CH. 4 Professional Nursing Practice by Mary Koloroutis

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CH. 4 Professional Nursing Practiceby Mary
Koloroutis

• Key Constructs to Professional Nursing
• The nurse-patient is the cornerstone
• The two major H.C. drivers can negatively impact
  Professional Nursing
• Financial decisions
• Technology issues
• Magnet Status is positively related to
  Professional Nursing

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Key Constructs to Professional Nursing continued

• Aiken Study (1994) gt P. N.
• Facilitate professional autonomy
• Nursing control over their practice
• Positive nurse-physician relations
• P.N. numbers/mix impact patient outcomes by
  3-12 (Needleman, 2001)
• Provides compassionate care to clients
• OJT does not normally meet the requirements of a
  professional occupation.

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What is a Profession?

• Abraham Flexner (1910)
• Intellectual vs physical (care plan vs IV)
• Based on an assessable body of knowledge
• Is practical rather than theoretical
• Can be taught through professional Ed
• Has a strong internal organization of members
• Has practitioners motivated by altruism

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Explore the Meaning of a Professional vs.
Technical Practice

• Describe the similarities or differences between
  the chef at the Brown Palace the cook at the
  Village Inn?

Cook
Chef
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Professional vs. Technicalfor all practice areas

• Professional Practices
• Have a culture that supports professional
  activities frameworks, CE, research
• Has a defined body of knowledge gained by formal
  education
• Is a discipline with peer review and a code of
  ethics
• Autonomy in practice with legislative and legal
  sanctions
• Is an organized system of practice-society
  recognized

• Technical Practices
• Are more likely to have more OJT than formal
  education.
• Are skill focused
• Have trade journals or technique trainings
• Do not focus on what advances the practice
• Develop through certifications
• Want less accountability

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Professional vs. TechnicalThinking and Valuing

• Professional thinking
• More is best
• Specialization in depth and breadth
• Evidence-based education
• Invests energy beyond the work-associations,
  research, reading
• Expects self accountability
• Resilient with change and believes change is
  valuable

• Technical Thinking
• Least is best
• Specialization in depth
• Experience is the primary educator
• Conserves energy beyond the workday
• Prefers others be accountable
• Enjoys consistency and believes change is
  disruptive

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Professional vs. TechnicalNursing Competencies

• Professional

• Technical

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Imagine Nursing as Never Changing-Flat Line

• Completely controlled
• Impact on patient outcomes
• Impact on new nurses
• Impact on physicians
• Impact on quality
• Impact on staff

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What Would it Look Like with Fluctuation and
Change?

• How is Fluctuation Change different from Random
  Chaos?
• What are the Benefits of Fluctuation and Change?
• Called Cybernetics II
• (as system in constant changeshaping toward
  improvements)

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Imagine Minimal Change
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Professionals believe there are Mind and Body
Failures

• Limited knowledge
• Information processing barriers
• Environmental barriers
• Motivational (internal) barriers
• Emotional barriers
• Perceptual barriers
• Intellectual barriers
• Cultural barriers (bias)

• KEY RESPONSES ARE
• More people need to be stepping up to critical
  decisions with
• Shared Governance
• We need practice theories to keep us on track and
  tell us when we are lost
• We need to practice in an evidence-based care
  environment

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Conceptual Frameworks-Theory Allow You To
Organize Your Thinking and Connect it to
Principles

• It helps to know what we believe and why
• These are the the building blocks of our
  knowledge and beliefs
• This allows us to move into new territory as if
  we have a map for the unknown
• We have less surprises, and then react less
  stressed
• It is an external support for our faulty thinking

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Imagine Nursing as Random PracticeNot a
Discipline

• Inconsistent care
• Patient confusion
• Evidence based practices are not encouraged
• There is confusion and constant conflict
• No accountability

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Metaparadigms

• Broadest consensus of a discipline
• Have general parameters creates boundaries
• Have a distinctive domain and cover all of it
• Most theories include these components
• Person (humans)
• Environment (context)
• Health (ideas of health)
• Nursing (nursing as a discipline)
• Caring
• Quality

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Propositions Linkages Relationships

• Belief regarding person to their own health
• Belief regarding person to environment
• Belief regarding health to nursing practice
• Belief regarding the connection of person,
  environment, health , and the practice of nursing
• Beliefs about caring, quality and practice

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The Focus of Ones PracticeImpacts the practice
and workplace

• Client focused
• Family focused
• Person-environment focused
• Nursing therapeutic focused
• Humanistic focused
• Spiritually focused
• Process focused

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Models Give you a Picture of How the Parts are
Related
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A Philosophy Has Your Key Values Presented for
Others
Advocacy through Caring About Quality Nursing Practice
Patients are the reason we exist and our caring shows that we advocate for them Quality is the combination of clinical competency and the art of caring Nursing is at the forefront of our excellence
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Other TheoriesImpact the practice and the
workplace

• Growth and development (Erikson, Piaget)
• Adult development (Kohlberg, Gilligan, Rest)
• Aging and death (Kubler-Ross)
• Chronic Disease (Geriatric Theories)
• Human Intelligence (Gardner)
• Psychological development (Psych. Theories)
• Cause and Effect Multifactorial (Medicine)
• Potentiality, Consciousness Reality (Q.M.)

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Definitions of Nursing (ANA)

• Provision of a caring relationship that
  facilitates health and healing
• Attention to the range of human responses to
  health and illness, the physical and social
  environments
• Integrates objective data and subjective
  experience.
• Apply scientific knowledge
• Advance knowledge through scholarly inquiry
• Influence social and public policy for social
  justice

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Definition of Nursing (ANA)

• Nursing is the protection, promotion, and
  optimization of health and abilities, prevention
  of illness and injury, alleviation of suffering
  through the diagnosis and treatment of human
  response, and advocacy in the care of
  individuals, families, communities, and
  populations.

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The Scope of Nursing Practice

• Dependent on their educational preparation
• Their experience
• Their role
• And the nature of the patient population
• Practice within recognized standards of
  professional nursing practice (varies with
  education, experience

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Three Realms of Practice

• Delegated
• RNs carry out medical plans of action
• RN is responsible to confirm safety, and
  appropriateness of the order
• Independent
• Focus is on the patients response to actual or
  potential health problems
• Interdependent
• Interdisciplinary care, planning, and services

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Entry Levels of Nursing Today

• Certified Nursing Assist.
• Licensed Practical Nurse
• PN, LPN, LVN
• Professional Entry
• AD, BSN, (Dip), ND
• Advanced Practice Nurses
• NP, CNS, ND
• Terminal Degrees
• Ed.D., Ph.D., DNSc, DNP, DScN,

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Creating Boundaries for Practical Nursing
What is in the Domain of
NOT Practical Nursing
Practical Nursing
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Quiz 1 Name Date
List four things that are in the domain of
practical nursing four things that are beyond
the scope of practical nursing

Beyond LPN
Within LPN
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Creating Boundaries for NursingWhat is the
Discipline?
What is in the domain And what is not
NOT NURSING
NURSING
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Evaluating the boundaries of Nursing

• 1.    Distinctions between human and non-human
  (not nursing),
• 2.    Distinctions between living and nonliving
  (not nursing),
• 3.    Nature of environments and
  human-environmental interactions from cellular to
  societal levels,
• 4.    Illness versus health and well-being
• 5. What you do to or for your clients

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Academic Training for RNs

• All Nursing
• Assessment
• Diagnosis
• Outcomes Identified
• Planning
• Implementation
• Coordination of Care
• Health teaching, Promotion
• Consultation
• Prescriptive Authority
• Evaluation

• Professional Nursing
• Quality of Practice
• Education
• Professional Prac. Eval.
• Collegiality /Collaboration
• Ethics
• Research
• Resource Utilization
• Leadership

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Roles of Professional Nursing

• Have a Voice of Agency
• 1. Sentry (Watch over, protect others)
• 2. Healer (Care for anothers body, mind, spirit)
• 3. Guide (Leads another through unfamiliar
  territory)
• 4. Teacher (Imparts knowledge)
• 5. Collaborator (Works with others)
• 6. Leader (Has authority to act on behalf of
  others)

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Essential Functions of Nursing Practice

• Assessment of needs through data collection,
  clinical assessment, plan, implement, evaluate
• Manage and deliver the care required for the
  patients condition and individual human response
• Communication and coordinate care with others who
  are interacting with the patient
• Coordinate the patient transfer or discharge

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Benners Novice to Expert (1984)

• Novice
• Advanced Beginner
• Competent
• Proficient
• Expert

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Quotes form Ch. 4

• There must be a relationship with the patient to
  know their strengths, weaknesses, hopes and
  fears our challenge is to balance tasks with
  relationship. (Manthey)
• Within the dominant, modern, Western mindset, the
  caring-healing practices of nursing have been on
  the marginshave been repressed and silenced.
  (Watson)