Nursing
Definition: Although nursing practice varies both through its various specialties and countries, these nursing organizations offer the following definitions: Nursing encompasses autonomous and collaborative care of individuals of all ages, families, groups, and communities, sick or well, and in all settings.
Nursing includes the promotion of health, prevention of illness, and the care of ill, disabled, and dying people. Advocacy, promotion of a safe environment, research, participation in shaping health policy and in patient and health systems management, and education are also key nursing roles.
International Council of Nurses
The use of clinical judgment in the provision of care enables people to improve, maintain, or recover health, cope with health problems, and achieve the best possible quality of life, whatever their disease or disability, until death.
Royal College of Nursing (2003)
Nursing is the protection, promotion, and optimization of health and abilities; prevention of illness and injury; alleviation of suffering through the diagnosis and treatment of human responses; and advocacy in health care for individuals, families, communities, and populations.
American Nurses Association
The unique function of the nurse is to assist the individual, sick or well, in the performance of those activities contributing to health or its recovery (or to peaceful death) that he would perform unaided if he had the necessary strength, will, or knowledge. — Virginia Avenel Henderson.
As a profession
The authority for the practice of nursing is based upon a social contract that delineates professional rights and responsibilities as well as mechanisms for public accountability. In almost all countries, nursing practice is defined and governed by law, and entrance to the profession is regulated at the national or state level.
The aim of the nursing community worldwide is for its professionals to ensure quality care for all while maintaining their credentials, code of ethics, standards, and competencies, and continuing their education.
There are several educational paths to becoming a professional nurse, which vary greatly worldwide; all involve extensive study of nursing theory and practice as well as training in clinical skills.
Nurses care for individuals of all ages and cultural backgrounds who are healthy and ill in a holistic manner based on the individual’s physical, emotional, psychological, intellectual, social, and spiritual needs.
The profession combines physical science, social science, nursing theory, and technology in caring for those individuals. To work in the nursing profession, all nurses hold one or more credentials depending on their scope of practice and education.
In the United States, a Licensed Practical Nurse (LPN) works independently or with a Registered Nurse (RN).
The most significant difference between an LPN and RN is found in the requirements for entry to practice, which determines entitlement for their scope of practice.
RNs provide scientific, psychological, and technological knowledge in the care of patients and families in many health care settings. RNs may earn additional credentials or degrees.
In the United States, multiple educational paths will qualify a candidate to sit for the licensure examination as an RN.
The Associate Degree in Nursing (ADN) is awarded to the nurse who has completed a two-year undergraduate academic degree awarded by community colleges, junior colleges, technical colleges, and bachelor’s degree-granting colleges and universities upon completion of a course of study usually lasting two years.
It is also referred to as Associate in Nursing (AN), Associate of Applied Science in Nursing (AAS), or Associate of Science in Nursing (ASN).
The Bachelor of Science in Nursing (BSN) is awarded to the nurse who has earned an American four-year academic degree in the science and principles of nursing, granted by a tertiary education university or similarly accredited school.
After completing either the LPN or RN education programs in the United States, graduates are eligible to sit for a licensing examination to become a nurse, the passing of which is required for the nursing license.
The National Licensure Examination (NCLEX) test is a standardized exam (including multiple choice, select all that apply, fill in the blank, and “hot spot” questions) that nurses take to become licensed. It costs two hundred dollars to take and examines a nurse’s ability to properly These options can also include, community health, mental health, clinical nursing specialists, and nurse midwives.
RNs may also pursue different roles as advanced practice nurses. Nurses are not doctors’ assistants. This is possible in certain situations, but nurses more often are independently caring for their patients or assisting other nurses.
RNs treat patients, record their medical history, provide emotional support, and provide follow-up care.
Nurses also help doctors perform diagnostic tests. Nurses are almost always working on their own or with other nurses. However, they also assist doctors in the emergency room or trauma care when help is needed.
Despite equal opportunity legislation, nursing has continued to be a female-dominated profession in many countries; according to the WHO’s 2020 State of the World’s Nursing, approximately 90% of the nursing workforce is female.
For instance, the male-to-female ratio of nurses is approximately 1:19 in Canada and the United States.
This ratio is represented around the world.
Notable exceptions include Francophone Africa, which includes the countries of Benin, Burkina Faso, Cameroon, Chad, Congo, Côte d’Ivoire, the Democratic Republic of Congo, Djibouti, Guinea, Gabon, Mali, Mauritania, Niger, Rwanda, Senegal, and Togo, which all have more male than female nurses.
In Europe, in countries such as Spain, Portugal, the Czech Republic, and Italy, over 20% of nurses are male.
In the United Kingdom, 11% of nurses and midwives registered with the Nursing and Midwifery Council (NMC) are male.
The number of male nurses in the United States doubled between 1980 and 2000.
However female nurses are still more common, but male nurses receive more pay on average. Research has indicated that there can be negative effects of diversity within nursing. When there is a heavier focus on diversity in nursing, the quality of care or performance of the nurses can be hindered.
Research demonstrates that as people begin to be different in a work setting, this can create issues if not addressed correctly. When hospitals begin to focus on diversity over their patients, the quality of care can be negatively affected if diversity becomes the main goal. care for a client. Study books and practice tests are available for purchase.
Some nurses follow the traditional role of working in a hospital setting. Other options include pediatrics, neonatal, maternity, OBGYN, geriatrics, ambulatory, and nurse anesthetists and informatics (eHealth). There are many other options nurses can explore depending on the type of degree and education acquired.
Minorities in U.S. nursing
Statistically speaking, in the United States, 19.2% of nursing positions are held by people of minority backgrounds. The remaining 80.8% of positions are held by Caucasian individuals, particularly women. Diversity in nursing is lacking.
Theory and process
Nursing practice is the actual provision of nursing care. In providing care, nurses implement the nursing care plan using the nursing process. This is based on a specific nursing theory which is selected in consideration of the care setting and the population served. In providing nursing care, the nurse uses both nursing theory and best practices derived from nursing research.
The nursing process is made up of five steps:
- evaluate,
2. an implement,
3. plan,
4. diagnose, and
5. assess.
Nurses can use this process from the American Nurses Association to determine the best care they can provide for the patient. There are many other diverse nursing theories as well.
In general terms, the nursing process is the method used to assess and diagnose needs, plan outcomes and interventions, implement interventions, and evaluate the outcomes of the care provided. Like other disciplines, the profession has developed different theories derived from sometimes diverse philosophical beliefs and paradigms or worldviews to help nurses direct their activities to accomplish specific goals.
Scope of activities
Activities of daily living assistance
Nurses manage and coordinate care to support activities of daily living (ADL). Often the provision of such care is delegated to nursing assistants. This includes assisting in patient mobility, such as moving an activity intolerant patient within bed.
Medication
Medication management and administration are a part of most hospital nursing roles, however, prescribing authority varies between jurisdictions. In many areas, registered nurses administer and manage medications prescribed by a professional with full prescribing authority such as a nurse practitioner or a physician.
As nurses are responsible for evaluating patients throughout their care – including before and after medication administration – adjustments to medications are often made through a collaborative effort between the prescriber and the nurse. Regardless of the prescriber, nurses are legally responsible for the drugs they administer.
There may be legal implications when there is an error in a prescription, and the nurse could be expected to have noted and reported the error. In the United States, nurses have the right to refuse any medication administration that they deem to be potentially harmful to the patient.
In the United Kingdom, some nurses have taken additional specialist training that allows them to prescribe any medications from their scope of practice.
Patient Education
The patient’s family is often involved in the education. Effective patient education leads to fewer complications and hospital visits. ] Many times, nurses are very busy and have a hard time giving information to the patient because they have so many other things going on. Educating the patient and their family increases the chance for a better patient experience.
Giving the best care requires informing the patient of what is going on and support. While explaining procedure, recovery, and taking care of the patient, nurses also have to help patients and their families cope with different medical situations.
When speaking with the patient, nurses have to be able to communicate in a way that can be understood by the patient. Informing the patient may involve speaking in broad, general terms, using visuals or different reading materials, and even including demonstrations if necessary. The more the patient and their family understand what the nurse is saying, the better healthcare the patient can receive without the assistance of a nurse.
Specialties and practice settings
Nursing is the most diverse of all health care professions. Nurses practice in a wide range of settings but generally, nursing is divided depending on the needs of the person being nursed.
The major populations are: communities/public family/individuals across the lifespan adult-gerontology pediatrics neonatal women’s health/gender-related mental health informatics (eHealth) acute care hospitals ambulatory settings (physician offices, urgent care settings, camps, etc.) school/college infirmaries Nurses with higher degrees allow for specialization within the medical field.
Many specific nursing professions can be separated into categories of care type, age, gender, certain age group, practice setting, etc. Nurses can specialize in a combination of these categories as well.
There are also specialist areas such as cardiac nursing, orthopedic nursing, palliative care, perioperative nursing, obstetrical nursing, oncology nursing, nursing informatics, telenursing, radiology, and emergency nursing.
Nurses practice in a wide range of settings,
including hospitals, private homes, schools, and pharmaceutical companies. Nurses work in occupational health settings (also called industrial health settings), freestanding clinics and physician offices, nurse-led clinics, long-term care facilities, and camps. They also work on cruise ships and in military service.
Nurses act as advisers and consultants to the health care and insurance industries.
Many nurses also work in the health advocacy and patient advocacy fields at companies such as Health Advocate, Inc. helping with a variety of clinical and administrative issues.
Some are attorneys and others work with attorneys as legal nurse consultants, reviewing patient records to assure that adequate care was provided and testifying in court. Nurses can work temporarily, which involves doing shifts without a contract in a variety of settings, sometimes known as per diem nursing, agency nursing, or travel nursing.
Nurses work as researchers in laboratories, universities, and research institutions. Nurses have also been delving into the world of informatics, acting as consultants to the creation of computerized charting programs and other software. Nurse authors publish articles and books to provide essential reference materials.
Occupational hazards
Internationally, there is a serious shortage of nurses. One reason for this shortage is the work environment in which nurses practice. In a recent review of the empirical human factors and ergonomic literature specific to nursing performance, nurses were found to work in generally poor environmental conditions.
Some countries and states have passed legislation regarding acceptable nurse-to-patient ratios. The fast-paced and unpredictable nature of health care places nurses at risk for injuries and illnesses, including high occupational stress.
Nursing is a particularly stressful profession, and nurses consistently identify stress as a major work-related concern and have among the highest levels of occupational stress when compared to other professions.
This stress is caused by the environment, psychosocial stressors, and the demands of nursing, including new technology that must be mastered, the emotional labor involved in nursing, physical labor, shift work, and high workload.
This stress puts nurses at risk for short-term and long-term health problems, including sleep disorders, depression, mortality, psychiatric disorders, stress-related illnesses, and illness in general.
Nurses are at risk of developing compassion fatigue and moral distress, which can worsen mental health. They also have very high rates of occupational burnout (40%) and emotional exhaustion (43.2%). Burnout and exhaustion increase the risk of illness, medical error, and suboptimal care provision.
Nurses are also at risk for violence and abuse in the workplace. Violence is typically perpetrated by non-staff (e.g. patients or family), whereas abuse is typically perpetrated by other hospital personnel. Of American nurses, 57% reported in 2011 that they had been threatened at work; 17% were physically assaulted.
There are 3 different types of workplace violence that nurses can experience.
First, physical violence can be hitting, kicking, beating, punching, biting, and using objects to inflict force upon someone. Second, psychological violence is when something is done to impair another person through threats and/or coercion. Third, sexual violence can include any completed or attempted nonconsensual sexual act.
Workplace violence can also be categorized into two different levels, interpersonal violence, and organizational coercion. Interpersonal violence could be committed by co-workers and/or patients by others in the hospital. The main form of this level is verbal abuse.
Organizational coercion may include an irrationally high workload, forced shifts, forced placement in different wards of the hospital, low salaries, denial of benefits for overwork, poor working environment, and other workplace stressors.
These problems can affect the quality of life for these nurses who may experience them. It can be extremely detrimental to nurses if their managers lack understanding of the severity of these problems and do not support the nurses through them. There are many contributing factors to workplace violence.
These factors can be divided into environmental, organizational, and individual psychosocial. The environmental factors can include the specific setting (for example the emergency department), long patient wait times, frequent interruptions, uncertainty regarding the patient’s treatment, and heavy workloads.
Organizational factors can include inefficient teamwork, organizational injustice, lack of aggression and/or stress management programs, and distrust between colleagues. Individual psychosocial factors may include nurses being young and inexperienced, previous experiences with violence, and a lack of communication skills.
Misunderstandings may also occur due to the communication barrier between nurses and patients. An example of this could be the patient’s condition being affected by medication, pain, and/or anxiety. There are many causes of workplace violence. The most common perpetrators of harassment and/or bullying against nursing students were registered nurses including preceptors, mentors, and clinical facilitators.
However, the main cause of workplace violence against nurses was patients. 80% of serious violent incidents in health care centers were due to the nurses’ interactions with patients.
There are many different effects of workplace violence in the field of Nursing. Workplace violence can hurt nurses both emotionally and physically.
They feel depersonalized, dehumanized, fatigued, worn out, stressed out, and tired. Because of the severity of some incidents of violence, nurses have reported manifestations of burnout due to frequent exposure. This can heavily impact a nurse’s mental health and cause nurses to feel unsatisfied with their profession and unsafe in their work environment.
Prevention
Several interventions can mitigate the occupational hazards of nursing. They can be individual-focused or organization-focused. Individual-focused interventions include stress management programs, which can be customized to individuals. Stress management programs can reduce anxiety, sleep disorders, and other symptoms of stress.
Organizational interventions focus on reducing stressful aspects of the work environment by defining stressful characteristics and developing solutions to them. Using organizational and individual interventions together is most effective at reducing stress on nurses. In some Japanese hospitals, powered exoskeletons are used. Lumbar supports (i.e. back belts) have also been trialed.
