Ncm 100 fundamentals of nursing practice
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1 Define health and wellness. 2 Describe factors causing significant changes in the health care delivery system and their impact on health care and the nursing profession. 3 Describe the practitioner, leadership, and research roles of nurses. 4 Describe nursing care, delivery models. 5 Discuss expanded nursing roles.
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Ncm 100 fundamentals of nursing practice
- 1. P R E PA R E D B Y: L E N D E L L K E L LY B . Y TA C , R N NCM 100 FUNDAMENTALS OF NURSING PRACTICE
- 2. LEARNING OBJECTIVES 1 Define health and wellness. 2 Describe factors causing significant changes in the health care delivery system and their impact on health care and the nursing profession. 3 Describe the practitioner, leadership, and research roles of nurses. 4 Describe nursing care delivery models. 5 Discuss expanded nursing roles.
- 3. WHAT IS NURSING? • “to put the patient in the best condition for nature to act upon him,”(Florence Nightingale,1858). • nursing leaders have described nursing as both an art and a science. • nursing as the diagnosis and treatment of human responses to health and illness (ANA Social Policy Statement, 2003).
- 4. FOCUS OF NURSING CARE AND RESEARCH • Self-care processes • Physiologic and pathophysiologic processes such as • rest, sleep, respiration, circulation, reproduction, activity, nutrition, elimination, skin, sexuality, and communication • Comfort, pain, and discomfort • Emotions related to health and illness • Meanings ascribed to health and illnesses • Decision making and ability to make choices
- 5. FOCUS OF NURSING CARE AND RESEARCH • Perceptual orientations such as self-image and control over one’s body and environments • Transitions across the lifespan, such as birth, growth, development, and death • Affiliative relationships, including freedom from oppression and abuse • Environmental systems
- 6. RESPONSIBILITIES OF A NURSE • Nurses have a responsibility to carry out their role as described in the Social Policy Statement to comply with the nurse practice act of the state in which they practice, and to comply with the Code of Ethics for Nurses as spelled out by the ANA (2001) and the International Council of Nurses (ICN, 2006).
- 7. THE PATIENT/CLIENT • Patient-which is derived from a Latin verb meaning “to suffer,” has traditionally been used to describe a person who is a recipient of care. Connotes dependence. • Client-which is derived from a Latin verb meaning “to lean,” connoting alliance and interdependence.
- 8. THE PATIENT NEEDS • Maslow’s Hierarchy of Needs • Maslow ranked human needs as follows: physiologic needs; safety and security; sense of belonging and affection; esteem and self- respect; and self-actualization, which includes self fulfillment, desire to know and understand, and aesthetic needs. • Lower-level needs always remain, but a person’s ability to pursue higher-level needs indicates movement toward psychological health and well-being. • Such a hierarchy of needs is a useful framework that can be applied to the various nursing models for assessment of a patient’s strengths, limitations, and need for nursing interventions.
- 9. MASLOW’S HIERARCHY OF NEEDS
- 10. HEALTH, WELLNESS AND HEALTH PROMOTION • Health- “state of complete physical, mental, and social well-being and not merely the absence of disease and infirmity” (WHO, 2006 pg. 1). • Wellness-Wellness- is Considered a conscious, sefl- directed and evolving process of achieving full potential. -is multidimensional and holistic, encompassing lifestyle, mental and spiritual well-being, and the environment.
- 11. HEALTH VS. WELLNESS • Health- is a state of being • Wellness- is a state of living a healthy lifestyle.
- 12. COMPONENTS OF WELLNESS 1. The capacity to perform to the best of one’s ability. 2. The ability to adjust and adapt to varying situations. 3. A reported feeling of well-being 4. A feeling that “everything is together” and harmonious.
- 13. COMPONENTS OF HEALTH • Social Health-refers to the ability or interact with people and the environment with and having satisfying interpersonal relationships. • Mental Health- the ability to learn; one’s intellectual capabilities. • Emotional Health- ability to control emotions so that one feels comfortable expressing them appropriate and does express them appropriately.
- 14. COMPONENTS OF HEALTH • Spiritual Health- refers to the belief in some unifying force. For some people that will be nature, scientific laws, godlike force. • Physical Health- It refers to the ability to perform daily task without undue fatigue; biological integrity of the individual.
- 15. MODELS OF HEALTH LEAVELLAND CLARK’S AGENT-HOST- ENVIRONMENTAL MODEL • State that there are three interactive factors that affect health and illness • Agent • Host • Environment
- 16. MODELS OF HEALTH LEAVELLAND CLARK’S AGENT-HOST- ENVIRONMENTAL MODEL • Agent-any factor or stressor that can cause or lead to illness • Host- person who may or may not be risk of acquiring the disease • Environment- any factor external to the host that may or may not predispose to the development of the disease.
- 17. COMMON CAUSE OF DISEASE • Biologic agents (Microorganisms) • Inherited genetic defects (hemophilia, Cancer, Hypertension) • Developmental defects (imperforated anus) • Physical agents (hot and cold substance) • Chemical agents ( emissions from smoke) • Tissue response to injury (inflammation)
- 18. COMMON CAUSE OF DISEASE • Faulty chemical/metabolic process (inadequate iodine intake- goiter) • Emotional/physical reaction to stress (anxiety)
- 19. THE HEALTH-ILLNESS CONTINUUM • Continuum- is a grid or graduated scale. The health grid shows where a health axis and an environmental axis intersect. The resulting quadrants represent degrees of health and wellness. • Health and illness- conceptualized along separate but coexisting continuum.
- 22. MAGNIFICATION OF DOTS ON THE CONTINUUM Physical Health TOTAL HEALTH Spiritual Health Social Health Emotional Health Mental Health
- 24. STAGES OF ILLNESSS 1. Symptoms Experience- Person come to believe something is wrong -Physical-experience of symptoms -Cognitive- the interpretation of the symptoms in terms that have some meaning to the person. -Emotional- fear and anxiety
- 25. STAGES OF ILLNESSS 2. Assumption of the sick role - Acceptance of the illness - Excuse from normal duties and role expectation - Confirm from family and friends 3. Medical care contract - Seek advice of the health professionals for validation of real illness, explanation of symptoms, and reassurance or prediction of of what the outcome will be.
- 26. STAGES OF ILLNESSS 4. Dependent client role - Client becomes dependent on the health professionals for help - Accept/rejects health professional’s suggestions. 5. Recovery of Rehabilitation - Client is expected to relinquish the dependent role and resume former roles and responsibilities
- 27. LEAVELL AND CLARK’S THREE LEVEL OF PREVENTION 1. Primary prevention - To encourage optimal health and to increase the person’s resistance to illness - Seeks to prevent a disease or a condition at a pre- pathologic state - Health Promotion –Avoid smoking, alcohol intake; Exercise regularly, Eat- well balance diet, reduce fat intake and increase fiber in diet
- 28. LEAVELL AND CLARK’S THREE LEVEL OF PREVENTION 2. Secondary prevention - Health maintenance - seek identify specific illness or conditions at an early stage with prompt intervention to prevent or limit disability - Early diagnosis/detection/ screening – annual PE, Pap’s Smear for women, BSE
- 29. LEAVELL AND CLARK’S THREE LEVEL OF PREVENTION 3. Tertiary Prevention - Occurs after a disease or disability has occurred and the recovery process has begun - Intent is to halt the disease or injury process and assist the person in obtaining an optimal health status. Rehabilitation
- 30. ADVANCED PRACTICE NURSE (APN) • A title which encompasses the nurse practitioners (NPs), clinical nurse specialists (CNSs), certified nurse midwives (CNMs) and certified registered nurse anesthetists (CRNAs).
- 31. COLLABORATIVE PRACTICE MODEL • involves nurses, physicians, and ancillary health personnel functioning within a decentralized organizational structure and collaboratively making clinical decisions.
- 32. COMMUNITY-ORIENTED NURSING PRACTICE • nursing intervention that promotes wellness, reduces the spread of illness, and improves the health status of groups of citizens or the community at large with emphasis on primary, secondary, and tertiary prevention.
- 33. CONTINUOUS QUALITY IMPROVEMENT (CQI) • The ongoing examination of processes used to provide care, with the aim of improving quality by assessing and improving those processes that might improve patient care outcomes and patient satisfaction.
- 34. INFLUENCE OF HEALTH CARE DELIVERY • The health care delivery system is constantly adapting as the population shifts its health care needs and expectations change. • The shifting demographics of the population, the increase in chronic illnesses and disability, the greater emphasis on health care costs, and technologic advances have resulted in changing emphases in health care delivery and in nursing.
- 35. FACTORS AFFECTING HEALTH CARE DELIVERY SYSTEM • Population and demographics - Aging population - Cultural Diversity • Changing in pattern of disease • Advances in Technology and Genetics • Demand for Quality Health Care - Quality Improvement and Evidence-Based Practice - Clinical Pathways and Care Mapping -Case Management
- 36. ROLES OF THE NURSE • Practitioner Role • Leadership Role • Research Role
- 37. CRITICAL THINKING EXERCISES 1 Your clinical assignment is in a long-term care facility. Identify a patient care issue (eg, nutritional status) that could be improved. Describe the mechanism that is available within a clinical facility to address such quality improvement issues.
- 38. CRITICAL THINKING EXERCISES 2. You are planning the discharge of an elderly patient who has several chronic medical conditions. A case manager has been assigned to this patient. How would you explain the role of the case manager to the patient and her husband?
- 39. 3 You are assigned to care for a hospitalized patient who is obese, with a history of diabetes, and a new diagnosis of stable angina. There is a clinical nurse leader (CNL) assigned to provide consistent, quality care for this patient from hospital admission to discharge. Identify the evidence that supports the effectiveness of CNLs in supervising care of patients and promoting positive patient outcomes. What is the strength of the evidence? How might this specific patient’s care be affected?
Editor's Notes
- Population and demographics -Changes in the population in general are affecting the need for and the delivery of health care. -Not only is the population increasing, but also its composition is changing. The decline in birth rate and the increase in lifespan due to improved health care have resulted in fewer school-age children and more senior citizens, many of whom are women. -The population has become more culturally diverse as increasing numbers of people from different national backgrounds enter the country. -Because of population changes, the health care needs of people of specific ages, of women, and of diverse groups of people in specific geographic locations is altering the effectiveness of traditional means of providing health care. As a result, far-reaching changes in the overall health care delivery system are necessary. Aging Population The elderly population in the United States has increased significantly and will continue to grow in future years. In 2003, the 35.9 million adults who were older than 65 years of age constituted 12.4% of the U.S. population (U.S. Bureau of the Census, 2004). By the year 2030, 20% of the U.S. population is expected to be older than 65 years of age. Cultural Diversity An appreciation for the diverse characteristics and needs of people from varied ethnic and cultural backgrounds is important in health care and nursing. Some projections indicate that by 2030, racial and ethnic minority populations in the United States will triple. With increased immigration, both legal and illegal, this figure could approach 50% by the year 2030 (U.S. Bureaus of Census, 2004). Changing in pattern of disease -Although many infectious diseases have been controlled or eradicated, others, such as tuberculosis, acquired immunodeficiency syndrome (AIDS), and sexually transmitted diseases/infections, are on the rise. - An increasing number of infectious agents are becoming resistant to antibiotic therapy as a result of widespread and inappropriate use of antibiotics. Obesity has become a major health concern, and the multiple comorbidities that accompany it, such as hypertension, heart disease, diabetes, and cancer, add significantly to its associated mortality. Advances in Technology and Genetics -Sophisticated techniques and devices have revolutionized surgery and diagnostic testing, making it possible to perform many procedures and tests on an outpatient basis. Demand for Quality Health Care -Nurses in acute care settings must work with other health care team members to maintain quality care while facing pressures to discharge patients and decrease staffing costs. Quality Improvement and Evidence-Based Practice -In the 1980s, hospitals and other health care agencies implemented ongoing quality assurance (QA) programs. These programs were required for reimbursement for services and for accreditation by the Joint Commission (previously known as the Joint Commission for Accreditation of Healthcare Organizations [JCAHO]). These QA programs sought to establish accountability to society on the part of the health professions for the quality, appropriateness, and cost of health services provided. -Continuous quality improvement (CQI) was identified as a more effective mechanism for maintaining quality health care and its implementation was mandated in health care organizations in 1992. The Joint Commission specifies that patients have the right to health care (1) that is considerate and preserves dignity; (2) that respects cultural, psychosocial, and spiritual values; and (3) that is age specific (Joint Commission, 2007). Clinical Pathways and Care Mapping Many health care facilities and home health services use clinical pathways or care mapping to coordinate care for patients (Kinsman, James & Ham, 2004). Clinical pathways are tools for tracking a patient’s progress toward achieving positive outcomes within specified time frames. Clinical pathways based on current literature and clinical expertise have been developed for patients with certain diagnosis related groups (DRGs) (eg, heart failure, ischemic stroke, fractured hip), for high-risk patients (eg, those receiving chemotherapy), and for patients with certain common health problems (eg, diabetes, chronic pain). The pathways indicate key events, such as diagnostic tests, treatments, activities, medications, consultation, and education, that must occur within specified times for patients to achieve the desired and timely outcomes.
- Roles of the Nurse As stated previously, nursing is the diagnosis and treatment of human responses to health and illness and therefore focuses on a broad array of phenomena. Professional nurses who work in institutional, community-oriented, or community- based settings have three major roles: the practitioner role, which includes providing care, teaching, and collaborating; the leadership role; and the research role. Although each role carries specific responsibilities, these roles are characteristic of all nursing positions, relate to one another, and are designed to meet the immediate and future needs of consumers who are the recipients of nursing care. Often, nurses act in a combination of roles to provide comprehensive patient care. Leadership Role The leadership role is often viewed as a role assumed by nurses who have titles that suggest leadership and who are the leaders of large groups of nurses or related health care professionals. However, because of the constant fluctuation of health care delivery demands and consumers, a broader definition of nursing leadership, one that identifies the leadership role as inherent within all nursing positions, is required. The leadership role involves those actions that nurses execute when they assume responsibility for the actions of others directed toward determining and achieving patient care goals. Many staff nurses now work in settings where they are held accountable for the nursing care delivered by unlicensed assistive personnel (UAPs) who work under their direct supervision. Research Role The research role is considered to be a responsibility of all nurses in clinical practice. Nurses are constantly alert for nursing problems and important issues related to patient care that can serve as a basis for the identification of researchable questions. Nurses with a background in research methods can use their research knowledge and skills to initiate and implement timely, relevant studies.
- Nurses, physicians, and ancillary health personnel function within a decentralized organizational structure, collaboratively making clinical decisions. A joint practice committee, with representation from all care providers, may function at the unit level to monitor, support, and foster collaboration. Collaborative practice is further enhanced with integration of the health or medical record and with joint patient care record reviews. The collaborative model, or a variation of it, promotes shared participation, responsibility, and accountability in a health care environment that is striving to meet the complex health care needs of the public.