Nursing Trends

40

65

Two thirds of all rural hospitals

46.8 years

5.7%

49%

56%

14.9%

11.5%

78%

13.8%

Advanced Practiced RNs (APRNs) = 8.6%

• Breakdown of APRNs:
• NP = 51%
• CNS (Clinical Nurse Spec) = 24%
• CRNAs = 13%
• NP-CNS = 6%
• Nurse Midwives = 4%

Many textbooks and journal articles may become out of date quickly.

Reinforces development of effective writing skills and the use of standard protocols required in academic and professional documents.

Florence Nightingale

Patient advocate

A process of systematic inquiry or study to build knowledge in the discipline of nursing.

Nursing is a practice profession, therefore it is important that clinical practice be based on scientific knowledge. Evidence generated by nursing research provides support for the quality and cost-effectiveness of nursing interventions.

Florence Nightingale

The process of systematically finding, appraising, and using research findings as a basis for making decisions about patient care.

They don't exist anymore. You don't finish with a degree. They were, however, excellent nurses because they received on-the-job training.

• 1. National Institute for Nursing Research (NINR)
• 2. Agency for Healthcare Research and Quality (AHRQ)
• 3. Private Foundations
• 4. Professional Organizations

• Part of the National Institutes of Health
• Supports research on the biological and behavioral aspects of critical health problems that confront the nation.
• Major emphasis on at-risk, underserved populations, and on high-quality, cost-effective care.
• For instance, NINR, improves clinical settings.

• Agency of the Department of Health and Human Services
• Mission: to improve the quality, safety, efficacy, effectiveness of healthcare for all Americans.
• This is a Federal agency that funds research, for instance, for patient safety (e.g., the right meds, the right surgery on the right patient, the right blood for the right patient, etc.)
• Their biggest priority: PATIENT SAFETY

• 1. Systematic method
• 2. you research just about anything you do
• 3. process of systematic inquiry or study to build knowledge in the discipline of nursing

As a practice profession, it's important that clinical practice be based on SCIENTIFIC knowledge.

• 1. Part of all nursing curricula
• 2. the process of systematically finding, appraising, and using research findings as a basis for making decisions about patient care.
• 3. Nurses figure out what needs to be researched because of what they do on the job.

• 1. Formulate a question
• 2. Define the purpose
• 3. Review the literature
• 4. Formulate the hypothesis and define the variables
• 5. Select the research design
• 6. Select the sample
• 7. Conduct the pilot study
• 8. Collect the data
• 9. Analyze the data
• 10. Communicate the conclusions

Opinions and Feelings

Numbers and Statistics -- You can rank something and get a percentage.

A small study also referred to as a feasibility study. The purpose is to identify the strengths and limitations of the proposed LARGER study.

• 1. Related to Quality
• 2. Related to Nurses
• 3. Related to Healthcare Organizations
• 4. Related to the Nursing Profession

• Be a role model!
• Ask Questions
• Do the right thing
• Embrace change
• Be a patient Advocate

• 1. Acute pain management in infants, children and adolescents
• 2. Prediction and prevention of pressure ulcers in adults
• 3. Identification and treatment of urinary tract incontinence in adults (monitor what goes in and out, weigh them, color and clarity of urine).

There are 5 libraries; the best resource for nursing is the CINAHL

A committee also called a human subjects committee who's purpose is to examine all research proposals involving human subjects to ensure that the ethical rights of the individuals participating in the proposed study are protected.

IRB makes sure that the subjects are not adversely harmed. They have to approve any study before the research can move forward.

• 1. Any NIH websites are credible
• 2. Make sure that the information is 5 years or earlier when you recommend a patient or a consumer to look it up.
• 3. Make sure the author is credible
• 4. Non-sponsored site
• 5. Are there links that have continuity credibility?
• 6. Can you get feedback interaction?

1. There are hospital information systems that cross check orders, for instance, allergies that a patient may have, double orders, competing meds, meds that are contraindicated for certain age groups, etc.

2. Coded arm bands and meds - automated med management systems

3. Smart infusion pump delivery systems - DO NOT RELY ON THESE. Always calculate this yourself.

4. Electronic Health Record System - all of your information in one place. This is for more consistent patient healthcare. The Netherlands leads the way with this system.

1. The ability to do things at the bedside.

2. istat - gives you ABGs, Hbs, etc. on the spot without having to wait two hours for lab results. However, it has reliability issues. Most information can be uploaded on the computer.

You can run into HIPPA issues if you leave your computer on with patient information if you choose to walk away with it and leave yourself logged on.

You can't even look up your own information since you're not responsible for your own information as the care giver.

This is traceable and needs to remain professional. The VA leads the way in this type of assistance with patients that have congenital heart disease.

One of Three Americans are an Ethnic minority

When people within a group have more of a burden of a disease than others do. (e.g. African Americans have a greater risk for sickle cell disease).

When you have a preconceived notion about something or someone and your act solely based on that notion.

• 1. 1893 - The Nightingale Pledge
• 2. 1950 - ANA Code of Ethics for Nursing
• 3. 1954 - International Council of Nurses Code of Ethics
• 4. A public statement of a profession's agreement with society

Utilitarianism: the ends justify the means

The "great happiness principle"

Duty and obligation

End results are unimportant

• 1. Actions are based on innate moral traits
• 2. Moral character of an individual is the key to good behavior
• 3. Virtue is learned by habit
• 4. Virtuous people do virtuous things

• 1. Autonomy
• 2. Beneficience
• 3. Nonmaleficence
• 4. Justice

• 1. Freedom to make independent choices
• 2. Self-governing
• 3. Right to self-determination

• 1. Do good
• 2. Nurse must act to benefit of the patient
• 3. Good can be medical good or patient's total well-being
• 4. Protect the patient from incompetent, unethical, illegal, or impaired practice

• 1. Each person is respected.
• 2. Each person is able to determine personal goals
• 3. Each person has the capacity to decide
• 4. Each person must be free to act on personal choices

Avoid causing harm

Fair, equitable, and appropriate treatment

• 1. Truth-telling
• 2. promise-keeping
• 3. Professional accountability
• 4. Practice within the scope of nursing practice

• 1. Keep all personal patient information private
• 2. Respect of persons
• 3. NO sharing of patient information

• 1. Moral integrity
• 2. Sensitivity, compassion and caring
• 3. Responsibility
• 4. Empowerment
• 5. Patience and willingness to deliberate

Nursing process - a deliberate activity that provides a systematic method for nursing practice utilizing both logical thinking and intuitive knowing.

• 1. Articulate the problem
• 2. Gather data and ID conflicting moral claims; analyze alternatives
• 3. Explore strategies
• 4. Implement the strategy and justify the selection
• 5. Evaluate the outcomes of action

• Life
• Death
• In-between

• Moral distress
• Moral outrage
• Moral reckoning

• Challenge of veracity
• Challenge of paternalism
• Challenge of autonomy
• Challenge of accountability

• 1. Holmes lifeboat method
• 2. Triage or cost-benefit calculation of worth method
• 3. Lottery method
• 4. Equal shares method
• 5. Equal consideration method