Evolution of Nursing

• Nursing


  To nourish
• Nursing evolves as society and health care needs and policies change
• Our profession responds and adapts to the changes by dealing with new challenges as they arise
• Factors that have changed nursing

  • How we care for the sick
  • The way people live
  • Relationship of people with their environment
  • Search for knowledge and truth through education
  • Technologic advances
  • Adapts to changes in health
• Florence Nightingale (1820-1910)


  • Improved standards of care
  • Used good hygiene and sanitation
  • Accurate record keeping
  • Reformed hospitals
  • Influenced public health policies
  • First nursing theorist
  • Established training school for nurses
  • Considered to be the founder of modern nursing
• Contributions of Florence Nightingale in use today

  • Nutrition in healing
  • Clean, fresh air
  • OT and recreational therapy
  • Emotional support
  • Changed psychological aspects for soldiers
• Nightingale Plan


  • New standards in nursing
  • Strict rules for admission
  • Complete records kept
  • Became model for nursing education
  • Patient care improved by good hygiene, sanitation, patient observation, and nutrition improved
• First states to mandate nursing licensure were NC, NJ, NY, VA in 1903
• National League for Nursing (NLN)

  • Founded in 1893 as the American Society of Superintendents of Training Schools for Nurses, the National League for Nursing was the first nursing organization in the United States
• American Nurses Association (ANA)

  • Representing the interests of the nation's 4 million registered nurses
• Changes in nursing during the twentieth century

  • Licensing of nursing
  • National League for Nursing (NLN)
  • American Nurses Association (ANA)
• Nursing caps, uniforms, and pins

  • Cap and Apron
  • Ritual ceremony
  • Decline - more informal, interfered with care, hair loss, harbored germs
  • Dress codes
  • Pinning ceremonies
• Significant changes in nursing during the twenty-first century

  • Demographic changes - older adults, chronic illness
  • Women's health care issues
  • Research has increased
  • Men in nursing - fewer than 10%, common in ED, management, and surgery
  • Human rights - older, dying, pregnant, medically underserved
  • Nursing shortage - average nurse age 42.6, lots of nurses getting ready to retire, other jobs for women, no qualified educators further hinders growth
• Attendant nurses


  • First PN 1892
  • Young Women's Christian Association (YMCA)
  • 3 months education, emphasis on home care, cooking, nutrition, basic science and basic nursing
  • Practical nursing programs improved educational standards, federal funds helped recruitment of men and women
• National Federation of Licensed Practical Nurses (NFLPN)


  • Founded by Lillian Kuster in 1949
  • Membership limited to LPN/LVNs
  • Set standards for LPN, promote and protect LPN's
• National League for Nursing (NLN)

  • In 1961, established the Department of Practical Nursing Programs
  • Developed an accreditation service for these programs, which today is called the Council of Practical Nursing Programs
• Types of practical nursing programs offered for LPN/LVNs

  • Programs must meet minimum state standards
  • Length 12-18 months
• Nurse practice acts


  • Information about the scope of nursing
  • Managed by state agencies such as the state board of nursing
• National Council Licensure Examination for Practical Nurses (NCLEX-PN)


  • Exam successfully completed awards licensure for the state
  • Administered several times a year
  • Pass score
  • Pretest questions
  • Minimum 75 questions maximum 145
  • Five hours to complete
• Health Care System


  • Complete network of agencies, facilities, and providers involved within a specified geographic area
  • Goal to achieve optimal levels of health care for a defined population
  • To meet the needs of the patient
• Wellness-Illness Continuum


  • Range of a person's total health
  • Each individual's position is ever-changing
  • Wellness versus illness
  • Role of holistic health care
  • Factors include age, gender, family relationships, emotional stressors, ethnic and cultural influences and economic status
• Maslow's Model of Health and Illness


  • Most common model utilized
  • Higher levels not requirement but can enhance life
  • Person must meet needs at base of pyramid before advancing to others
  • Higher needs met enhance life

  
• Levels of health promotion

  • Primary prevention - avoid disease, vaccinations
  • Secondary prevention - presence of disease, early detection and treatment
• Person's total health


  Each individual's position is ever-changing
• Wellness versus illness


  Role of holistic health care
• Factors affecting health


  • Age
  • Gender
  • Family relationships
  • Emotional stressors
  • Ethnic and cultural influences
  • Economic status
• Maslow's Model of Health and Illness


  • Most common model utilized
  • Higher levels not requirement but can enhance life
  • Person must meet needs at base of pyramid before advancing to others
  • Higher needs met enhance life

  
• Levels of health promotion

  1. Primary prevention: Avoid disease, Vaccinations

  2. Secondary prevention: Presence of disease, Preventing disease-related complications, Screenings

  3. Tertiary prevention: Management of care of those with serious health problems
• Continuity of Care


  • Patient is the focus in health care
  • Determining patient's individual needs
  • Navigation is challenging due to complexity of health care
• Participants in the Health Care System

  • Professional health care specialist
  • Registered nurses (RNs)
  • LPN/LVN
  • Technologists (baccalaureate degree)
  • Medical technicians (associates or certificate)
  • Dietitians
  • Respiratory therapist
  • Paraprofessionals unlicensed assistive personnel (UAP), unit secretary, etc.
• Holistic medicine


  • Looks at whole person, not just physical symptoms
  • Treats someone as mind, body and spirit, instead of treating only the part of the patient that is most sick
• Economic Factors Affecting Health and Illness

  • Rising health care costs
  • Increasing number of aging Americans
  • Advances in technology
  • Health care insurance
  • Malpractice insurance
• Changes in delivery system

  1. Case management nursing utilizes clinical pathways

  2. Cross-training allows employers to maximize the use of staff
• Social and Environmental Factors that Affect Health and Illness

  • Financial hardships
  • Lifestyle choices
  • Social pressures
  • Personal behavior
  • Level of education
• Patient rights


  • US believes that everyone has a right to health care, regardless of race, color, creed or economic status
  • American Hospital Association (AHA) issued Patient's Bill of Rights in 1972
• Health care providers' rights

  Patients to actively participate in care, ask questions and follow treatment plan
• Interdisciplinary Approach to Health Care

  • Development of comprehensive care plan
  • Effective communication
  • Accurate documentation
• Nursing Care Models


  • Nursing encompasses the roles and actions of the nurse
  • Person or client is the individual receiving the care
  • Health is the area along the wellness-illness continuum that the patient occupies
  • Environment
• Nursing theorists include Roy, Rogers, King, Orem, Neuman, Watson, Benner, Parse, and Leininger
• Practical and Vocational Nurse Defined

  • LPN/LVN provides direct services under supervision of a registered nurse (RN)
  • Is educated to provide safe, responsible, and effective care
  • Performs basic therapeutic, rehabilitative, and preventive care
  • Provides care in all types of settings