Characteristics of advanced nursing practice Development of the framework Implementation of the framework Evaluation and research Scope of nursing practice Principles Values and key components
The nursing practice act Nursing practice in different settings Trend in nursing practice Broadening focusing Scientific basis Technology Indication of increasing technology Expansion of employment opportunity Nursing public perception Changing and modern trends in nursing DEFINITION OF ADVANCED NURSING PRACTICE Advance nursing practice is an umbrella term describing an advance level of clinical practice that maximizes the use of graduate educational preparation, in depth nursing knowledge and expertise in meeting the health needs of the individual, families, group, communities and population. It involves Analyzing and synthesizing knowledge. Understanding, interpreting and applying nursing theory and research. Developing and advancing nursing knowledge and the profession as the whole.
DEFINITION OF NURSING PRACTICE
Nursing practice is an act of providing care to the patient. I n providing care to the patient the nurses implement a nursing care is based on initial condition of the patient. I t is based on specific nursing theory following nursing theory and nursing practice research side by side is must for patient care and nursing practice
CHARACTERSTICS OF NURSING PRACTICE In advance nursing practice nurses builds on their expertise in a specially area, integrating and consistently displaying the following feature and characteristics:- Provision of effective and efficient care, delivered with a high degree of autonomy. Demonstrate of leadership and initiation of change to improve client, organization and system outcomes. Deliberate, purposeful and integrated use of in-depth nursing knowledge, research and clinical expertise.
CONTI Depth and breadth of knowledge that draws on a wide range of strategies to meet the needs of client and to improve access to and quality of care. Ability to apply and explain the theoretical empirical, ethical and experiential foundation of nursing practice. Demonstration of advance judgment and decision making skills. Critical analysis of and influence on healthy policy.
DEVELOPMENT OF THE FRAMEWORK
One of the first priorities of the vice president and CNO (Chief Nursing Office) of the Calgary Health Region was to developmental of this vision, it became apparent that a mission for nursing was also essential. As this work progressed, an evident need emerged to establish a definition of professional practice and a guideline or framework that nurses could utilize on daily basis to achieve the vision and mission of nursing in the region.
APPROVAL OF THE FRAMEWORK After several month of consultation with nurses across the region, discussion at regional nursing council and numerous revisions, the final draft of professional practice framework was approved by Nursing Council and distributes during nurse week 2003. The professional nursing practice framework for the Calgary Health Region.
PROFESSIONAL NURSING PRACTICE FRAMEWORK Implementation Of The Framework Numerous sessions were held to familiarize nursing staff with the framework when it was first launched.
Introduction to the framework is now routinely incorporated into the orientation of all new nurses who join the region
The framework also gives the development preceptors and change nurses.
The major element of the framework next have been linked to the expected RN and RPN competencies articulated in job description, and application of the nurses ongoing professional development and continuing education plan. Evaluation and Research What facilitate internalization of the professional practice framework? Did its implementation change nursing practice of select units? Did changes in nursing practice affects the role of other members of the health care team/ what difference if any? Did implementation of a professional practice framework make in job satisfaction and patient outcomes? What went well in implementing the framework? What could have been done differently?
SCOPE OF NURSING PRACTICE The scope of nursing includes:- Direct care giving Evaluation of care and its impact Advocating for patient and for health Supervising ad delegating to other Leading and managing Teaching, Conducting research Developing health policies for health care system.
The scope of nursing practice is the range of roles, functions, responsibilities and activities which a registered nurse is educated, competent and has the authority to perform.
Nursing is both an art and science. It requires the understanding and applications of specific knowledge and skills and its draws on knowledge and techniques drive from the humanities and the physical, social, medical and biological science.
DEFINITION PRINCIPLES The following are the basis for making decision with regards to the scope of practice for an individual nurse:- The primary motivation for expansion of practice must be the best interest of patient/clients and the promotion and maintenance for the best quality health services for the population.
Expansion of the practice must be made in the context of the definition of nursing and the values that underpin nursing practice.
Expansion of practice must only be made with due consideration to legislation National policy, local policy and guidelines. In determining of his or her scope of practice the nurse/midwife must make a judgment as to whether he/she is competent to carry out the role function. The nurse/midwife must take measures to develop and maintain the competence, communications and evaluations. Expansion of the practice must be based on appropriate assessment, planning, communication and evaluation.
PRINCIPLES The nurse who is delegating a particular role/function (the delegator) is accountable for the decision to delegate.
The individual nurse is accountable for his/her practice this means that he/she is accountable for decision he/she makes in determining his/her scope of practice that included decision to expand or not to expand his/her practice.
PRINCIPLES The following values are mentioned below:-
In making decision about an individuals nurses scope of practice, the best interest of the patient/client and the importance promoting and maintaining the highest standards of quality in the health services should be foremost.
Nursing care should be delivered in a way that respects the uniqueness and dignity of each patient/clients regardless of culture and religion.
Fundamental nursing practice is the therapeutic relationship between the nurse and the patient/client that is based on trust, understanding and support and serve to empower the patient/client to make life choice. SCOPE OF NURSING PRACTICE Nursing profession is accountable for ensuring that its member act in the public interest and provide the unique service that has been designated to them by society. This process is called professional regulation
The profession of nursing regulates itself through defining practice, establishing and developing the public standard of practice and a code of ethics.
CONTI.. In turn, the state through statues, attests to the public that registered nurses meet minimal standards for practice and prohibits unlicensed individual from practicing as registered nurse. Since each state has legal authority for the regulation of nursing, the definition and therefore the scope of nursing practice may vary from state to state. However the laws remain consistent to protect the public.
The nurse practice act was enacted by the legislature to regulate the practice for the purpose of protecting the public.
The act does not designed to protect the public from incompetent nursing, not to protect nurses from discriminatory or questionable employment practice.
Each nurse is responsible and accountable for making decision and practicing in accordance with the individuals educational background and experience in nursing.
NURSING PRACTICE IN DIFFERENT SETTING Individual RNs The registered nurse is responsible and accountable, professionally and legally for determining his/her professional scope of nursing practice.
Since the role and consequently the scope of nursing practice, is ever changing and increasing in complexity. It is important that the nurse makes decision regarding his/her own scope of practice. The Nurse Manager And Nurse Executive The nurse executive in a changing and complex health delivery system is knowledgeable regarding change in rules and regulation accreditation standards and standards for care and practice in addition to evaluation of boundaries specified in nurse practice act.
The nurse executes and/or the nurse manager facilitates changes to assure quality patient care outcomes and develop mechanism that will promote the same.
Mobile Nursing Practice The need was seen in 1984, for local resident to offer extensive care at home. Reduce the cost and remain in their home for a longer period of time Organization known as Mobile health care limited and later changed into Mobile nursing services limited. Provides care during day and night but previously it was given only on business hours. This practice is innovative leader in home health are service and transformed this method to southeast area. It is a largest and oldest home health care system in that area. Mobile introduces many innovation in local health care market and continue to do so Mobile Nursing Services Patient discharge early from hospital Patient suffering from chronic and acute medical problems Surgical patient. Patient requiring I.V. therapy. The elderly. Respiratory patients. The seriously ill.
Patient in need of medication management Hospice concept Ventilator dependent (Assistance) with bathing, dressing, meals, transportation, light housekeeping Service may be covered by Medicare, medical private insurance, private payment.
These services provide home teaching and care for patient with varied needs and health problem:-
MILITARY NURSING SERVICES The military nursing services has its origin from the Army Nursing Service formed in 1881 part of Royal army. After the war on 1 October 1926 the nursing services was granted permanent status in Indian Army Second World War:-
With the outbreak of second world war, nurses once again found themselves serving all over the world During the mid of the war,1943 Indian Army Nursing services separated from Indian Military nursing service ordinance. And redesignated as Military Nursing Service (MNS) The Military Nursing Service stands out as one of the oldest services where women have contributed directly to the nations war effort by providing care to the sick and wounded soldiers; this is true for all the armed forces of the world.
The army nurses have made a permanent place in every Nations heart by nursing million of sick and wounded soldiers back to health The officers of Military Nursing Services had distinguished themselves in the Second World War, through the care of the sick and wounded soldiers in India and also at many foreign threats of war Post independence, the nursing officers cared for the wounded soldiers in five major bloody conflicts with the neighboring countries. RANK STRUCTURE Commissioned officers Major- General Brigadiers Colonel Lieutenant Colonel Major Captain Lieutenant
TELE NURSING Refers to the use of telecommunication and information technology for providing nursing services in health care whenever a large physical distance exists between patient and nurse, or between any numbers of nurses As a field it is part of tele health and has many points of contacts with other medical and non medical application, tele monitoring etc. Tele nursing is achieving large number of growth in many countries, due to several factors, the preoccupation in driving down the costs of health care, an increase in the number of aging and chronically ill, population and the increase in coverage of health care to distant, rural or small populated region. Among its many benefits, tele nursing may solve increasing shortages of nurses; to reduce distance and save travel time and to keep patient out of hospital. A greater degree of job satisfaction has been registered among tele nurses
The development of nursing robot system included the development of a mobile robot system to help physically handicapped people. Completed in 1986, the nursing Robot was one of the first fully functioning mobile robots equipped with a manipulators arm, also integrated with seven different sensor systems. The system was controlled by four networked on board Sinclair spectrum computer and on off board IBM-PC.
COTIN The nursing robot system comprises their major components; a self propelled vehicle, a robotic arm mounted on it, and a communication post next to the disabled persons bed.
Onboard the mobile robot low cost micro-computers are interconnected as a hierarchical network in order to control a variety of activities, sensor data processing motion control, path planning, communication and others.
The vehicle can move autonomously in a room with unexpected obstacles.
Nursing in Occupational Health OHNs are registered nurses who independently observe the assess the workers health status with respect to job tasks and hazards, using their specialized experience and education, these registered nurse recognize and prevent health effects from hazardous exposure and treat workers injuries/illness
SCOPE OF OHN OHNs bring their nursing expertise to all industries such as meat packing, manufacturing, construction as well as the health care industry, OHNs have:-
Have special knowledge of work place hazards and the relationship to the employee health status.
Understand industrys hygiene principles of engineering controls, administrative controls, and personal protective equipment.
Have knowledge of toxicology and epidemiology as related to the employee and the work site.
School Health Nursing School nurses are primary care nurses for school children. They work with individual children young people and families, schools and communities to raising educational standards.
A school nurse is qualified, experienced professional and the only trained nurse working across health and education boundaries, they also provide the link between school, home and the community Responsibilities of School Health Nurse Promoting healthy life style and school Child and adolescent mental health. Chronic and complex health care need in children and young people Vulnerable children and young people
Activities of school health nurses Health assessment for children at entrance to the school when required. Individual health interviews offered to young people aged 13 -14 years. Immunization programme. Child protection. Health education.
TRENDS IN NURSING PRACTICE Trends in nursing care closely tied to what is happening to health care in general. Trends are fascinating phenomena, but they do not existing in vacuums; Most are interrelated; one trend often spawns another, although trends are more than fads, They are far from money back guarantees. We watch to anticipate the direction that particular trends will take us, to remove the elements of surprise, when we look back on trends, however, some will have permanent changes, but other might have temporary.
BROADENING FOCUS The focus of nursing has broadened from the care of the ill person to the care of the people in illness and from care of only the patient to care of the clients, the family, and in some instance the community.
In the past, nursing like medicine was oriented towards disease and illness.
Today there is increasing recognition of people needs for health care as distinct from illness care and of the nurses independent functions in this area.
CONTI. Another aspect of the broader nursing focus is to the movement of nursing practice into the community. In a sense there is a return to the beginning of nursing that is before it becomes a recognized occupation.
Throughout most of this century however nurse worked only in institution, increasingly nursing services are provided in community often in homes and clinics.
The nursing activity not only assists those who are ill but also helps those who are healthy to maintain or continue their health.
Scientific Basis In the past nursing largely was either intuitive or relied on experience or observation rather than on research, through trial and error the individual nurses discovered with measures that would assist the client and many nurses become highly skilled in providing care through experience.
TECHNOLOGY Technology or mechanization is being applied in the health field extensively. Certain areas of a hospital care most technologic than others. Nurses find themselves in the midst of rapidly changing, increasingly technologic environment in hospital and in clients homes.
Indication Of Increasing Technology The proliferation of the technologic equipment used in case of client in hospitals and homes. The increasing home and self care equipment. Use of computers in many areas of health care.
Many nurses feel they need more education to obtain the knowledge and skills necessary to use the new technology. High technology has enabled nurse to gather client assessment data through non-invasive techniques (eg:- pulse oxymetry) rather than the costly invasive procedure.
Expansion of employment opportunities Nursing practice trends include a growing variety of employment setting in which nurses have greater independence, autonomy and respect as member of the health care team.
Nursing role continue to expand and develop broadening the focus of nursing are and providing a more holistic and all encompassing domain.
Nursing therapies are not only drawing from traditional nursing and medicine, spiritual and emotional realms, but also expanding into alternative therapies such as healing touch, massage therapy and use of natural herbs and vitamins. The Johnson Foundation has developed compelling, attention getting media campaign on nursing profession.
This media clips show nursing practice, and the nurses featured in the advertisement and described their satisfaction in the profession, nursing is a pivotal health care profession, as frontline health care providers, nurses practice in all health care setting and constitute the largest number of professionals.
Nurses are essential to provide skilled, specialized knowledgeable care, to improve the health status of the public and to ensure safe effective quality care; in addition, the American Public rated nurses high in honesty and ethics in their professional role Nursing Public Perception Nursing Impact on Politics and Health Policy The ability to influence or persuade an individual holding a government office to exert the power of that office to affect a desired outcome is known as Political power or influence.
Nurse involvement in politics is receiving greater emphasis in nursing curricular professional organization and health care setting.
Professional nursing organizations have employed lobbyists to urge state legislature and the US congress to improve the quality of health care.
CHANGING TRENDS IN NURSING Nursing has originated from the word nurturing which means nourishing, helping in growth and development of a human being, in the past nursing was family based work. Modern nursing began in the 19 th century under the leadership of Florence Nightingale. The aim of nursing was only to promote the recovery of patients. Even now the central concern of nursing is nurturing the human beings.
The present day nurse provides care for the people in health services and illness. Nursing is one of the health services which contribute to well being of an individual, family and community. Therefore, nursing is defined as a humanistic science dedicating to maintain and promote health preventing illness care for and rehabilitation of the sick and disabled person Nursing process includes doing, thinking and interaction component. It is mainly and basically a problem solving approach of nursing cares. The nursing process consists of five steps
Assessment Nursing Diagnosis Planning Implementation Evaluation MORDEN TRENDS IN NURSING PRACTICE
. A Rekindled interest in Eastern Religion, lifestyle and medicine has fueled the development of complementary holistic, alternative complementary modalities. Client are seeking out alternative/complementary therapies because most such therapies are non invasive, holistic and in many instance less expensive than going to a physician.
In 1993 a landmark survey found 1/3 of the US population had used some nontraditional alternative method of treatment in addition to the standard medical treatment. In 1993 the US Government established an Office of Alternative Medicine at the National Institute of Health. One of the reason for the OAMs creation was the US citizens are pursuing alternative methods of health care with unpredicted enthusiasm. In 1992, the OAMs was allocated 2 million to investigate the use of nontraditional treatment methods. A few therapies investigated by the OAMs -1995:-
Biofeedback to control pain Acupuncture to relieve depression Imagery to control Asthma Ayurvedic medicine to treatment to treat parkinsons disease Music therapy to treat brain injured client Shark cartilage to treat cancer
Kozier, Fundamental Of Nursing 5 th Edition, page no. 18-21, 40-41. Lois While Fudamental of Nursing Mosby Publication, Page No.85, 224. Patricia A. Potter, fundamental Of Nursing 3 rd edition, Mosby Publication, Page no.- 29-31 Potter and Perry, fundamental Of Nursing, 5 th edition Mosby publication. Shabeer P. Basheer, A Concise Book of Advanced Nursing Practice 1 st
edition, 2012, Emmss medical publishers, page no. 648-675.