Chapter 1 – Nursing Past and Present
Nursing Today: Full-Spectrum Nursing
Nurses today are highly trained, well-educated, caring, and
competent professionals. They are essential members of the
healthcare team. The complexity of healthcare delivery requires
that nurses use their critical thinking, communication,
organizational, leadership, advocacy, and technical skills to ensure
that patients receive safe and effective care.
Safe, Effective Nursing Care Nursing education emphasizes
quality and safety so that students will be able to deliver safe,
effective nursing care in their practice after graduation.
Nursing Practice. The Institute of Medicine (Greiner & Knebel,
2003) has identified quality and safety competencies that all
health professionals are expected to demonstrate in their
practice (see the Safe, Effective Nursing Care box Quality
Improvement Competency).
Nursing Education. The Quality and Safety Education for
Nurses (QSEN) project has identified competencies that students
are expected to acquire before graduation (Cronenwett,
Sherwood, Barnsteiner, et al., 2007). If you are interested in the
QSEN competencies,
Go to the QSEN Institute Web site at http://qsen.org/competencie
Full-Spectrum Nursing and Safe, Effective Nursing Care. To
implement quality care using the full-spectrum nursing model
(Chapter 2), we will refer to “safe, effective nursing care”
competencies (see the Safe, Effective Nursing Care [SENC]
boxes that appear in almost all chapters in this book).
Application of Knowledge, Skill, and Caring KEY
POINT: Nurses apply knowledge from the arts and sciences
in their various roles to provide patient-centered care
(Table 1-1). Nurses use clinical judgment, critical thinking, and
problem-solving as they care for patients. (You will learn more
,about full-spectrum nursing in the section in Chapter 2, What Is
Full-Spectrum Nursing?)
To be safe providers, nurses must carefully consider their
actions and think carefully about the patient, the treatment plan,
the healthcare environment, the patient’s support system, the
nurse’s support system and resources, and safety.
Clinical judgment involves observing, comparing, contrasting,
and evaluating the client’s condition to determine whether change
has occurred. It also involves careful consideration of the client’s
health status in light of what is expected based on the client’s
condition, medications, and treatment. These actions, collectively
known as the nursing process, are discussed in Chapters
3 through 7 and in each of the clinically focused chapters.
Critical thinking is a reflective thinking process that involves
collecting information, analyzing the adequacy and accuracy of
the information, and carefully considering options for action.
Nurses use critical thinking in every aspect of nursing care. Critical
thinking is discussed at length in Chapter 2 and applied in every
chapter in this text.
Problem-solving is a process by which nurses consider an issue
and attempt to find a satisfactory solution to achieve the best
outcomes. You will often use problem-solving in your professional
life. The nursing process (see Chapters 2 through 7) is one type of
problem-solving process.
International Council of Nurses Definition
The International Council of Nurses (ICN) is an organization that
represents nurses throughout the world. In 1973, ICN
defined nursing as follows:
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.
(Henderson, 1966, p. 15)
, BOX 1-2 Important Qualities for Nurses
Critical-Thinking Skills
Required Action: Monitor the client, note changes, and take
actions to ensure safe and effective care.
Example: Call the provider to obtain a stronger pain medication
for a client who, 2 hours after receiving pain medication, rates
his pain 7 out of 10.
Caring and Compassion
Required Action: Show kindness, concern, and sincerity that
convey to clients that you care about their well-being.
Example: Sit with and hold the hand of a client who has just
been told that he has a terminal illness.
Detail Oriented
Required Action: Pay attention to details to prevent and identify
potentially harmful errors in care.
Example: Seek clarification and correct a dosage that is written
as 7 mg that should be 0.7 mg.
Organizational Skills
Required Action: Prioritize the needs of your client and meet the
needs of the most critical clients first.
Example: Care for the postoperative client with difficulty
breathing prior to performing a dressing change.
Speaking Skills
Required Action: Communicate correct and pertinent information
to clients and members of the healthcare team.
Example: Teach the client how to perform a dressing change at
home after discharge from the hospital.
Listening Skills
Required Action: Listen to clients’ concerns; take verbal or
telephone prescriptions from providers.
Example: The provider telephones you and gives you
prescriptions to implement for your client.
Patience
Nursing Today: Full-Spectrum Nursing
Nurses today are highly trained, well-educated, caring, and
competent professionals. They are essential members of the
healthcare team. The complexity of healthcare delivery requires
that nurses use their critical thinking, communication,
organizational, leadership, advocacy, and technical skills to ensure
that patients receive safe and effective care.
Safe, Effective Nursing Care Nursing education emphasizes
quality and safety so that students will be able to deliver safe,
effective nursing care in their practice after graduation.
Nursing Practice. The Institute of Medicine (Greiner & Knebel,
2003) has identified quality and safety competencies that all
health professionals are expected to demonstrate in their
practice (see the Safe, Effective Nursing Care box Quality
Improvement Competency).
Nursing Education. The Quality and Safety Education for
Nurses (QSEN) project has identified competencies that students
are expected to acquire before graduation (Cronenwett,
Sherwood, Barnsteiner, et al., 2007). If you are interested in the
QSEN competencies,
Go to the QSEN Institute Web site at http://qsen.org/competencie
Full-Spectrum Nursing and Safe, Effective Nursing Care. To
implement quality care using the full-spectrum nursing model
(Chapter 2), we will refer to “safe, effective nursing care”
competencies (see the Safe, Effective Nursing Care [SENC]
boxes that appear in almost all chapters in this book).
Application of Knowledge, Skill, and Caring KEY
POINT: Nurses apply knowledge from the arts and sciences
in their various roles to provide patient-centered care
(Table 1-1). Nurses use clinical judgment, critical thinking, and
problem-solving as they care for patients. (You will learn more
,about full-spectrum nursing in the section in Chapter 2, What Is
Full-Spectrum Nursing?)
To be safe providers, nurses must carefully consider their
actions and think carefully about the patient, the treatment plan,
the healthcare environment, the patient’s support system, the
nurse’s support system and resources, and safety.
Clinical judgment involves observing, comparing, contrasting,
and evaluating the client’s condition to determine whether change
has occurred. It also involves careful consideration of the client’s
health status in light of what is expected based on the client’s
condition, medications, and treatment. These actions, collectively
known as the nursing process, are discussed in Chapters
3 through 7 and in each of the clinically focused chapters.
Critical thinking is a reflective thinking process that involves
collecting information, analyzing the adequacy and accuracy of
the information, and carefully considering options for action.
Nurses use critical thinking in every aspect of nursing care. Critical
thinking is discussed at length in Chapter 2 and applied in every
chapter in this text.
Problem-solving is a process by which nurses consider an issue
and attempt to find a satisfactory solution to achieve the best
outcomes. You will often use problem-solving in your professional
life. The nursing process (see Chapters 2 through 7) is one type of
problem-solving process.
International Council of Nurses Definition
The International Council of Nurses (ICN) is an organization that
represents nurses throughout the world. In 1973, ICN
defined nursing as follows:
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.
(Henderson, 1966, p. 15)
, BOX 1-2 Important Qualities for Nurses
Critical-Thinking Skills
Required Action: Monitor the client, note changes, and take
actions to ensure safe and effective care.
Example: Call the provider to obtain a stronger pain medication
for a client who, 2 hours after receiving pain medication, rates
his pain 7 out of 10.
Caring and Compassion
Required Action: Show kindness, concern, and sincerity that
convey to clients that you care about their well-being.
Example: Sit with and hold the hand of a client who has just
been told that he has a terminal illness.
Detail Oriented
Required Action: Pay attention to details to prevent and identify
potentially harmful errors in care.
Example: Seek clarification and correct a dosage that is written
as 7 mg that should be 0.7 mg.
Organizational Skills
Required Action: Prioritize the needs of your client and meet the
needs of the most critical clients first.
Example: Care for the postoperative client with difficulty
breathing prior to performing a dressing change.
Speaking Skills
Required Action: Communicate correct and pertinent information
to clients and members of the healthcare team.
Example: Teach the client how to perform a dressing change at
home after discharge from the hospital.
Listening Skills
Required Action: Listen to clients’ concerns; take verbal or
telephone prescriptions from providers.
Example: The provider telephones you and gives you
prescriptions to implement for your client.
Patience
