safe and healthy manner.
  26. 26. Professional Responsibilities and Roles of Nurses  Care Giver  Advocate  Educator  Communicator  Manager
  27. 27.  Decision Maker  Client Counselor  Research Consumer  Change Agent  Leader  Co-coordinator
  28. 28. Expanded roles of Nurse  Clinician Provide direct care, educate client & restore health  Advanced Practice Nurses (APN)  Independent functioning nurse with masters’ degree in nursing  Advanced education in pharmacology and physical assessment Certification and expertise in a specialized area of practice.      Clinical Nurse Specialist (CNS) Nurse Practitioner Certified Nurse Midwife (CNM) Certified Registered Nurse Anesthetist (CRNA)
  29. 29.  Nurse Educator  Works in schools of nursing, staff development of health care agencies and client education departments.  Nurse Administrator  manages client care and the delivery of specific nursing services within a health care agency.  begins her position such as the charge nurse or assistant nurse manager.  Nurse Research
  30. 30. Qualities of Professional Nurse  Truthfulness, loyalty & honesty  Empathy  Love for the fellowmen  Humor  Caring  Kindness  Commitment  Morality  Compassion, generosity  Courage  Acceptance, assertiveness  Accountability  Punctuality  Authenticity  Fairness  Alertness  Self esteem and tolerance  Intelligence  Appreciation  Efficiency  Creativity  Self discipline  Imagination  Openness  Confidence  Independent
  31. 31. Attributes of Professionalism in Nursing  Knowledgeable How do we stay knowledgeable?  Involved in nursing organizations  Reading journals  Continuing our education  Continually seeking out new information
  32. 32.  Inquisitive  A professional nurse is always curious to investigate.
  33. 33.  Autonomy  working independently  exercising decision- making  having the ability to carry out the appropriate course of action  having the capacity as a nurse to determine her/his own course of action
  34. 34.  Innovator and Visionary  Innovation: Bring in new methods, ideas, etc.  Visionary: The act or faculty of seeing, sight; imaginative insight; ability to plan or form policy in a far-sighted way  Accountability and Dependability  Admit mistakes and learns from them  Timeliness  Keeps their word
  35. 35.  Advocacy  Respectful of others  Understands the needs of the patient  Recognizes that the family members of the patient are also their responsibility  Collegiality and Collaboration  Willingness to help others  Teamwork
  36. 36.  Honesty and Integrity  Attitude  Truthful  IS EVERYTHING!  Does not gossip  Sets the tone  Upholds patient  Should be positive confidentiality and privacy
  37. 37.  Appearance  First impressions are important  Can instill confidence or mistrust  Represents your pride in yourself and your profession
  38. 38. Professional Registered Nurse Education In-service Education EDUCATION AL PREPARATI Post ON graduation Continuing Education Education Graduate Education
  39. 39. Educational Preparations of Nursing Profession  Professional Registered Nurse Education  Diploma in Nursing  Associate Degree in Nursing  Graduate Education • Basic BSc Nursing • Post Basic Nursing:
  40. 40. Postgraduate Program • Masters’ Education • Doctoral Preparation Continuing Education In-service Education
  41. 41. Factors Influencing Contemporary Nursing Practice  Economics  Greater financial support provided through public and private health insurance programs has increased the demand for nursing care.  Increased cost of health care  Current health care industry is shifting its emphasis from inpatient to outpatient care  Consumer Demands  People are better educated and have more knowledge about health and illness.  The publics’ concept about health and nursing also changed  Consumer has become an active participant in making decisions about health care.
  42. 42.  Family Structure  More people are living away from the extended family and the nuclear family.  Many single men and women rear children and in many two parent families both parents work.  Adolescent mothers also need specialized nursing services, both while they are pregnant and after their babies are born.  Science and Technology  Nurses will need to expand their knowledge base and technical skills as they adapt to meet the new needs of client.
  43. 43.  Collective Bargaining  More nurses are using collective bargaining to deal with their concerns.  The ANA participates in collective bargaining on behalf of nurses through its economic and general welfare programs.  Nursing Associations  Provides leadership that affects many areas of nursing.  Accreditation of nursing programs is given by associations which are regulatory bodies.
  44. 44.  Information and Telecommunications  Nurses may need to interpret internet sources of information for clients and their families.  Nurses has to help client to access high quality, valid websites; interpret information and then help to evaluate the information.  Legislation  Legislation about nursing practice and health matters affect both the public and nursing.  E.g. Patient Self Determination Act (PSDA)  Demography  From demographic data, needs of the population for nursing service can be assessed.
  45. 45.  Nursing Shortage 1. Aging nurses workforce    Number of nurses under 30 decreasing Number of nurses age 40-49 increasing with 40% older than 50 by 2010 New graduates entering workforce at an older age and will have fewer years to work. 2. Aging of nursing faculty  As nursing faculty retire, nursing program may have fewer faculty to educate further nurses. 3. Reduced entry of younger population into nursing
  46. 46. 4. Aging population  Increased health needs 5. Increased demands for nurses   Increased need for specialized nurses Shorter hospital stay resulting in transfer of clients to long term care and community setting creating increased demand for nurses in the community. 6. Workplace issues       Inadequate staffing Heavy workload Overtime work Lack of sufficient support staff Inadequate wages Difficult recruiting and retaining nurses
  47. 47. Impacts of nursing shortage on healthcare:  Increased nurses’ patient workloads  Increased risk for error, thereby compromising patient     safety Increased risk of spreading infection to patients and staffs Increased risk for occupational injury Increase in nursing turnover, thereby leading to greater costs for the employer and the health care system Increase in nurses' perception of unsafe working conditions, contributing to increased shortage and hindering local or national recruitment efforts
  48. 48. Professional Nursing Organizations  International Council of Nursing  American Nurses Association  National League for Nursing  American Association of Colleges of Nursing  National Student Nurses Association  Specialty Organizations  The Indian Nursing Council  Trained Nurses Association Of India  The Student Nurses Association
  49. 49. TRENDS AND ISSUES IN CURRENT AND FUTURE NURSING  Influence of today’s health care settings  Expansion of Employment opportunities  Nursing’s public perception  Nursing impact on Politics and Health policy
  50. 50. Trends in India  Changes in society     Intensive efforts of government to meet the health needs of people. Gradual improved literacy level of the people with the growing awareness of health needs. Advanced scientific technology The changing role of women and the continuing growth of population.  Changes in other professions  Growing specialization in medical field is resulting in a trend towards increased specialization in nursing.  The development of new diagnostic procedure and equipments make specialization even more necessary.  Patients’ Bill of Rights  The nurses are also accountable for patients care and have legal responsibilities for the patient.
  51. 51.  Developments in other discipline  Nursing is moving towards more specific nursing functions  Leadership within the profession  Leadership within the profession also influences the trends in nursing.  Nursing is moving towards professionalism due to the untiring efforts of nurses who have been dedicated to achieve the aim  Working and studying in abroad  Shortage of nurses in other countries, higher salary paid in abroad is the main causes for the working of Indian nurses in abroad.
  52. 52.  Greater specialization in nursing education and practice  Greater specialization in nursing education and practice is a trend related to that in the medical profession and the growing amount of scientific knowledge available.  Working conditions  Working conditions for nurses are also changing.  There is a gradual change towards shorter and more convenient hours of duty, better accommodations and higher salaries.  Trends in other countries  Trends in other country also influence the trends in the nursing profession in India.  The rapid development of the degree25 programme has promoted the same emphasis and development here for professional nursing.
  53. 53. BIBLIOGRAPHY  Patricia Potter, Anne Griffin Perry. Fundamentals of Nursing. 6th        ed. New Delhi: Elsevier Publications;2006 Carol Tylor, Carol Lillis,Priscilla Lumon. Fundamentals of Nursing. 5th ed. New Delhi: wolter kluwer health;2006 Andry Berkman,Shirlee Synder, Barbara Kozier, Glenora Erb. Kozier’s & Erb’s Fundamentals of Nursing. 5th ed. New Delhi: pearson education;2008 Kay Kittrel, Chilty, Beth perry Black. Professional Nursing Concepts and Challenges. 6th ed. USA: saunders publication;2013 Susan B Hassmiller. The National Perspective on Future Nursing: where we are going. Vol 72. http:/enwikipedia/wiki/nursing Pires DE. Rev Bras Enferm. 2013 Sep;66(spe):39-44. PMID:24092308
  54. 54. QUESTIONS