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Full Download PDF of Professional Nursing: Concepts & Challenges 8th Edition by Beth Black (Ebook PDF) All Chapter
Full Download PDF of Professional Nursing: Concepts & Challenges 8th Edition by Beth Black (Ebook PDF) All Chapter
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Ideas for Further Exploration
Communication Theory
Adjusting to Illness
Illness Behaviors
8
Health Care Reform and Universal Access
Getting Involved
Epilogue
Glossary
9
Index
10
Copyright
11
nurses refer to the definitions and defining characteristics of the
diagnoses listed in this work.
Notices
Knowledge and best practice in this field are constantly changing.
As new research and experience broaden our understanding,
changes in research methods, professional practices, or medical
treatment may become necessary.
To the fullest extent of the law, neither the Publisher nor the
authors, contributors, or editors, assume any liability for any
injury and/or damage to persons or property as a matter of
products liability, negligence or otherwise, or from any use or
operation of any methods, products, instructions, or ideas
contained in the material herein.
12
Description: Eighth edition. | Maryland Heights, Missouri :
Elsevier/Saunders, [2017] | Includes bibliographical references and
index.
Identifiers: LCCN 2016001024 | ISBN 9780323431125 (pbk. : alk.
paper)
Subjects: | MESH: Nursing | Vocational Guidance
Classification: LCC RT82 | NLM WY 16.1 | DDC 610.73068--dc23
LC record available at http://lccn.loc.gov/2016001024
Printed in China
13
Dedication
—BPB
14
Reviewers
Michele Bunning, RN, MSN, Associate Professor, Good
Samaritan College of Nursing and Health Science, Cincinnati, Ohio
15
Preface
Nursing is evolving, as is health care in the United States. With the
debates and discussions, lawsuits, and legislation that surround the
Affordable Care Act, health care has become a central feature of
American political and social discourse. With their increasing
response to calls to advance their education and their strong record
of safety and quality care, nurses are positioned to take a leadership
role in the provision of health care in the United States.
To be effective leaders, nurses must master knowledge about
health and illness and human responses to each, think critically and
creatively, participate in robust interprofessional collaborations, be
both caring and professional, and grapple with ethical dilemmas
that are complex and that challenge providers in a time when
health care resources are not unlimited. As leaders, nurses must
have an understanding of their history, because the past informs
the present, and have a vision for the future that builds on the
lessons of today.
The eighth edition of Professional Nursing: Concepts & Challenges
reflects my commitment to present current and relevant
information. Since the last edition, the Affordable Care Act (ACA)
has withstood repeated attempts in Congress to repeal it.
Importantly, the ACA has withstood two significant challenges
brought before the U.S. Supreme Court. The provisions of the ACA
have been implemented, and more Americans than ever have
health insurance. The 2016 presidential election is 1 year away as
this is being written, with one side arguing for the repeal of the
ACA, while one candidate on the other side is arguing for a single-
payer health care system. This early posturing almost certainly
16
foreshadows a continuing lively debate on critical questions of
health care in America.
In this edition, the order of the chapters has been changed
considerably to reflect a more cohesive view of nursing, its history,
education, conceptual and theoretical bases, and the place of
nursing in the U.S. health care system. Faculty are encouraged,
however, to use the chapters in any order that reflects their own
pedagogical and theoretical approaches. This edition has additional
examples from nurses, especially textboxes featuring compelling
stories from nurses who have shaped their careers in creative,
innovative ways. The effects of the Internet and social media on
nursing are addressed extensively with regard to their legal and
ethical implications and their role in professional socialization and
communication. There are fewer figures and statistics than in
previous editions because students respond more favorably to
narratives and examples. With the easy and free availability of
health-related statistics from .gov websites, I decided that today’s
students would benefit more from narrative and less from pages of
statistics. I have rarely met a nurse engaged in practice who didn’t
start a story with, “I had a patient once who…” These narratives
teach us about what is important in nursing.
Throughout the book, I have been very careful to be inclusive, to
avoid heteronormative and ethnocentric language, to use examples
that avoid stereotypes of all types, and to include photographs that
capture the wonderful diversity of American nursing.
A note about references: older references refer to classic papers or
texts. There are a few references that don’t reach the level of
“classic” texts, but the author turned a phrase in a clever or elegant
way that needed to be cited. No manner of updated paper could
replace these interesting comments or points of view. Research and
clinical works are relevant and contemporary.
As with the last three editions, the eighth edition is written at a
level appropriate for use in early courses in baccalaureate curricula,
in RN-to-BSN and RN-to-MSN courses, and as a resource for
practicing nurses and graduate students. An increasing number of
students in nursing programs are seeking second undergraduate
degrees, such as midlife adults seeking a career change and others
17
who bring considerable experience to the learning situation.
Accordingly, every effort has been made to present material that is
comprehensive enough to challenge users at all levels without
overwhelming beginning students. The text has been written to be
engaging and interesting, and care has been taken to minimize
jargon that is so prevalent in health care. A comprehensive glossary
is provided to assist in developing and refining a professional
vocabulary. As in previous editions, key terms are highlighted in
the text itself. All terms in color print are in the Glossary. The
Glossary also contains basic terms that are not necessarily used in
the text but may be unfamiliar to students new to nursing.
Some features from previous editions have gotten significant
“makeovers.” Some self-assessment exercises were retained, but the
language was updated. Several chapters contain Challenge boxes
that typically, but not always, are related to an issue of culture.
Some older textboxes from previous editions have been eliminated
to make room for fresher content. To be consistent with the focus of
the book—concepts and challenges—I have changed the former
“Key Points” content to address major concepts from each chapter
with a corresponding challenge for the student or for nursing as a
profession. I have included “Ideas for Further Exploration” to
replace “Critical Thinking Questions” with the hope that these
ideas will generate a spark of curiosity in students as they consider
some of the challenging aspects of the profession.
I sincerely hope that the eighth edition continues to reach the
high standards set forth by Kay Chitty, who edited the first four
editions of this book. I hope that students and faculty will find this
edition readable, informative, and thought provoking. More than
anything, I hope that Professional Nursing: Concepts & Challenges,
Eighth Edition, will in some way contribute to the continuing
evolution of the profession of nursing.
Beth Perry Black
18
Acknowledgments
With each new edition of Professional Nursing: Concepts & Challenges,
I find myself increasingly in awe of the intelligence, creativity,
humility, and work ethic of the nurses who continue to inspire me.
I am so grateful to the many people whose support and
assistance have made this book possible, each in different ways:
• To the faculty who used earlier editions and shared their helpful
suggestions to make this book better.
• To students who sent e-mails, expressing their gratitude for an
interesting and readable textbook while offering ideas for
improvement.
• To the many nurses who were generous in sharing their
experiences when I asked for an example or a story. Nurses
narrate their work like no others.
• To my colleagues in the School of Nursing at the University of
North Carolina at Chapel Hill, and to our extraordinary nursing
students and alumni who make us proud.
• To Trish Wright and Rana Limbo, my “grief buddies,” who are
also my dear friends and writing companions.
• To my friend Paula Anderson, who assisted me in the preparation
of this text and whose warm, generous spirit infuses everything
she does with light.
• To my dear friends Jen and Rick Palmer, whose loving support
has been and continues to be a lifeline.
• To my incredibly smart, funny, and supportive daughters,
Amanda Black and Kylie Johnson, and to their respective
partners, Hudson Santos, Jr., and Pierce Johnson, who serve to
both buoy and anchor them. Thanks, schweeties!
19
I am deeply indebted to each of you.
20
1
Nursing in Today’s
Evolving Health Care
Environment
LEARNING OUTCOMES
21
Chapter opening photo used with permission from iStockphoto.
22
an important report of the opportunities this legislation affords
nurses, the Committee on the Robert Wood Johnson Foundation
Initiative on the Future of Nursing at the Institute of Medicine
noted that “nurses have a considerable opportunity to act as full
partners with other health professionals and to lead in the
improvement and redesign of the health care system and its
practice environment” (Institute of Medicine, 2010, pp. 1–2). This
important initiative continues to have a profound influence on the
evolution of nursing and nursing education since its publication.
Welcome to nursing. You are entering this great profession at an
exciting time in our history. Writing about “nursing today” poses a
challenge, because what is current today may have already changed
by the time you are reading this. What does not change, however, is
the commitment of nurses to what Rosenberg (1995) referred to as
“the care of strangers”—professional caring, learned through
focused education and deliberate socialization (Storr, 2010). In other
words, you will be taught to think like a nurse and to do well those
things that nurses do. You will become a nurse.
In this chapter, you will learn some basic information about
today’s nursing workforce: who nurses are, the settings where they
practice, and the patients for whom they are providing care. You
will also be introduced to some nurses who have had intriguing
experiences and opportunities that you may not know are even
possible. One of the best features of nursing is the flexible set of
skills that you will develop and, therefore, the wide variety of
experiences that await you as your begin your career as a
professional registered nurse (RN).
23
The U.S. Department of Health and Human Services responded
to this need by conducting a comprehensive survey of the nursing
workforce every 4 years, beginning in 1977. Known as the National
Sample Survey of Registered Nurses (NSSRN), this effort gave
policy makers, educators, and other nurse leaders data about the
workforce, allowing them to make informed decisions about
allocation of resources, development of programs, and recruitment
of nurses. The final NSSRN was conducted in 2008 and results were
published in 2010. The federal government has since discontinued
this very useful survey. The final version of the 2008 federal nursing
workforce survey The Registered Nurse Population: Findings from the
2008 National Sample Survey of Registered Nurses (U.S. Department of
Health and Human Services, 2010) is available as a .pdf file in a
direct link:
http://bhpr.hrsa.gov/healthworkforce/rnsurveys/rnsurveyfinal.pdf.
In response to the discontinuation of the NSSRN and the ongoing
need to understand the nursing workforce, in 2013 the National
Council of State Boards of Nursing (NCSBN) and the Forum of
State Nursing Workforce Centers (FSNWC) combined efforts to
conduct a comprehensive national survey of RNs (Budden, Zhong,
Moulton, et al., 2013). In this chapter, data from the 2013 NCSBN
and FSNWC survey are presented in conjunction with other sources
of workforce data, including the 2008 NSSRN data, to provide you
with a thumbnail sketch of nursing, specifically focusing on the
number of nurses in the workforce, as well as their gender, age,
race, ethnicity, and educational levels.
24
positions. Among those working full time in nursing, 12% had a
second nursing position; 14% of those working part time in nursing
held a second nursing position (U.S. Department of Health and
Human Services, 2010).
Gender
Nursing remains a profession dominated by women; however, the
percentage of men in nursing increased by 50% between 2000 and
2008 (U.S. Department of Health and Human Services, 2010).
Overall, 7% of nurses are men. Among NCSBN/FSNWC survey
respondents licensed before 2000, 5% were men. Of those licensed
between 2010 and 2013, 11% were men (Budden et al., 2013).
In 2014, men comprised 11.7% of students in entry-level bachelor
of science in nursing (BSN) programs (AACN, 2015a). Male and
female RNs were equally likely to have a bachelor’s or higher
degree in nursing or nursing-related fields (49.9% and 50.3%,
respectively). Men, however, were more likely than women to have
a bachelor’s or higher degree in nursing and any nonnursing field
(62% vs. 55%). A higher percentage of the men work in hospitals
(76% vs. 62%). At 41%, men are overrepresented in the advanced
practice role of certified registered nurse anesthetists. Among all
other job titles held by men, staff nurse and administration have
proportional representation, with about 7% of these positions held
by men. Nurse practitioners and “other” positions (e.g., consultant,
clinical nurse leader, informatics, researcher) are slightly less
proportional, with 6% of these positions held by men. Interestingly,
men hold only about 3.8% of faculty positions.
Age
The future of any profession depends on the infusion of youth, and
the steady increase in the age of the nursing workforce has been a
concern. In the past decade, however, the rate of aging of nurses in
the workforce has slowed (U.S. Department of Health and Human
Services, 2010). This is a result of the increased number of working
RNs who are under age 30, which offsets the increasing number of
nurses age 60 or older who continue to work. The rise in the
number of nurses under age 30 is attributed to the increased
25
Another random document with
no related content on Scribd:
d’ignorer la préférence dont vous m’honorez. Parlez donc, ma douce
bien-aimée ; que vos lèvres chéries fassent, en présence de votre
mère, cet aveu qui doit décider de mon sort… Mathilde, chère
Mathilde, c’est de vous que dépend le bonheur ou le malheur de ma
vie. Je vous offre ma main, voulez-vous l’accepter ?
Mathilde frissonna comme une feuille agitée par le vent, pâlit,
roula des yeux effarés, et se laissa tomber dans les bras de mon
maître, en murmurant un Oui très-distinct.
Milady contempla d’un air stupéfait ce gracieux tableau vivant ;
mais bientôt la surprise fit place à une fureur concentrée. Elle grinça
des dents, ses yeux flamboyèrent, sa poitrine se gonfla comme un
ballon prêt à crever, et son visage devint aussi blanc que son
mouchoir. Elle ressemblait comme deux gouttes d’eau à Mme
Malibran, dans l’opéra de Médée, lorsque cette chanteuse dénaturée
s’apprête à égorger ses petits. Lady Griffin n’égorgea personne ; elle
se contenta de sortir sans prononcer un mot, et faillit renverser
l’auteur de ces Mémoires, qui, par hasard, se trouvait auprès de la
porte, l’œil à la hauteur de la serrure. Je jugeai à propos de
m’éloigner à mon tour, laissant mon maître auprès de son héritière
bossue.
J’ai donné mot pour mot la déclaration de Cinqpoints ; mais je
possède dans mes cartons le brouillon d’un autre discours,
sténographié par moi quelques jours auparavant, et qui, à une ou
deux variantes près, est une répétition de ce petit speech. Par
exemple, au lieu de : Miss Griffin ! Mathilde ! on lit : Lady Griffin !
Léonore !
On me demandera sans doute pourquoi milady ne s’empressa
pas de dévoiler à sa belle-fille les turpitudes amoureuses de mon
maître ? La raison en est bien simple. Elle était trop femme pour ne
pas savoir que Mathilde ne la croirait pas ; peut-être aussi avait-elle
d’autres motifs qui se révéleront d’eux-mêmes.
Cinqpoints, au lieu d’imiter l’âne philosophe, avait enfin choisi la
botte de foin qui lui paraissait la plus avantageuse. Lady Griffin
n’avait que l’usufruit d’une partie de la fortune ; le principal devait
revenir à Mathilde ou à ses héritiers. Il eût fallu être aussi borné que
le quadrupède en question pour hésiter une minute de plus.
En dépit de son père, qui désormais ne paraissait plus à
craindre ; en dépit de ses dettes, lesquelles, à vrai dire, ne l’avaient
jamais beaucoup embarrassé ; en dépit de sa pauvreté, de sa
paresse, de ses escroqueries, de sa vie débauchée, choses qui, en
général, nuisent à un jeune homme qui a son chemin à faire, voilà
donc mon maître devenu le fiancé d’une femme aussi riche que
stupidement amoureuse.
VII
UNE ANGUILLE SOUS ROCHE
» Mathilde ? »
Cet autographe (le premier que mon maître eût reçu de miss
Griffin) nous fut apporté, à six heures du matin, par ce pauvre
Fitzclarence, qu’on avait dérangé exprès. Croyant qu’il s’agissait
d’une affaire de vie ou de mort, je m’empressai de réveiller
Cinqpoints pour lui remettre le tricorne en question. Dès qu’il eut
parcouru les premières lignes de cette tendre épître, il se mit à jurer
comme un charretier, envoya aux cinq cents mille diables celle qui
l’avait écrite, la roula en boule, me la jeta au visage et se rendormit.
Le fait est que, pour une première épître, ce style devait sembler
par trop incendiaire à un homme auquel on n’avait pas encore lu le
testament de sir Georges. Mais que voulez-vous, la demoiselle était
ainsi faite. Les romans mélancoliques dont elle se nourrissait avaient
fini par déteindre sur elle.
J’ai dit que Cinqpoints ne se donnait plus la peine de lire ces
lettres ; mais, afin de sauver les apparences, il me chargeait d’en
prendre connaissance et de lui indiquer celles qui exigeaient une
réponse. La confiance dont il daigna m’honorer en cette occasion
explique comment la correspondance de miss Griffin est restée entre
mes mains.
Le billet suivant (qui, dans l’ordre de réception, porte le no XLIV)
est daté du lendemain de la déclaration officielle de Cinqpoints :
» M. G.
« Jeudi matin.
» M. G. »
» L. E. G. »
Tout cela est parfaitement exact ; je veux dire aussi exact que
peut l’être un article de journal. L’excellent père, que je soupçonne
d’avoir rédigé lui-même le paragraphe en question, était arrivé chez
nous assez tard dans l’après-midi.
— John, voilà une bien triste affaire, me dit-il après avoir vu son
fils. Ah ! il faut beaucoup de philosophie pour supporter les épreuves
de cette misérable vie ! Approchez un peu ce canapé du feu ; là,
voilà qui est bien… Avez-vous quelques cigares dans la maison ? Et,
à propos, faites-moi monter à goûter et une bouteille de vieux
bordeaux. Je ne puis quitter mon pauvre fils avant que les médecins
l’aient déclaré hors de danger.
IX
MÉTAMORPHOSE