Week 1A: Professional Identity, Theory, and Nursing Theory

Professional Identity, Theory, and Nursing Theory Readings: pg 12-14, 22-23, 62-83, 216-230 The Development of Nursing Education in Canada (pg 12-14) - Nursing education gradually shifted from physicians-as-teachers and the apprenticeship model to institutional training - The first university program in Canada was established in 1919 at the University of British Columbia (UBC) - University programs emphasized the theoretical aspects of nursing, and then you would move to the hospitals for hands-on training experiences - Dr. Margaret Elder Hart provided leadership for the advancement of nursing education at the University of Manitoba. She served as director at the School of Nursing for 24 years. Dr. Helen Preston Glass succeeded Dr. Hart and created the Master of Nursing Program, the Manitoba Research Institute, and served as president of the CNA. - In Canada, nurses who undertake further study, typically at the graduate or master’s level, can become advanced practice nurses. - Like CNS’s, and NP’s (which have different roles) - NP’s: can perform activities beyond the scope of an RN; including prescribing medications, ordering and managing the results of screening and diagnostic tests, and performing minor surgical and invasive procedures - CN’s: functions within the full scope of an RN and do not require additional regulatory authority; direct and indirect care in collaboration, scholarship, and empowerment The Art and Science of Nursing (pg 22-23) - Enacting the art and science of knowing requires knowledge from the four domains: empirical knowing, personal knowing, ethical knowing, and the aesthetics of nursing - The nurse-patient relationship is always professional and therapeutic, and is characterized by the following components: - Trust - Respect - Professional intimacy - Empathy - Power Professional Regulation (pg 62-83) - Regulation: establishing and enforcing rules to govern behaviour of people or groups - Self regulation: recognizes that a profession is in the best position to determine standards for education and practice and ensure standards are met - Regulatory body: an organization that monitors and enforces these standards (ie. nursing) They are given authority through legislation, to set out standards, among other duties it must perform, to ensure that the public is protected. - - Regulating in public interest - Public interest refers to how a profession enacts its obligations to ensure the welfare of society; in nursing this means the provision of safe, competent, and ethical client care for all people. We place the interests of the public above interests of the profession or individual nurses - This relationship between the nursing profession and society (the public) is a type of social contract where professional rights and responsibilities are set as well as expectations for public accountability Health professional regulation in Canada is a provincial/territorial matter Nursing regulatory bodies have the authority to regulate individual nurses, not the organizations in which they work The regulatory body protects the public by being a gatekeeper, setting out requirements for those entering the profession and how they maintain their registration in the profession (including the competencies, education program, annual requirements for registration etc.) What is Nursing? - The title of nurse is highly regulated so that only those with the proper qualifications are given the title of nurse so the public can feel safe knowing those with that title are properly regulated with the proper standards. - Scope of practice refers to those activities that nurses are educated and legally authorized to perform. The scope of practice is usually set out in legislation, and just like the definition of nursing, it is fairly broad. → Health Professions Act (HPA) National and International Perspectives of Nursing - The Canadian Nurses Association (CNA) is the national professional association of registered nurses. It does not regulate nurses, but it does work with provincial/territorial regulatory bodies - The International Council of Nurses (ICN) is a federation of national nurses’ associations representing nursing worldwide; CNA is a member of the ICN. The ICN acts as a global forum for member countries to establish or reform nursing professional regulatory practices. - Professionals are regulated. Students have not yet assumed the professional role, but they are still expected to practice within their competence level as a student, to practice within the standards, and to practice within the policies of the education program in which they are enrolled - The nursing profession has characteristics that define it as a profession: accountability, specialized body of knowledge, competent application of knowledge, code of ethics, service to the public, and self-regulation Regulation and Nursing Education - The regulatory bodies protect the public by setting the standards of practice and competencies to be demonstrated in order to be eligible for registration following - - - graduation. The competencies encompass the knowledge, abilities, skills, attitudes, and clinical judgments required to provide competent, safe, and ethical client care A standard is an authoritative statement that describes the required behaviour of every nurse and is used to evaluate individual performance Practice standards are different from professional standards because practice standards are normally short documents that describe standards for carrying out particular aspects of client care that are essential to client’s physical and psychological safety - Eg. medications, documentation of client care, on client records or charts, and nurse-client relationships, confidentiality and the privacy of client information, medical assistance in dying (MAID), client consent to care, duty to provide care, and duty to report Knowledge-based practice is based on up-to-date knowledge and the latest research findings, not on myth, or things have always been done Requisite skills and abilities to attain entry-level competencies: - Cognitive - Behavioural - Communication - Interpersonal - Physical - Sensory perceptual - Environmental Although review processes vary by province/territory there are commonalities in most regulatory bodies, like the requirement to undergo a review process on a regular basis (at least every 4-7 years) - The review process is a systematic evaluation to determine whether the provincial/territorial regulatory body will approve or recognize the nursing education program. This is done to establish the eligibility of program graduates to proceed in the registration process Interacting in a Responsible and Accountable Way - You are responsible for ensuring clients know who you are and what you will be doing. You are also holding yourself accountable because clients can ask questions or express any concerns they may have about your care. Clients and the public have the right to complain about their care; if they do not know your name and role, clients are hampered in acting on this right - Nurses have ethical and legal responsibilities to ensure clients give their consent to accept care based on their full understanding of what is being done. - Informed consent - Consent for care or treatment - Right to refuse treatment - Right to participate or not participate in a research study - Consent related to the release of any of their health information - Client information is shared only on a need-to-know basis, that is, by those health-care - providers who need the information to plan, provide, and evaluate client care Social media talk of patients is unacceptable Professional presence means acting with confidence, integrity, optimism, passion, and empathy in accordance with professional standards, guidelines, and codes of ethics (including reflective practice, verbal and nonverbal communications, and the ability to articulate a positive role and professional image) Being: How to Be a Professional - Under certain circumstances and conditions you are able to refuse care for which you are not competent, educated, or authorized to perform because it is considered unsafe practice - In all cases, the nurse never abandons the client(s) and is always expected to follow a process to communicate concerns to the appropriate authority such as the employer and ensure that the client’s care and safety is not compromised. - Nurses have a legal and ethical duty to provide safe, ethical, and competent care. We call this a duty to provide care - Nurses are not expected to place themselves or remain in situations of unnecessary risk - Categories of situations that may influence your duty to provide care: - Unreasonable burden - Personal danger - Individual competence - Conscientious objection - Nurses, along with other health professionals have an ethical duty to report unsafe, incompetent, or unethical practice. This means that nurses who observe practices by nurses or other health professionals that place clients at risk have an obligation to report significant concerns about an individual professional to their regulatory body - Failure to report may place you in a position of professional misconduct - Fitness to practice refers to all the qualities and capabilities of an individual relevant to his or her capability to practice as a nurse, including freedom from any cognitive, physical, psychological, or emotional condition or a dependence on alcohol or drugs, that impair his/her ability to practice nursing - It is the individual's responsibility for maintaining fitness to practice - Eg. illness or injury, emotional health, drinking, head injury, drugs, sleep deprivation, severe emotional distress Understanding the Requirements for Individual Self-regulation - Self-regulation refers to how you, as an individual regulate your practice - Self-assessment of one's own competence is a cornerstone of safe practice and lies in the heart of self-regulation by individuals. Self-assessment may also be referred to as self-evaluation - Reflecting on your practice enables you to look back at your performance and feelings to identify what you did well and what you can improve, and what things you need to learn about, practice, and plan to do next - Learning plans help you learn one of the typical quality assurance/continuing - - - - competence requirements for nurses. Part of a learning plan is to evaluate its effectiveness in order to develop future learning plans that enable you to maintain and advance your ability to consistently provide safe, competent and and ethical care with patients Government legislation typically requires that regulatory bodies have a quality assurance or continuing competence program to ensure the continued competence of nurses to provide safe care, and increase their competence from year to year Many regulatory bodies have developed a jurisprudence examination as part of registration or continuing competence/quality assurance requirements. Jurisprudence refers to knowledge of the laws, regulations, and standards that relate to nursing practice Continuing competence means the ongoing ability of a registered nurse to integrate and apply the knowledge, skills, judgment, and personal attributes required to practice safely and ethically in a designated role and setting. Maintaining ongoing abilities involves a continual process linking the code of ethics, standards of practice, and lifelong learning. The regulatory bodies develop and keep the standards of practice up-to-date by consulting with nurses in practice, education, research, and administration, as well as other stakeholders, including employers and government Setting the Stage: Concepts and Theory (pg 216-230) - A concept is an idea or notion that represents some aspect of personal/human experience. Our understandings of concepts can change over time - A theory comprises several concepts used to describe, explain, or make predictions about a phenomenon (what we are interested in understanding). Theory helps us to organize knowledge, make sense of ideas, and promote new discoveries to advance the practice of nursing Understanding the Use of Theory in Knowledge Development in Nursing - In England during the 19th century, poor, uneducated women tended to the needs of wealthy people in their homes. They were called “nurse” or “governess”. This role was to provide domestic help, look after the children in the home, and to tend to the needs of the sick. Formal education or training was not deemed necessary - Women began to pursue an education for better wages and nursing as a profession became more acceptable, and led to a gradual shift in the positive perception of nursing - Florence Nightingale is considered to have founded modern nursing through her work of caring for ill and injured soldiers during the Crimean War, as well as increasing the sanitation of the soldier’s surroundings. The Metaparadigm Framework - Metaparadigm describes the key concepts that are central to the discipline of the nursing profession. This model was created by Fawcett and includes 4 frameworks: - Person: receives care from the nurse - Health: beyond being well, one’s ability to use all human powers - - - - Environment: external (eg. fresh air) and internal (eg. intake) factors Nursing: modifying and/or managing the environmental factors to implement laws of health Health is a subjective or relative concept that is determined by each individual or community. There are many interpretations of health that are often intertwined with the idea of wellness/illness. The concept of health includes the physical, psychosocial, relational, and spiritual aspects of an individual, family, or community The WHO defines health as “a state of complete physical, mental, and social well-being, and not merely the absence of disease and infirmity” Environment affects individuals both externally and internally. The CNA helps to identify every Canadian nurse’s place in promoting a healthy environment, given its impact on health The definition of nursing includes the care (health promotion and illness prevention) provided to individuals of all ages, families, groups, and communities, sick or well, and in all settings. The practice of a nurse in Canada is guided, in part, by the CNA’s Code of Ethics and we have the ethical responsibility to: - Provide safe, compassionate, competent, and ethical care - Promote health and well-being - Promote and respect informed decision-making - Preserve dignity - Maintain privacy and confidentiality - Promote justice - Be accountable Nursing Theorists and Nursing Theories - Nursing theory represents the body of knowledge that is used to describe or explain various concepts found in nursing practice - Grand nursing theories: are abstract and serve to frame disciplinary knowledge that are not specific to any particular areas of practice or client situations - Midrange theories: are narrower in scope, serving as a bridge between grand nursing and practice level theories. They are considered to be focused enough to provide guidance for practice and research and can be tested - Nursing practice theories: are developed for use within specific nursing care situations and others. They provide a framework for nursing interventions or activities, and suggest outcomes or the impact of nursing practice - Nursing (and health care) has historically focused on a deficit model of care. Strengthsbased nursing care represents theory that introduces a new way of thinking in nursing; thinking that has implications for practice and nursing interventions. It signifies refocusing on individual, family, and community strengths as a foundation for nursing care - Katharine Kolcaba developed a middle-range theory, in part, based on her contributions related to the concept of comfort in nursing (relief, ease, and transcendence) as well as the physical, psychospiritual, environmental, and social contexts where comfort occurs - Barbara Carper’s Fundamental Patterns of Knowing - Empirics: scientific, factual, and objective data used to explain a phenomenon Aesthetics: subjective knowledge developed from personal experiences Personal: knowledge that emerges from an interaction between the nurse and the patient Ethics: the moral knowledge that a nurse possesses; what is right and wrong