Conceptual Foundations of

NursingPeggy Korman, CNM

How would you define Nursing?

3

Nursing

• Caring

• Commitment

• Dedicated to meeting the health needs of people

Florence Nightingale

• Environmental theory

• A person’s surroundings such as clean air, water, and lighting can play a part in their healing process and their quality of care

Virginia Henderson “first lady of nursing”

• “Definition of Nursing”

• Nurses should help a client regain as much independence as quickly as possible with a holistic approach

• Treat each client as an individual, include them in the plan of care and assist them with a quick and healthy recovery

Jean Watson• Philosophy and Science

of Caring

• Supports humanistic and holistic care; focus on “caring” promoting health and preventing illness.

• Focus on the importance of the “caring “ relationship and communication in an individual’s health

Patricia Benner• Nurses move through

stages of expertise and skill as they practice nursing; defines a set of competencies from novice to expert nurse

• Made nursing aware of effects of clinical skills on client care and client outcomes.

• Made community more aware of nursing as a responsible and caring practice

Dorothea Orem• Self-Care Deficit theory

of nursing

• Nurses assist clients to their highest level of self-care

• Made nurses more aware of individualized client care, their participation in the plan of care and return to their highest possible level of self-care

Madeline Leninger• “Margaret Mead of

Nursing”: pioneer nurse-anthropologist

• Encourages nurses to gain an awareness of the uniqueness of each culture to meet the individual needs of each client

• Culturally specific care is provided in a caring manner

Betty Neuman• Systems Model

• Wholistic approach to client care, addresses homeostasis of the client and the environment

• Focus on primary prevention

• Wholistic approach to assessment and client-centered care

• Encourages continued research

Hildagard Peplau• Client-nurse relationships

use interpersonal skills and knowledge gained through previous research from other disciplines

• You must understand your own behavior before you can help someone else understand his behavior

• Used in mental-health field to develop therapeutic communication

What did you see???

• Yes we provide care and comfort to the sick

• We function independently and collaboratively

• Must haves: assertiveness, knowledge, ability to make sound judgments, ability to communicate in the written and oral form, spirit of collegiality with other team members.

Becoming A Caring Nurse at DSN

Nursing, Person, Environment, Wellness, RBC Values

Benners stages of Development:Novice-Advanced Beginner-Competent-

Proficient-Expert

The Nurse:Patient Advocate, Care-Giver, Educator,

Change Agent,Leader, User of RBC Values/Practice

Nurses deal with the whole person

Marjory Gordon’s Functional Patterns

• Helps us organize information about patients

• Consistent with human needs

• Health perception, Activity & Exercise, Nutrition, Elimination, Sleep & Rest, Cognition & Perception, Coping & Stress, Sexuality

• Welcome to NRS 320!!!!

All this and more….

Health, Wellness, Illness

• Health is “a state of complete physical, mental and social well-being, not merely the absence of disease or infirmity” (WHO, 1948)

• Holism

• Disease: a state of disharmony of mind, body, emotions, and spirit.

Illness Prevention

• Primary prevention:

• Secondary prevention:

• Tertiary prevention:

Complimentary and Alternative

Therapies

Definitions

• Complementary therapy:• Used with conventional treatment

• Alternative therapy:• Used in place of conventional treatment

Complementary/Alternative Medicine (CAM)

• Factors contributing to popularity:

National Center for CAM

• Established in 1998 at National Institutes of Health (NIH)

• Rigorous research on CAM

• Training CAM researchers

• Disseminating information to public and professionals

• Integrative medicine

Benefits of CAM

• Emphasizes maintenance of wellness and prevention of illness

• Utilizes a holistic approach

• May be less expensive

• May be more accessible

Risks of CAM

• Lack of standardization

• Lack of regulation and research

• Inadequate training and certification of some healers

• Financial and health risks of unproven methods

Traditional Chinese MedicineEnsures a balance of energy

Chi is invisible flow of energy in the body.Chi flows along pathways or meridians.

Yin and yang:Opposing pathways that form the whole

Quigong

Ayurveda

• Five elements:• Ether, wind, fire, water,

and earth

• Three tendencies, called doshas:• Vata, pitta, and kapha

• The goal is to balance the doshas

HomeopathyHealing system that uses like to cure like

Remedies are minute dilutions of substances

Reiki

Therapeutic Touch

YOGA

Reflexology

Massage

Meditation

Herbal Remedies

• Nutritive value of foods

• Dietary supplements

• Herbal medicine

Manipulative and Body-Based Therapies

• Chiropractic medicine

• Hydrotherapy

• Exercise

• Massage therapy

• Hatha Yoga

• Reflexology

Acupressure/Acupuncture

More Mind-Body Therapies

• Hypnosis

• Biofeedback

• Visualization

• Guided imagery

• Meditation

• Prayer

Healthcare in the community and Home

• The design, delivery and evaluation of healthcare services in the community.

• Community= workplace, school district, geographic area, managed-care enrollees, the HOME.

• Discharge planning “a coach”: helps pt move from one level of care to another within or outside the current healthcare facility. Referrals. Assessment. Pt education. Advocacy. Holistic care. Know the community resources.

Cultural Awareness, Sensitivity and Competence

A Culturally Competent Professional

….performs in a manner that meets the expectations of a particular cultural group, and acknowledges that group’s values, beliefs and practices.

“Indeed nursing itself, is a largely cultural phenomenon”

Specific to Nursing…

“Culturally competent care occurs when the nurse adjusts attitudes and behaviors to work effectively in cross-cultural situations.”

(Cross, Bazron, Dennis, & Issacs, 1989)

Who says we need cultural sensitivity

• WHO

• US HHS

• The Bureau of Nursing

• CDC

• JCAHO

• Healthy People 2020

• Be honest, you do too!

Iceberg

“Awareness” a better word

• Be very cautious with generalizations

• Learn to ask questions and listen to the answer

• Be prepared to get a different answer to what you believe to be the same question

• Be flexible

• Laugh: culture can become very political, be more lighthearted

Watch Translation

• Medical words

• What the pt hears

• Could be completely different

Stategies to Achieve Cultural Competence

Strategies….

How do you ask about Cultural Wishes or Needs???

• Don’t be shy

• Let the patient and family know that you CARE!

• Approach in a non-judgmental manner

• Express an interest in their culture and traditions

• Keep a resource book or current articles available on your unit

• Document any preferences so the next shift will be able to provide continuity

Use Translation Services

• Availabililty of translator (NOT family or friends) is now required by Federal payers

• Lay workers are NOT adequate for medical translation

• 1-800-At & T Translation Line!!!!! 1-800-874-9426

• Many local advocacy groups offer assistance

• Internet translation available

Plan for “Cultural Transformation”

• Review JCAHO Standards regarding patient care

• Seek resources for written materials with diverse ethnic representation

• Consider a “Cultural Nursing Rounds” format for education of staff

• Develop contacts in your community with various ethnic groups

• Be a cultural Change Agent

100 Questions and Answers About Arab Americans

• www.allied-media.com/Arab-American/100%20questions%20about%20arab%20americans.htm

DSN Video

• Jane’s School Video

Communication and Nursing Practice

• A lifelong process for nurses

• An essential attribute of professional practice

• Builds relationships with clients, families, and multidisciplinary team members

Nonverbal Communication

Communication and Interpersonal Relationships

• The means to establish helping and healing relationships.

• The ability to relate to others is important for interpersonal communication.

• Developing communication skills requires both an understanding of the communication process and of one’s own communication experience

Levels of Communicationmatching exercise

1. Intrapersonal A. One-to-one interaction between two people

2. Interpersonal B. Occurs within an individual

3. Transpersonal C. Interaction with an audience

4. Small Group D. Interaction within a person’s spiritual domain

5. Public E. Interactions with a small group of people

Professional Nursing Relationships

• Nurse-client helping relationships

• Nurse-family relationships

• Nurse-health team relationships

• Nurse-community relationships

Elements of Professional Communication

Appearance, Demeanor, and Behavior

Courtesy

Use of Names Trustworthiness

Autonomy and responsibility Assertiveness

Therapeutic Communication

• Seeking Clarification:

• Sharing Observation:

• Silence:

• Summarization:

Therapeutic Communication

• Open Question:

• Paraphrasing:

• Reflection:

Therapeutic Communication

• Acknowledgement:

• Closed Question:

• Focused Question:.

• Giving information:

Blockers

• False Reassurance:

• Giving Advice or Opinions:

• Showing Approval or Disapproval:

• Sidestepping the Topic:

• Stereotyped Responses:

Blockers

• Asking “Why” Question:

• Changing the topic:

• Defensive Responses:

• Failure to listen: