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NRS 430 Discussion: Contemporary Nursing Practice

NRS 430 Discussion: Contemporary Nursing Practice

Scope of Practice and Differentiated Practice Competencies: Contemporary Nursing

Nursing practice has changed over the decades from when nurses had minimal education to having complex nursing training programs and when nurses provided basic care to performing complex medical and nursing procedures. Nursing was initially a woman’s work where women cared for the sick at home in the era where there were no hospitals (Egenes, 2017). Modern nursing is attributed to Florence Nightingale, who developed nursing practices that created new standards for nursing practice.  In this regard, this paper will discuss the evolution of nursing practice, the differences between ADN and BSN nurses, and the significance of evidence-based practice in nursing.

Evolution of Nursing Practice

Nurses were formerly not provided formal nursing education but were instead given on-job training on how to provide basic care such as clean and dress wounds. They did not have autonomy and received instructions from physicians. As the nursing practice evolved and more hospitals were established, women began receiving nursing training in small to medium-size hospital systems (Egenes, 2017). However, the training was observation-based, taking two to three years, and the scientific rationale for interventions was not emphasized.

Advances in medicine and technology created a need for complex and specialized nursing education. As a result, nursing training shifted from hospital observation to the classroom.  Certification programs have been created, changing the scope of nursing practice (Egenes, 2017). Nurses also have Master’s and Doctorate levels, which increase a nurse’s scope of practice to include duties similar to physicians such as taking history and physical exams, making diagnoses, interpreting diagnostic results, and initiating treatment plans.  Furthermore, standards of nursing practice have been created to ensure quality nursing care, and nurses are educated on ethical practice and providing culturally sensitive care.

Practice Competencies between an Associate and Baccalaureate Education in Nursing

Nurses with an Associate Degree in Nursing (ADN) and with a Baccalaureate Degree (BSN) are both registered nurses (RNs). Both BSN and ADN programs prepare nursing students to deliver patient care that meets the set standards. Besides, both programs equip the future RN with nursing skills and ensure they attain the clinical practice competencies necessary for nursing practice (Northrup-Snyder et al., 2017). However, the BSN program emphasizes more on areas of informatics and research. It also has courses not offered in the ADN program, such as nursing theories, social sciences, public health, leadership, and management. The differences in the ADN and BSN training result in differences in the scope of practice. ADN RNs are generally more focused on technical, clinical duties and everyday direct patient care, including monitoring patients, administering treatment, performing basic nursing procedures, and updating charts (Ghaffari, 2017). On the other hand, the scope of BSN nurses includes nursing educator, research, public health, administrative, leadership, management roles, and direct patient care.

Approaches to Decision-Making in a Patient Care Situation of a BSN vs.ADN

Approaches to decision‐making would differ in a BSN and ADN nurse caring for a diabetic patient with uncontrolled sugars and a worsening foot ulcer.  An ADN nurse will care for the patient by providing basic care such as dressing the wound, administering insulin or hypoglycemics, and monitoring blood sugar levels. Conversely, the BSN nurse will perform these tasks but get concerned about the uncontrolled sugars and delayed wound healing. As a result, the BSN will assess the patient’s diet and exercise patterns and educate the patient on the needed changes to promote optimal glycemic levels. Besides, the nurse will apply evidence-based interventions to promote healing of the ulcer and educate the patient on foot care.

Applying Evidence‐Based Practice to Nursing Care

In the past decades, evidence-based practice (EBP) has become a key element of excellent patient care. EBP is applied in various aspects of nursing as it offers valuable insight into clinical care approaches backed by evidence to address issues in direct patient care, infection control, and patient workflow (Mackey & Bassendowski, 2017). It enables nurses to apply the latest research methods in the patient care setting, including direct patient care. It focuses on established outcomes, thus promoting enhanced patient care. The BSN program equips students with knowledge and skills on EBP, which helps to analyze patient care approaches that can improve health outcomes (Mackey & Bassendowski, 2017). Students are trained on scientific research, gathering, and analyzing evidence, which they apply to establish the best patient care interventions.

Interdisciplinary Communication and Collaboration in Nursing Practice

Nurses today are part of the interdisciplinary teams and play a major role in developing patients’ care plans. Nurses communicate with the interdisciplinary teams using CUS and SBAR protocols. CUS is an acronym for Concerned, Uncomfortable, and Safety. It is a communication tool used by nurses to express concerns to the interdisciplinary team about changes in a patient’s health status respectfully and professionally. The SBAR protocol representing situation, background, assessment, and recommendations is used by nurses when having a clinical problem that needs to be conveyed to the team (Müller et al., 2018). Communication using the SBAR protocol is usually purposive, straight, and prepared and promotes information exchange between the nurse and the team. The CUS and SBAR protocols foster quality and safe patient care since patient information is communicated through an efficient and well-organized format.

Conclusion

Unlike in the past, where nurses conducted similar tasks, nurses’ scope today is determined by their level of education and the specialized courses they have undertaken. Both BSN and ADN nurses have the same licensing level; however, some of their roles are different. ADNs focus on technical, clinical duties, while BSNs focuses on research, management, leadership, and informatics.  Nurses need to communicate accurately, succinctly, and purposeful with the interdisciplinary teams to promote collaborative care.

 

 

References

Egenes, K. J. (2017). History of nursing. Issues and trends in nursing: Essential knowledge for today and tomorrow, 1-26.

Ghaffari, M. (2017). Preparing Nurses for Community Health Care: A Comparative Study of the ADN and BSN Programs. International Journal5(2), 32-45. https://doi.org/10.18488/journal.9.2018.52.32.45

Mackey, A., & Bassendowski, S. (2017). The history of evidence-based practice in nursing education and practice. Journal of Professional Nursing33(1), 51-55. https://doi.org/10.1016/j.profnurs.2016.05.009

Northrup-Snyder, K., Menkens, R. M., & Dean, M. (2017). Student competency perceptions from associate degree to bachelor degree completion. Journal of Nursing Education56(10), 581-590. https://doi.org/10.3928/01484834-20170918-02

Müller, M., Jürgens, J., Redaèlli, M., Klingberg, K., Hautz, W. E., & Stock, S. (2018). Impact of the communication and patient hand-off tool SBAR on patient safety: a systematic review. BMJ open8(8), e022202. https://doi.org/10.1136/bmjopen-2018-022202

NRS 430 Discussion: Contemporary Nursing Practice

Topic 3 DQ 1

Apr 18-20, 2022

How has nursing practice evolved over time? Discuss the key leaders and historical events that have influenced the advancement of nursing, nursing education, and nursing roles that are now part of the contemporary nursing profession.

REPLY TO DISCUSSION

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Replies to Billie Gabbard

CAT: What would Florence Think?

Imagine that Florence Nightingale was able to return to see what nursing is today. What would Florence think about today’s nurse and nursing in general. (this is an opinion question- no citations or references needed unless you use a source).

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Replies to Billie Gabbard

Hello Billie,

I think if Florence Nightingale were to be around today, she would have embraced the evolution that had taken place in Nursing practice. She would see the art and science she believed inculcated into the nursing of today. Florence had a great interest and limitations during her time. she was able to pull through the challenges with the limited resources available at the time. The nursing practice at the time was limited by education and were seen as a voluntary service for humanity to alleviate suffering and dying. I believe Florence and her team would have had reward compensation commensurate to the effort they put in during the Crimea war and at other times.

 

Florence would have seen the limitations in the practice at the time and better ways to deal with the challenges.

Also, she might feel some bias about nurses who came into the profession due to its lucrative aspect. She would have laid emphasis on sacrificing without expecting a regard.

It might be a bit challenging for her to adjust completely to the nursing of today and changing world of medicine which has evolved with better training, responsibilities, specialization , safety and quality care.

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Replies to Chioma Nwachukwu

Chioma,

Thank you for the response. Florence did feel that nursing was a calling from God. There are some that choose to go into nursing because it is a good paying job. Often, there is a quick realization that the money does not fully compensate for the role the nurse has. There has to be a desire or calling to do nursing to be truly happy, in my humble opinion.

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Replies to Billie Gabbard

Hi Billie,

I think Florence would see that nurses are now more educated, better trained and able to critically think about their tasks. Nurses of today undergo rigorous training by following detailed and well-defined syllabus. Nurses now have access to advanced technology and medical equipment.

Florence would marvel at the advances in medicine such as changes in medicine, remote diagnosis, surgical procedures, telemedicine etc. This would have been a challenge back in those days. Human lifespan itself has increased through advancements in medicine.

On the other hand, she might be worried about the affordability of healthcare for low-income families.

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Replies to Rose Francis

Thank you, Rose. In general, the use of technology would probably be overwhelming if Florence was just dropped into today’s word. Imagine how many changes have occurred just over the last 50 years.

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Replies to Billie Gabbard

Hi Billie,

I think that Florence Nightingale would be very impressed with the evidence based practice method of nursing that we perform our profession with day in and day out. I think by her leading the way with proper hand hygiene and sanitation processes in the patient care environment shows that she was already moving toward and evidence based practice method. I think she would be impressed with our patient care rules and regulations when it comes to HIPPA and safety checks such as scanning medications and proper charting, as well as the fact that we have stuck to a few of her key pillars of care such as disease prevention, risk reduction and overall health promotion all by using our evidence based practice basis in todays age. Florence Nightingale sounds like an amazing person, I really enjoyed reading about her in this weeks chapter, the reading was very informational, factual and educational.

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Topic 3 DQ 2

Apr 18-22, 2022

Discuss the difference between a nursing conceptual model and a nursing theory.

 

Select a nursing theory and provide a concise summary of it. Provide an example in nursing practice where the nursing theory you selected would be effective in managing patient care.

REPLY TO DISCUSSION

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Replies to Billie Gabbard

CAT: A thought on your practice.

Good morning, everyone.

A component to being a profession is that the discipline have it’s own body of knowledge, and in some cases theoretical support. Our Florence Nightingale started us off with her Environmental Theory. We often do not think about why we do what we do on a daily basis as a nurse. Have you thought about what theory drives your nursing practice? While I may use several, Orem’s Theory was my go to theory when caring for patients. What theory drive’s your practice?

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Replies to Billie Gabbard

Hi Billie,

Virginia Henderson’s Nursing need theory has been a source of inspiration to my practice. Her definition of nursing says it all. Without a need to care, there won’t be a practice. Most times, i remind myself that if this patient does not have a defect in health, there won’t be a reason to be in a health care facility.

Hence, the nurse helps them when they are dependent while preparing them for independence when discharged home.

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Replies to Chioma Nwachukwu

Chioma,

Care is one element that makes nursing, well….nursing. We add care into everything we do.

Billie

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Replies to Billie Gabbard

Hi Billie,

I would say that I have never really thought about what nursing theory guides my professional nursing practice, but after reading this week and learning more about the nursing theories I got to thinking about what nursing theories guide my practice. I would say that I practice with multiple nursing theories regularly but one that stands out to me the most that I would say I use is Kurt Lewins Field Theory, where human behavior is related to both the individual and the environment (Whitney 2018). I tend to think that people are often a product of their environments. For example if you are sitting in a cold dark room all day you may end up being depressed, whereas if you go outside and get some sunshine on your face and smile you may actually feel happier. In nursing I think if we promote a healing environment, that is warm, quite, relaxing and positive we may have a better patient outcome on healing than if we were to promote a uncomfortable environment. I also feel that if we promote a safe environment then we will inherently have less falls and injuries to patients that if we were to not. Overall the environment in which someone is, in my opinion, has a lot to do with patient outcomes.

 

Whitney, Stacey. (2018). Dynamics in Nursing: Art and Science of Profession Practice. History of Profession Nursing. Grand Canyon University. https://lc.gcumedia.com/nrs430v/dynamics-in-nursing-art-and-science-of-professional-practice/v1.1/#/chapter/2

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Replies to Cassidy Wright

Cassidy,

Thank you for sharing. I agree that often we do not think about what drives our care….we just do it. I will also add along with your post, Florence Nightingale’s Environmental theory addressed light, etc. which also goes along with your post.

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Replies to Billie Gabbard

Billie, I know in my previous post I talked about Rogers’s science of unitary human beings but working in an outpatient surgery setting, that really seems to be the theory that drives my practice. Our patients come in to a situation where it is totally foreign to them! We, as nurses, deal daily with what to expect in the different phases of surgery and recovery but it is totally new to our patients and we have to be cognizant of that daily.

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