Definition of Nursing

• Nursing is the protection, promotion, and

optimization of health and abilities,
prevention of illness and injury, alleviation
of suffering through diagnosis and
treatment of human response, and
advocacy in the care of individuals,
families, communities, and populations
(ANA, 2003)
Definition of Nursing

• Nursing encompasses autonomous and

collaborative care of individuals of all
ages, families, groups, and communities,
sick or well in all settings. Nursing
includes the promotion of health,
prevention of illness, and the care of ill,
disabled, and dying people (International
Council of Nurses, 2002).
Definition of Nursing

• Advocacy, promotion of a safe

environment, research, participation in
shaping health policy and in patient and
health systems management, and
education are also key nursing roles (ICN,
2002).
Definition of Nursing

• Nursing = Care of Others

• Blend of Art and Science
History of Nursing
• Ancient Civilizations through the Renaissance
– Illness had supernatural causes
– Women delivered custodial care to family
– Medicine men treated disease
– As civilizations grew priests were seen as physicians
– Under Christianity educated and wealthy women dedicated themselves
to care of the sick
– Phoebe became the 1st Deaconess
– During the Crusades all-male military orders flourished and all-female
religious orders declined
– During the Renaissance medicine moved into the University
– Male nurses vanished from profession
– Home major locality for nursing care
– Only poor hospitalized, cared for by prostitutes and female criminals
History of Nursing

• Colonialism and Revolution

– Physicians not required to have license
– Hospital care only available in cities
– Mentally ill “warehoused”
– More soldiers died in Revolutionary War due
to disease than wounds
History of Nursing
• Industrialization
– Population explosion
– Increased incidence illness, injury, and early
mortality
– Hospitals opened
– Schools of nursing started: Sisters of Charity,
Kaiserworth school of nursing in Germany
1836, Dr Joseph Warrington in Philadelphia
1839
History of Nursing
• Influence of War
– Crimean war, notable for Florence Nightingale
– American Civil War, emergence of early nursing
leaders
– Training for nurses more apprenticeship than
education, hospital-based schools of nursing
– WWI, female nurses under control of male hospital
administrators and physicians
– WWII, large # women working outside home
– Increased need for nurses
– Move into university and college settings
History of Nursing

• Influence of War
– Korean War, growth of AD programs in
community colleges
– Vietnam War, expansion civilian hospitals,
advancement of specialization
– Concept of nursing diagnosis
– Masters and PhD programs in nursing
Current Trends in Nursing
• Change in education, disappearance of hospital based
schools of nursing
• Nursing shortage
• Evidence-based practice
• Decreased hospital length of stay
• Community based nursing
• Aging population
• Increase in chronic health conditions
• Culturally competent nursing care
• Increase costs of health care/managed care
Major Factors to Evolution of
Nursing
• Industrial revolution
• Wars
• Closure of diploma programs
• Nursing shortage
• Movement from inpatient to outpatient
• Increasing costs of health care
Florence Nightingale

• Wealthy well-educated
• In Crimean War reduced soldiers mortality
from 42.7% to 2.2% in 6 months
• Established training school for nurses
• Wrote books about healthcare and nursing
education “Notes on Nursing”
Florence Nightingale
• 1st Nursing Theorist
• Nursing is separate and distinct from
medicine
• All women are natural nurses
• Emphasized importance of environment:
fresh air, cleanliness, nutrition
• Maintained accurate records, 1st Nursing
Researcher
Is Nursing a Profession?
• Well-defined body of specific and unique knowledge that undergoes
continual growth through research
• Services provided are vital to human beings and the welfare of
society
• Practitioners have autonomy and control their own policies and
activities
• Practitioners are motivated by the service they provide and consider
their work important to their lives (altruism)
• Practitioners decisions and conduct are guided by a code of ethics
• Professional organization sets standards
• Practitioners receive education in institutions of higher learning
Registered Nursing Education

• Diploma in Nursing
• Associate Degree in Nursing
• Baccalaureate in Nursing
• Direct entry Masters Degree in Nursing
• Advanced practice Masters in Nursing
• PhD in Nursing
 Physical Sciences Humanities

A&P Biology Microbiology Chemistry Ethics Literature

Pathophysiology Pharmacology History

Philosophy
Food & Nutrition
NURSING

Research Abnormal Psychology

Mathematics & Statistics Psychology Sociology

Growth & Development

Writing & Composition Social Sciences

Liberal Arts & Nursing

Professional Nursing Organizations

• American Nurses Association (ANA):

establishes standards of practice,
encourages research to advance nursing
practice, and represents nursing for
legislative actions
• National Student Nurses’ Association
(NSNA)
– OSNA
Professional Nursing Organizations

• National League for Nursing (NLN): foster

development and improvement of nursing
education; voluntary accreditation
• American Association of Colleges of Nursing
(AACN): national accreditation for collegiate
nursing programs
• International Council of Nurses (ICN)
• Specialty Nursing Organizations: Sigma Theta
Tau International Honor Society of Nursing
Professional Organizations and
Nursing Process
• Term 1st used in 1955
• ANA Standards of Nursing Practice
• Canadian Nurses Association standard of
effective use of nursing process
• Joint Commission of Accreditation of Healthcare
Organizations requires care documentation
according to nursing process
• ANA recommends educational programs
incorporate nursing process
Nursing Process and Critical
Thinking
• Nursing process provides a framework for
critical thinking
CRITICAL THINKING

• Abstract concept
• Learned thinking skills
• Has a purpose
• Considers evidence, context, past
knowledge, alternatives, creativity
WHY CRITICALLY THINK?

• Nursing is an applied discipline

• Nursing draws on knowledge from
other fields
• Nurses deal with change in stressful
environments
• Nurses make frequent, varied, and
important decisions
CRITICAL THINKING

• SKILLS
– Objectively gather information
– Recognize need for more info
– Recognize gaps in own knowledge
– Listen carefully; read thoroughly
– Separate relevant from irrelevant data
– Group info in meaningful way
– Draw tentative conclusions
• SKILLS (cont)
– Integrate findings with previous knowledge
– Identify potential solutions
– Evaluate each potential solution
– Choose best solution
– Carry out intervention
– Evaluate credibility and usefulness of sources
of info
Sound like the problem-solving or scientific method?
CRITICAL THINKING

• ATTITUDES
– Independent thinking
– Intellectual curiosity
– Intellectual humility
– Intellectual courage
– Intellectual perseverance
– Fair-mindedness
STAGES OF SKILL
ACQUISITION
• Novice
– Rule-governed, limited, inflexible
– Total recall mode
• Advanced Beginner
– Notes recurrent aspects
– Beginning development of professional habits
• Competent
– Able to recognize own thinking
– Able to analyze problems
– Lacks speed and flexibility of proficient nurse
– 2-3 years in setting
BENNER (cont)

• Proficient
– Perceives each situation as a whole
– Long-term goals
– Advanced level of critical thinking
– 3-5 years in setting
• Expert
– Intuitive grasp of situation
– 5-15 years in setting
Patricia Benner: From Novice to Expert
OBSTACLES

• Overuse of habit with questioning

“We’ve always done it that way”
• Anxiety
• Working under deadlines
• Biases, own as well as patient
• Lack of confidence in own thinking
NURSING PROCESS

• Structure for critical thinking

NURSING PROCESS
• Assessment
• Nursing Diagnosis
• Planning (expected outcomes)
• Nursing Intervention
– Implementation of plan
• Evaluation
NURSING PROCESS
Nursing
Diagnosis

Assessment
Standards of
Professional
Practice Planning
ANA code of Ethics
Evidence-Based
Practice
Evaluation

Intervention