https://www.cnn.com/2022/01/16/tennis/novak-djokovic-australian-open-federal-courthearing-spt-intl-hnk/index.html
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read chapter 19 Global Health
view the Typhoid Mary video and read the Novck Djokivic article and compare and contrast both
situations
support your post and response with evidence-based resources
How far have we come in 100 years?
what are your evidence-based and supported recommendations
post no longer than one page and response no longer than 1/2 page (concise & clear)
proofread for typos, spelling and grammatical errors
raise questions for clarity
Brief Contents
About the Authors
Thank You xi
Preface xiii
CHAPTER 1: Beginning the Journey
Unit I:
Unit III: Processes Guiding Professional
Practice 264
ix
1
Foundations of Professional
Nursing Practice 17
CHAPTER 2: Socialization to Professional
Nursing Roles 17
CHAPTER 3: Historical Foundations of
Professional Nursing 37
CHAPTER 4: Ethical Foundations of
Professional Nursing 53
CHAPTER 5: Legal Foundations of
Professional Nursing
74
CHAPTER 6: Knowledge Development in
Nursing 99
Unit II: Professional Nursing
Roles 120
CHAPTER 7: The Nurse as Health
Promoter and Care
Provider 120
CHAPTER 8: The Nurse as Learner and
Teacher 140
CHAPTER 9: The Nurse as Leader and
Manager 170
CHAPTER 10: The Nurse’s Role in
Evidence-Based Health
Care 191
CHAPTER 11: The Nurse’s Role in Quality
and Safety 204
CHAPTER 12: The Nurse’s Role as Political
Advocate
231
CHAPTER 13: The Nurse as Colleague and
Collaborator 245
CHAPTER 14: Communicating
Effectively 264
CHAPTER 15: Managing Change
284
CHAPTER 16: Technology and
Informatics 300
Unit IV: Professional Nursing in a
Changing Health Care
Environment 315
CHAPTER 17: Nursing in an Evolving
Health Care Delivery
System 315
CHAPTER 18: Providing Care in Home and
Community 327
CHAPTER 19: Global Health
354
CHAPTER 20: Dimensions of Holistic
Health Care 380
CHAPTER 21: Nursing in a Culturally
Diverse World 395
CHAPTER 22: Nursing in a Spiritually
Diverse World 422
CHAPTER 23: Nursing in a Culture of
Violence 441
Unit V: Into the Future
456
CHAPTER 24: Advanced Nursing
Education and
Practice 456
CHAPTER 25: The Future of Nursing
Index
493
475
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Professional
Nursing
Practice
Seventh Edition
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Professional
Nursing
Practice
Concepts and Perspectives
Seventh Edition
Kathleen Koernig Blais, Ed.D., RN
Florida International University
Janice S. Hayes, PhD, RN
University of Northern Colorado
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therapy and drug reactions, the reader is urged to check the package inserts of all drugs for any change in
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Copyright © 2016, 2011, 2006 by Pearson Education, Inc. All rights reserved. Manufactured in the United
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Library of Congress Cataloging-in-Publication Data
Blais, Kathleen, author.
Professional nursing practice : concepts and perspectives/Kathleen Koernig Blais, Janice S. Hayes.
— Seventh edition.
p. ; cm.
Includes bibliographical references and index.
ISBN 978-0-13-380131-6 — ISBN 0-13-380131-4
I. Hayes, Janice S., author. II. Title.
[DNLM: 1. Nursing. 2. Nurse’s Role. 3. Nursing Theory. WY 16 AA1]
RT84.5
610.73—dc23
2015004901
ISBN-10:
0-13-380131-4
ISBN-13: 978-0-13-380131-6
Dedication
I dedicate this book to all who have taught me; my teachers past and present; my students,
who continue to challenge me and make me a better teacher; and, most of all, David, Sarah,
Harrison, and Margaret.
Kathleen Blais
This work is dedicated to Sierra, Marc, Otto, and Vinnie who motivate and inspire me to reach
out to a new generation of nurses.
Janice S. Hayes
This page intentionally left blank
About the Authors
Kathleen Blais
Kathleen Blais received her Diploma in nursing from Temple University Hospital School of Nursing (Philadelphia,
Pennsylvania), her BSN and MSEd from Florida International University (Miami, Florida), MSN from the University of Miami (Miami, Florida), and EdD from Florida
Atlantic University (Boca Raton, Florida). She has taught
in both undergraduate and graduate nursing programs.
Dr. Blais has held faculty and academic leadership positions throughout her career. She is currently a Professor
Emerita of Nursing at Florida International University
Nicole Wertheim College of Nursing and Health Sciences.
Janice S. Hayes
Janice Hayes received her BSN from the University of
Evansville, MSN from Indiana University, and PhD from
Purdue University. She has taught both in undergraduate
and graduate nursing programs as well as providing
research leadership with clinical institutions. Dr. Hayes
has maintained a research trajectory in the areas of development risk and trauma outcomes. She has served as the
Assistant Director for Graduate Programs in the School of
Nursing at the University of Northern Colorado.
ix
This page intentionally left blank
Thank You
Thanks go to our colleagues from schools of nursing around the world, who generously gave their time to help create this
book. These professionals helped us plan and shape our book by contributing their collective experience and expertise as
nurses and teachers, and we made many improvements based on their efforts.
Contributors
Catherine E. Dingley, PhD, RN, FNP
Post Doctoral Research Fellow
University of Utah
Salt Lake City, Utah
Kathleen Dunemn, PhD, APRN, CNM-BC
Associate Professor
University of Northern Colorado
Greeley, Colorado
J. Craig Phillips, PhD, LLM, RN, ARNP,
PMHCNS-BC, ACRN
Associate Professor of Nursing
University of Ottawa
Ottawa, Ontario, Canada
Rhonda D. Squires, PhD, APRN-BC, FNP
Assistant Professor
University of Northern Colorado
Greeley, Colorado
Reviewers
Barbara Celia, EdD, RN
Clinical Assistant Professor
Drexel University
College of Nursing and Health Professions
Philadelphia, Pennsylvania
A. Kate Eby, MN, APRN, ONC, FNP-C, CNE
Lecturer, RN-BSN Program
Frostburg State University
Frostburg, Maryland
Sarah Gabua, DNP, RN
Adjunct Professor
Ferris State University
Big Rapids, Michigan
Kristine M. Gill, PhD., RN
Associate Professor of Nursing, Emeritus
The University of Akron
Akron, Ohio
Irma Lorraine Goodrich, ABD, MSN, BSN, RN
Instructor of Nursing/Interim Director
Eastern New Mexico University
Portales, New Mexico
Linda Pennington Grimsley, PhD
Assistant Vice President for Academic Affairs &
Professor of Nursing
Albany State University
Albany, Georgia
Patricia Hall, MSN/Ed, RN
Faculty
University of South Florida College of Nursing
Tampa, Florida
Kim Clevenger, EdD, MSN, RN, BC
Baccalaureate & RN-BSN Program Coordinator/
Associate Professor of Nursing
Morehead State University
Morehead, Kentucky
Terri Hood-Brown
Assistant Professor
Ohio University
Zanesville, Ohio
Fredi de Yampert, PhD, RN
Interim VP for Academic Affairs
Nursing Department Chair
Finlandia University
Hancock, Michigan
Sara K. Kaylor, Ed.D, RN, CNE
Assistant Professor
The University of Alabama
Capstone College of Nursing
Tuscaloosa, Alabama
xi
xii
THANK YOU
Ramona S. Kerner, DHEd, RN, CNOR
Assistant Professor
Southeastern Louisiana University School of Nursing
Hammond, Louisiana
Neal Rosenburg, PhD, COI, RN
Dean and Associate Professor
Nevada State College
Henderson, Nevada
Marilyn Meder, PhD, RN
Assistant Professor
Kutztown University
Kutztown, Pennsylvania
Polly Royal, DNP, RN
Clinical Assistant Professor
Purdue University
West Lafayette, Indiana
Maria Olenick, PhD, FNP, RN
Chair of Undergraduate Nursing
Florida International University
Nicole Wertheim College of Nursing and Health Sciences
Miami, Florida
Melody F. Sharp, DNP, RN
Director, Post-Licensure & Accelerated
BSN Associate Professor
Jefferson College of Health Sciences
Roanoke, Virginia
Barbara Patterson, EdD, MS, RN, CNE
Associate Dean, School of Nursing
Southwestern Oklahoma State University
Weatherford, Oklahoma
Jessica Spellman, MSN, RN, CCRN
The Ohio State University
Associated Clinical Faculty
Columbus, Ohio
Judith Miller Peters, Ed.D, RNC
Associate Professor of Nursing
Loma Linda University School of Nursing
Loma Linda, California
Jennifer L. Taylor, PhD, RN
Associate Professor
Director of Undergraduate Programs
Lindenwood University
St. Charles, Missouri
Jenny Radsma, PhD, RN
Associate Professor
University of Maine at Fort Kent
Fort Kent, Maine
Linda J. Thomas, PhD, MSN, RN, CNE
RN-BSN Coordinator
Murray State University
Murray, Kentucky
Patricia L. Reid, MSN, RN, CNS
Director of Continuing Education
The Ohio State University
Columbus, Ohio
Janet Weber, EdD, RN
Director RN-BSN Program
Southeast Missouri State University
Cape Girardeau, Missouri
Desma R. Reno, PhD(c), APRN, GCNS-BC
Assistant Professor
Southeast Missouri State University
Cape Girardeau, Missouri
Evelyn M. J. Yeaw, PhD, RN
Professor Emerita
The University of Rhode Island
Kingston, Rhode Island
Susan Rieck, PhD, RN
Associate Professor & Assistant Dean
Northern Arizona University
Flagstaff, Arizona
Benson K. L. Yeung, MSN, RN
Lecturer and Clinical Faculty
California State University, School of Nursing
Los Angeles, California
Preface
A dynamic healthcare environment requires growth and
change in the nursing profession. Skills in communication
and interpersonal relations are needed for nurses to be
effective members of collaborative interdisciplinary healthcare teams. Critical thinking and creativity are necessary as
nurses implement care with clients of diverse cultural and
spiritual backgrounds in a variety of settings. Nurses must
be prepared to provide care not only in hospital settings but
also in community and residential settings, such as work
sites, schools, faith-based communities, homeless shelters,
and prisons. The nurse’s unique role demands a blend of
nurturance, compassion, sensitivity, caring, empathy, commitment, courage, competence, and skill that comes from a
broad knowledge base of the arts, humanities, biological
and social sciences, and the discipline of nursing. Nurses
need skills in teaching, collaborating, leading, managing,
advocacy, political involvement, and applying theory,
research, and evidence to practice. An understanding of
holistic healing modalities and complementary therapies
used in the care of patients and clients is becoming more
essential. Knowledge of global health includes the nurse’s
understanding of nursing and health care as practiced
around the world and how health/disease conditions in
other countries can affect the health status of citizens and
residents of our own country. Quality and safety in health
care are of primary concern to the profession.
This book addresses content by which nurses build
their repertoire of nursing knowledge. This content includes,
but is not limited to, wellness, health promotion, and disease/injury prevention; holistic care; multiculturalism,
global health; nursing history; technology and informatics;
nursing theories and conceptual frameworks; nursing
research; quality and safety; and professional empowerment
and politics.
Professional Nursing Practice: Concepts and Perspectives, 7th Edition, is intended as a text for registered
nurses who are in transition or bridge programs to achieve
a baccalaureate or higher degree in nursing. It may also be
used in generic nursing programs or in transition or bridge
programs for vocational nurses (LPNs or LVNs) to complete the professional nursing baccalaureate degree. This
text addresses the areas of knowledge that professional
nurses require to be effective in the changing healthcare
environment.
The organization of this text emphasizes the foundational knowledge related to professional nursing, including
nursing history, nursing knowledge development, ethics, and
legal aspects; the roles of professional nurses, including
health promoter and care provider, learner and teacher, leader
and manager, research consumer, advocate, and colleague
and collaborator; the processes guiding nursing, including
communication, change, and technology and informatics;
nursing in a changing healthcare delivery system, including
healthcare economics, holistic health care, global health, cultural and spiritual dimensions of client care, and nursing in a
culture of violence; graduate education and advanced nursing
practice; and nursing in the future.
NEW TO THIS EDITION
All chapters have been revised to reflect current professional nursing knowledge based on foundational knowledge:
• A new chapter, Chapter 11, “The Nurse’s Role in
Quality and Safety,” addresses quality and safety education for nurses (QSEN). Regulations, quality indicators, and benchmarking are discussed as they apply to
professional nursing.
• A new chapter, Chapter 19, “Global Health,” describes
the goals of global health, demographic and epidemic
shifts, communicable and noncommunicable diseases
around the world, health systems models in the global
environment, and nursing roles, responsibilities, and
opportunities in global health.
• New content on healthcare reform and implementation of the Affordable Care Act of 2010 as it has implications for nursing has been added to this edition.
• New content on nursing knowledge development and
evidence-based practice has been added.
• Chapter summaries are now presented as a bulleted
list of chapter highlights to facilitate student preparation for exams.
Hallmark Features
The seventh edition of Professional Nursing Practice:
Concepts and Perspectives retains several of the features
that have been well received by faculty and students who
have used previous editions:
• All new to this edition, Research Currents (formerly
called Evidence for Practice) boxes that describe
quantitative and qualitative research studies relevant
to chapter content and relate them to clinical or professional practice.
xiii
xiv
PREFACE
• Critical Thinking Exercises that require readers to
apply concepts from chapters to exemplar situations.
• Reflect On . . . sections that ask the reader to contemplate her or his own practice and beliefs about professional nursing in relation to the chapter content.
• Interviews of practicing nurses, which can be found in
two chapters: Chapter 19, “Providing Care in the
Home and Community,” and Chapter 24, “Advanced
Nursing Education and Practice.” The profiles include
information about why these practitioners chose their
specific practice areas, what qualities they think are
necessary to be a nurse in that area, what their practice
entails, and what encouragement they would offer a
nurse considering practice in this area. The profiles
provide useful first-person perspectives for readers.
• InfoQuest, which directs students to Internet-based
information resources related to chapter content.
Organization
This edition is organized into five units, with an introductory chapter preceding the first unit. Units and chapters can
be used independently or in any sequence. Some nursing
programs use this text for first-semester nursing students
in a professional socialization course. Other nursing programs use the text at the end of their nursing program in a
professional transition course. And yet other programs use
the text as a primary text in one course and a secondary text
in other professional role courses.
• Chapter 1, “Beginning the Journey,” was created to
assist registered nurses as they return to school. It provides information regarding factors influencing nurses’
return to school for baccalaureate and higher degrees
and overcoming barriers that may interfere with student success. New content in this chapter includes
learning with technology and evaluating Internet sites.
• Unit I, “Foundations of Professional Nursing Practice,” focuses on professionalism, including socialization, and historical, legal, ethical, and knowledge
development of nursing.
• Unit II, “Professional Nursing Roles,” includes information on the professional roles of health promoter
and care provider, learner and teacher, leader and
manager, research consumer, advocate, and colleague
and collaborator. It also addresses quality and safety
in providing health care.
• Unit III, “Processes Guiding Professional Practice,”
focuses on communicating effectively, managing
change, and using technology and informatics.
• Unit IV, “Professional Nursing in a Changing Health
Care Environment,” includes chapters devoted to
healthcare economics, providing care in the home and
community, global health, holistic health care, nursing in a culturally diverse world, nursing in a spiritually diverse world, and nursing in a culture of
violence.
• Unit V, “Into the Future,” looks at the nurse’s professional development and the future of nursing. It includes
chapters on advanced nursing education and practice
and concludes with visions for the future of nursing and
health care.
We hope this book helps learners appreciate the proud
heritage of professional nursing, understand what is meant
by professional, view nursing as a profession, and develop
knowledge and abilities that will contribute to the advancement of the profession. In addition, we hope the knowledge
gained will help nurses provide quality care in a constantly
changing healthcare environment.
ACKNOWLEDGMENTS
We extend our sincere thanks to the many talented and
committed people who assisted in the birthing of this
text:
• Barbara Kozier and Glenora Erb, without whom this
text would never have been conceived. Every day
that we write, we think of them with fondness and
respect.
• The reviewers who provided many discerning comments and suggestions that expanded our thinking and
writing.
• Barbara Price, Developmental Editor, who provided
suggestions and encouragement throughout the process of this revision. Her commitment to the manuscript, understanding of writing demands, and
technical and personal support throughout the project
contributed positively to this revision.
• Pamela Fuller, Acquisitions Editor, who initiated the
work on this edition.
• Peggy Kellar of iEnergizer Aptara®, Ltd. for vital attention to details and Margaret Ritchie for copyediting.
• To all who helped create and manage the media supplements. Their work provides a contemporary dimension to readers’ use of this edition.
• Most importantly, our many students, who have challenged and taught us and, in doing so, have helped to
guide the direction of this book.
Contents
About the Authors
Thank You xi
Preface xiii
ix
The Initial Process of Professional
Socialization 24
Ongoing Professional Socialization
and Resocialization 25
Chapter 1: Beginning the Journey
1
Factors in Society That Promote
the Nurse’s Return to School 1
Changing Trends of Nursing
as a Profession 2
Factors That Influence the Nurse’s
Return to School 5
Education for Initial and Continuing
Licensure 5
Credentialing Requirements 6
Professional Role Transition
7
Bridges’s Model of Transition 7
Spencer and Adams’s Model of
Transition 8
Strategies for Success: What It
Will Take to Get There 9
Time Management 10
Money 10
Social Supports 10
Working With Faculty 12
Technology Skills 13
Study Skills 13
Unit I:
16
Foundations of Professional
Nursing Practice 17
Chapter 2: Socialization to Professional
Nursing Roles 17
Challenges and
Opportunities 18
Professionalism 18
Nursing as a Discipline and
Profession 18
Pavalko’s Occupation-Profession
Continuum Model 19
Scope and Standards of Nursing
Practice 21
Professional Socialization
Role Theory
26
Elements of Roles 27
Boundaries of Nursing Roles
Role Stress and Role Strain
22
Critical Values of Professional
Nursing 23
29
29
Reducing Role Stress and
Strain 31
Stress Reduction Strategies 31
Managing Role Stress and Role
Strain 31
Chapter Highlights
References 35
35
Chapter 3: Historical Foundations
of Professional Nursing
Pedagogic Features for Using
This Text 15
Chapter Highlights
References 16
Kramer’s Postgraduate
Resocialization Model 25
Dalton’s Career Stages
Model 26
Benner’s Stages From Novice to
Expert 26
Challenges and
Opportunities 38
Nursing in History
37
38
Nursing in Primitive Societies
Nursing in Ancient
Civilizations 39
The Role of Religion in the
Development of Nursing 40
The Development of Modern
Nursing 41
The Development of Nursing
in the Americas 42
Historical Leaders in Nursing
The Founders 44
Men in Nursing 44
The Risk Takers 45
The Social Reformers
38
43
46
Nursing: A History of Caring 47
The Development of Professional
Nursing Organizations 48
American Nurses Association 48
National Student Nurses’
Association 49
National League for Nursing 49
xv
xviii
CONTENTS
Improving Patient Safety and
Quality of Care 218
Team Nursing 183
Primary Nursing 184
Interdisciplinary Team Model
184
Case Management 185
Differentiated Practice 186
Shared Governance 186
Mentors and Preceptors 187
Networking 188
Chapter Highlights
References 189
Chapter Highlights
References 228
189
Chapter 10: The Nurse’s Role in EvidenceBased Health Care 191
Challenges and
Opportunities 191
Evidence-Based Practice 192
Research in Nursing 193
Roles in Research 194
Historical Perspective 195
Ethical Concerns 195
Approaches in Nursing
Research 196
Steps in the Research Process
Using Research in Practice
Critiquing Research Reports
Integration of Research into
Practice 198
Chapter Highlights
References 203
Methods and Tools 218
Just Culture Principles 223
Teamwork and Collaboration
Patient-Centered Care 226
Challenges and
Opportunities 231
Power 232
Empowerment 232
Sources of Power 232
Caring Types of Power 234
Laws of Power 234
197
198
198
Chapter 11: The Nurse’s Role in Quality
and Safety 204
Challenges and
Opportunities 205
Overview of Patient Safety and
Quality 205
208
Professional and Regulatory
Standards of Safety and
Quality 210
The Joint Commission 210
Centers for Medicare and Medicaid
Services 213
State Regulatory Agencies 213
Other Influential
Organizations 214
Quality Indicators: Measuring
Performance 215
Benchmarking and Comparing
Safety and Quality 217
235
Nursing and Political Action 235
Strategies to Influence Political
Decisions 236
Developing Political Astuteness
and Skill 239
Seeking Opportunities for Political
Action 240
Chapter Highlights
References 243
202
Evaluating Patient Safety
and Quality of Care 215
227
Chapter 12: The Nurse’s Role as Political
Advocate 231
Politics
Historical Context 205
Current Trends and Concepts
224
243
Chapter 13: The Nurse as Colleague
and Collaborator 245
Challenges and
Opportunities 246
Collaborative Health Care
246
Collaborative Practice 247
The Nurse as a Collaborator
Benefits of Collaborative
Care 250
248
Factors Leading to the Need
for Increased Collegiality and
Collaboration 252
Healthcare Consumers 252
Personal Responsibility
Initiatives 252
Changing Demographics and
Epidemiology 253
Healthcare Access 253
Technological Advances 253
Competencies Basic to
Collaboration 253
Communication Skills 253
Mutual Respect and Trust 254
xvi
CONTENTS
American Association of Colleges
of Nursing 49
Canadian Nurses Association 49
International Council of
Nurses 49
Sigma Theta Tau International 50
Specialty Nursing
Organizations 50
Special-Interest Organizations 50
Chapter Highlights
References 52
51
Chapter 4: Ethical Foundations of
Professional Nursing 53
Challenges and
Opportunities 53
Values 54
Values Transmission 54
Values Clarification 55
Identifying Personal Values 55
Helping Clients Identify Values 56
Moral and Ethical Behavior
56
Moral Development 56
Lawrence Kohlberg 57
Carol Gilligan 58
Moral and Ethical Theories or
Frameworks 59
Moral and Ethical Principles 59
Ethics in Nursing
60
Nursing Codes of Ethics 61
Types of Ethical Problems 63
Making Ethical Decisions 63
Specific Ethical Issues 67
Strategies to Enhance Ethical
Decision Making 69
Advocacy
Chapter Highlights
References 73
72
Chapter 5: Legal Foundations of
Professional Nursing
74
Challenges and
Opportunities 75
The Legal System 75
Constitutions 75
Statutory Law 75
Administrative Law 76
Judicial or Decisional Law 76
Types of Legal Actions 76
Safeguarding the Public
76
77
Licensure 77
Registration 79
Certification 79
Accreditation 79
Standards of Care 79
Potential Liability Areas
80
Negligence and Malpractice 80
Documentation 82
Delegation 83
Restraints 84
Informed Consent 85
Advance Healthcare Directives 88
Do-Not-Resuscitate Orders 89
Adverse Events and Risk
Management 89
Death and Related Issues 90
The Impaired Nurse 92
Sexual Harassment 93
Nurses as Witnesses 94
Collective Bargaining 95
Chapter Highlights
References 97
96
Chapter 6: Knowledge Development
in Nursing 99
Challenges and
Opportunities 99
Worldviews and Knowledge
Development 100
Defining Terms 101
Theory Development in
Nursing 101
Early Knowledge Development
in Nursing 102
70
The Advocacy Role 70
Professional/Public Advocacy
Credentialing
Selected Nursing Theories
70
104
Rogers’s Science of Unitary
Human Beings 104
Orem’s Self-Care Deficit Theory
of Nursing 105
King’s Goal-Attainment
Theory 105
Neuman’s Systems Model 106
Roy’s Adaptation Model 107
Benner’s Novice to Expert 108
The Caring Theorists 109
Middle-Range Theory 112
Relationship of Theories to
the Nursing Process and
Research 116
Chapter Highlights
References 118
118
xvii
CONTENTS
Unit II: Professional Nursing
Roles 120
Processing Information 149
Using Information 149
Factors That Facilitate
Learning 149
Chapter 7: The Nurse as Health
Promoter and Care
Provider 120
Challenges and
Opportunities 121
Defining Health Promotion
Healthy People 2020 123
Leading Health Indicators
Four Foundation Health
Measures 124
121
124
Health Promotion Activities
126
Types of Health Promotion
Programs 127
Sites for Health Promotion
Activities 128
Health Belief Models
131
Stages of Health Behavior
Change 134
The Nurse’s Role in Health
Promotion 136
138
Chapter 8: The Nurse as Learner
and Teacher 140
Challenges and
Opportunities 141
Nurses as Learners 141
The Learning Process 143
Theories of Learning 143
Behaviorism 143
Social Learning Theory 144
Cognitivism 144
Humanism 145
Categorization 146
Constructivism 146
Multiple Intelligences 146
Bloom’s Domains of Learning 146
Applying Learning Theories 148
Cognitive Learning
Processes 149
149
151
152
Health Literacy
Pender’s Health Promotion
Model 131
Neuman Systems Model 133
Acquiring Information
150
Factors That Inhibit
Learning 151
Literacy
130
Health Promotion Models
Chapter Highlights
References 138
149
Emotions 151
Physiological Factors 151
Cultural and Spiritual Factors
129
Health Locus of Control
Model 129
The Health Belief Model
Motivation 149
Readiness 149
Active Involvement
Feedback 150
Simple to Complex
Repetition 150
Timing 150
Environment 151
152
Nurses as Teachers
The Art of Teaching
153
155
Guidelines for Learning
and Teaching 156
Assessing Learning Needs 156
Planning Content and Teaching
Strategies 159
Implementing a Teaching
Plan 163
Evaluating Learning and
Teaching 164
Special Teaching Strategies 165
Teaching Clients of Different
Cultures 167
Documentation of Teaching
Chapter Highlights
References 169
168
168
Chapter 9: The Nurse as Leader
and Manager 170
Challenges and
Opportunities 171
Nursing Leadership
171
Leadership Characteristics
Leadership Style 173
Nursing Management
172
177
Resources 177
Management Competencies
Management Roles 179
178
Magnet Recognition 181
Nursing Delivery Models 182
Total Patient Care 182
Functional Method 182
xix
CONTENTS
Barriers to Communication 277
Nursing Documentation 277
Giving and Receiving
Feedback 254
Decision Making 255
Conflict Management 255
Methods of Documentation
Interprofessional Health
Care 256
Physicians 256
Pharmacists 257
Dietitians and Nutritionists 258
Social Workers 258
Physical Therapists 259
Occupational Therapists 259
Speech-Language
Pathologists 260
Respiratory Therapists 260
Interprofessional Focus 261
Global Collaboration 261
Chapter Highlights
References 262
261
Unit III: Processes Guiding Professional
Practice 264
Challenges and
Opportunities 265
Definitions of
Communication 265
The Communication
Process 266
282
Chapter 15: Managing Change
284
Challenges and
Opportunities 285
Meanings and Types of
Change 285
Spontaneous Change 285
Developmental Change 285
Planned Change 286
Change Theory
286
Approaches to Planned
Change 286
Change Strategies 288
Frameworks for Change
Managing Change
Chapter Highlights
References 299
289
292
293
298
Chapter 16: Technology and
Informatics 300
Sender 267
Message 267
Channel 267
Receiver 267
Response 267
Challenges and
Opportunities 300
Nursing Informatics,
Healthcare Informatics,
and Technology 301
268
Developmental Stage 268
Gender 269
Roles and Relationships 269
Sociocultural Characteristics 269
Values and Perceptions 269
Space and Territoriality 269
Environment 270
Congruence 270
Interpersonal Attitudes 270
Types of Communication
Chapter Highlights
References 283
Change Agent 292
Steps in the Change Process
Resistance to Change 294
Examples of Change 296
Chapter 14: Communicating
Effectively 264
Factors Influencing the
Communication Process
279
Communicating Through
Technology 280
271
Oral/Verbal Communication 271
Nonverbal Communication 272
Therapeutic Communication 273
Written Communication 274
Nursing Roles and Education 301
Technology and Informatics 302
Informatics Frameworks 303
Issues Related to Information
Technology 304
Ethical Concerns 305
Confidentiality of Medical Records
and Data 305
Data Integrity 305
Caring in a High-Tech
Environment 305
The Technology Explosion
306
Evolution of Technology 306
Computer Technology in Practice,
Education, Research, and
Administration 307
xx
CONTENTS
Current Applications of Information
Technology in Practice 309
Physician Order Entry 309
Clinical Information Systems 309
Wireless and Portable Devices 309
Electronic Health Record 310
Evidence-Based Practice 310
Telehealth 310
Chapter Highlights
References 313
312
Public Sector Settings 333
Public–Private Partnership
Settings 336
Private Sector Settings 337
Nursing in Rural
Communities 339
Chapter 17: Nursing in an Evolving
Health Care Delivery
System 315
Home Health Nursing
Demand Versus Supply of
Health Care 317
Paying for Health Care 317
Cost Containment Strategies
Access to Health Care 318
340
Definitions of Home Health
Nursing 340
Perspectives of Home Health
Nursing 341
Differences Between Home
Health Nursing and Hospital
Nursing 342
Challenges and
Opportunities 316
Changes in Health Care in the
United States 316
Healthcare Cost Issues 317
Influencing Community Health
Outcomes 343
318
Concepts of Health, Wellness, and
Well-Being 319
Health 319
Wellness and Well-Being 320
Case Management 320
Health Care Economics 321
322
Nursing Economics 323
Financial Management 323
Profit Versus Not-for-Profit
Organizations 323
Costs and Budgeting 324
Chapter Highlights
References 326
Community-Oriented Nursing
Practice 332
Community-Based Nursing
Practice 332
Public Health Nursing
Practice 332
Settings for Community Nursing
Practice 333
Unit IV: Professional Nursing in a
Changing Health Care
Environment 315
Billing Methods 321
International Perspectives
Philosophical Paradigms
of Community Nursing
Practice 330
325
Chapter 18: Providing Care in Home
and Community 327
Challenges and
Opportunities 328
Community Health Nursing: An
Integrated Approach 329
Definitions of Community and
Community Nursing 330
Assessment and Community
Engagement 343
Diagnosing 346
Planning and Implementation
Evaluation 351
Chapter Highlights
References 352
Chapter 19: Global Health
350
351
354
Challenges and
Opportunities 355
Understanding Global
Health 355
Goals of Global Health 356
Principles of Global Health 357
Human Rights and Ethical
Considerations 360
Global Health Concerns
361
Demographic and Epidemic
Shifts 362
Communicable Disease 362
Noncommunicable Disease 366
Environment and Health 367
Health Systems in a Global
Environment 368
Governmental and
Intergovernmental Systems
368
CONTENTS
Community Development
Assistance Agencies 369
Nongovernmental Systems
370
Health Delivery Systems Around
the World 371
Health System Models
371
Nursing and Global Health
372
Nursing Roles in Global
Health 373
Nursing and Health Professions
Organizations 373
Nursing Opportunities in Global
Health 375
Nurse Migration 375
Chapter Highlights
References 377
377
Barriers to Integrating Culture and
Care 403
Conveying Caring to Diverse
Groups 404
Selected Cultural Parameters
Influencing Nursing Care 406
Health Beliefs and Practices 406
Family Patterns 407
Communication Style 409
Space Orientation 411
Time Orientation 412
Nutritional Patterns 412
Pain Responses 413
Childbirth and Perinatal Care 413
Death and Dying 415
Chapter Highlights
References 420
Challenges and
Opportunities 381
The Expanding View of Health
Care 381
Complementary and Alternative
Medicine 381
Holistic Nursing 382
Health Promotion and Healthy
Lifestyles 383
Primary, Secondary, and Tertiary
Prevention 384
Transition to Integrative
Health 385
Complementary Therapies
386
Biologically Based Therapies
Manipulative Body-Based
Therapies 389
Energy Therapies 390
Mind-Body–Based Therapies
387
391
393
420
Chapter 22: Nursing in a Spiritually
Diverse World 422
Challenges and
Opportunities 423
Concepts Related to
Spirituality 424
Spirituality, Religion, and
Faith 424
Spiritual Development 426
Prayer and Meditation 428
Selected Spiritual and Religious
Beliefs Influencing Nursing
Care 429
Holy Days 429
Sacred Writings and Symbols 430
Dress 430
Health Beliefs and Practices 431
Childbirth and Perinatal Care 432
Pain, Suffering, and Their Spiritual
Meaning 432
Chapter 21: Nursing in a Culturally
Diverse World 395
Death and Dying
Challenges and
Opportunities 397
Concepts Related to Culture
397
Characteristics of Culture 399
Components of Culture 400
Culture and Health Care
Integrating Cultural Knowledge in
Care 403
Providing Culturally Competent
Care 416
Chapter 20: Dimensions of Holistic
Health Care 380
Chapter Highlights
References 394
xxi
400
Leininger’s Sunrise Model 400
Purnell’s Model for Cultural
Competence 402
432
Spiritual Distress 433
Providing Spiritually Competent
Care 434
Spiritual Assessment 434
Diagnosing, Planning, and
Implementing Spiritually
Competent Care 434
Chapter Highlights
References 439
439
xxii
CONTENTS
Chapter 23: Nursing in a Culture
of Violence 441
Advanced Nursing Practice
Challenges and
Opportunities 441
Violence in Society 442
Family Violence and Abuse
442
Intimate Partner Abuse 443
Family Violence and Children
Elder Abuse 446
Selecting a Graduate
Program 469
443
Violence in the Community
Professional Career Goals 469
Personal and Family Factors 470
Program Characteristics 470
447
Exposure to Community
Violence 447
School Violence 447
Violence in the Workplace
Chapter Highlights
References 473
448
Risks to the Healthcare
Workforce 448
Horizontal or Lateral Violence
Challenges and
Opportunities 475
Driving Forces for Change
448
Events That Promoted Nursing’s
Growth and Development 477
Events That Have Indirectly
Affected Nursing 478
Social Movements and
Technological Initiatives That Have
Affected Nursing 479
452
Looking Toward the Future
of Nursing 480
454
Computer Technology and Its Effect
on Health and Nursing Care 481
Healthcare System Changes 482
Regulatory Changes 483
Continued Medical, Surgical, and
Pharmacological Advances 483
456
Chapter 24: Advanced Nursing Education
and Practice 456
Applying Past Lessons to the
Future 485
Visions of Tomorrow 485
Challenges and
Opportunities 456
Advanced Nursing
Education 457
Preparation for Advanced Nursing
Practice 457
Master’s Degree in Nursing 459
476
Past Events That Have Affected
Nursing 477
Threats of Mass Destruction 452
Strengthening the Public Health
System 453
Unit V: Into the Future
475
Healthcare Reform 476
Population Changes 477
Short-Term Interventions 450
Long-Term Interventions 450
Chapter Highlights
References 454
472
Chapter 25: The Future of Nursing
Assessing the Effects of Violence
and Abuse 449
Planning/Implementing
Interventions for the
Abused 450
Prevention of Violence and
Abuse 451
Terrorism and Public Health
459
Types of Advanced Practice 460
Regulation of Advanced
Practice 465
The International Perspective 467
The Future of Advanced Practice
Nursing 468
Chapter Highlights
References 491
Index
493
490
1
Beginning the
Journey
Chapter Outline
Factors in Society That Promote the Nurse’s
Return to School
Changing Trends of Nursing as a Profession
Factors That Influence the Nurse’s Return to
School
Education for Initial and Continuing
Licensure
Credentialing Requirements
Professional Role Transition
Bridges’s Model of Transition
Spencer and Adams’s Model of Transition
Strategies for Success: What It Will Take to
Get There
Time Management
Money
Social Supports
Working With Faculty
Technology Skills
Study Skills
Pedagogic Features for Using This Text
Chapter Highlights
Objectives
1. Examine changes in society that promote the nurse’s return to
school for further education.
2. Examine changes in the profession that promote the nurse’s
return to school for further education.
3. Apply models of transition to professional role change.
4. Identify strategies that will assist the nursing student in the
formal academic setting.
5. Identify helpful approaches to academic success.
6. Implement personal lifestyle and study strategies to promote
success.
7. Use pedagogic features to enhance learning.
T
he evolution of nursing has been dramatic in recent history.
While most of the changes in nursing are in response to
changes in society and in the healthcare system, there are also
changes related to the evolution of the profession. The reciprocal
relationships among nursing, medicine, health, and society
require that nursing must change as society changes, and as the
nursing profession changes, nurses must also transform in response
to professional and societal demands.
Factors in Society That Promote the
Nurse’s Return to School
Changes in society place new demands on nurses. An aging population results in older patients with more complex health problems.
Changing reimbursement practices result in patients being discharged more quickly from hospitals, even though they still need
skilled nursing care either in long-term care facilities or in their
homes. With the passage of the Patient Protection and Affordable
Care Act of 2010, health care is available to a greater percentage
of the population, but there are still those who are uninsured or
underinsured. More care is being delivered in community and outpatient settings. A more diverse population requires nurses to be
more knowledgeable about cultural and social influences on
health. New technology and scientific discoveries require nurses to
update their knowledge and skills continuously. New diseases
2
CHAPTER 1 • BEGINNING THE JOURNEY
related to social and environmental problems require
nurses to have a greater, integrated knowledge of the biological, psychological, and social sciences to promote
health, to prevent illness or injury, and to care for those
who are already ill or injured. Many of these societal
changes will be discussed in more detail in later chapters.
Changing Trends of Nursing as a
Profession
Changed views of men’s and women’s roles are at the
foundation of some of the profession’s internal changes.
Historically, nursing was considered a woman’s occupation; however, that has been changing since the 1980s. In
1980, 2.7% of registered nurses (RNs) were male (U.S.
Department of Health and Human Services, 2004); by
2000, the percentage increased to 5.4% (U.S. Department
of Health and Human Services, 2004); and in 2013, 7% of
RNs were male (Budden, Zhong, Moulton, & Cimiotti,
2013). As more men entered nursing, the image of the profession changed.
Use of traditional identifying symbols of nursing,
such as nurses’ caps and white uniforms, declined. There
also has been less acceptance of the passive behaviors
associated with the historical “handmaiden” role, when the
nurse was viewed as the submissive and unquestioning
assistant to the physician. As members of the healthcare
team, RNs contribute from their area of expertise and are
expected to be accountable and responsible for their work.
These expectations require a more assertive and proactive
role for the contemporary professional nurse as she or he
participates in a more collaborative healthcare system.
Other factors have also accounted for changes in the
role of the professional nurse. The average age of RNs has
increased. In 2000, the average age of RNs was 45.2 years
(U.S. Department of Health and Human Services, 2004);
in 2013, the average age of RNs had increased to 50 years
(Budden et al., 2013). Of concern is the fact that 11% of
licensed RNs are retired, and that percentage is expected
to increase as the baby boomer nurses approach retirement. Based on data from the Department of Labor, the
American Association of Colleges of Nursing (2014) predicts a continuing shortage of RNs. The number of individuals graduating from nursing programs is not keeping
up with the number of nurses leaving the profession
because of retirement or other personal reasons. However,
even as nurses retire, 8% of RNs 65 years of age and older
continue to work full or part time in nursing. In the past, a
nurse may have been more likely to work until having
children and then stop working or work only part time or
short term when additional income was needed. In 1980,
52% of RNs were working full time in nursing. By 2004,
the percentage of RNs working full time in nursing had
increased to 58% (U.S. Department of Health and Human
Services, 2004), and by 2013, that percentage had
increased to 60% (Budden et al., 2013).
The minimum educational requirement for entry into
nursing practice has been debated within the profession for
the last five decades and thus has influenced professional
identity. Hospital-based diploma training was the mainstay
of nursing education until the mid-20th century. Between
1980 and 2013, the percentage of nurses who received a
diploma in nursing as their entry preparation declined from
63.2% to 14% (U.S. Department of Health and Human Services, 2004; Budden et al., 2013). Many diploma nursing
programs closed or affiliated with colleges or universities
offering associate or baccalaureate degrees in nursing.
However, as enrollment in diploma nursing programs
declined, enrollment in associate and baccalaureate degree
programs increased. Between 1980 and 2004, enrollment in
associate degree nursing programs increased from 19% to
40%, and the percentage of RNs receiving their basic nursing education in baccalaureate degree programs increased
from 17% to 37% (U.S. Department of Health and Human
Services, 2004; Budden et al., 2013). Educational preparation in institutions of higher learning socialized nurses to
formal education and even to the idea of continuing their
career development through graduate education. In 1980,
5% of nurses had master’s or doctoral degrees (U.S. Department of Health and Human Services, 2004). By 2013, 13%
of nurses had master’s degrees in nursing (MSN) and 1%
had doctoral degrees in nursing or another discipline
(Budden et al., 2013). This increase in the numbers of RNs
achieving academic degrees beyond their initial nursing
preparation has been influenced by the availability of
employer-provided tuition reimbursement programs.
The focus of professional nursing practice is shifting
from acute hospital-based illness care to primary outpatientbased community care emphasizing health promotion and
illness/injury prevention. Between 1980 and 2013, the percentage of RNs working in hospitals decreased, specifically
down from 66% in 1980 to 57% in 2004 (U.S. Department
of Health and Human Services, 2004; Budden et al., 2013).
This trend has given nurses more autonomy in institutions
with less rigid organizational structure and hierarchy.
Many of these positions require a minimum of a baccalaureate degree for employment. See Table 1–1 for selected
characteristics of RNs in 2013.
Specialty certification for nurses creates rewards in
terms of both recognition by employers and peers and selffulfillment for the nurse. Specialty certification validates a
nurse’s knowledge and experience in a nursing specialty. In
recent years, requirements for taking specialty certification
exams include having extensive experience and continuing
CHAPTER 1 • BEGINNING THE JOURNEY
3
TABLE 1–1 Selected Results of the 2013 National Workforce Survey of Registered Nurses (n ! 42,294)
Number of Registered Nurses
Employment status
Approximately 3 million*
Actively employed in nursing
Full time
60%
Part time
15%
Per diem
7%
Actively employed in field other than nursing
4%
Part time
3%
Per diem
1%
Unemployed
7%
Seeking work as a nurse
3%
Not seeking work as a nurse
3%
Retired
Age
Ethnicity
Initial nursing education (n ! 34,467)
Male
2%
11%
7%
Female
93%
Average age
50 years

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