3/6/2012

N507 MIDTERM: 50 Questions, Multiple Choice. 1 hr 15 min (11:00-12:15)

Historical Development of Nursing:
Early Civ. Egypt – sutures to repair wounds, community planning, system of caretakers.
Greece – Hippocrates “Father of Medicine”, diseases due to natural causes, use scientific method to solve
problems.
China – yin/yang.
Middle Ages – women lead in healing and caring. During Crusades idea of ‘formal hospital’ took root.
Physicians translated med. Essays, provided little care. Nursing a ‘high-level occupation.’
Renaissance and Reformation – major advances. New emphasis on medical education.
Dark ages of nursing - Famine, plague. Nursing programs initiated out of social welfare.
Three Images of nursing – folk image, religious and servant (Dark Ages).
Colonial America – 1751, Ben Franklin built 1st hospital in Philly. 1798, US Public Health Service founded.
Civil War (1861-1865) – no organized system, after civil war ended nursing training schools increased – on the
job training, cheap labor. Sparked the beginning of training schools.

Historical Figures in Nursing (Matching) Textbook Readings, Names carved in stone in front of building. Know who
did what in terms of contributions.
Florence Nightingale: 1820-1910, trained in Germany in 1851, during Crimean War worked at Barracks Hospital where
she instituted public health principles (sanitation & infection control). Big on statistics, death rate declined. 1st
nursing researcher. 1st nursing school = St. Thomas, London, 1860. Believed that nurses need to be educated.
Advocated holism. Recognized that environment influences health. Two types of nursing: care of the ill & promotion of
health. Nightingale AGAINST nursing licensure – go against nursing autonomy.

Lillian Wald: (1867-1940) Henry Street Settlement House = 1st “clinic”—public & home health nurses… lady leaping
across buildings in NYC, focused on low-income immigrant families there. 1st public health nurse. Began nursing
services in public schools. Approached insurance companies to offer free public health nurses to their policy
holders—MetLife the 1st to sign on board.

Mary Breckenridge: Frontier Nursing Service… lady on horse… service to women & children in rural areas.

Dorothea Dix: 1802-1887), in charge of Union’s nurses (3,000 of them) during Civil War, worked for better treatment
of mentally ill + prisoners, known as “Dragon Dix”—demanded good work from those under her.

Clara Barton: (1821-1912), worked at U.S. Patent Office, during Civil War organized medical supply donation
drives/distribution, traveled with army ambulances distributing stuff, performed services that would grow into the
American Red Cross.

Mary Mahoney: 1st Afr Am RN in U.S., mainly worked as private duty nurse, director of an orphanage on LI, one of
original members of Nurses Assoc Alumnae of the U.S. & Canada (which later became the ANA).

Louisa Parsons: Univ of MD SON est under her in 1889. She graduated from Flo’s school in London.

Lucille Petry: a nurse from JHU SON, director of U.S. Cadet Nurse Corp that was est in 1943 by FDR during WWII
in response to increased need for nurses. Designated as Chief Nursing Officer of U.S. Public Health Service, rank =
brigadier general, 1st woman.

Mary Adelaide Nutting: 1st nursing professor, graduate of JHU SON.

Isabel Hampton Robb: head of JHU, instrumental in formation of 1st nursing organizations.

Harriet Tubman: aside from the obvious, she served in the Civil War as a scout, army nurse, & spy.
 Lavinia Dock: campaigned for nurses to control their own profession (rather than doctors); worked with Mary Nutting
& Isabel Robb to create the precursor to the NLN.

Concepts basic to nursing.

- Person
- Environment
- Health
- Nursing

Acts that influenced Nursing:

Social Security Act – 1935 – jobs for nurses.

Nurse Training Act – 1943 – Federal money for nurse training.
Hill-Burton Act – 1946 – Money to construct hospitals, help states plan for other health care facilities.
Community Mental Health Centers Act – 1963 – Money to construct community outpatient mental health centers.
Medicare and Medicaid Act – 1965 – amendment to social security act of 1935

Know Reports from first few lectures, major reports that influenced nursing. Know where they are in the sequence. Know
when Flexner report was and what the impact. Report on characteristics of profession.
1912: Adelaide Nutting: The Educational Status of Nursing (difficult living conditions of students and teaching
methods).
1923: Goldmark Report: The study of nursing and nursing education – lack of prepared teachers
1934: Nursing schools today and tomorrow – recommend collegiate education.
1948: The Brown Report (Carnegie Foundation) – planned program of education, basic schools of nursing should be
in colleges, programs should be periodically reviewed (no life-time accreditation).
1952: National Accreditation of Nursing Programs – 1890s Chicago World Fair forerunner (other group of ANA). NLN
temporary accreditation program to improve study.
1963: Report of the Surgeon General – federal gov role in providing adequate nursing services to the country.
1965: ANA Position Paper- The education of all those licensed to practice nursing should take place in institutions of
higher education. BSN is the foundation for practice.
1970: Lysaught Report – doctorate in education, increase research on practice.
1978: ANA resolution by 1985 entry into practice be BSN
1980: The National Commission on Nursing – two reports – block to advancement due to conflict about educational
preparation.
1982: NLN the position statement on nursing roles – BSN minimum, AD entry into technical practice (Montag spoke
about this in 1952).
Key Reports in 1993 (21st century nursing education)
NLN Vision for Nursing Education
AACN Nursing Education Agenda
Pew Health Professions Commissions – about all health professions, all educated together – difficult to put into
practice.
1987: Omnibus Reconciliation Act (OBRA) – state oversight, minimum education, examination of theory and practice –
check requirements. Education and certification for nursing assistants in nursing homes. 75 hours minimum of T&P

FLEXNER REPORT
1910 report focused on medical education reform.
1915 report gave list of criteria characteristic of professions:
Activities must be:
 - intellectual with high degree of individual responsibility
- Based on a body of knowledge refined via research
- Practical, in addition to being theoretical
- Taught via highly specialized education
A profession is a strong internal organization of members, a well-developed group of consciousness.
Practitioners are motivated by altruism (unselfishness), responsive to public interests.

RICHARD H. HALL Characteristics of a profession published in 1968.

- Sociologist, belief in value of public service, belief in self-regulation.
- Professional organization a primary point of reference.
- Commitment to profession goes beyond economic incentives.
- Sense of Autonomy

LUCIE KELLY Criteria on nursing, complied set of 8 characteristics of a profession.

- Services provided are vital to humanity and welfare of society.
- Special body of knowledge continually enhanced via research.
- Services involve intellectual activities; individual responsibility/accountability a strong feature.
- Education via institutions of higher learning.
- Practitioners relatively independent and control own policies and activities.
- Motivated by service and consider their work an important component of their life.
- Code of ethics to guide decisions and conduct.
- Organization that encourages and supports high standards of practice.

Distinguishing characteristics of a profession as compared to an occupation.

5 Criteria for characteristics of a profession:
- Service: a sense of calling to the discipline, mission, and responsibility to the public.
- Knowledge: specialized education, including both theoretical and techniques/skills
- Practice autonomy: having control over one’s own practice.
- Code of ethics: governing standards of conduct within the profession.
- Body of knowledge
Occupation – what occupies, or engages, one’s time; business employment.
Profession – a calling, vocation, or form of employment that provides a needed service to society and possesses
characteristics of expertise, autonomy, long academic preparation, commitment, and responsibility. Differs from
occupation with preparation & commitment.
Professionalization – the process through which an occupation evolves to professional status.
Professionalism – generally refers to the extent to which an individual reflects professional attributes.

Role of Nursing Theory, matching theorists with theories. (See assigned reading along with slides)
- Orem’s Self-care Model - focuses on the patient’s self-care capacities and the process of designing nursing
actions to meet the patient’s self-care needs. Appropriate care for the patient is developed through a series of
3 operations:
o diagnostic (establishment of nurse-patient relationship).
o prescriptive(therapeutic self-care requisites (based on deficits) are determined).
o regulatory (nurse designs, plans, and produces a system for care).

- King’s Interacting Systems Framework – focused on persons, their interpersonal relationships, and social
contexts with three interacting systems:
o Personal – provide understanding of individuals, personally & intrapersonally
o Interpersonal – deals with interactions and transactions between two or more persons
o Social – consider social contacts, such as those at school, work or in social settings.
Kings work provides a view of persons from the perspective of their interactions with other people at 3
levels.
 - Roy’s Adaptation Model – focus on the individual as a biopsychosocial adaptive system. Describes nursing
as a humanistic discipline that emphasizes the person’s adaptive or coping abilities. The individual and the
environment are sources of stimuli that require modification to promote adaptation in the patient.

- Martha Rogers – “nursing aims to assist people in achieving their maximum health potential.
Maintenance and promotion of health, prevention of disease, nursing diagnosis, intervention, and
rehabilitation encompass the scope of nursing’s goals.”

- Bette Neuman’s System Model – involves person, health, and environment. Person is viewed as an open
and dynamic system constantly interacting with internal and external environments. Nursing is viewed as
chiefly concerned with maintaining client system stability via primary, secondary and tertiary care.

- Ida Jean Orlando’s Nursing Process Theory – theory about how nurses process their observations of
patient behavior and also about how they react to patients on the basis of inferences from patient’s
behavior, including what they say. Is specific to nurse-patient interactions. Specified how patients are
involved in nurses’ decision making.

- Madeline Leininger’s Cultural Care Theory – involves planning nursing care based on knowledge that is
culturally defined, classified, and tested and used to provide care that is culturally congruent.

- Margaret Newman’s Health as Expanding Consciousness Theory – Includes the health of all persons
regardless of the presence or absence of disease. Every person in every situation, no matter how disordered
and hopeless it may seem, is part of the universal process of expanding consciousness (a process of becoming
more of oneself, finding greater meaning in life, and of reaching new dimensions of connections with other
people and the world).
**UMB – no conceptual model, has mission statement

Types of nursing preparation, when was the first baccalaureate? Where?

5 educational routes for RN: (ALL 5 sit for the NCLEX)
Hospital-based diploma programs (1871-1873)
Associate degree- 2 year community college
BS- first program in 1909 University of Minnesota; magnet hospitals employ more BSNs. Accredited.
Generic Masters (CNL) – first degree in nursing
Generic doctoral: DNP/ND- practice, PhD/DNSc- research

Nightingale – St. Thomas in London, first formal nursing school.

1871-1873: Earliest type of nursing education began in hospital setting.
(Bellevue Training School for Nurses (NYC), Connecticut … (New Haven), Boston
1900: 432 diploma school programs, ranging 6-24 months to complete.
1909: 1st Baccalaureate School of Nursing started at University of Minnesota, part of medical school.
1924: Yale School of Nursing, first school of nursing as separate department within university.
1952: Shift toward associate degree education, 2-year community colleges, cadet program created in WW1.

Baccalaureate Degree Programs: greater emphasis on leadership development, community health, research and
theoretical basis of practice. Basic preparation for graduate studies.
Now ~60% of new nurses are from AD programs, ~36% from BSN & ~3% from diploma schools.

CNL Vision:
Care Quality reports spur CNL Role:
IOM: To Err is Human, 2000 – 98,000 die due to errors
Joint Commission: Healthcare at the Crossroads, 2002
AHA: In Our Hands, 2002
Studies report nurses’ education mix impacts patient morbidity and mortality.
Vision for CNL evolved: Pittsburgh Med Center, INOVA, Baptist, Iowa, AACN task forces, CNL – an advanced
generalist.
CNL – leader in decisions for clinical interventions, NOT an administrator/manager.
Micro system
NOT an APRN role
Professional WITHIN interdisciplinary care environment
Role for all patient care settings
Job is NOT to look after the staff but to ENHANCE skills with people one is working with.
CNL Practice – evidence based, client outcomes (key measure), fiscal stewardship, communications, information (client
self-care).

CNL= AACN board reaffirmed position: BSN the minimum education required for entry into professional nursing
practice.
CNL program started in 2004.

Education models- A (for BSN grads- 50%), B (for BSN grads that awards masters credit towards CNL- 10%), C (those
with a bachelors in other studies- second degree masters- 15%), D (RN-MSN, 5%), E (post-masters certificate program-
5%)

Factors Influencing Nursing Education

- 1912: Nutting: The education Status of Nursing – difficult living conditions of students, teaching
methods
- 1923: Goldmark Report: The Study of Nursing and Nursing Education - Students, clinical, hospitals
control over schools. Lack of prepared teachers and instructors.
- 1934: Nursing Schools Today and Tomorrow – Recommendation’s for collegiate education.
- 1948: The Brown Report (Carnegie Foundation) – Nursing needs to shift from apprenticeship to a
planned program of education. Basic schools of nursing should be in colleges, universities.
Programs should be periodically reviewed.
- 1952: National Accreditation of Nursing Programs – NLN had a temporary accreditation
program in place, and was helping schools to improve programs of study.
- 1963: Report of the Surgeon General – The surgeon general of the US PHS appointed a group to
advise him of the federal government’s role in providing adequate nursing services to the
country.
- **1965: The ANA Position Paper: The education of all those licensed to practice nursing should
take place in institutions of higher education. BSN is the foundation for practice.
- 1970: The Lysaught Report – an abstract for action to increase research on practice and education for
nurses and enhance educational systems and curricula in nursing.
- 1978: ANA resolution that by 1985, entry into practice should be BSN.
- 1980s: the National Commission on Nursing published 2 reports, major block to advancement –
conflict about educational preparation.
- 1982: NLN: The position statement on nursing roles – affirmed BSN as the minimum for enter into
professional practice & AD as entry into technical practice.
- 1993: 3 Key Reports
o NLN’s Vision for Nursing Education
o AACN’s Nursing Education Agenda for the 21st Century
o Pew Health Professions Commission: Health Professions Education for the Future: Schools
in Service to the Nation
 o common themes- recruiting diverse students/faculty, develop critical thinking skills,
feature abilities to communicate, form interpersonal relationships, make collaborative
decisions, increase number of advanced practice nurses, increase health promotion and
maintenance
- 2000-2010: Key Reports
o 2003 – Keeping patient’s safe: Transforming the Work Environment of Nurses
o 2008 – Retooling for An Aging America: Building the Healthcare Workforce
o 2009 – Redesigning Continuing Education in the Health Professions
o 2010 - Lifelong Learning in Medicine and Nursing Report
o 2010 – Educating Nurses: A call for radical transformation
 BSN for entry into practice
 All RNs to get masters within 10 years of licensure
o 2010 – The Future of Nursing: Leading Change, Advancing Health
 Ensure nurses practice to full extent of training, improve education, provide
opportunities for nurses to take on leadership and act as full partners in health care
improvement.
- 2000-2006: Quality for Care Reports
o 2000 – To Err is Human: Building a Safer Health System
o 2001 – Crossing the Quality Chasm: A New Health System for the 21st Century
o 2003 – Priority Areas for National Action: Transforming Health Care Quality
o 2004 – 1st Annual Crossing the Quality Chasm Summit: A focus on Communities.
o 2005 – Improving the Quality of Healthcare for Mental and Substance Abuse Conditions:
The Quality Chasm Series
o 2006 – Preventing Medication Errors: The Quality Chasm Series

Understand concept of articulation.

Articulated Education Programs – The purpose of articulation is to facilitate opportunities for nurses to move up the
educational ladder. Multiple entry, multiple exit programs. Example = LPN/ADN/MSN/MSN program, 1 st year LPN,
2nd year ADN, & so on.

Licensure versus certification versus accreditation

- Licensure – The process by which an agency of government grants permission to qualified persons to engage
in a given profession or occupation.
- Certification – Validation of specific competencies demonstrated by a registered nurse in a defined area of
practice.
- Accreditation – A voluntary review of process of educational programs or service agencies by professional
organizations. Nursing program reviewed is measured against a stringent set of criteria. Ensures that
standards for excellence are met. Accrediting Agencies Include:
o 1952-1996: National League for Nursing (NLN) was the only accreditation organization
o 1996: American Association of Colleges of Nursing (CCNE)
o 1997: National League for Nursing Accreditation Commission (NLNAC)
 Mandated by US Dept of Education
 Assumed responsibility for all national program accreditation.
 AD, diploma, BSN & higher degree programs.
o 1999: CCNE Recognized by US Dept of Education
 National accrediting body for BSN & Higher degree programs.
 Once a program has been accredited reviews take place every 8-10 years

History of Credentialing:
1896 – Chicago’s World Fair – Nurses’ Associated Alumnae of US and Canada (later ANA) was created.
Focus establishment of legal licensure for nurses, wanted state licensing laws (voluntary system – permissive licensure).
No requirement.
 1903 – North Carolina first Nurse Practice Act
1923 ALL existing states had permissive licensure laws. Most nurses had licensures.
1947 – Mandatory licensure in New York – requirement.
Even if license in one state not allow to practice in another state, License by exam or endorsement.
Exception: Compact States – DOES NOT apply for Advanced Practice RNs. Accepting original license by
endorsement.

Know about the compact states and what it means in terms of licensure.
- Interstate Compact: Agreement between 2 or more states to address problems that transcend
state lines. States enact identical statues establishing and defining the compact and its role. Rest =
creation of both state law and an enforceable contract with other states that adopt the contract.
- Nurse Licensure Compact: Allows a nurse to have 1 license in their state of residency, and to
practice in other states. The nurse is subject to each state’s nurse practice act and related
regulations.
- Each compact state must enact legislation authorizing the Nurse Licensure Compact, Adopt
administrative rules and regulations for implementation of the compact designate a nurse licensure
compact administrator to facilitate the exchange of information between the states relating to
compact nurse licensure and regulation.

Nurse Practice Act: License to protect the public, all States etc have acts, regulated by the State Boards of
Nursing.
Key Components: Definition of professional nursing, minimum educational qualifications, legal
titles/abbreviations, disciplinary action for violation, defines responsibilities, defines authority of Board of
Nursing.
Declaratory Ruling – has the force of law.

State Boards – make rules/regulations to clarify NPA (nurse practice act), enforce the NPA (incl. disciplinary action),
standards for licensure, renewal, approve educational programs.
Disciplinary Action: Denial, Reprimand, Suspension, Revocation (take way for life), Probation, Fine, Summary
suspension (emergency) – all published.

Authority of the Board of Nursing.

Can they legislate? (NO, they just implement it).
Rules and regulations have the force of law but that is very different from legislation.
Can they revoke licenses (yes), but can’t put you in jail.

How many times do you take the NCLEX exam in your life time? Just once. If you get licensure on another state, don’t
need to take NCLEX again

Nurse Practice Act (Is it the same across every state) what types of implications does this have for scope of practice.
Purpose of licensing certain professionals is to protect the health, safety, and welfare of the public.
- All states, US territories, and DC have nurse practice acts.
- They are regulated and enforced through State Boards of Nursing. Each state accomplishes these objectives:
o Defines practice of professional nursing, defines responsibilities.
o Sets minimum of educational qualifications and other requirements for licensure.
o Determines legal titles and abbreviations nurses may use.
o Includes disciplinary action for violations.
o Defines authority of Board of Nursing.
NCLEX
How many times do you take the NCLEX exam in your life time? ONCE. If you get licensure on another state, you don’t
need to take NCLEX again. Apply through State Board of Nursing.
Scope and standards of practice.
- Outlines the expectations of the professional role within which all registered nurses must practice
and delineates the standards of care & associated competencies for professional nursing.
- Goal of establishing standards is to improve the health and well-being of all recipients of nursing
care and to establish the responsibilities for which nurses are accountable.
- Established by law to protect public, establishes boundaries.
- 4 documents:
o The Nurse Practice Act (force of law only, differs from state to state, passed by the legislature)
o Nursing’s Social Policy Statement
o The Code of Ethics for Nurses
o Nursing: Scope and Standards of Practice

Types of Laws:
 Common Law – decisional or judge-made law. Each time a judge makes a decision, the body of common law
expands.
 Statutory Laws – Constitutional law, federal and state laws.
 Administrative Law – Legislative branch of government delegates authority to governmental agencies to
create rules and regulations to implement laws.
 Civil law – Issues between individuals or businesses, disputes over legal rights. Within healthcare delivery we
are most concerned with civil law.
 Criminal law – Addresses the general welfare of the public, Involves public concerns against an individual’s
unlawful behavior that threatens society.

TORT: ((Violation of a civil law))

 INTENTIONAL: Refers to willful acts that violate another person’s rights or property.
o Assault, Battery, defamation, invasion of privacy.
 UNINTENTIONAL
o Negligence – failure to act as a reasonably prudent person would have acted in specific circumstances.
o Malpractice – Negligence applied to the acts of a profession, professional fails to act as a reasonably
prudent professional would have acted under specific circumstances.

Know acronyms.
- JC: Joint Commission
- ***ANA: American nurses association- strongest voice for nursing profession. Fosters high standards of
nursing practice. Help enhance nursing practice.
- AACN: American association of colleges of nursing- national voice for BSN and grad-degree nursing
programs. Provides standards/resources, fosters innovation to advance professional nursing education,
research, and practice
- AAN: American academy of nurses- serves public and nursing profession by advancing health policy
- NLNAC: National league of nursing accrediting corporation
- CCNE: Commission on collegiate nursing education.
- ANCC: American Nurses Credentialing Center (Magnet Recognition Program)
- NCSBN: National council of state boards of nursing- membership comprises the boards of nursing in each
state, US territory, and DC. Provides leadership to advance regulatory excellence.
- NSNA: National Student Nurses’ Association- organize, represent, and mentor students preparing for initial
licensure of RN
- NLN: national league of nursing- advance quality nursing education that prepares nurses to meet the needs
of diverse populations in an everchanging health care environment

5 R’s of delegation outlined in text (page numbers are given)

1. Right Task – Is the task appropriate for delegation in a specific care situation?
 2. Right Circumstances – Is delegation appropriate in this case? Consider the patient’s health status, care
delivery setting, complexity of the activity and delegate’s competency, and available resources, and determine
any other relevant factors.
3. Right Person – Can the nurse verify that the person delegated to do the task is competent to complete this
task.
4. Right direction/communication – Has the RN given clear, specific instructions? These include identifying
the patient clearly, the objective of the task, time frames, and expected results.
5. Right supervision/evaluation: Can the RN or other licensed nurse provide supervision and evaluation of
the patient and the performance of the task?

Informed Consent:
Nurse must ensure 4 major conditions:
1. Voluntary, or free from coercion.
2. Competency, must be able to understand and process information.
3. Completeness, must provide appropriate and necessary information. The
patient is the ultimate decision maker.

1991 Patient Self-Determination Act:

Applies to acute care and long-term care facilities that receive Medicare and Medicaid funds. Encourages patients
to consider which life-prolonging treatment options they desire and to document their preferences in case they
become incapable. Facilities must:
1. Provide written information to all adult patients about their rights under state law.
2. Ensure institutional compliance with state laws on advance directives.
3. Provide for education of staff and the community on advance directives.
4. Document in the medical record whether the patient has an advance directive.
**Advanced directives may or may not include durable power of attorney for health care.

1996 Health Insurance Accountability and Portability Act:

First federal privacy standard governing protection of patients’ medical records.
 Patients are able to see and obtain copies of their medical records
 Providers must give patients written notice describing the provider’s information explaining patient’s
rights.
 Limitations are placed on the length of time records can be retrieved, what information can be shared,
where it can be shared and who can be present when it is shared.

Advance Directives
Advance directives allow individuals to provide directions about the kind of medical care they do or do not want if they
become unable to make decisions or communicate their wishes.
 2 types:
o Treatment Directive – A living will provides specific instructions to health care providers about
particular kinds of health care treatment an individual would or would not want to prolong life. Often
used to declare a wish to refuse, limit, or withhold life-sustaining treatment.
 Oral Advance Directives – are allowed in some states if there is clear and convincing evidence
of the patient’s wishes. Legal rules surrounding oral directives vary by state.
o Appointment Directive – A durable power of attorney for health care allows an individual to appoint
someone, called a health care proxy, agent, or surrogate, to make health care decisions for him or her
should he or she lose the ability to make decisions or communicate his or her wishes.

Ethics
Branch of philosophy, reflects the “should” of human behavior.
Morals
 Basic standards for what we consider to be right or wrong. Reflects the “is” of human behavior
Nurses’ Code of Ethics
Written, public document, guided by ethical standards (of practice) promoted by Nightingale, modified over years,
strengthen and guide nurses decision making.

Ethical Principles will be tested. (Scenario’s will be given)

- Altruism: selflessness, an attitude or way of behaving marked by unselfish concern for the welfare of others.
- Amoral: without morals.
- Autonomy: the capacity of a rational individual to make an informed, un-coerced decision.
- Beneficence: to do good.
- Deontology (Immanuel Kant): There is a right way to behave no matter what the consequence is.
- Descriptive Ethics: Describes what actually is versus prescriptive ethics which is what should be.
- Fidelity: Faithfulness or honoring one’s commitments or promises. Nurses must be faithful in keeping their
promises of respecting all individuals, upholding code of ethics, etc.
- Justice: equals should be treated the same and unequals should be treated differently. Patients with the
same diagnosis and health care needs should receive the same care.
- Moral Agent: Anyone who acts decently or good on behalf of another.
- Naturalism: All ethics and morals are derived from observing nature.
- Nonmaleficence: To do no harm
- Social Equity and Justice (John Rawls): In terms of fairness across populations or groups of people.
- Subjectivism: theory that limits knowledge to subjective experience
- Utilitarianism (Bentham and Mill): The greatest good for the greatest number, you are looking at the
consequences.
- Veracity: Telling the truth or not lying. Fundamental to the development and continuance of trust
among human beings.

Where nurses work:

Health promotion, illness prevention, diagnosis and rehabilitation treatment, rehab/long term care

Ways of classifying agencies:

Governmental (federal, state, govt) vs. voluntary (private)
Governmental is NOT voluntary!

Primary care- most generalized. Doctors, PAs, NPs

Secondary care- specialists on a specific body system. Ex) cardiologist
Tertiary care- provide higher level of care within the hospital. Requires highly specialized equipment. Ex)
hemodialysis, plastic surgery, neurosurgeries, coronary artery bypass surgery

License by indorsement- when you want to get your license in another state
License by examination- getting your license for the very first time (initial license)
Credentials- having competence; standard; intended to protect the public; diploma, degree, license

Duty to report- report infectious, communicable diseases or abuse to authorities

Duty to care- responsible for providing best care possible to all patients

Started in 1952- Mildred Montag- research project developing 8 programs; original concept was that the tech RN (AD)
would work with the professional RNs (BSN) as a team.

Differentiated practice- refers to technical RN (AD) and the professional RN (BSN)

First Nurse practice act- 1903- north Carolina

NPA= Punishments, minimum education requirements, etc.