¡First adopted in 1950

Emphasized a broad spectrum role of the RN

 Kohlberg-Justice- studied men and boys' moral reasoning as a function of cognitive development and found 1. preconventional 2. conventional 3. postconventional stages of moral development/reasoning

1. Task
2. ¡Circumstances
3. ¡Person
4. ¡Direction/communication
5. ¡Supervision/evaluation

•Crimean War:

Carper’s ways of knowing in nursing

Potential reasearch questions related to Carper's ways of knowing: Empirical Research

Is a measurement of hope affected by variables

such as age, sex, culture, location, services,

supports, and the trajectory of grief?

What are the correlations, moderators and

mediators of hope during grief?

How effective is a hope intervention in

increasing the level of hope?

Potential reasearch questions related to Carper's ways of knowing:

Esthetic Research

What are the processes of hope during

bereavement?

What is the main concern of bereaved

caregivers, relating to hope, and how do they

resolve this concern?

How effective and appropriate is a hope

intervention in a specific practice setting?

How do a group of bereaved palliative

caregivers socially construct the experience of

hope?

Potential reasearch questions related to Carper's ways of knowing: 

Personal Knowing

What is the caregiver’s experience of hope after the

loss of a spouse?

How is the meaning of hope constructed by a

bereaved caregiver?

What are the processes of hope within the

bereaved caregivers’ social context?

How does race or social class affect the experience

and meaning of hope?

Potential reasearch questions related to Carper's ways of knowing: 

Ethical Research

What is the context of care for the bereaved

palliative caregiver?

How effective, efficient, and equitable are the

services and interventions offered to bereaved

caregivers?

What are the rights of the bereaved palliative

caregiver in the context of the health care system?

What theories apply to the bereaved palliative

caregiver’s experience of hope, in an overall

evaluation of a system of care?

Carper's Esthetics Approach

The esthetic approach, or the art of nursing, encourages

the examination and appreciation of the human

experience of health and illness.

Carper's Ethics Approach

The ethical pattern of knowing in nursing emphasizes

 multidisciplinary care plans outlining a patient's treatments and expected outcomes day by day

 –Read the shift nurses’ notes and get report from direct caregivers before giving report.

 •Identifying patient data

Done:  

 •Is care relevant to patients’ needs? Is it appropriate, complete, and timely?

PERSON-Humans—biologic, psychological social beings with the ability for self-care

HEALTH -Ability to live life to the fullest through self-care

ENVIRONMENT-The medium through which the client moves

NURSING-Helping the client achieve health through assistance in self-care activities

PERSON-Person exchanges energy and information with the environment to meet needs HEALTH-Dynamic process to achieve the highest level of functioning.

ENVIRONMENT-Personal, interpersonal, and social systems and the external physical world

NURSING-Dynamic process to identify and meet the health care needs of the person

PERSON Individual has needs, grows, and develops to reach a state of harmony

HEALTH Dynamic state of growth and development leading to full potential as a human being ENVIRONMENT Those factors that a client must overcome to achieve health

NURSING Science of caring that helps clients reach their greatest potential

PERSON Person-a behavioral system that is and organized and integrated whole composed of seven subsystems

HEALTH A balanced and steady state within the behavioral system of the client

ENVIRONMENT All those internal and external elements that affect the client behavior

NURSING Activities that manipulate the environment and help clients achieve the balanced state of health.

PERSON An open system that constantly interacts with internal and external environment.

HEALTH Relatively stable internal functioning of the individual in a high state of wellness (stability) ENVIRONMENT Internal and external stressors that produce change in the client

NURSING Identifies boundary disruption and helps clients in activities to restore stability.

Maintaining Belief = Attitudes to person to clients

Knowing = Clinical Condition the situation the client

Standards of reasoning

(#1 a)

a set of intellectual standards used to explore thequality of thinking withn the nursing process:

Clarity-gives an example;assists in accuracy of info

Accuracy-truth of a statement;validity of a statement

Precision-exactness

Relevance-how does the info relate

Depth-are complexities of situation addressed

Breadth-other view points considered

Logic-makes sense

Types of nursing knowledge and ways of knowing

(#1 b)

Scientific knowledge-research findings as well as conceptual models of nursing, theoretical explanations of other disciplines

Art of nursing-The way in which nurses use knowledge. Scientific plus feelings gained by subjective experiences

Ethical knowledge-knowldege of professional standards of conduct and processes for determinign right and wrong actions. A code of ethics (set of written goals and values) assists nurses in being accountable to clients

Personal Knowledge-Knowing one's self

Practice wisdom-acquired form intuition, tradition, authority, trial and error, and clinical experience

Guidelines for developing critical thinking

(#1 c)

Perform a self assessment-

   Independent thinking-

   Intellectual humility-accept what you don't know

   Intellectual courage-examine own beliefs

   Intellectual empathy-

   Intellectual integrity-consistency in thinking          

       standards you apply

   Intellectual perseverence-exploring to gain insight

   Intellectual curiosity- attitude of inquiry

   Faith in reason-well reasoned thinking leads to

       trustworthy conclusions

   Fair mindedness-treating all viewpoints alike without 

       referencing your own vested interest

   Interest in expanding thoughts and feelings-emotions

       can influence thinking and all thoughts create 

       some kind of feeling

Tolerate dissonance and ambiguity-suspend judgement and see all sides

Seek situations where good thinking is practiced-attend conferences or educational settings that support all sides of issues as well as opposing view points.

Create environments that support critical thinking-encourage difference of opinion

Practice critical thinking-

Attributes of critical thinkers

(#1 d)

Rationality and reason

Reflection

Skills and attitudes

Creative thinking knowledge

History, education pattern and social context;

Differnetiation of nursing from medicine

(#2 a)

Recommendation of ANA in 1965 position paper titled "Educational Preparation for Nurse Practitioners and Assistants to Nurses"

(#2 c)

4 recommendations:

1. Edcucation of liscenced practiotioners should take place in institutions of higher learning
2. Minimum prep for beginning professional nursing practice should be a baccalaureate in nursing
3. Minimum prep for beginning technical nurses should be an associates degree in nursing
4. Health assistant education should consist of short, intense programs in vocational schools and institutions rather than on the job

Evaluation/accreditation of nursing programs

(#2 d)

Differentiate between LPN and RN

(2 f)

Scope of practice

(4 d)

Landmarks in the history or nursing education

(2 i)

1860- Florence Nightengale founded the first organized program to educate nurses (St Thomas Hosp)

1872- "Famous trio" 1st year long nursing school established in the US; Bellevue Hosp, New England Hosp, Massachusetts General

1873- Melinda Anne RIchards became first nurse to graduate in the US

1899- Teachers College, Columbia University, offered the first graduate course in hospital economics for nurses

1907- Mary Adelaide Nutting became the first nursing professor at Teachers College, Columbia University

1909- First baccalaureate degree established at univerisity of Minnesota

1923- Goldmark report published, focusing on hospital control of nursing and lack of proper teacher preparation

1924-Yale University established the first nursing school as a separate university department with its own dean: Annie W. Goodrich

1932- First doctoral degree in nursing education (EdD) was granted by Teachers College.

1934-First PhD program in nursing was initiated by New York University

1948-Esther Lucille Brown's report "Nursing for the future" was published recommending that basic nursing programs be situated in colleges and universities rather than hospitals

1952-First associates degree nursing program, based on Dr. Mildred Montag's model was established

1965- ANA sissued a position paper advocating the baccalaureate degree as a minimum educational preparation for entry into nursing practice

Describe the history of associate degree nursing programs

(2 j)

Describe external and articulated programs

(2 k)

External programs- distance learning (excelsior)

Articulated programs- "ladder" LPN, ADN, BSN, MSN

both are helpful for nurses who work but needed options to progress in the profession

Compare and contrast liscensure and certification

(3 a)

Both are forms of credentialing for nurses.

Liscensure- refers to state regulation of the practice of nursing and is required of individuals at the entry point of practice with periodic renewal. It assures public safety by assessing basic and continuing competence.

Certification- goes beyond liscensure by validating a high level of knowledge and proficiency in a particular practice area. It is pursued voluntarily by individual nurses and therefore is a credential that has professional but not legal status

Describe nursing as a profession. Does it meet the criteria?

(3 b)

Describe the characteristics of a professional

(3 c)

ANA, NLN, AACN, STTI, and ANCC and their functions

(3 d)

ANA-American Nurse Association is a professional organization that addresses ethics, clinical standards, public policy, and the economic and general welfare of nurses. Membership is limited to nurses.

NLN-National League for Nursing is a national organization that seeks to advance the profession of nursing through advocacy and improving educational standards for nurses. Non-nurses may be members.

AACN-American Association of Colleges of Nursing is a national organization devoted to advancing nurse education at the baccalaureate and graduate levels

STTI-Sigma Theta Tau International is an International honors society for nursing

ANCC-American Nurses Credentialing Center is the credentialing arm of the ANA; responsible for certification of individual nurses and approval of organizations as continuing education providers

Discuss Flexner and Hall's contribution to the definition of profession

(3 e)

Flexner stipulated that a profession is 1)intellectual and has a high charge of responsibility 2)based on a body of knowledge that can be learned 3)Practical and theoretical 4)Can be taught through highly specialized education 5)Strong internal organization of members 6)practitioners are altruistic

Hall stated that 1) professional organization is the primary point of reference 2) belief in value of public service 3) belief in self regulation 4)comittment to profession that goes beyond economic incentive 5)sense of autonomy in practice. also noted that each profession needs its own measure of professionalism.

Discuss barriers to professionalism in nursing

(3 f)

Variability in educational preparedness-members with various educational backgrounds are allowed to practice:ADN vs BSN

Gender issues-Lower numbers of male nurses, and outmoded thinking with resultant devaluation of "womens work" in society

Historical influences- Military and religious ties lead to an "obedient" mind set wheras questioning and critical thinking are needed

External conflics-nurses must strive for collaboration, not competition with physicians and other health personnel with whom they work

Internal conflicts- Fragmentation by sub-groups and dissension; rivalry among diploma-educational, associte degree- educated adn baccalaureate -educated nurses saps the vitality of the profession

Discuss nursing's contract with society

(3 g)

responses of a family and patient experiencing a serious illness

(6 a)

illness creates a variety of emotional responses for the patient:

Guilt

Anger

Anxiety

Stress

Family responses—the family experiences increased stress; family problems are seen as increasing/worsening with illness

Emotional responses:

--Frightened

--Angry/guilty

--Resentful

--Feelings of hopelessness

--Distrust of healthcare providers

Behavioral responses:

--critical and demanding behavior

--withdrawal from the situation

--confusions

--deny seriousness of patient’s illness

--promote dependence by patient

Caregiver stress:

common in families of patients with prolonged, progressive illnesses, like dementia; is a role strain

a)      Discuss assault and battery as it relates to nursing (pp 87)

1)      Occasionally the basis for legal action against a nurse defendant

2)      Assault- a threat or an attempt to make bodily contact with another person without the persons consent; assault precedes battery; it causes the person to fear that battery is about to occur

3)      Battery- the assault carried out; the unprivileged touching of one person by another; actual harm or injury may or may not occur as a result of assault and battery

4)      Example: a nurse threatens a patient with a vitamin injection if he/she does not eat his meals (assault); actually giving the injection against the patient’s will = battery (even if there is a physician’s order)

(1)   By common law and by statute, informed consent is needed in the health care context as a defense to battery

      a threat or an attempt to make bodily contact with another person without the persons consent; assault precedes battery; it causes the person to fear that battery is about to occur

 Example: a nurse threatens a patient with a vitamin injection if he/she does not eat his meals (assault)

    the assault carried out; the unprivileged touching of one person by another; actual harm or injury may or may not occur as a result of assault and battery

   Example: actually giving an injection against the patient’s will = battery (even if there is a physician’s order)

  By common law and by statute, informed consent is needed in the health care context as a defense to battery

Discuss the ways in which nurses can become more political (pp 370)

1)      Nurse citizens

2)      Nurse activists—take a more active role than nurse citizen

3)      Nurse politicians— desires to develop the legislation, not just influence it

Discuss the ways in which nurses can become more political (pp 370)

Nurse citizens

Voting; registration and voting in every election

Keep informed about health care issues

Speaking up when services or working conditions are inadequate

Participating in public forums that advocate for health and human services

Joining politically active nursing organizations

Join a political party

Know local, state, and federal elected officials

Involvement in community activities

Discuss the ways in which nurses can become more political (pp 370)

Nurse activists—take a more active role than nurse citizen

Join politically active nursing organizations

Contacting a public official through letters, e-mails, or phone calls

Registering other people to vote

Contributing money to a political campaign

Lobbying

Forming/joining coalitions that support an issue of concern

Writing letters to the editor of a local newspaper

Asking legislators to visit the workplace

Discuss the ways in which nurses can become more political (pp 370)

Nurse politicians— desires to develop the legislation, not just influence it

Run for elective office

Seek appointment to a regulatory agency

Be appointed to a governing board in the public/private sector

Use nursing expertise as a front-line policy maker who can enhance health care and the profession

Discuss the elements necessary to prove a malpractice case

From Box 4-3 pp 86

Failure to follow standards of care

Failure to:

Perform a complete admission assessment or design a plan of care

Adhere to standardized protocols or institutional policies and procedures

        -Using improper injection site

        -Follow a physician’s verbal or written orders

Discuss the elements necessary to prove a malpractice case

From Box 4-3 pp 86

Failure to use equipment in a responsible manner

Failure to:

            - Follow the manufacturer’s recommendations for operating equipment

             - Check equipment for safety before use

             - Place equipment properly during treatment

             - Learn how equipment functions

Discuss the elements necessary to prove a malpractice case

From Box 4-3 pp 86

Failure to communicate

Failure to:

-Notify a physician in a timely manner when conditions warrant it

-Listen to patient complaints and act on them

-Communicate effectively with a patient (ex. Inadequate or ineffective communication of discharge instructions

-Seek higher medical authorization for a treatment

Discuss the elements necessary to prove a malpractice case

From Box 4-3 pp 86

Failure to document, including failure to note in the patient’s medical record

Not recording:

-Patient’s progress and response to treatment

-A patient’s injuries

-Pertinent nursing assessment information (drug allergies)

-A physician’s medical orders

-Information about telephone conversations with physicians (time, content of communication, actions taken)

Discuss the elements necessary to prove a malpractice case

From Box 4-3 pp 86

Failure to assess and monitor

-Not completing a shift assessment

-Not implementing a plan of care

-Not observing patient’s ongoing progress

-Failure to interpret a patient’s signs and symptoms

Discuss the elements necessary to prove a malpractice case

From Box 4-3 pp 86

Failure to act as a patient advocate

-Not questioning discharge orders when a patient’s condition warrants it

-Not questioning incomplete or illegible medical orders

-Not providing a safe environment

Describes 9 ethical provisions that cover all aspects of nursing practice; adds a number of clarifying statements for each of the nine provisions; knowledge of your professional organization’s code of ethics is an important protection

1. Copy of the state nurse practice act

2. Nursing's social policy statemtne

3. Nursing: Scope and Standards of Practice

4. ANA's COde of Ethics for Nurses with interpretive statements

1.Practice with compassiona dn respect for all

2. Primary commitment is to the patient (regardless of number of patients)

3. Promote, advocate, and strive to protect health, safety, and rights of a patient

4. Be responsible and accountable for individual nursing practice; appropriately delegate tasks

5. Nurse owes the same duty to self as they do others; preserve integrity, safety, competence and continue professional growth

6. Participate in establishing, improving and maintaing helath care

7. Participate in the advancement of the profession through contributions to practice, education etc...

8. Collaborate with other helath professionals and the public in promoting health efforts

9. The profession as represented by professional organizations and its memebrs is responsible for articualting nursing values, maintaining integrity of the profession and its practice and for shaping social policy

Describe the 4 documents that all nurses should own (box 4-5 pp 95)

Nursing: Scope and Standards of Practice (published by ANA)

-Expands on the social policy statement; focuses on defining and delimiting clinical practice and its safe implementation;

-Is used in legal cases to determine whether or not a nurse has met the “standard of care” in a particular case

Describe the 4 documents that all nurses should own (box 4-5 pp 95)

Nursing’s Social Policy Statement

Lays out the most current definition of nursing; the knowledge base for nursing, including specialized and advanced practice roles; and the regulation of practice; has considerable impact on the national scope of practice

                 Represents and “expression of the social contract between society and professional nursing

Describe the 4 documents that all nurses should own (box 4-5 pp 95)

Nurse practice act

Being familiar with the law your state is a key safeguard against accidentally overstepping the limits of practice while understanding the full set of responsibilities that your state requires you to fulfill

what actions an individual should take; process oriented and involve critical analysis of actions

attitudes, ideas or beliefs that an individual or a group holds and uses to guide behavior; usually expressed in terms of right and wrong, hierarchies of importance, or how one should behave; freely chosen by individual