Chapter 07_mcgee

The Nurses, Ideas, and Forces That
Define the Profession
Chapter 7
Copyright © 2014, 2009 by Mosby, Inc.,
an imprint of Elsevier Inc.

 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.
an imprint of Elsevier Inc. 2

 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.

 Religious
 Nursing considered a calling
 Knights of Saint Lazarus
 Knights Hospitaliers of Saint John of Jerusalem
 Alexian Brothers
 Parish nursing

 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

 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

 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

 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

 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.

 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

 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.

 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.

 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

 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

 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.

 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

 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

 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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