Chapter 1-4 Objectives

Question 1

Describe the demographic profile of registered nurses today.

Answer 1

1.) Gender: nursing is dominated by women (93%) although the number of men has increased since 2000. Men more likely to have a degree (11% BSN students). 41% of men are CRNAs

2.) Average age of grads from all programs is 31. BSN grad age is 28. Associate diploma degree is 33

3.) Race: racial/ethical minorities comprise 34% of U.S. population, but only 17% RN population, there is an increase, but it is very slow growing

Question 2

Recognize the wide range of settings and roles in which today’s registered nurses’practice.

Answer 2

1.) Hospital (primary): 62.2% Direct care, educators, managers, and associates

2.) Ambulatory care: 10.5% Nurse based practice, physician based practice, emergency and surgical centers

3.) Community health & Public Health: 7.8%

4.) Extended care/nursing homes: 5.3%

5.) Remainder: nursing organizations, school of nursing, government agencies, and insurance companies

Question 3

Identify evolving practice opportunities for nurses.

Answer 3

1. nurse entrepreneur
2. office based nursing
3. occupational and environmental health
4. military nurse
5. school nurse
6. hospice/palliative care
7. flight nurse
8. faith community nurse
9. nursing informatics

Question 4

Consider nursing roles in various practice settings.

Answer 4

• Nurse educators: RNs working in educational/academic programs

-Clinical nurse leaders: advanced degree, clinical expert in the care of a distinct group.

-Advance practice nurse (APN): RN who met advance degree and practice requirements.
1.) Certified nurse practitioner (CNP)
2.) Clinical nurse specialist (CNS)
3.) Certified nurse midwife (CNM)
4.) Certified registered nurse anesthetist (CRNA)

Question 5

Explain the roles and education of advanced practice nurses.

Answer 5

1.) CNP: nurse with advanced education that works with a specific group of people (ex: children, pregnant women, elderly)

2.) CNS: resource person for other nurses

3.) CNM: assist women/couples with uncomplicated pregnancies, deliveries, and post-delivery period.

4.) CRNA: specializes in administration of anesthesia.

Question 6

Identity the social, political, and economic factors and trends that influenced the development of professional nursing in the United States.

Answer 6

Social Content of Nursing: Gender, image, diversity, and shortage.

Diversity: Nurses need to be educated to be aware and respectful of culture differences.
Cultural competence, cultural sensitivity, and cultural humility.
National Standards for Culturally and Linguistically Appropriate Services (CLAS) in Health and Health Care.

Question 7

Describe the influence of Florence Nightingale on the development of the nursing profession.

Answer 7

During the Crimean War (1854-1856), Nightingale took 38 nurses to a hospital in Turkey to clean the hospital and provide care to the wounded soldiers.

Collected data on morbidity and mortality of the soldiers which helped reform the British medical system.

!! Founded the first training school for nurses at St. Thomas’ hospital in London in 1860 !!

Question 8

Identify nursing leaders and explain their significance to nursing.

Answer 8

1. Dorothea L. Dix: superintendent of women nurses by union army. Trained nurses who were employable postwar. Began to set up a formal system of training.
2. Susie King Taylor: former slave, taught soldiers to “read and write”
3. Mary Ann Bickerdyke: addressed poor conditions (clean and sanitary)
4. Clara Barton: established distribution pipelines; founder of the Red Cross.
5. Walt Whitman: served as a wound dresser; helped on the war front.
6. Mary Seacole (1805-1881): from Jamaica, was declined by Nightingale when wanting to work with her in the crimean war, this was because of Seacole’s race. She reduced infection spread in soldiers.

Question 9

Describe the development of schools of nursing.

Answer 9

Training schools for nurses were established after the civil war.

1869 AMA and US Sanitary Commission recommended large hospitals begin training nurses

1873 - Nightingale school-modeled training schools in America (NYC, Connecticut, Boston)

Feminization of nursing began (Victorian belief)

Separate nursing schools for African Americans

1893: men were more prominently seen as nurses vs. women, because women were believed to only be house wives and workers.

Linda Richards was the first trained nurse in the U.S.; graduated in 1874.

Question 10

Explain the role that the military and wars have had on the development of the nursing profession.

Answer 10

Roles of the Crimean War on nursing (1853-1856): Reform of the entire British Army medical system

Roles of the Civil War on nursing (1861-1873): no professional nurses & no organized system of medical care existed at the start. Catholic orders served as nurses. It helped advance professional nursing practice because these leaders, largely untrained, achieved dramatic improvements in care. The success in the reform of military hospitals served as a model for reform of civilian hospitals nationwide.

Roles of the Spanish-American war on nursing (1898): Initially wanted only graduates of nurse training schools, began including the Sisters of the Holy Cross and untrained African American nurses to treat typhoid fever epidemic. Led to development of permanent Army Nurse Corps (1901) & Navy Nurse Corps(1908).

Roles of WWI on nursing (1917-1925): Flu epidemic infecting 1/3 of world’s population. National committee on nursing created national publicity campaign to recruit young women to enter nursing training. Established Army School of Nursing w/ Annie Goodrich as dean. Publication of the 1923 Goldmark Report: study of nursing education that advocated for the establishment of schools of nursing associated with colleges & universities, rather than hospital-based. Frontier nursing service founded in 1925 by Mary Breckinridge, nurse & midwife. 1st organized midwifery program in U.S. By the time WW1 ended, the nursing profession had demonstrated its ability both to provide care to wounded soldiers and to respond effectively to the influenza pandemic.

Roles of WWII on nursing (1928-1945): there was a shortage of nurses, therefore congress enacted legislation to provide financial support to nursing programs & nursing education.

Roles of the Vietnam War on nursing (1961-1982): 1965 - Medicare and Medicaid
Specialization of nurses - ICUs, Psych
1971 - Certified nurse practitioner role
Emergency and trauma nursing- performed advanced emergency procedures. This time in Vietnam provided nurses with opportunities to stretch the boundaries of nursing. Nurses worked without direct supervision of physician

Question 11

Describe the struggles and contributions of minorities and men in nursing.

Answer 11

11th, 12th, and 13th centuries: men as nurses under military and religious orders

Stereotype: men supply strength or control of patients when needed (psychiatric nursing).
Men are likely to be younger, employed full-time in nursing, have non-nursing education, and nursing is a second career.

Reasons why men become nurses:
-Desire to help people
-Nursing is a growth profession with career paths
-Desire for a stable career

1974: American Assembly for Men in Nursing (AAMN)

Question 12

Describe nursing’s efforts to manage and improve its image in the media.

Answer 12

Media depiction of nurse

Nursing caps and other forms of identification

2014 Gallup: Nurses were rated the highest among a number of professions and occupations on honesty and ethics.

2002 Johnson & Johnson campaign to “enhance image of nursing profession…”

The truth about nursing is a nonprofit organization with the mission to “increase public understanding of the central, front-line role nurses play in modern health care.”

Question 13

Evaluate the implications for nursing in a technologically driven era.

Answer 13

The early 1980s marked the recognition and spread of HIV.
-Preventive measures included: Needle/intravenous use and disposal, routine glove use, strict protocols for handling blood products.
-increase in the use of medical technologies and life support.

Question 14

Describe how nursing has reacted to nursing shortages.

Answer 14

The Hill Burton Act (1946) provided funds to construct hospitals.

Rapid expansion of facilities resulted in an acute shortage of nurses leading to:
1. “Team nursing”
2. Creation of Associate Degree in Nursing (ADN) programs

Causes of nursing shortage: internal causes and external causes; international nursing shortage

Question 15

Explain how nursing shortages affect patient outcomes.

Answer 15

Harm the profession, jeopardize patient care, are costly to nurses and their employers, organizations inside and outside of nursing have called for mechanisms to ensure more even distribution of the workforce.

Question 16

Identify the characteristics of a profession.

Answer 16

1. Education takes place in a college or university.
2. Education is prolonged.
3. Work involves mental creativity.
4. Decision making is based largely on science or theoretical constructs (evidence-based practice).
5. Values, beliefs, and ethics are an integral part of preparation.
6. Commitment and personal identification are strong.
7. Workers are autonomous.
8. People are unlikely to change professions.
9. Commitment transcends material reward.
10. Accountability rests with individual.

Question 17

Distinguish betweenthe characteristics of professions and occupations.

Answer 17

Occupation:
1. Training may occur on the job.
2. Length of training varies.
3. Work is largely manual.
4. Decision making is guided largely by experience or by trial and error.
5. Values, beliefs, and ethics are not prominent features of preparation.
6. Commitment and personal identification vary.
7. Workers are supervised.
8. People often change jobs.
9. Material reward is main motivation.
10. Accountability rests primarily with employer.

Profession:
1. Education takes place in a college or university.
2. Education is prolonged.
3. Work involves mental creativity.
4. Decision making is based largely on science or theoretical constructs (evidence-based practice).
5. Values, beliefs, and ethics are an integral part of preparation.
6. Commitment and personal identification are strong.
7. Workers are autonomous.
8. People are unlikely to change professions.
9. Commitment transcends material reward.
10. Accountability rests with individual.

Occupation moves along the continuum toward a profession

Question 18

Describe how professions evolve.

Answer 18

Houle:
1. Defining the group’s mission and foundations of practice

2. Mastery of theoretical knowledge, development of the capacity to solve problems, use of practical knowledge, and self-enhancement (continued learning and development)
3. Development of a collective identity as an occupation evolves into a profession

Flexner:
1. Is basically intellectual (as opposed to physical) and is accompanied by a high degree of individual responsibility
2. Is based on a body of knowledge that can be learned and is developed and refined through research
3. Is practical, in addition to being theoretical
4. Can be taught through a process of highly specialized professional education
5. Has a strong internal organization of members and a well-developed group consciousness
6. Has practitioners who are motivated by altruism (the desire to help others) and who are responsive to public interests

Kelly:
1. The services provided are vital to humanity and the welfare of society. (caring)
2. There is a special body of knowledge that is continually enlarged through research. (evidence-based practice)
3. The services involve intellectual activities; individual responsibility (accountability) is a strong feature. (nursing process)
4. Practitioners are educated in institutions of higher learning.
5. Practitioners are relatively independent and control their own policies and activities (autonomy).
6. Practitioners are motivated by service (altruism) and consider their work an important component of their lives.
-When nurses demand higher compensation altruism is questioned
7. There is a code of ethics to guide the decisions and conduct of practitioners.
8. There is an organization (association) that encourages and supports high standards of practice. (ANA- official voice of nursing)

Question 19

Identify barriers to nursing’s development as a profession.

Answer 19

1. Varying levels of education for entry into practice
   -BSN, AND, and diploma in nursing.
2. Gender issues
3. external conflicts:
   -Tension between medicine and nursing
   -Lobby for protection of nursing practice
4. internal conflicts:
   Fragmented power and influence in professional nursing; ex. tension amongst nurses with different levels of education

Question 20

Explain the elements of nursing’s contract with society.

Answer 20

Nursing’s Social Policy Statement: Serves as a framework for understanding professional nursing’s relationship with society and nursing’s obligation to those who receive professional nursing care.

The Code of Ethics for Nurses: It is a statement of ethical values, obligations, duties, and professional ideals of nurses individually and
collectively.
-It is nursing’s non-negotiable ethical standard
-It expresses nursing’s own understanding of its commitment to society.
-Provisions of 2015 Code:
FIRST three provisions - fundamental values and commitments of the nurse
NEXT three provisions - boundaries of duty and loyalty
LAST three provisions - aspects of duties beyond individual patient encounters

Nursing: Scope and Standards of Practice: Outlines the expectations of the professional role within which all RNs must practice and delineates the standards of care and associated competencies for professional nursing.

Question 21

Recognize characteristic behaviors that exemplify professional nurses.

Answer 21

Varying levels of education for entry into practice: diploma (ADN (associates), BSN (bachelors), MSN (masters))

Gender issues

Historical influences: connections with religious orders and military

External conflicts: tension between nursing and medicine

Internal conflicts: educational differences

Question 22

How nurses assess themselves in the development of professional conduct.

Answer 22

There is a code of ethics to guide the decisions and conduct of practitioners.

Essence of Collegiality: promotion of a supportive and health work environment, cooperation, and recognition of interdependence among members of the nursing profession.

Professional nurses demonstrate collegiality by sharing with, supporting, assisting, and counseling other nurses and nursing students.

Collegial Behaviors

Question 23

Describe the various levels of entry into nursing practice.

Answer 23

1. Diploma programs: Diploma in nursing: 3 years of hospital education- only 3.11% of nurses since 2004
2. Associate degree programs: 2 year Associate Degree in Nursing (ADN): basic education, majority
3. Baccalaureate programs: 4 year BSN: over 50% of nurses

Question 24

Understand the role of professional certification and accreditation processes in nursing education.

Answer 24

Certification: goes beyond licensure by validating a high level of knowledge and proficiency in a particular practice area.
Certification has professional but not legal status.

-must have master’s degree, comprehensive exam is required, as well as documentation of experience, letters of reference, and other documents

-completion effective for 3-5 years

Accreditation: voluntary review process of educational programs by a professional organization. Assures students that their educational program is accountable for offering quality education

-Two agencies responsible for accrediting programs:
-Accreditation Commission for Education in Nursing (ACEN): LPN/LVN, diploma and ADN programs
-Commission on Collegiate Nursing Education (CCNE): BSN and higher degree programs

-An accredited program voluntarily adheres to standards that protect the quality of education, safety, and the profession itself.

-Takes place every 8-10 years

Question 25

Clearly define the concept of nursing and how that definition is related to professional socialization.

Answer 25

-A definition establishes the parameters (or boundaries) of the profession and clarifies the purpose and functions of the work of nursing.

-A definition guides the educational preparation of aspiring practitioners and guides nursing research and theory development.

-A clear definition makes the work of nursing visible and valuable to the public and to policy makers who determine e when, where, and how nurses can practice.

Professional Identity: Structural conditions are this in which one’s professional role is shaped by rules. Cultural conditions are those in which traditions, symbols, language, and other idea systems in a society are at work in shaping how one becomes a fully socialized professional nurse.

Influencing Socialization: the Code of Ethics require that nurses work with all patients regardless of their beliefs.
-4 Stages Necessary for Satisfactory Socialization to Occur:
1. Unilateral Dependence
2. Negativity/
independence
3. Dependence/Mutuality
4. Interdependence

Question 26

Recognize how the definition of nursing has evolved through political and historical events.

Answer 26

Florence Nightingale: “I use the word nursing for want of a better. It has been limited to signify little more than the administration of medicines and the application of poultices. It ought to signify the proper use of fresh air, light, warmth, cleanliness, quiet, and the proper selection and administration of diet— all at the least expense of vital power to the patient”
-definition foreshadowed contemporary nursing’s focus on the therapeutic milieu as well as the modern emphasis on health promotion & maintenance

WWII:
1. Peplau: “Nursing is a significant, therapeutic, interpersonal process … Nursing is an educative instrument … that aims to promote forward movement of personality in the direction of creative, constructive, productive, personal, and community living.” -Reinforced the idea of the patient as an active collaborator in his or her own care.

2. Dorothea Orem: “nursing is best described as the giving of direct assistance to a person, as required, because of the person’s specific inabilities in self-care resulting from a situation of personal health.”
   -Nurses should do for a person only those things the person cannot do without assistance emphasized the patient’s active role.
   -self-care theory of nursing
3. Henderson: “The unique function of the nurse is to assist the individual, sick or well, in the performance of the activities contributing to health or its recovery (or to a peaceful death) that he would perform unaided if he has the necessary strength, will or knowledge. And to do this in such a way as to help him gain independence as rapidly as possible.”
   -Definition adopted by ICN and is still widely accepted across the world.

ANA: “Nursing encompasses the prevention of illness, the alleviation of suffering, and the protection, promotion, and restoration of health in the care of individuals, families, groups, and communities.”

Question 27

Identify factors that influence an individual’s professional socialization in nursing.

Answer 27

1. Structural conditions are those in which one’s professional role is shaped by rules.
2. Cultural conditions are those in which traditions, symbols, language, and other idea systems in a society are at work in shaping how one becomes a fully socialized professional nurse.

Professional Socialization: process of internalization and development or modification of an occupational identity that “begins when the students are in formal nursing program and continues as they practice in the real world”

Formal Socialization:
1. Lectures, online activities, assignments, and clinical experiences such as planning nursing care, writing a paper on professional ethics, learning steps of a physical exam, starting an IV line, communication skills, time with mentor
2. Nursing faculty as the first mentor
3. Orderly, building-block fashion

Informal Socialization:
1. Incidental/unplanned lessons (learn more)
2. Observation of a nurse teaching a young mom how to care for infant, hearing nurses discuss patient care

Question 28

Describe two developmental models of professional socialization.

Answer 28

1. Cohen’s model of basic student socialization:

Stage I:
Unilateral dependence
-Inexperienced, lack knowledge, rely on external limits such as teachers.
-Do as they are told because they lack the experience and knowledge to question

Stage II: Negativity/independence
-Think critically about what they are being taught, critical thinking and knowledge bases expand

Stage III: Dependence/mutuality
-Reasoned evaluation of others’ ideas

Stage IV:
interdependence
-Develop capacity to make decisions in collaboration with others.

2. Benner’s stages of nursing proficiency:
3. Novice- little background & limited practical skills; relies on rules & expectations
4. Advanced beginner- marginally competent skills; uses theory & principles much of the time; experiences difficulty establishing priorities
5. Competent practitioner- feels competent, organized; plans & sets goals; thinks abstractly & analytically; coordinates several tasks simultaneously
6. Proficient practitioner- views patients holistically; recognizes subtle changes; sets priorities with ease; focuses on long term goals
7. Expert practitioner- performs fluidly; grasps patient needs automatically; responses are integrated; expertise comes naturally

Question 29

Describe strategies to ease the transition from student to professional nurse.

Answer 29

Reality Shock: the feelings of powerlessness and ineffectiveness experienced by new graduates
-It generates psychological stress that decrease the ability of individuals to cope effectively with the demands of the new role.

4 causes of Reality Shock:
1. Absence of positive reinforcement (such as one gets from clinical faculty) and lack of frequent communication
2. Lack of support, such as the availability of faculty that students have
3. The gap between the ideals taught in school and the actual work setting
4. The inability to provide nursing care effectively because of circumstances such as a heavy case load or time constraints

Kramer described ways nurses “drop-out” rather than take steps to resolve reality shock, including:
1. Disengaging mentally and emotionally
2. Driving oneself and others to the breaking point by trying to do it all
3. “Job hopping” - looking for the perfect, non-stressful job that is completely compatible with professional values
4. Prematurely returning to school (seeking the routine and known expectations of a student)
5. Burning out—a condition of unresolved reality shock with subsequent emotional exhaustion
6. Leaving the nursing profession entirely, which neither nursing nor society can afford

5 Strategies to reduce reality shock:
1. Seek practical experiences outside of school
2. Balance work with academic responsibilities
3. “Shadowing” programs
4. Take initiative to form group for mutual support
-Mentors and preceptors
5. Care for self