The Profession of Nursing Flashcards
Professionalism:
· Areas of personal professional development for individual nurses (Miller, Adams, & Beck, 1993)
- Education, including continuing education
- Adherence to the code of ethics
- Participation in the professional association
- Communication and publication
- Autonomy and self-regulation
- Community service
- Theory use, development, and evaluation
- Research involvement
Job vs Career
·JOB: group of tasks that are organized so that one individual can carry them out
CAREER: usually viewed as the person’s major lifework that progresses and develops as the person ages
Profession: what is required?
- Its requirement for prolonged specialized training or preparation to acquire a pertinent body of knowledge
- An orientation to service
Criterial of a Profession
- Entrusts the education of its practitioners to institutions of higher education
- Strives to compensate its practitioners by providing freedom of action, opportunity for continuous professional growth and economic security.
Professionalism: Self-Regulation
- Nursing is a self-regulated profession
- In each province/territory, the monitoring of nurses is delegated to the profession of nursing itself (i.e. OIIQ is the regulatory body of nursing in Quebec)
- The primary goal of self-regulation is protection of the public
Responsibilities of Nursing regulatory bodies: (Responsibility of the OOIQ)
- Setting requirements of entrance into the profession
- Ensuring standards of practice are met and adhered to
- Ensuring consistency in competence and quality of care
- Enforcing disciplinary measures when nurses do not adhere to standards
Professional Socialization
- Involves learning to behave, feel and see the world in which you work in similar manner to others in same role.
- internalize these roles, knowledge, skills, and behaviors as you enter into new professional roles
Two methods of socialization:
1.Formal socialization: students learn from teachers how to care for and interact with patients.
2. Informal socialization: occurs as students witness nursing care in the clinical setting and engage in student professional organizations.
Professional Socializatin: Process
Professional Socialization: Process
- The goal is to ultimately instill in the individual (the nurse) the norms, values, attitudes and behaviors deemed essential for the practice and survival of the Nursing profession.
Code of ethics of nurses (Quebec)
e.g. Division 1:
“Duties inherent to the practice of the profession”
e.g. art. 3 A nurse shall not perform any act or behave in any manner that is contrary to what is generally admissible in the practice of the profession.
Active Socialization Process
- As a student - actively engage in the socialization process:
- ormation of study groups, identification of role models
- Goal: become functioning professionals
Socialization: Student-to-Nurse
- learn the “technology of the profession—facts, skills, and theory;
- learn to internalize the professional culture;
- find a personally and professionally acceptable version of the role;
- integrate this professional role into all the other life roles
Nursing Socialization: Process
- Follow: Code of Ethics for Registered Nurses CNA, e.g. Values: safe, competent and ethical care, dignity, accountability, confidentiality etc.
- Codes provide the expectations by which you create and develop your professional practice.
- *Socialization: interactive process**
4. Ability to function in a diverse community, including knowledge of different cultural and economic contexts;
- A range of attitudes and dispositions including self-awareness, empathy, and flexibility and adaptability
Stages of Expertise
(Benner, P. From Novice to Expert, 1984. Addison-Wesley Pub.
Stages of Expertise: Novice
· Beginners without prior experience
· Because beginners possess limited knowledge and experience, their behavior can be rigid and limited
· Rely on clear rules and guidelines for clinical judgment
· True not only of students but also of nurses who transfer to an area in which they have no experience
Stages of expertise: Advanced Beginner
· demonstrate minimally satisfactory performance (routine)
· having experienced enough real-life situations to be able to recognize recurring meaningful situational characteristics or aspects of the situation
· With instruction, guidance by nurse mentor, advanced beginners develop the ability to formulate principles that require prior experience
· require support in the clinical setting and assistance with priority setting and time management
Stages of expertise: Competent
· Employed in the same or similar area for 2–3 years
· have consciously developed long-range plans for themselves to facilitate their practice, both present and future
· considerable conscious, abstract, analytic contemplation of the problem
· have gained mastery of skills (e.g., organizational ability) and engage in conscious and deliberate planning
· lack the speed and flexibility of proficient nurses in
practice: in planning and coordinating the care of patients with complex health issues
Stages of expertise: Proficient
Brown belt
· the nurse sees a situation, not as parts, but as a whole in light of long-term goals
· learning from experience, proficient nurses gain a deeper understanding of situations and know how to make appropriate adjustments
· with experience, inductive incorporating of clinical circumstances to help the nurse identify what to expect in different kinds of situations.
Stages of expertise: Expert
· nurse has an intuitive awareness of situations and does not need to rely on rules and guidelines
· The expert “operates from a deep understanding of the total situation”
· Experience is a requisite for achieving expertise
Various Nursing Roles
- Undergrad
- Graduate
- Advnance Practice Nursing
- Clinical Nurse Specialst
- Nurse Practitioner
- Case Manager
- Doctoral Perpared nurses
Nursing Care Delivery Models
Continuity of care – a seamless continuous implementation of a plan of care that is reviewed and revised to meet the changing needs of the client (RNAO).
Functional Nursing
- Model adapted to times of nursing shortage (e.g. WWII).
- Nurses available are designated a task for all patients on the ward:
- A medication nurse
- A dressing nurse and IV nurse
- Assigned nurse may have excellent skills (IV), but does not have holistic knowledge of client/family.
- Advantage: Increased efficiency, nurses become experts with the task.
- Disadvantage: minimal continuity of care, task focused, fragmented care, impersonal care, does not ensure that clients’ needs are met from shift-to-shift, ineffective communication, staff dissatisfaction.
Team Nursing
- Model adapted to times of nursing shortage
- Nurse leads a group of health care workers: another nurse (junior), RNA, orderlies, PAB
- Nurse coordinates overall care, can be provided together or individually
- Nurse is responsible for meds, treatments, IV, orders, may not see “more stable clients”
- Disadvantage: nurse is unable to make thorough assessment of all patients.
- Remains to be task oriented
- Limited team member collaboration
- Limited communication with physicians.
Total Patient Care
- RN is responsible for all of her assigned patients’ care for the duration of the shift
- Patient assignment may change from day to day
- Some care may be delegated to others (RNA, orderly) but remains accountable.
- Works with patient, family, MD to reach set GOALS FOR THE DAY.
- Disadvantage: difficult continuity of care and communication in between shifts, very expensive because nurses provide all aspects of care.
Primary Nursing
- RN assumes responsibility for a group of clients and cares for these for the DURATION OF THE STAY.
- Responsible for assessment, plan, establishes goals and interventions
- Same patient assignment, plan followed from shift to shift and delegated to others on a PRN basis
- Continuity of care, holistic approach, higher level of autonomy for nurse
- Disadvantage: does initially require higher proportion of RN to other staff, $$$$$.
Case/Care Management
- Nurse is responsible for continuity of care for a group of clients who may be may not be on same ward but have similar health care needs
- some may be on home therapy (IV), dsg changes
- Holistic care with special focus on area of need
- E.g. ostomy care
- Disadvantage: nurse not always present at times of change in condition
- Relies on client/ other nurse to notify of change
Nursing and Leadership
- Advocate for quality care
- Collaborator
- Articulate communicator
- Mentor
- Role model
- Visionary, innovator
To Lead and Influence Change
- Leadership: involves change, innovation, growth and empowerment of self and others
- Shared purpose is essential so the changes positively impact the well-being of both the leader and followers, consistent with the collective values
- Based on making choices,
- Making choices involves knowledge and understanding of issues
Leadership: Need to Know
- Need to have an understanding of present day health care,
- The pressures which affect the system ($$, organization, ideology, business model)
- To know the facts, various view points
- Knowledge of ethics (guide to practice)
- Knowledge of our nursing associations: stand on issues, focus of concerns and professional development
- Be informed about the dominant players in health care, who has voice , their agenda, their influence
- Need to keep current, new changes, effect on your patients, institution, your practice.
- Work together with others for collective action towards a specific goal.
Politics and Nursing
- Many “bedside” problems are Health care system problems
- Have profound effect on health and well-being of patients and the general public
- Government and institution policies have direct effect on our level of nursing practice and ability to deliver quality care
Role of Nursing and Politics
Steps in analyzing and articulating an issue:
- Identify the topic (ideally one of interest)
- Select the problem, articulate it clearly. Define your own beliefs and assumptions about it
- Proceed with the analysis using steps/method
- Identify barriers
- Explore strategies for issue resolution
Nursing and Politics: analyzing issues
- Assessment: ask politically focused questions: looking at the BIG picture:
- Who suffers? Or does not benefit? Who or what is left behind?
- Who benefits from this situation?
- What is the cost?
- Who pays the cost?
- Whose purpose is served by this situation remaining unchanged?
Identify the Barriers
- Limited accessibility to resources
- Unable to clarify issues, not clearly understood
- Irresolvable differences or competing interest: block
- Power inequities: resistance to change
- Participant fatigue and unconscious resistance
- Stakeholders may lack tolerance for different viewpoint
- Stakeholders have different own values and beliefs
Strategies for resolution
- Communication and well developed plan is key to success
- Formation of lobby group
- Join an already existing group
- Prepare resolutions for presentation: contact need to know people
- Letter-writing, so all kept in the loop, can serve as subtle pressure (awareness raising)
- May need to contact news media
