Fundamentals of Nursing Practice - Lecture

BS NURSING / FIRST YEAR

STUDENT ACTIVITY SHEET
Session # 2

LESSON TITLE: CONCEPT OF NURSING Materials:

Pen and notebook
LEARNING OUTCOMES:

Upon completion of this lesson, you can:

1. Discuss the development of professional nursing roles;
2. Describe educational programs available for
professional registered nurse (RN) education;
3. Describe the roles and career opportunities for nurses;
and, Reference:
4. Discuss the influence of social, historical, political, and Potter, P. A., Perry, A.G., et al. (2021). Fundamentals
economic changes on nursing practices. of nursing (10th ed.). Singapore: Elsevier.

LESSON PREVIEW/REVIEW
Answer the following questions in your SAS based on your understanding. You may use the back sheet of this page for
your answers. Here are the questions as follow:
1. What is nursing as a science?

2. What is nursing as an art?

3. What is nursing as a profession?

MAIN LESSON
You will study the contents of this lesson and read your book, if available.

• Nursing is an art and a science.

• As a professional nurse you will learn to deliver care artfully with compassion, caring, and respect for each
patient’s dignity and personhood.
• As a science, nursing practice is based on a body of knowledge that is continually changing with new discoveries
and innovations.
• When you integrate the art and science of nursing into your practice, the quality of care you provide to your
patient is at a level of excellence that benefits patients and their families.

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 • Because nursing is both an art and a science, nursing practice requires a blend of the most current knowledge
and practice standards with an insightful and compassionate approach to patient care. Your patients’ health care
needs are multidimensional and constantly changing.
• Thus your care will reflect the needs and values of society and professional standards of care and performance,
meet the needs of each patient, and integrate evidence-based findings to provide the highest level of care.
Nursing has a specific body of knowledge; however, it is essential that you socialize within the profession and
practice to fully understand and apply this knowledge and develop professional expertise.

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

Science and Art of Nursing Practice

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

Scope and Standards of Practice

• Nursing definitions by American Nurses
Association (ANA) and The International
Council of Nurses
• Nursing: Scope and Standards of Practice
⮚ 1960: Documentation began
⮚ Standards of Practice
⮚ Standards of Professional Performance
• Goal
⮚ To improve the health and well-being of all
individuals, communities, and populations
through the significant and visible
contributions of registered nursing using
standards-based practice

Standards of Practice
• Six standards of practice:
⮚ Assessment
⮚ Diagnosis
⮚ Outcomes identification
⮚ Planning
⮚ Implementation
⮚ Evaluation

• The nursing process is the foundation of

clinical decision making and includes all
significant actions taken by nurses in providing
care to patients.

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 Standards of Professional Performance

Ethics Quality of Practice Professional Practice Evaluation

Education Communication Resources
Evidence-Based Practice & Leadership
Environmental Health
Research Collaboration

• The ANA has identified 10 Standards of Professional Performance.

• These standards serve as objective guidelines for nurses to follow.

Code of Ethics
• A code of ethics is the philosophical ideals of right and wrong that define principles used to provide care.
• It is important for you to incorporate your own values and ethics into your practice.
• It will be important to incorporate the ANA code of ethics, as well as your personal values and ethics, into your
nursing practice.
• The ANA has a number of publications that address ethics and human rights in nursing. The Code of Ethics for
Nurses with Interpretive Statements is a guide for carrying out nursing responsibilities that provide quality nursing
care; it also outlines the ethical obligations of the profession.

Professional Roles
Autonomy and Accountability Educator
Caregiver Communicator
Advocate Manager

• You are responsible for obtaining and maintaining specific knowledge and skills for a variety of professional roles
and responsibilities.
⮚ Autonomy is an essential element of professional nursing that involves the initiation of independent
nursing interventions without medical orders. Accountability means that you are responsible
professionally and legally for the type and quality of nursing care provided.
⮚ As a caregiver, you help patients maintain and regain health and find their maximum level of independent
function through the healing process. A patient’s health care needs include the patient’s emotional,
spiritual, and social well-being.
⮚ As a patient advocate you protect your patient’s human and legal rights and help patients assert those
rights when needed.
⮚ As an educator, your teaching can be formal or informal. Always use teaching methods that match your
patient’s capabilities and needs, and incorporate other resources, such as the family, in teaching plans.
⮚ Your effectiveness as a communicator is central to the nurse—patient relationship. It allows you to know
your patients, including their strengths, weaknesses, and needs. You will routinely communicate with
patients and families, other nurses and health care professionals, resource people, and the community.
⮚ As a manager, you will establish an environment for collaborative patient-centered care to provide safe,
quality care with positive patient outcomes.

Career Development
Nursing provides an opportunity for you to commit to lifelong learning and career development.
• Provider of care
• Advanced practice registered nurses
⮚ Clinical nurse specialist
o An APRN who is an expert clinician in a specialized area of practice, such as a population (e.g.,
geriatrics), a setting (e.g., critical care), a disease specialty (e.g., diabetes), a type of care (e.g.,
rehabilitation), or a type of problem (e.g., pain).
⮚ Certified nurse practitioner
o An APRN who provides health care to a group of patients, usually in an outpatient, ambulatory
care, or community-based setting. NPs provide care for patients with complex problems and a
more holistic approach than physicians.
⮚ Certified nurse midwife

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 o An APRN who is also educated in midwifery and is certified by the American College of
Nurse-Midwives. The practice of nurse-midwifery involves providing independent care for women
during normal pregnancy, labor, and delivery and care for the newborn.
⮚ Certified registered nurse anesthetist
o An APRN with advanced education from a nurse anesthesia–accredited program. Nurse
anesthetists provide surgical anesthesia under the guidance and supervision of an
anesthesiologist who is a physician with advanced knowledge of surgical anesthesia.
• Nurse educator
⮚ Works primarily in schools of nursing, staff development departments of health care agencies, and patient
education departments.
• Nurse administrator
⮚ Manages patient care and the delivery of specific nursing services within a health care agency.
• Nurse researcher
⮚ Investigates problems to improve nursing care and further define and expand the scope of nursing
practice. The nurse research often works in an academic setting, hospital, or independent professional or
community service agency.

Historical Influences
• Nurses:
⮚ Respond to needs of patients
⮚ Actively participate in determining best practices
• Knowledge of the history of the nursing profession increases your ability to
understand the social and intellectual origins of the discipline.

Florence Nightingale
• First practicing epidemiologist
• Organized first school of nursing
• Improved sanitation in battlefield hospitals
• Practices remain a basic part of nursing today

Civil War to the Beginning of the Twentieth Century

• Clara Barton - founder of the American Red Cross, tended soldiers on the battlefields.
• Mother Bickerdyke - organized ambulance services and walked abandoned battlefields at night, looking for
wounded soldiers.
• Harriet Tubman - a prominent female in the Underground Railroad movement to free slaves.
• Mary Mahoney - the first professionally trained African-American nurse. She was concerned with the relationship
between cultures and races; and as a noted nursing leader she brought forth an awareness of cultural diversity
and respect for the individual, regardless of background, race, color, or religion.
• Lillian Wald and Mary Brewster - opened the Henry Street Settlement, which focused on the health needs of poor
people who lived in tenements in New York City.

The 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 Teachers College
⮚ Army and Navy Nurse Corps established
⮚ 1920s: Nursing specialization began

Twenty-First Century
• Changes in curriculum
• Advances in technology and informatics
• New programs address current health concerns
• Leadership role in developing standards and policies

Contemporary Influences
• Importance of nurses’ self-care

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Education (Department of Nursing)
 ⮚ Compassion fatigue, secondary traumatic stress, and burnout impact the health and wellness of nurses
and the quality of care provided to patients.

• Changes in society lead to changes in nursing:

⮚ Affordable Care Act (ACA) ⮚ Demographic changes
⮚ Rising health care costs ⮚ Medically underserved

Trends in Nursing

• Evidence-based practice
⮚ Your practice needs to be based on current evidence, not just according to your education and
experiences and the policies and procedures of health care facilities.
• Quality and Safety Education for Nurses (QSEN)
⮚ QSEN addresses the challenge to prepare nurses with the competencies needed to continuously improve
the quality of care in their work environments.
• Impact of emerging technologies
⮚ Many emerging technologies have the potential to rapidly change nursing practice. Some of these help
nurses use noninvasive, more accurate assessment tools; implement evidence-based practices; collect
and trend patient outcome data; and use clinical decision support systems.
• Genomics
⮚ A newer term that describes the study of all the genes in a person and interactions of these genes with
one another and with that person’s environment.
• Public perception of nursing
⮚ As frontline health care providers, nurses practice in all health care settings and constitute the largest
number of healthcare professionals. When you care for patients, recognize how your approach to care
influences public opinion. Always act in a competent professional manner.
• Impact of nursing on politics and health policy
⮚ Nurses are becoming more politically sophisticated and, as a result, are able to increase the influence
nursing has on health care policy and practice.

Professional Registered Nurse Education

• Registered nurse education
⮚ 2-year associate’s degree
⮚ 4-year baccalaureate degree
• Graduate education
⮚ Master’s degree, advanced practice RN
⮚ Doctoral degrees
• Continuing and in-service education
⮚ Involves formal, organized educational programs offered by universities, hospitals, state nurses’
associations, professional nursing organizations, and educational and health care institutions.

CHECK FOR UNDERSTANDING

You will answer and rationalize this by yourself. This will be recorded as your quiz. One (1) point will be given to the
correct answer and another one (1) point for the correct ratio. Superimpositions or erasures in your answer/ratio is not
allowed.

1. A nurse is caring for a patient with end-stage lung disease. The patient wants to go home on oxygen and be
comfortable. The family wants the patient to have a new surgical procedure. The nurse explains the risk and benefits
of the surgery to the family and discusses the patient's wishes with them. The nurse is acting as the patient's:
a. Educator.
b. Advocate.
c. Caregiver.
d. Case manager.
ANSWER: ________
RATIO:___________________________________________________________________________________________
_________________________________________________________________________________________________

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2. The nurse spends time with the patient and family reviewing the dressing change procedure for the patient's wound.
The patient's spouse demonstrates how to change the dressing. The nurse is acting in which professional role?
a. Educator
b. Advocate
c. Caregiver
d. Case manager
ANSWER: ________
RATIO:___________________________________________________________________________________________
_________________________________________________________________________________________________

3. Contemporary nursing requires that the nurse has knowledge and skills for a variety of professional roles and
responsibilities. Which of the following are examples? (Select all that apply.)
a. Caregiver
b. Autonomy
c. Patient advocate
d. Manager
ANSWER: ________
RATIO:___________________________________________________________________________________________
_________________________________________________________________________________________________

4. You are preparing a presentation for your classmates regarding the clinical care coordination conference for a patient
with terminal cancer. As part of the preparation you have your classmates read the Nursing Code of Ethics for
Professional Registered Nurses. Your instructor asks the class why this document is important. Which of the following
statements best describes this code?
a. Improves self–health care
b. Protects the patient's confidentiality
c. Ensures identical care to all patients
d. Defines the principles of right and wrong to provide patient care
ANSWER: ________
RATIO:___________________________________________________________________________________________
_________________________________________________________________________________________________

5. The nurses on an acute care medical floor notice an increase in pressure ulcer formation in their patients. A nurse
consultant decides to compare two types of treatment. The first is the procedure currently used to assess for pressure
ulcer risk. The second uses a new assessment instrument to identify at-risk patients. Given this information, the nurse
consultant exemplifies which career?
a. Clinical nurse specialist c. Nurse educator
b. Nurse administrator d. Nurse researcher
ANSWER: ________
RATIO:___________________________________________________________________________________________
_________________________________________________________________________________________________

6. Nurses in an acute care hospital are attending a unit-based education program to learn how to use a new
pressure-relieving device for patients at risk for pressure ulcers. This is which type of education?
a. Continuing education
b. Graduate education
c. Professional Registered Nurse Education
d. All of the above
ANSWER: ________
RATIO:___________________________________________________________________________________________
_________________________________________________________________________________________________

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7. An 18-year-old woman is in the emergency department with fever and cough. The nurse obtains her vital signs, listens
to her lung and heart sounds, determines her level of comfort, and collects blood and sputum samples for analysis.
Which standard of practice is performed?
a. Diagnosis
b. Evaluation
c. Assessment
d. Implementation
ANSWER: ________
RATIO:___________________________________________________________________________________________
_________________________________________________________________________________________________

8. A patient in the emergency department has developed wheezing and shortness of breath. The nurse gives the
ordered medicated nebulizer treatment now and in 4 hours. Which standard of practice is performed?
a. Planning
b. Evaluation
c. Assessment
d. Implementation
ANSWER: ________
RATIO:___________________________________________________________________________________________
_________________________________________________________________________________________________

9. Who established the Red Cross in the United States in 1882?

a. Clara Barton c. Jane Addams
b. Dorothea Dix d. Florence Nightingale
ANSWER: ________
RATIO:___________________________________________________________________________________________
_________________________________________________________________________________________________

10. Which of the following is used by the nurse to identify the patient’s healthcare needs and strengths and to establish
and carry out a plan of care to meet those needs?
a. Nursing standards c. Nurse practice acts
b. Nursing orders d. Nursing process
ANSWER: ________
RATIO:___________________________________________________________________________________________
_________________________________________________________________________________________________

RATIONALIZATION ACTIVITY
The instructor will now provide you the rationalization to these questions. You can now ask questions and debate among
yourselves. Write the correct answer and correct/additional ratio in the space provided.

1. ANSWER: ________
RATIO:________________________________________________________________________________________
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2. ANSWER: ________
RATIO:________________________________________________________________________________________
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3. ANSWER: ________
RATIO:________________________________________________________________________________________
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4. ANSWER: ________
RATIO:________________________________________________________________________________________
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Education (Department of Nursing)
5. ANSWER: ________
RATIO:________________________________________________________________________________________
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6. ANSWER: ________
RATIO:________________________________________________________________________________________
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7. ANSWER: ________
RATIO:________________________________________________________________________________________
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8. ANSWER: ________
RATIO:________________________________________________________________________________________
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9. ANSWER: ________
RATIO:________________________________________________________________________________________
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10. ANSWER: ________
RATIO:________________________________________________________________________________________
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LESSON WRAP-UP

You will now mark (encircle) the session you have finished today in the tracker below. This is simply a visual to help you
track how much work you have accomplished and how much work there is left to do.

You are done with the session! Let’s track your progress.

AL Activity: CAT 3-2-1

This strategy provides a structure for you to record your own comprehension and summarize your learning.

Three things you learned:

1. _______________________________________________________________________________________
2. _______________________________________________________________________________________
3. _______________________________________________________________________________________

Two things that you’d like to learn more about:

1. _______________________________________________________________________________________
2. ________________________________________________________________________________________

One question you still have:

1. ________________________________________________________________________________________

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