Fundamentals of Nursing Concepts, Process and Practice PDF

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Fundamentals of Nursing Concepts, Process, and Practice

Health, Wellness, Illness Health was defined in terms of the presence or absence of disease. Florence Nightingale “state of being well and using every power the individual possesses to the fullest extent.” World Health Organization “a state of complete physical, mental, and social wellbeing, and not merely the absence of disease or infirmity.” Talcott Parsons Conceptualized health as the ability to maintain normal roles. Wellness is a state of well-being. Anspaugh, Hamrick, and Rosato (2009) propose seven components of wellness. Components of wellness: 1. Physical 2. Social 3. Emotional 4. Intellectual 5. Spiritual 6. Occupational 7. Environmental

Models of Health and Wellness Because health is such a complex concept, various researchers have developed models or paradigms to explain health and in some instances its relationship to illness or injury. 1. Clinical Model 2. Role Performance Model 3. Adaptive Model 4. Eudemonistic Model 5. Agent–Host–Environment Model 6. Health–Illness Continua Illness is a highly personal state in which the person’s physical, emotional, intellectual, social, developmental, or spiritual functioning is thought to be diminished Disease - can be described as an alteration in body functions resulting in a reduction of capacities or a shortening of the normal life span. Etiology - causation of a disease or condition. Acute illness - is typically characterized by symptoms of relatively short duration. Chronic illness - is one that lasts for an extended period, usually 6 months or longer, and often for the person’s life. Illness behavior - a coping mechanism, involves ways individuals describe, monitor, and interpret their symptoms, take remedial actions, and use the health care system.

Remission, when the symptoms disappear. Exacerbation, when the symptoms reappear. Levels of Care  Promoting health and wellness  Preventing illness  Restoring of health  Care for the dying Levels of prevention occur at various points of a course of disease progression. Leavell and clark (1965) defined three levels of prevention: primary, secondary, and tertiary. 1. Primary prevention focuses on (a) health promotion and (b) protection against specific health problems (e.g., immunization against hepatitis B). 2. Secondary prevention focuses on (a) early identification of health problems and (b) prompt intervention to alleviate health problems. 3. Tertiary prevention focuses on restoration and rehabilitation with the goal of returning the individual to an optimal level of Needs Theories In needs theories, human needs are ranked on an ascending scale according to how essential the needs are for survival. Abraham Maslow (1970), perhaps the most renowned needs theorist, ranks human needs on five levels.

Five levels in ascending order are as follows: 1. Physiological needs. Needs such as air, food, water, shelter, rest, sleep, activity, and temperature maintenance are crucial for survival. 2. Safety and security needs. The need for safety has both physical and psychological aspects. The person needs to feel safe, both in the physical environment and in relationships. 3. Love and belonging needs. The third level of needs includes giving and receiving affection, attaining a place in a group, and maintaining the feeling of belonging. 4. Self-esteem needs. The individual needs both self-esteem (i.e., feelings of independence, competence, and self- respect) and esteem from others (i.e., recognition, respect, and appreciation). 5. Self-actualization. When the need for self-esteem is satisfied, the individual strives for self-actualization, the innate need to develop one’s maximum potential and realize one’s abilities and qualities.

Abraham Maslow’s Hierarchy of Needs is in every nurse’s toolbox for setting patient care priorities.

Nursing students are taught to apply this motivational theory when prioritizing care decisions, first addressing problems that interfere with patients’ physiologic and safety needs, before moving on to those that impede their sense of belonging, their self- esteem and, ultimately, their ability to achieve personal goals.

Nursing as a Profession Definitions of Nursing  Florence Nightingale defined nursing nearly 150 years ago as “the act of utilizing the environment of the patient to assist him in his recovery” .  Nightingale considered a clean, well- ventilated, and quiet environment essential for recovery. Often considered the first nurse theorist, Nightingale raised the status of nursing through education.  Nurses were no longer untrained housekeepers but people educated in the care of the sick.  Virginia Henderson was one of the first modern nurses to define nursing. She wrote, “The unique function of the nurse is to assist the individual, sick or well, in the performance of those activities contributing to health or its recovery (or to peaceful death) that he would perform unaided if he had the necessary strength, will, or knowledge, and to do this in such a way as to help him gain independence as rapidly as possible.” Scope of Nursing  Promoting Health and Wellness  Preventing Illness  Restoring Health  Caring for the Dying

Roles and Functions of Nurse 1. Caregiver has traditionally included those activities that assist the client physically and psychologically while preserving the client’s dignity. The required nursing actions may involve full care for the completely dependent client, partial care for the partially dependent client, and supportive-educative care to assist clients in attaining their highest possible level of health and wellness. Caregiving encompasses the physical, psychosocial, developmental, cultural, and spiritual levels. 2. Communicator  Communication is integral to all nursing roles.  Nurses communicate with the client, support persons, other health professionals, and people in the community.  In the role of communicator, nurses identify client problems and then communicate these verbally or in writing to other members of the health team. The quality of a nurse’s communication is an important factor in nursing care.  The nurse must be able to communicate clearly and accurately in order for a client’s health care needs to be met. 3. Teacher  As a teacher, the nurse helps clients learn about their health and the health care procedures they need to perform to restore or maintain their health.

 The nurse assesses the client’s learning needs and readiness to learn, sets specific learning goals in conjunction with the client, enacts teaching strategies, and measures learning. 4. Client Advocate  A client advocate acts to protect the client. In this role the nurse may represent the client’s needs and wishes to other health professionals, such as relaying the client’s request for information to the physician.  They also assist clients in exercising their rights and help them speak up for themselves. 5. Counselor  Counseling is the process of helping a client to recognize and cope with stressful psychological or social problems, to develop improved interpersonal relationships, and to promote personal growth. It involves providing emotional, intellectual, and psychological support.  The nurse counsels primarily healthy individuals with normal adjustment difficulties and focuses on helping the person develop new attitudes, feelings, and behaviors by encouraging the client to look at alternative behaviors, recognize the choices, and develop a sense of control. 6. Change Agent  The nurse acts as a change agent when assisting clients to make modifications in their behavior. Nurses also often act to make changes in a system, such as clinical care, if it is not helping a client return to health.

7. Leader  A leader influences others to work together to accomplish a specific goal.  The leader role can be employed at different levels: individual client, family, groups of clients, colleagues, or the community. 8. Manager  The nurse manages the nursing care of individuals, families, and communities. The nurse manager also delegates nursing activities to ancillary workers and other nurses, and supervises and evaluates their performance.  Managing requires knowledge about organizational structure and dynamics, authority and accountability, leadership, change theory, advocacy, delegation, and supervision and evaluation. 9. Case Manager  Nurse case managers work with the multidisciplinary health care team to measure the effectiveness of the case management plan and to monitor outcomes.  Each agency or unit specifies the role of the nurse case manager. In some institutions, the case manager works with primary or staff nurses to oversee the care of a specific caseload. In other agencies, the case manager is the primary nurse or provides some level of direct care to the client and family. 10.Research Consumer  Nurses often use research to improve client care. In a clinical  area, nurses need to (a) have some awareness of the process and language of research, (b) be sensitive to issues related to protecting the

rights of human subjects, (c) participate in the identification of significant researchable problems, and (d) be a  Discriminating consumer of research findings.

Values, Ethics and Advocacy

Values -are enduring beliefs or attitudes about the worth of a person, object, idea, or action. Values are important because they influence decisions and actions, including nurses’ ethical decision making. Beliefs -(or opinions) are interpretations or conclusions that people accept as true. They are based more on faith than fact. Beliefs do not necessarily involve values.

Attitudes -are mental positions or feelings toward a person, object, or idea (e.g., acceptance, compassion, openness). Typically, an attitude lasts over time, whereas a belief may last only briefly. Attitudes are often judged as bad or good, positive or negative, whereas beliefs are judged as correct or incorrect. Attitudes have thinking and behavioral aspects. Attitudes vary greatly among individuals.

Ethics -has several meanings in common use. -It refers to (a) a method of inquiry that helps people to understand the morality of human behavior (i.e., it is the study of morality), (b) the practices or beliefs of a certain group (e.g., medical ethics, nursing ethics), and (c) the expected standards of moral behavior of a particular group as described in the group’s formal code of professional ethics.

Nursing ethics -refers to ethical issues that occur in nursing practice. The American Nurses Association (ANA) has updated its Scope and Standards of

Practice (2010) publication, which holds nurses accountable for their ethical conduct. Morality - usually refers to private, personal standards of what is right and wrong in conduct, character, and attitude.

Essential Nursing Values

Altruism is a concern for the welfare and well-being of others. In professional practice, altruism is reflected by the nurse’s concern for the welfare of patients, other nurses, and other health care providers.

Autonomy is the right to self- determination. Professional practice reflects autonomy when the nurse respects patients’ rights to make decisions about their health care. Human dignity is respect for the inherent worth and uniqueness of individuals and populations. In professional practice, human dignity is reflected when the nurse values and respects all patients and colleagues.

Integrity is acting in accordance with an appropriate code of ethics and accepted standards of practice. Integrity is reflected in professional practice when the nurse is honest and provides care based on an ethical framework that is accepted within the profession.

Social justice is acting in accordance with fair treatment regardless of economic status, race, ethnicity, age, citizenship, disability, or sexual orientation.

Moral Principles -are statements about broad, general, philosophical concepts such as autonomy and justice. They provide the foundation for moral rules, which are specific prescriptions for actions. 1. Autonomy refers to the right to make one’s own decisions. 2. Nonmaleficence is duty to “do no harm.” Although this would seem to be a simple principle to follow, in reality it is complex. Harm can mean intentionally causing harm, placing someone at risk of harm, and unintentionally causing harm. 3. Beneficence means “doing good.” Nurses are obligated to do good, that is, to implement actions that benefit clients and their support persons. 4. Justice is frequently referred to as fairness. Nurses often face decisions in which a sense of justice should prevail. 5. Fidelity means to be faithful to agreements and promises. By virtue of their standing as professional caregivers, nurses have responsibilities to clients, employers, government, and society, as well as to themselves. 6. Veracity refers to telling the truth. Although this seems straightforward, in practice, choices are not always clear.

Advocacy When people are ill, they are frequently unable to assert their rights as they would if they were healthy.

An advocate is one who expresses and defends the cause of another. The health care system is complex, and many clients are too ill to deal with it. If they are to keep from “falling through the cracks,” clients need an advocate to cut through the layers of bureaucracy and help them get what they require. The Advocate’s Role The overall goal of the client advocate is to protect clients’rights. An advocate informs clients about their rights and provides them with the information they need to make informed decisions.

Critical Thinking A tool utilized by nurses in the process of solving problems of patients and decisions making process with creativity to enhance the effect.  Critical thinking and nursing judgment  Good problem solving skills  Not always a clear textbook answer

 A nurse must learn to question, look at alternatives. Components of Critical Thinking  Scientific knowledge base  Experience  Competencies  Attitudes  Standards Decision Making Nurses use critical thinking skills in decision making to help them choose the best action to meet a desired goal. Decisions must be made whenever several mutually exclusive choices are available or when there is an option to act or not. Nurses make decisions in the course of solving problems. Decision making, however, is also used in situations that do not involve problem solving. Nurses make value decisions (e.g., to keep client information confidential), time management decisions (e.g., taking clean linens to the client’s room at the same time as the medication in order to save steps), scheduling decisions (e.g., to bathe

the client before visiting hours), and priority decisions (e.g., which interventions are most urgent and which can be delegated). Nurses must make decisions and assist clients to make decisions. When faced with several client needs at the same time, the nurse must prioritize and decide which client to assist first. The nurse may (a) look at the advantages and disadvantages of each option, (b) apply Maslow’s hierarchy of needs, (c) consider which tasks can be delegated to others, or (d) use another priority-setting framework. Highlights  Critical thinking skills include the ability to do critical analysis, perform inductive and deductive reasoning, make valid inferences, differentiate facts from opinions, evaluate the credibility of information sources, clarify concepts, and recognize assumptions.  Critical thinkers have certain attitudes: independence, fairmindedness, insight, intellectual humility, intellectual courage to challenge the status quo and rituals, integrity, perseverance, confidence, and curiosity.  After gaining an idea of what it means to think critically, solve problems, and make decisions, nurses need to become aware of their own thinking style and abilities.  Acquiring critical thinking skills and a critical attitude then becomes a matter of practice.  Critical thinking is not an “either-or” phenomenon; people develop and use it more or less effectively along a continuum.  Some people make better evaluations than others do, some people believe information from nearly any source, and still others seldom believe anything without carefully evaluating the credibility of the information.

 Critical thinking is not easy. Solving problems and making decisions is risky.

Sometimes the outcome is not what was desired. o With effort, however, everyone can achieve some level of critical thinking to become an effective problem solver and decision maker.

Common Medical Abbreviation...