COMMUNICATIONS AND INTRODUCTION TO NURSING

1. COMMUNICATIONS AND INTRODUCTION TO NURSING ANITA CATLIN, DNSc KATHLEEN ROCKET, MSN FALL 2003

2. PLAN FOR DAY • Read article in class • Discuss what is a nurse • Communication Tool • Discuss confidentiality • Do nursing interview on classmate • View Video on American Oncology Nurses

3. Who Can I Think of as a Mentor?

4. DEFINITION OF NURSINGHENDERSON, 1939 Nursing is primarily helping people (sick or well) in the performance of those activities contributing to health, or its recovery (or to a peaceful death) that they would perform unaided if they had the necessary strength, will, or knowledge. It is likewise the function of nurses to help people gain independence as rapidly as possible.

5. Virginia Henderson, Definition of NursingInternational Council of Nurses, 1960 Nursing is primarily assisting individuals (sick or well) in the performance of those activities contributing to health, or its recovery (or to a peaceful death) that they would perform unaided if they had the necessary strength, will, or knowledge. Nursing is a process through which care is provided to individuals, families, or community groups.

6. WEIDENBACH, 1964Delineation between medicine and nursing: The physician’s role is to treat the patient’s primary condition. The nurse’s role is to treat the patient’s response to this condition.

7. ANA CODE OF ETHICS • Last written in 1985 • 10 years of discussion • Brought to nurse ethicists for review • Input from nation • Revised in 2001

8. Compassion and respect, regardless and unrestricted • Commitment to patient; individual, family, group, community • Advocates for health, safety, and rights of patient • Responsible and accountable • Maintains moral self respect and competence

9. Maintains health care environment • Advances profession by maintaining standards and active involvement • Collaborates with other health care professionals, local and worldwide • Promotes nursing values and social reform

10. NURSES TRAINED TO SEE OUTSIDE THE BED HistorySociologyEthnicitySocial EconomicsFamily DynamicsSpiritualityLoveHope

11. Imogene King, 1981MUTUAL INTERACTION MODEL Exploration Information and Analysis Mutual Goal Setting Strategies Implementation of Alternatives Evaluation

12. DEFINITION OF CARING IN NURSING Swanson, 1983KnowingBeing WithDoing ForEnablingMaintaining Belief Caring for patients with community prevention or in tertiary settings, living or dying, throughout the lifespan

13. THOUGHTFUL DELIBERATION • Fostering critical thinking • Using the nursing process • Socratic method helpful • Purposeful conversation

14. ACCOUNTABILITY • Using critical thinking before taking actions • Being responsible for your actions • Entering the professional role • Working at the level of your peers • Using the nursing process

15. MEDICAL EDUCATION • Science based • Cellular/molecular understanding of disease process • Medical school, internship, residency, fellowship; all honed to specific understanding • “War” against disease • Death is the “enemy”

16. GOALS OF MEDICINE • Promotion of health and prevention of disease • Relief of symptoms, pain and suffering • Cure of disease • Preventing untimely death • Improvement of functional status or maintenance of compromised status • Education and counseling of patients regarding their condition and its progress • Avoid harm to the patient in the course of care

17. AMERICAN MEDICAL ASSOCIATIONPRINCIPLES OF MEDICAL ETHICS, 1997 Physician shall have competency, compassion and respect for human dignity Shall be honest and expose those engaging in fraud or deficient character Respect the law and work to change law that is bad for patient care Respect the rights and confidences of others Continue to study, use consultation, advance scientific knowledge Freedom to choose own patients and own practice environment Participate in improving the community

18. PHYSICIAN DESCRIPTIONCatlin study, 1998 I think if you really want the truth on the whole, you are asking somebody who is medically trained to wear more hats than that of a physician. You are asking them to be a physician; you are asking them to be ethicist; you are asking them to be an economist; you are asking them to be a minister of religion; you are asking them to be a judge and jury and it is a big mantle of responsibility. And peer pressure, family pressure, societal pressure, and fear of litigation all play a role in the decisions that are being made.

19. Germany Hungary Scotland USA Slovak Republic Spain Chile Italy Sweden Czech Republic Denmark Indonesia The Netherlands China GOALS OF MEDICINE WORK GROUP, 1997-1999

20. MOVING TOWARDS EACH OTHER • Physicians learning “context” • Advanced practice nurses accepting medical model of diagnosis and treatment • Palliative care has entered into medical practice: initiated for adults, less so for children

22. MARTHA ROGERS, NURSE THEORIST • “When an apple is cut, others see seeds in the apple. We, as nurses, see apples in the seeds.”

23. STUDENT NURSES’ CODE OF ETHICS Code of Academic and Clinical Conduct • Similar to American Nurses Association • Additional discussion on: • impairment in clinical • not performing skills that haven’t been taught yet • Collaborate with instructors who have your best interests at heart

25. HEALTH • According to the World Health Organization is well-being in these domains: • Emotional • Physical • Social • Spiritual

26. HEALTH ILLNESS CONTINUUM • View of each person of where he or she sits on the health illness scale • The patient’s opinion may be different than ours • Ours may be different than the patient’s • It is a dynamic process

27. HIGH LEVEL WELLNESS • Mental health • Physical health • Social health • Family health • Community health

28. HOLISTIC HEALTH • Interaction of • mind • body • spirit • Nursing care is based on this

29. PATIENT ADVOCACY • Expressing and defending the cause of another • Informing • Supporting • Mediating • Ensuring access

30. PATIENT’S BILL OF RIGHTS • Considerate and respectful care • Complete, current, and necessary information • Informed consent prior to procedure • Right to refuse treatment • Confidentiality of records • Privacy

31. PATIENT’S BILL OF RIGHTS • Response to request for services • Involvement in transfer • Information about hospital and staff relationships • Knowledge of research and right to refuse • Continuity of care • Bill explanation • Hospital rules and regulations

32. CONFIDENTIALITY • Patient has the right to privacy • Patients entrust in us and we have earned that trust • Especially in small towns as we practice in • No discussion other than those who need to know • Patients will need to disclose private data • Discussion with your instructor is acceptable • Use patient initials on your work and notes • No talking in cafeteria, hallways, elevators

33. LEVELS OF CARE • Primary Care • Health promotion • Prevention • Outpatient • First line of care

34. LEVELS OF CARE • Secondary Care • Surgery • Specialists • OB/GYN • Local hospital treatment

35. LEVELS OF CARE • Tertiary Care • Regional medical care • Regionalized expertise • Medical school • Advanced diagnostics • Away from home • May be done by telehealth

36. CONTINUITY OF CARE • Care that begins with maintaining health, treats someone with an acute illness, and follows to home care for recovery or stabilization • A goal of good nursing • Rehabilitation begins with admission

37. TYPES OF NURSING CARE • Curative: Return to level of health • Preventive: Prevent disease process from occurring • Restorative/Rehabilitation: Restore function after disease • Supportive: Care for emotional aspects • Holistic: Body, mind, spirit • Palliative: Care for dying patient

38. ILLNESS • Acute • Chronic • Remission • Exacerbation

39. INDEPENDENT NURSING FUNCTIONS • Licensed to initiate based on knowledge and skills • Physical care • Gathering health information • Support and comfort • Teaching, counseling • Environmental support • Referrals

40. DEPENDENT/COLLABORATIVE NURSING FUNCTIONS • Under physician orders • Under protocols • Decisions under parameters • Student reports to faculty member

41. METHODS OF CARE DELIVERY • Functional • Team Nursing • Primary Care Nursing • Nurse Practitioner • Independent Nursing Practice • Private Duty Nursing • Home Care Nursing

42. HEALTH CARE PERSONNEL • Physician: Medical diagnosis and treatment, cure oriented, often given more leadership than trained for • Nurse Practitioner: MSN, Advanced practice, can Dx and Tx • Clinical Nurse Specialist: Advanced role in acute care settings • Nurse: LVN, ADN, BSN, PHN, MSN, PhD, DNSc, JD • Midwife: Advanced Practice, MSN

43. HEALTH CARE PERSONNEL • Dietician: Trained in nutrition and food services • Physical Therapist: Muscular-skeletal focus • Pharmacist: Preparation/Dispensing Meds • Respiratory Therapist: Management of airway, lung, and ventilator issues

44. HEALTH CARE PERSONNEL • Social Worker: College degree, support and counsel patients and staff, transfers and placement • Hospital chaplain: Issues of spirituality and death and dying • Occupational therapist: Fine motor training and activities of daily living • Speech therapy: Speech and swallowing • Paramedical technologist: Skills blood draw, EKG

45. HEALTH CARE FINANCING • Employment linked insurance • Prepaid insurance policies • Federally and state funded programs • Millions of Americans uninsured

46. CONSUMER INFLUENCE & SOCIAL CHANGES IMPACT ON HEALTH CARE • Women’s movement led to improved access to birth control • Consumers demanded that families be present at deliveries • Men’s movement made prostate cancer more discussed • Breast cancer activists have increased attention to this disease

47. FUTURE CHALLENGES • Nursing shortage • Increased telehealth care • Increased use of life extending technologies • Increased training in pain control and end of life comfort