Act of Congress for Public Health
Established the Red Cross
PHEN (Paradigm = Phen)
SCARFI (need a scarf-I in order to be accepted)
Documentation of everything!
– use of statistics to improve health
– early research
– Founded 1st training school for nurses at St. Thomas’s hospital in London
Influential in training some nurses that helped in Civil War
Primary – prevention
Secondary – Early detection of illness and effort it prevent for escalating
Tertiary – Treating illness
(“Neuman”salad dressing where primary is fat free dressing, secondary light dressing, teriary is full fat dressing)
(nurse & patient have to have the same “IMAGE”to attain goal and be the KING of recovery)
(Patricia = Practice skills
Benner = Better nurse)
(abDELLah =RESEARCH on dell computer)
– got expelled from John’s Hopkins but later put back in program by Adelaide Nutting
complex and dynamic conceptual building blocks, are the basis of our nursing language
More loosely structured than theories
– She improved health conditions for British soldiers
Gods controlled the illnesses
Paved way for scientific method
Hippocrates: Father of Medicine
Importance of prenatal care
Moral Obligation to Society was basis for education & gov’t
– family unit, community
Yin & Yang
– balance = good health
Ancient Chinese Medicine
Adapted medical practices from those they enslaved
– Galen (Greek) made important medical contributions as a slave
Both male & female took care of sick
Plagues – yellow fever, typhoid, small pox
Still used purging (bleeding)
Created field hospitals to improve response time
Triage & early response
North had better care and were more organized with supplies and training.
Clara Barton assisted = “Angel of the Battlefield”
Sojourner Truth – insisted on better sanitation & cleanliness
Susie King Taylor – taught soldiers to read and write
No pay, no formal title
Required that nurses be over 35, plain, no jewelry, no hoopskirts
Organized for the North
Phoebe Pember – matron at Chimborazo Hospital in Richmond
– Documentation! Records now kept on patients
– hospital for the Confederacy
– now a museum
more than 6 million hospitalized
Atlanta Baptist Seminary (later called Spellman College) – 1st nursing school for African-Am female nurses
North segregated by custom, south segregated by law
Need for Nurses
– add campaigns
– Pres Bush created nursing scholarships
Lacking nurse educators
Increased workload in hospitals
This clinical practice must be based on scientific knowledge = use of scientific method
Evidence generated by nursing research provides support for the quality and cost-effectiveness of nursing interventions.
The purpose of this data collection is to provide a body of scientific knowledge, which provides the basis for nursing practice.
Recent focus is on patient outcomes
Useful to improve nursing care
Nursing research is the systematic approach to scientifically explain/support the theory
Nursing practices are influenced by results of research and research is fueled by practice
A.k.a, “top down” Researcher starts at the top with a very broad spectrum of information and they work their way down to a specific conclusion.
Begin with a theory about topic of interest & then narrow that down into more specific hypotheses that can be tested. The hypotheses are then narrowed down even further when observations are collected to test the hypotheses. This ultimately leads the researcher to be able to test the hypotheses with specific data, leading to a confirmation (or not) of the original theory and arriving at a conclusion.
AKA= a “bottom up” approach. The researcher begins with specific observations and measures, begins to then detect patterns and regularities, formulate some tentative hypotheses to explore, and finally ends up developing some general conclusions or theories.
* Stems form past problems of abuse to research subjects
(Problem, purpose, literature, hypothesis. design-method, sample, pilot) pplhdsp
(research designed for discovery rather than verification, looking to explain phenomena or process rather than to verify a cause & effect)
Ex: one on one interviews
(The use of various research methods or different data collection techniques in the same study)
Evidence-based practice challenges nurses to look at the “why” behind existing methods and processes in the search for improvement.
Improves standards of care
Critical awareness or research
Helps in learning to critique research articles
Protections in place IRB
– confidentiality (anonymous)
– fair treatment
– protection from discomfort and harm
Concerns for vulnerable populations
This encourages the nurse to flourish as a professional, focuses on professional autonomy, decision making at the bedside, involves nursing in determining the nurse work environment, provides professional education and promotes leadership. Magnet recognition means that collaborative working relationships are fostered. Teamwork and positive relationships among different departments and disciplines are demonstrated.
Tuskegee Syphilis Study
Declaration of Helsinki
Applicable principles regarding human experimentation developed by the world medical association. Regarded as cornerstone document of human research ethics
IRB (institutional review board)
What were study limitations
What would you do different next time
o Varied historically: prostitutes, women of wealthy nobility, religious orders.
o Victorian: women innately sensitive- high morals/ sensitivity, breeding, intelligence, and ladylike behavior, including submission to authority
o Current: Professional
Expected to avoid risk raking and conflict; to give in to authority, to seek careers suitable for females
Stereotype of intellectual inferiority
Effects on status and pay
Separate educational programs- up until GI Bill
• GI Bill- post WWII- more funding for education of military corpsmen
6-8% men in nursing today
o concerns: lack of uniformity of nursing education programs and need for scientific training
o formed American society for superintendents of training schools for nurses—later, national league for nursing (NLN)
Bedford Fenwick – founded International Council of Nurses (1899).
National Association for Colored Graduate Nurses (1908) to raise standards & eliminate discriminatory practices.
African American nurses no full participation in ANA till 1950’s.
Jessie Sleet Scales: African American nurse established Stillman House – community health services to African Americans in NY
1929 -Depression – no longer funds for private duty
Civil Works Administration (1933) provided nursing employment in rural & school settings.
Hospitals forced to close schools of nursing, & began to hire trained nurses as staff.
Encouraged the evolution of public health nursing.
Much of hospital care funded by Medicare and Medicaid.
Nurses stayed primarily in hospital settings.
Specialties in nursing – 1960s (psychiatry, critical care, coronary care, nurse practitioners)
Rapid expansion of facilities resulted in nursing shortage (Larger buildings but less staff – as today?)
Discussion—bridging the gap:
• Creating better communication
• Interactive strategies
• Working together
What has not changed:
• Patient centered
• Respect for patient
• Striving for best care
• Making patients comfortable / caring!!
5.7 – Employed RNs are males
Largest number of health care workers in US
Average age (2004)- 46.8 y.o.
• 8.1% of newly licensed RN were under 30
o History from patient
o From family members
“my baby had a fever yesterday”- subjective- this is what she is telling you
o Medical records
o Other professionals
o History of present illness
How long has this been happening?
Does anything help?
Has this happened before?
o Past Medical history
What medications are they on?
Any other health problems?
o Anything that you observe
o Vital signs, height, weight, physical assessment, labs, x-rays, other diagnostic tests
o IE: nursing Dx: ineffective breathing pattern
NIC: encourage slow, deep breathing; turning; coughing
NOC: client will report that he can breathe comfortably within 20 minutes