NURSING PRACTICE (Study Material)
BASIC CONCEPTS IN NURSING PRACTICE
Understanding basic concepts in nursing practice, such as roles of nursing, theories of
nursing, licensing and legal issues, helps enhance performance.
Definition of Nursing
1. Nursing is an art and a science.
2. Earlier emphasis was on care of sick patient, now the promotion of health is
stressed.
3. Nursing is the diagnosis and treatment of human response to actual and potential
health problems.
Roles of Nursing
1. Practitioner – involves actions that directly meet the health care and nursing needs
of patients, families and significant others; includes staff nurses at all levels of the
clinical ladder, advance practice nurses and community-based nurses.
2. Leader – involves actions such as deciding, relating, influencing and facilitating that
affect the actions of others and are directed toward goal determination and
achievement, may be formal nursing leadership role or an informal role periodically
assumed by the nurse.
3. Researcher – involves actions taken to implement studies to determine the actual
effects of nursing care to further the scientific base of nursing, can include all nurses,
not just academicians, nurse scientists and graduate nursing students.
History of Nursing
1. The first nurse was trained by religious institutions to care for patients; no standards
or educational basis.
2. In 1873, Florence Nightingale developed a model for independent nursing schools to
teach critical thinking attention to the patient’s individual needs and respect for the
patient’s rights.
3. During the early 1900s, hospitals used nursing students as cheap labor and most
graduate nurses were privately employed to provide care in the home.
4. After World War II, technological advancements brought more skilled and
specialized care to hospitals, requiring more experiences nurses.
5. Development of intensive and coronary care units during the 1950s brought forth
specialty nursing and advanced practice nurses.
6. Since the 1960s, greater interest in health promotes and disease prevention along
with a shortage of physicians serving rural areas, helped create the role of the nurse
practitioner.
Theories of Nursing
1. Nursing theories help define nursing as a scientific discipline of its own.
2. The elements of nursing theories are uniform- nursing person, environment and
health; also known as the paradigm or model of nursing.
3. Nightingale was the first nursing theorist; she believed the purpose of nursing was to
put the person in the best condition of nature to restore or preserve health.
, 4. More recent nursing theorist include:
a. Levine – nursing supports a person’s adaptation to change due to internal and
external environment stimuli.
b. Orem – nurses assist the person to meet universal, developmental and health
deviation self-care requisites.
c. Roy – nurses manipulate stimuli to promote adaptation in four models –
physiologic, self-concept, role function and interdependence relations.
d. Neuman – nurses affect a person’s response to stressors in the areas of
physiologic, psychological, sociocultural and developmental variables.
e. King – nurses exchange information with patients, who are open systems to
attain mutually set goals.
f. Rogers – nurses promote harmonious interaction between the person and
environment to maximize health; both are four-dimensional energy fields.
Nursing in the Health Care Delivery System
1. Technology, education, society values, demographics and health care financing have
an impact on where and how nursing is practiced.
2. Current trends to use health care dollars for primary care of many, rather than
specialized care for a few, have shifted nursing care out of the acute care hospital
and into the home and outpatient setting.
3. Inpatient staff nurses are now responsible for a greater number of patients who may
be older, more acutely ill and hospitalized for shorter stays.
4. The concept of managed care has expanded for health maintenance organizations
(HMOs) and preferred provider organizations to case management and
reimbursement control for most insurance plans. Therefore, more nurses are
working in utilization management or for hospitals or insurance companies to
determine the need for specialist consultations, costly procedures, surgeries and
hospitalizations.
5. More nurses are working for large outpatient centers run by hospitals or HMOs;
responsibilities include less “hands on” care, but more assessment and health
education for patients and their families.
6. The nursing role has expanded to meet health care challenges more efficiently with
certification in a variety of specialties to provide direct care or support and educate
other nurses in their roles.
Advanced Practice Nursing
1. Registered professional nurses with advanced training, education and certification are
allowed to practice in expanded scope.
2. This includes nurse practitioners, nurses, midwives, nurse anesthetists and clinical
nurse specialists.
3. Scope practice and legislation very by state.
a. Clinical nurse specialists are included in advanced practice nurse (APN) legislation in at
least 25 states (some of these include just psychiatric/mental health clinical nurse
specialists).
b. Nurse practitioners have some type of prescriptive authority in all 50 states and the
District of Columbia.
c. Nurse practitioners are now eligible for Medicare reimbursement across the US at 85%
of the physician fee schedule in most cases and are eligible for Medicaid reimbursement
in some states.
, d. Most states give authority to APNs through the Board of Nursing with some degree of
physician collaboration/supervision required.
4. Master’s degree preparation is becoming the requirement for most APN roles; however,
many certificate programs have trained APNs in the past 30 years.
5. Regulations of Canadian APNs has been slower than in the US, except for midwives, so
practice of APNs has been restricted.
6. The number of APNs, particularly nurse practitioners, is growing. It is predicted that by 2005
there will be approximately as many nurse practitioners as family physicians in the US.
7. Some acute care teaching hospitals are also increasing the number of nurse practitioners to
fill gaps in patient care coverage created by the resident duty hour guidelines.
Licensing/ Continuing Education
1. Every professional registered nurse must be licensed through the state board of
nursing in the US to practice in that state of the College of Nursing to practice in a
Canadian province.
2. Continuing education requirements vary depending on state laws, institutional
policies and area of specialty practice/certification. Continuing education units can
be obtained through a variety of professional nursing organizations and commercial
education services.
3. Many professional nursing organizations exist to provide education, certification,
support and communication among nurses; for more information, contact your state
Nurses’ Association, state board nursing.
Safe Nursing Care
Patient Safety
1. Patient safety has moved to forefront of health care as a result of the Institute of Medicine’s
(IOM) report, “To Err is Human: Building a Safer Health Care System” published in 2000.
2. The Joint Commission on Accreditation of the Health Care Organizations (JCAHO) is also
committed to improving safety for patients in health care organizations. Many of JCAHA
standards focus on patient safety.
3. In 2003, the IOM published a companion report to “To Err is Human” Titled “Keeping
Patients Safe: Transforming the Work Environment for Nurses” Recognizing nursing as the
largest segment of the health care work force, the report calls for changes in nursing staffing
levels and limits on nurses’ work hours, in addition to changes in nurse work place, work
processes and organizational culture.
Personal Safety
1. Nurses may be at risk for personal harm in the workplace. The American Nurses
Association (ANA) has sponsored initiatives to improve nurses’ personal safety.
2. The ANA’s “Safe Needled, Save Lives” campaign was key in promoting the use of
safety devices. Nurses and other health care workers are now protected by the
Needlestick Safety Prevention Act. (P.L. 106-430). The law requires health care
organizations to use needleless or shielded-needle devices, obtain input from clinical
staff in the evaluation and selection of devices, educate staff on the use of safety
devices and have an exposure control plan.
3. The physical work environment, which includes patient handling tasks, such as
manual lifting, transferring and repositioning patients, can also place nurses at risk
for musculoskeletal disorders such as back injuries and shoulder strains. The ANA’s
“Handle with Care” campaign aims to prevent such injuries and to promote safe
, patient handling through the use of technology and assistive patient handling
equipment and devices.
Culturally Sensitive Care
The changing demographics of the US and other countries bring a diverse array of
individuals with varying cultures and beliefs into nursing practice. Nurses must provide
culturally competent care by expanding their knowledge about different cultures. Many print
and online resources are available to provide information about the values, beliefs and
traditions of various cultures. However, the nurse must always use cautions and avoid
generating and stereotyping patients. Culturally sensitive care begins with an individualized
patient assessment, including his or her definition of health and expectations for care. Based on
this assessment, the nurse can develop an individual care plan.
Leininger (2002) offers guidelines for providing care to patients from different cultures.
Consider cultural care preservation, which allows patients to continue cultural practices that do
not cause harm or interfere with treatment. In cultural care negotiation, the patient and health
care staff negotiate the inclusion of cultural practices in treatment. If the patient is engaging in
harmful practices, the nurse can help the patient select a substitute practice within the
patient’s cultural values.
THE NURSING PROCESS
The nursing process is a deliberate, problem-solving approach to meeting the health
care and nursing needs of patients. It involves assessment, nursing diagnosis, planning,
implementation and evaluation with subsequent modifications used as feedback mechanisms
that promote the resolution of the nursing diagnoses. The process as a whole is cyclical, the
steps being interrelated, interdependent and recurrent.
STEPS IN THE NURSING PROCESS
1. Assessment – systematic collection of data to determine the patient’s health status and to
identify any actual or potential health problems.
2. Nursing diagnosis – identification of actual or potential health problems that are amenable
to resolution by nursing actions.
3. Planning – development of goals and a care plan designed to assist the patient in resolving
the nursing diagnoses.
4. Implementation – actualization of the care plan through nursing interventions or
supervisions of others to do the same.
5. Evaluation – determination of the patient’s responses to the nursing interventions and of
the extent to which the goals have been achieved.
Assessment
1. The nursing history
a. Obtain subjective data by interviewing the patient, family members or significant
other and reviewing past medical records.
b. Provides the opportunity to convey interest, support and understanding to the
patient and to establish a rapport based on trust.
2. The physical examination
a. Objective data obtained to determine the patient’s physical status, limitations and
assets.
b. Should be done in a private, comfortable environment with efficiency and respect.
BASIC CONCEPTS IN NURSING PRACTICE
Understanding basic concepts in nursing practice, such as roles of nursing, theories of
nursing, licensing and legal issues, helps enhance performance.
Definition of Nursing
1. Nursing is an art and a science.
2. Earlier emphasis was on care of sick patient, now the promotion of health is
stressed.
3. Nursing is the diagnosis and treatment of human response to actual and potential
health problems.
Roles of Nursing
1. Practitioner – involves actions that directly meet the health care and nursing needs
of patients, families and significant others; includes staff nurses at all levels of the
clinical ladder, advance practice nurses and community-based nurses.
2. Leader – involves actions such as deciding, relating, influencing and facilitating that
affect the actions of others and are directed toward goal determination and
achievement, may be formal nursing leadership role or an informal role periodically
assumed by the nurse.
3. Researcher – involves actions taken to implement studies to determine the actual
effects of nursing care to further the scientific base of nursing, can include all nurses,
not just academicians, nurse scientists and graduate nursing students.
History of Nursing
1. The first nurse was trained by religious institutions to care for patients; no standards
or educational basis.
2. In 1873, Florence Nightingale developed a model for independent nursing schools to
teach critical thinking attention to the patient’s individual needs and respect for the
patient’s rights.
3. During the early 1900s, hospitals used nursing students as cheap labor and most
graduate nurses were privately employed to provide care in the home.
4. After World War II, technological advancements brought more skilled and
specialized care to hospitals, requiring more experiences nurses.
5. Development of intensive and coronary care units during the 1950s brought forth
specialty nursing and advanced practice nurses.
6. Since the 1960s, greater interest in health promotes and disease prevention along
with a shortage of physicians serving rural areas, helped create the role of the nurse
practitioner.
Theories of Nursing
1. Nursing theories help define nursing as a scientific discipline of its own.
2. The elements of nursing theories are uniform- nursing person, environment and
health; also known as the paradigm or model of nursing.
3. Nightingale was the first nursing theorist; she believed the purpose of nursing was to
put the person in the best condition of nature to restore or preserve health.
, 4. More recent nursing theorist include:
a. Levine – nursing supports a person’s adaptation to change due to internal and
external environment stimuli.
b. Orem – nurses assist the person to meet universal, developmental and health
deviation self-care requisites.
c. Roy – nurses manipulate stimuli to promote adaptation in four models –
physiologic, self-concept, role function and interdependence relations.
d. Neuman – nurses affect a person’s response to stressors in the areas of
physiologic, psychological, sociocultural and developmental variables.
e. King – nurses exchange information with patients, who are open systems to
attain mutually set goals.
f. Rogers – nurses promote harmonious interaction between the person and
environment to maximize health; both are four-dimensional energy fields.
Nursing in the Health Care Delivery System
1. Technology, education, society values, demographics and health care financing have
an impact on where and how nursing is practiced.
2. Current trends to use health care dollars for primary care of many, rather than
specialized care for a few, have shifted nursing care out of the acute care hospital
and into the home and outpatient setting.
3. Inpatient staff nurses are now responsible for a greater number of patients who may
be older, more acutely ill and hospitalized for shorter stays.
4. The concept of managed care has expanded for health maintenance organizations
(HMOs) and preferred provider organizations to case management and
reimbursement control for most insurance plans. Therefore, more nurses are
working in utilization management or for hospitals or insurance companies to
determine the need for specialist consultations, costly procedures, surgeries and
hospitalizations.
5. More nurses are working for large outpatient centers run by hospitals or HMOs;
responsibilities include less “hands on” care, but more assessment and health
education for patients and their families.
6. The nursing role has expanded to meet health care challenges more efficiently with
certification in a variety of specialties to provide direct care or support and educate
other nurses in their roles.
Advanced Practice Nursing
1. Registered professional nurses with advanced training, education and certification are
allowed to practice in expanded scope.
2. This includes nurse practitioners, nurses, midwives, nurse anesthetists and clinical
nurse specialists.
3. Scope practice and legislation very by state.
a. Clinical nurse specialists are included in advanced practice nurse (APN) legislation in at
least 25 states (some of these include just psychiatric/mental health clinical nurse
specialists).
b. Nurse practitioners have some type of prescriptive authority in all 50 states and the
District of Columbia.
c. Nurse practitioners are now eligible for Medicare reimbursement across the US at 85%
of the physician fee schedule in most cases and are eligible for Medicaid reimbursement
in some states.
, d. Most states give authority to APNs through the Board of Nursing with some degree of
physician collaboration/supervision required.
4. Master’s degree preparation is becoming the requirement for most APN roles; however,
many certificate programs have trained APNs in the past 30 years.
5. Regulations of Canadian APNs has been slower than in the US, except for midwives, so
practice of APNs has been restricted.
6. The number of APNs, particularly nurse practitioners, is growing. It is predicted that by 2005
there will be approximately as many nurse practitioners as family physicians in the US.
7. Some acute care teaching hospitals are also increasing the number of nurse practitioners to
fill gaps in patient care coverage created by the resident duty hour guidelines.
Licensing/ Continuing Education
1. Every professional registered nurse must be licensed through the state board of
nursing in the US to practice in that state of the College of Nursing to practice in a
Canadian province.
2. Continuing education requirements vary depending on state laws, institutional
policies and area of specialty practice/certification. Continuing education units can
be obtained through a variety of professional nursing organizations and commercial
education services.
3. Many professional nursing organizations exist to provide education, certification,
support and communication among nurses; for more information, contact your state
Nurses’ Association, state board nursing.
Safe Nursing Care
Patient Safety
1. Patient safety has moved to forefront of health care as a result of the Institute of Medicine’s
(IOM) report, “To Err is Human: Building a Safer Health Care System” published in 2000.
2. The Joint Commission on Accreditation of the Health Care Organizations (JCAHO) is also
committed to improving safety for patients in health care organizations. Many of JCAHA
standards focus on patient safety.
3. In 2003, the IOM published a companion report to “To Err is Human” Titled “Keeping
Patients Safe: Transforming the Work Environment for Nurses” Recognizing nursing as the
largest segment of the health care work force, the report calls for changes in nursing staffing
levels and limits on nurses’ work hours, in addition to changes in nurse work place, work
processes and organizational culture.
Personal Safety
1. Nurses may be at risk for personal harm in the workplace. The American Nurses
Association (ANA) has sponsored initiatives to improve nurses’ personal safety.
2. The ANA’s “Safe Needled, Save Lives” campaign was key in promoting the use of
safety devices. Nurses and other health care workers are now protected by the
Needlestick Safety Prevention Act. (P.L. 106-430). The law requires health care
organizations to use needleless or shielded-needle devices, obtain input from clinical
staff in the evaluation and selection of devices, educate staff on the use of safety
devices and have an exposure control plan.
3. The physical work environment, which includes patient handling tasks, such as
manual lifting, transferring and repositioning patients, can also place nurses at risk
for musculoskeletal disorders such as back injuries and shoulder strains. The ANA’s
“Handle with Care” campaign aims to prevent such injuries and to promote safe
, patient handling through the use of technology and assistive patient handling
equipment and devices.
Culturally Sensitive Care
The changing demographics of the US and other countries bring a diverse array of
individuals with varying cultures and beliefs into nursing practice. Nurses must provide
culturally competent care by expanding their knowledge about different cultures. Many print
and online resources are available to provide information about the values, beliefs and
traditions of various cultures. However, the nurse must always use cautions and avoid
generating and stereotyping patients. Culturally sensitive care begins with an individualized
patient assessment, including his or her definition of health and expectations for care. Based on
this assessment, the nurse can develop an individual care plan.
Leininger (2002) offers guidelines for providing care to patients from different cultures.
Consider cultural care preservation, which allows patients to continue cultural practices that do
not cause harm or interfere with treatment. In cultural care negotiation, the patient and health
care staff negotiate the inclusion of cultural practices in treatment. If the patient is engaging in
harmful practices, the nurse can help the patient select a substitute practice within the
patient’s cultural values.
THE NURSING PROCESS
The nursing process is a deliberate, problem-solving approach to meeting the health
care and nursing needs of patients. It involves assessment, nursing diagnosis, planning,
implementation and evaluation with subsequent modifications used as feedback mechanisms
that promote the resolution of the nursing diagnoses. The process as a whole is cyclical, the
steps being interrelated, interdependent and recurrent.
STEPS IN THE NURSING PROCESS
1. Assessment – systematic collection of data to determine the patient’s health status and to
identify any actual or potential health problems.
2. Nursing diagnosis – identification of actual or potential health problems that are amenable
to resolution by nursing actions.
3. Planning – development of goals and a care plan designed to assist the patient in resolving
the nursing diagnoses.
4. Implementation – actualization of the care plan through nursing interventions or
supervisions of others to do the same.
5. Evaluation – determination of the patient’s responses to the nursing interventions and of
the extent to which the goals have been achieved.
Assessment
1. The nursing history
a. Obtain subjective data by interviewing the patient, family members or significant
other and reviewing past medical records.
b. Provides the opportunity to convey interest, support and understanding to the
patient and to establish a rapport based on trust.
2. The physical examination
a. Objective data obtained to determine the patient’s physical status, limitations and
assets.
b. Should be done in a private, comfortable environment with efficiency and respect.
