Nursing Today

Fall 2023 Foundations of

Nursing Practice
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Prof. Fulson, MSN, RN

WELCOME FUTURE
REGISTERED NURSES
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 •Objective. 1
•The student will examine nursing as a profession

• Identifying historical events influencing nursing practice.

(1a,1b,2c)
• Differentiating nursing roles and functions in nursing
practice. (1a,1b,2c)
• Summarizing standards of nursing practice and practice
Objectives settings. (1a,1b,2c,2d)
• Comparing how various health care agencies impact
nursing practice. (e.g., CDC, NIH, PHS, VA and others).
(1a,1b,2c,2d)
• Distinguishing among Associate Degree Nursing ADN,
Diploma, Baccalaureate, and graduate education and their
respective accrediting agencies. 1a,1b,2c,2d)
•Comparing nursing career pathways (1a,1b,2c,2d)
• Explain effects of legislation on health care(1a,1b,2c,2d)
•Evaluating current health care delivery trends. (1a,1b,2c,2d)

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 • Objective 2
• The student will explore leadership and
management principles

•• Examining leadership / management styles.

(1a,1b,2c,2d)
• Explaining the Coordinator of Care
role(1a,1b,2c,2d)
Objectives • • Defining just culture and its characteristics
• Explaining the impact of incivility in
nursing practice(1a,1b,2c,2d)
• Identifying effective strategies to promote
civility in the nursing
profession(1a,1b,2c,2d)
• Discussing the role of the nurse as a
member of an interdisciplinary
group(1a,1b,2c,2d)

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 • Patient-centered care
• Professionalism
• Requires critical thinking
• Administer patient-centered quality care
Nursing as a • Be responsible and accountable
• Health care advocacy groups
Profession • Robert Wood Johnson Foundation
(RWJF) Future of Nursing: Campaign for
Action
• Institute of Medicine (IOM) publication
on The Future of Nursing

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Science and Art of Nursing Practice

• Nursing requires:
• Current knowledge and practice standards
• Insightful and compassionate approach
• Critical thinking
• Benner’s stages of nursing proficiency:
• Novice
• Advanced beginner
• Competent
• Proficient
• Expert

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Scope and Standards of Practice

• Nursing definitions
• American Nurses
Association (ANA)
• International Council of
Nurses (ICN)
• Nursing: Scope and
Standards of Practice
• 1960: Documentation
began
• Standards of
Professional Nursing
Practice
• Standards of
Professional
Performance
• Code of Ethics

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Standards of Professional Nursing Practice
ANA Standards of Nursing
Practice
3. Outcomes Identification:
The registered nurse
identifies expected outcomes
for a plan individualized to
the health care consumer or
the situation.
5a. Coordination of Care: The
registered nurse coordinates
care delivery.
1. Assessment: The
registered nurse collects
pertinent data and
information relative to the
healthcare consumer’s health
or the situation.
4. Planning: The registered
nurse develops a plan that
prescribes strategies to attain
expected, measurable
outcomes.
5b. Health Teaching and
Health Promotion: The
registered nurse employs
strategies to promote health
and a safe environment.
2. Diagnosis: The registered
nurse analyzes the
assessment data to
determine the actual or
potential diagnoses,
problems, and issues.
5. Implementation: The
registered nurse implements
the identified plan.
6. Evaluation: The registered
nurse evaluates progress
toward attainment of
outcomes.
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 Standards of Professional
Nursing Practice

• The Standards of Professional Nursing Practice contain

authoritative statements of the duties that all registered
nurses, regardless of role, population, or specialty, are
expected to perform competently (ANA, 2015). The duties are
supported by a critical thinking model known as the nursing
process: assessment, diagnosis, outcomes identification and
planning, implementation, and evaluation (ANA, 2015). The
nursing process is the model for clinical decision making and
includes all significant actions taken by nurses in providing care
to patients (see Unit III).
• Standards of Professional Performance
• The ANA Standards of Professional Performance (Box 1.3)
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describe a competent level of behavior in the professional role
(ANA, 2015). The standards provide a method to assure
patients that they are receiving high-quality care and to ensure
that the nurses must know exactly what is necessary to provide
nursing care. The standards also are in place to determine
whether nursing care meets the standards.

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The Code
• The nursing code of ethics is a statement of philosophical ideals of right
and wrong that define the principles you will use to provide care to your
patients. It is important for you to also incorporate your own values and
ethics into your practice. As you incorporate these values, explore what
Of Ethics type of nurse you will be and how you will function within the
discipline.

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 Professional Responsibilities and Roles

Autonomy and
Caregiver Advocate
accountability

Educator Communicator Manager

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 Career Development
• Provider of care
• Advanced Practice
Registered Nurses
• Clinical Nurse Specialist
• Nurse Practitioner
• Certified Nurse-Midwife
• Certified Registered Nurse
Anesthetist
• Nurse Educator
• Nurse Administrator
• Nurse Researcher

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 • Correlation between direct care provided by an RN and:

Nursing • Positive patient outcomes

• Reduced complication rates
• More rapid return of the patient to optimal functional status

Shortage • With fewer available nurses, it is important for you to learn to use your
patient contact time efficiently and professionally.

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 • Nurses:

Historical • Respond to needs of patients

• Actively participate in determining best practices

Influences • Knowledge of the history of the nursing profession increases your ability
to understand the social and intellectual origins of the discipline.

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 • Established first nursing philosophy based on health
maintenance and restoration
Florence • Organized first school of nursing
• First practicing epidemiologist
Nightingale • Improved sanitation in battlefield hospitals
• Practices remain a basic part of nursing today

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Civil War to the
Beginning of the
Twentieth
Century

• Clara Barton
• Dorthea Lynde Dix and
Mother Bickerdyke
• Harriet Tubman
• Mary Mahoney
• Isabel Hampton Robb
• Lillian Wald and Mary
Brewster

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Twentieth Century
• Movement toward scientific, research-based
practice and defined body of knowledge
• Nurses assumed expanded and advanced
practice roles
• 1906: Mary Adelaide Nutting, first nursing
professor at Columbia Teacher’s College
• Army and Navy Nurse Corps established
• 1920s: Nursing specialization began
• 1990: ANA established Center for Ethics and
Human Rights

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 • Importance of nurses’ self-care
Contemporary • Health care reform and costs

Influences • Demographic changes

• Medically underserved

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 Trends in Nursing

Quality and Safety Impact of

Evidence-based
Education for emerging
practice
Nurses (QSEN) technologies

Impact of nursing
Public perception
Genomics on politics and
of nursing
health policy

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Professional
Registered
Nurse
Education
• Prelicensure
• 2-year associate’s
degree
• 4-year baccalaureate
degree
• Graduate education
• Master’s degree,
advanced practice RN
• Doctoral degrees
• Continuing and in-service
education

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Nursing Practice

• Nurse Practice Acts (NPAs)

• Overseen by State Boards of Nursing This Photo by Unknown Author is licensed under CC BY

• Regulate scope of nursing practice

• Protect public health, safety, and
welfare
• Licensure and certification
• Licensure: NCLEX-RN® examination
• Certification: requirements vary

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Professional
Nursing
Organizations
• Address member concerns
• Present educational
programs
• Publish journals
• Student organizations
• National Student Nurses
Association (NSNA)
• Canadian Student
Nurses Association
(CSNA)

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Managing Patient Care
Introduction
• Wherever you practice nursing, you
• Use critical thinking to
implement professional
standards of care
• Use health care resources
appropriately

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2
5

Building a
Nursing Team
• A strong nursing team works
together to achieve the best
outcomes for patients.
• Effective team development
requires team building and
training, trust, communication, and
a workplace that facilitates
collaboration.
• Empowered teams begin with the
nurse executive
Magnet
Recognition
Program
• Five model components
• Transformational
leadership
• Structural
empowerment
• Exemplary
professional practice
• New knowledge,
innovation, and
improvements
• Empirical quality
results

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Nursing Care
Delivery Methods

• Traditional models
• Team nursing
• Primary nursing
• Today’s models
• Patient- and family-centered
care
• Dignity and respect
• Information sharing
• Participation
• Collaboration
• Case management

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Decision Making
• Decentralized management
• Decision making occurs at the level of the staff
• Shared governance
• Encompasses
• Responsibility: duties and activities an individual
is employed to perform
• Autonomy: independent decisions about patient
care
• Authority: legitimate power to give commands
and make final decisions specific to a given
position
• Accountability: answerable for actions

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 • Learn to become a leader by:

Leadership • Consulting with instructors and nursing staff to obtain feedback in

making good clinical decisions

Skills for • Learning from mistakes and seeking guidance

• Working closely with professional nurses
Nursing • Trying to improve your performance during each patient interaction
• Important leadership skills to learn include
Students • Clinical care coordination, team communication, delegation,
knowledge building

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Clinical Care
Coordination
• Clinical decisions
• Priority setting
• Organizational skills
• Use of resources
• Time management
• Evaluation

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 Team
Communication
• Effective communication is critical to all
teams.
• Use open, professional communication
• Respect one another's ideas, share
information, and keep one another
informed
• Understand the roles and responsibilities of
everyone on the health care team
• The two-challenge rule allows concerns
about safety to be voiced twice.
• Situation-Background-Assessment-
Recommendation (SBAR)

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 Delegation (1 of 2)
• Delegation: the process of assigning
part of your responsibility to another
qualified person in a specific situation
• Effective delegation results in the
achievement of quality, safe patient
care; improved efficiency; increased
productivity; empowered staff; and
skill development
• Know which skills you are able to
delegate
• Never delegate clinical reasoning,
nursing judgment, and critical
decision-making to APs

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 Delegation (2 of 2)
• The five rights of delegation
• Right task, right circumstance,
right person, right directions or
communication and right
supervision or evaluation
• Tips for effective delegation
• Assess the knowledge and skills of
the person
• Match tasks to the person’s skills
• Communicate clearly:
• Task, outcome, time
• Listen attentively
• Provide feedback

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 Knowledge Building

MAINTAIN COMPETENCY ACTIVELY PURSUE LISTEN TO THE RESPECTFULLY INTERACT

LEARNING CONTRIBUTIONS OF WITH PROFESSIONAL
OPPORTUNITIES OTHERS COLLEAGUES

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