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Chapter 07_mcgee
- 1. The Nurses, Ideas, and Forces That
Define the Profession
Chapter 7
Copyright © 2014, 2009 by Mosby, Inc.,
an imprint of Elsevier Inc.
- 2. Timeline
Middle Ages
Most nursing care was performed by religious orders.
Renaissance
The influence of religious orders declined, helped along
by Protestant Reformation in Europe.
Nursing continued to move more fully into the general
population; it was no longer primarily the province of
religious orders.
Later, nursing care became more secular and more
structured.
Formal training programs were begun.
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an imprint of Elsevier Inc. 2
- 3. Timeline
Industrial Revolution
Women continued to push past societal boundaries to
improve nursing education and patient care.
Early 1980s
The nature of health care began changing dramatically
as cost reduction and quality improvement issues
surfaced.
Managed care emerged.
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an imprint of Elsevier Inc. 3
- 4. Religious
Nursing considered a calling
Knights of Saint Lazarus
Knights Hospitaliers of Saint John of Jerusalem
Alexian Brothers
Parish nursing
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an imprint of Elsevier Inc. 4
- 5. Social
Florence Nightingale
Highly educated with high social standing
Crimean War: decreased death rate from 42% to 2%
“Lady with the lamp”
Established a nursing school and wrote a textbook
Changed nursing to become a respectable profession
Believed nursing was an art, one that required
organized, practical, and scientific training
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- 6. Social
Clara Barton
“Angel of the battlefield” during American Civil War
Organized the American Red Cross
Lillian Wald
Established a visiting nursing service for poor families
in New York City
Mary Breckenridge
Organized a frontier nurses organization in rural
Kentucky that is still in operation today
Linda Richards
Known as America's first trained nurse
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- 7. Social
Isabel Hampton Robb
Reduced working hours of students and promoted
licensure exams
Mary Adelaide Nutting
Wrote a book on the history of nursing
Lavinia Dock
Well-known nurse who fought for women’s rights
issues and for the right to vote
Mildred Montag
Promoted creation of the associate degree as a shorter
route into nursing
Major social factor affecting nursing: society’s
attitude toward the role of women
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- 8. Political
Many important contributions to professional
nursing have been made during times of conflict.
Civil War
Dorothea Dix
Boston schoolteacher who had been crusading to improve
care of the mentally ill in institutions
Organized a training program for women volunteers to
care for the wounded
Spanish-American War
Marked the first time trained nurses were accepted in
military hospitals
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- 9. Political
World War I
Both the Army and the Navy had nurse corps.
World War II
Nurses were involved in all aspects of care: in military
hospitals, on battleships, or flying on medical
evacuation planes.
Korean conflict, the Vietnam War, Operation Desert
Storm, and the War on Terror
Nurses continue to assist the sick and wounded.
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an imprint of Elsevier Inc. 9
- 10. Aging population
“Graying of America”
Need knowledge for geriatrics and home care
Emphasis on health maintenance and disease
prevention
Nurses counsel/teach patients about health
screening, dietary needs, exercise programs,
treatment regimens, and self-care
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- 11. Outcomes-oriented patient-centered care
Nurses work with population groups, as well as
individual patients, to develop health-related goals.
Nurses play an important role in helping achieve
positive experiences for patients, with minimal
complications.
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- 12. Cost containment
Managed care
An insurance-based approach to reducing costs
Diagnosis-related groups (DRGs)
DRGs establish pretreatment diagnosis billing categories.
Preferred provider organizations (PPOs)
Patients receive a discounted rate for services when using
specified physicians or agencies.
Health maintenance organizations (HMOs)
This group health care agency has a prepaid fee.
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an imprint of Elsevier Inc. 12
- 13. Cost containment
Managed care
Medicare
National and state health insurance program for older
adults
Prospective payment system: limits the amount paid to
hospitals that are reimbursed by Medicare; uses DRGs
Medicaid
Federal public assistance program to assist those with
financial needs
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an imprint of Elsevier Inc. 13
- 14. Quality improvement
Quality care
Continuous quality improvement
Process in which the quality of patient care is
continuously monitored for effectiveness
Set of standards that produce excellence
Clinical care pathways or care paths
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- 15. Quality improvement
Monitor quality of care
Nurses are employed as outcomes managers, case
managers, and quality improvement managers.
The Joint Commission established a set of core
measures for certain disease processes.
The Centers for Medicare and Medicaid Services
created Hospital Quality Initiatives, 20 measures or
indicators as evidence of best practice.
The Leapfrog Group collects and reports patient safety
and quality data to the public and payers.
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an imprint of Elsevier Inc. 15
- 16. Patient Protection and Affordable Care Act
Increases grants for master’s and doctoral studies
Aims to increase nursing knowledge in quality standards,
assessment, and improvement
Expanded the National Health Service Corps
APRNs who agree to work in underserved areas receive loan
repayments.
Created a grant program that can be funded up to 1.5 billion
dollars for Maternal and Child Programs for at risk populations
More grant funding for the Nurse Managed Health Centers
increasing access to care
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an imprint of Elsevier Inc. 16
- 17. ANA Nursing’s Social Policy Statement
“Provision of a caring relationship that facilitates
health and healing
Attention to the range of human experiences and
responses to health and illness within the physical
and social environments
Integration of assessment data with knowledge
gained from an appreciation of
the patient or the group
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- 18. ANA Nursing’s Social Policy Statement
Application of scientific knowledge to the processes
of diagnosis and treatment through the use of
judgment and critical thinking
Advancement of professional nursing knowledge
through scholarly inquiry
Influence on social and public policy to promote
social justice
Assurance of safe, quality, and evidence-based
practice” (p.9)
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an imprint of Elsevier Inc. 18