Framework,scope and trends of nursing practice

1. 1. By;- Shalini joshi M.Sc.nsg 1st year S.C.O.N.,Dehradun

2. 2. Framework introduction Definition of nursing practice Characteristics of
advanced nursing practice Development of the framework Implementation of the
framework Evaluation and research Scope of nursing practice Principles Values
and key components The nursing practice act Nursing practice in different settings
Trend in nursing practice Broadening focusing Scientific basis Technology
Indication of increasing technology Expansion of employment opportunity Nursing
public perception Changing and modern trends in nursing
3. 3. DEFINITION OF ADVANCED NURSING PRACTICE Advance nursing practice is an
umbrella term describing an advance level of clinical practice that maximizes the use of
graduate educational preparation, in depth nursing knowledge and expertise in meeting
the health needs of the individual, families, group, communities and population. It
involves Analyzing and synthesizing knowledge. Understanding, interpreting and
applying nursing theory and research. Developing and advancing nursing knowledge
and the profession as the whole.
4. 4. DEFINITION OF NURSING PRACTICE Nursing practice is an act of providing care to
the patient. In providing care to the patient the nurses implement a nursing care is based
on initial condition of the patient. It is based on specific nursing theory following nursing
theory and nursing practice research side by side is must for patient care and nursing
practice
5. 5. CHARACTERSTICS OF NURSING PRACTICE In advance nursing practice nurses
builds on their expertise in a specially area, integrating and consistently displaying the
following feature and characteristics:- Provision of effective and efficient care, delivered
with a high degree of autonomy. Demonstrate of leadership and initiation of change to
improve client, organization and system outcomes. Deliberate, purposeful and
integrated use of in-depth nursing knowledge, research and clinical expertise.
6. 6. CONTI Depth and breadth of knowledge that draws on a wide range of
strategies to meet the needs of client and to improve access to and quality of care.
Ability to apply and explain the theoretical empirical, ethical and experiential foundation of
nursing practice. Demonstration of advance judgment and decision making skills.
Critical analysis of and influence on healthy policy.
7. 7. DEVELOPMENT OF THE FRAMEWORK One of the first priorities of the vice
president and CNO (Chief Nursing Office) of the Calgary Health Region was to
developmental of this vision, it became apparent that a mission for nursing was also
essential. As this work progressed, an evident need emerged to establish a definition of
professional practice and a guideline or framework that nurses could utilize on daily basis
to achieve the vision and mission of nursing in the region.
8. 8. APPROVAL OF THE FRAMEWORK After several month of consultation with nurses
across the region, discussion at regional nursing council and numerous revisions, the
final draft of professional practice framework was approved by Nursing Council and
distributes during nurse week 2003. The professional nursing practice framework for the
Calgary Health Region.
9. 9. PROFESSIONAL NURSING PRACTICE FRAMEWORK
10. 10. Implementation Of The Framework Numerous sessions were held to familiarize
nursing staff with the framework when it was first launched. Introduction to the
framework is now routinely incorporated into the orientation of all new nurses who join the
region The framework also gives the development preceptors and change nurses. The
major element of the framework next have been linked to the expected RN and RPN
competencies articulated in job description, and application of the nurses ongoing
professional development and continuing education plan.
11. 11. Evaluation and Research What facilitate internalization of the professional practice
framework? Did its implementation change nursing practice of select units? Did
changes in nursing practice affects the role of other members of the health care team/
what difference if any? Did implementation of a professional practice framework make
in job satisfaction and patient outcomes? What went well in implementing the
framework? What could have been done differently?
12. 12. SCOPE OF NURSING PRACTICE The scope of nursing includes:- Direct care
giving Evaluation of care and its impact Advocating for patient and for health
Supervising ad delegating to other Leading and managing Teaching, Conducting
research Developing health policies for health care system.
13. 13. DEFINITION The scope of nursing practice is the range of roles, functions,
responsibilities and activities which a registered nurse is educated, competent and has
the authority to perform. Nursing is both an art and science. It requires the understanding
and applications of specific knowledge and skills and its draws on knowledge and
techniques drive from the humanities and the physical, social, medical and biological
science.
14. 14. PRINCIPLES The following are the basis for making decision with regards to the
scope of practice for an individual nurse:- The primary motivation for expansion of
practice must be the best interest of patient/clients and the promotion and maintenance
for the best quality health services for the population. Expansion of the practice must be
made in the context of the definition of nursing and the values that underpin nursing
practice.
15. 15. PRINCIPLES Expansion of practice must only be made with due consideration to
legislation National policy, local policy and guidelines. In determining of his or her
scope of practice the nurse/midwife must make a judgment as to whether he/she is
competent to carry out the role function. The nurse/midwife must take measures to
develop and maintain the competence, communications and evaluations. Expansion of
the practice must be based on appropriate assessment, planning, communication and
evaluation.
16. 16. PRINCIPLES The nurse who is delegating a particular role/function (the delegator)
is accountable for the decision to delegate. The individual nurse is accountable for
his/her practice this means that he/she is accountable for decision he/she makes in
determining his/her scope of practice that included decision to expand or not to expand
his/her practice.
17. 17. The following values are mentioned below:- In making decision about an individuals
nurses scope of practice, the best interest of the patient/client and the importance
promoting and maintaining the highest standards of quality in the health services should
be foremost.
18. 18. Nursing care should be delivered in a way that respects the uniqueness and dignity
of each patient/clients regardless of culture and religion. Fundamental nursing practice
is the therapeutic relationship between the nurse and the patient/client that is based on
trust, understanding and support and serve to empower the patient/client to make life
choice.
19. 19. KEY COMPONENTS
20. 20. SCOPE OF NURSING PRACTICE Nursing profession is accountable for ensuring
that its member act in the public interest and provide the unique service that has been
designated to them by society. This process is called professional regulation The
profession of nursing regulates itself through defining practice, establishing and
developing the public standard of practice and a code of ethics.
21. 21. CONTI.. In turn, the state through statues, attests to the public that registered
nurses meet minimal standards for practice and prohibits unlicensed individual from
practicing as registered nurse. Since each state has legal authority for the regulation of
nursing, the definition and therefore the scope of nursing practice may vary from state to
state. However the laws remain consistent to protect the public.
22. 22. The Nursing Practice Act The nurse practice act was enacted by the legislature to
regulate the practice for the purpose of protecting the public. The act does not designed
to protect the public from incompetent nursing, not to protect nurses from discriminatory
or questionable employment practice. Each nurse is responsible and accountable for
making decision and practicing in accordance with the individuals educational
background and experience in nursing.
23. 23. NURSING PRACTICE IN DIFFERENT SETTING
24. 24. Individual RNs The registered nurse is responsible and accountable, professionally
and legally for determining his/her professional scope of nursing practice. Since the role
and consequently the scope of nursing practice, is ever changing and increasing in
complexity. It is important that the nurse makes decision regarding his/her own scope of
practice.
25. 25. The Nurse Manager And Nurse Executive The nurse executive in a changing and
complex health delivery system is knowledgeable regarding change in rules and
regulation accreditation standards and standards for care and practice in addition to
evaluation of boundaries specified in nurse practice act. The nurse executes and/or the
nurse manager facilitates changes to assure quality patient care outcomes and develop
mechanism that will promote the same.
26. 26. Mobile Nursing Practice The need was seen in 1984, for local resident to offer
extensive care at home. Reduce the cost and remain in their home for a longer period
of time Organization known as Mobile health care limited and later changed into Mobile
nursing services limited. Provides care during day and night but previously it was given
only on business hours. This practice is innovative leader in home health are service
and transformed this method to southeast area. It is a largest and oldest home health
care system in that area. Mobile introduces many innovation in local health care market
and continue to do so
27. 27. Mobile Nursing Services These services provide home teaching and care for patient
with varied needs and health problem:- Patient discharge early from hospital Patient
suffering from chronic and acute medical problems Surgical patient. Patient requiring
I.V. therapy. The elderly. Respiratory patients. The seriously ill. Patient in need
 of medication management Hospice concept Ventilator dependent (Assistance)
with bathing, dressing, meals, transportation, light housekeeping Service may be
covered by Medicare, medical private insurance, private payment.
28. 28. MILITARY NURSING SERVICES The military nursing services has its origin from
the Army Nursing Service formed in 1881 part of Royal army. After the war on 1 October
1926 the nursing services was granted permanent status in Indian Army
29. 29. Second World War:- With the outbreak of second world war, nurses once again
found themselves serving all over the world During the mid of the war,1943 Indian Army
Nursing services separated from Indian Military nursing service ordinance. And
redesignated as Military Nursing Service (MNS)
30. 30. The Military Nursing Service stands out as one of the oldest services where women
have contributed directly to the nations war effort by providing care to the sick and
wounded soldiers; this is true for all the armed forces of the world. The army nurses have
made a permanent place in every Nations heart by nursing million of sick and wounded
soldiers back to health
31. 31. The officers of Military Nursing Services had distinguished themselves in the Second
World War, through the care of the sick and wounded soldiers in India and also at many
foreign threats of war Post independence, the nursing officers cared for the wounded
soldiers in five major bloody conflicts with the neighboring countries.
32. 32. RANK STRUCTURE Commissioned officers Major- General Brigadiers
Colonel Lieutenant Colonel Major Captain Lieutenant
33. 33. TELE NURSING Refers to the use of telecommunication and information
technology for providing nursing services in health care whenever a large physical
distance exists between patient and nurse, or between any numbers of nurses As a
field it is part of tele health and has many points of contacts with other medical and non
medical application, tele monitoring etc. Tele nursing is achieving large number of
growth in many countries, due to several factors, the preoccupation in driving down the
costs of health care, an increase in the number of aging and chronically ill, population
and the increase in coverage of health care to distant, rural or small populated region.
Among its many benefits, tele nursing may solve increasing shortages of nurses; to
reduce distance and save travel time and to keep patient out of hospital. A greater degree
of job satisfaction has been registered among tele nurses
34. 34. The Nursing Robots The development of nursing robot system included the
development of a mobile robot system to help physically handicapped people.
Completed in 1986, the nursing Robot was one of the first fully functioning mobile
robots equipped with a manipulators arm, also integrated with seven different sensor
systems. The system was controlled by four networked on board Sinclair spectrum
computer and on off board IBM-PC.
35. 35. COTIN The nursing robot system comprises their major components; a self
propelled vehicle, a robotic arm mounted on it, and a communication post next to the
disabled persons bed. Onboard the mobile robot low cost micro-computers are
interconnected as a hierarchical network in order to control a variety of activities, sensor
data processing motion control, path planning, communication and others. The vehicle
can move autonomously in a room with unexpected obstacles.
36. 36. Nursing in Occupational Health OHNs are registered nurses who independently
observe the assess the workers health status with respect to job tasks and hazards,
 using their specialized experience and education, these registered nurse recognize and
prevent health effects from hazardous exposure and treat workers injuries/illness
37. 37. SCOPE OF OHN OHNs bring their nursing expertise to all industries such as meat
packing, manufacturing, construction as well as the health care industry, OHNs have:-
Have special knowledge of work place hazards and the relationship to the employee
health status. Understand industrys hygiene principles of engineering controls,
administrative controls, and personal protective equipment. Have knowledge of
toxicology and epidemiology as related to the employee and the work site.
38. 38. School Health Nursing School nurses are primary care nurses for school children.
They work with individual children young people and families, schools and communities
to raising educational standards. A school nurse is qualified, experienced professional
and the only trained nurse working across health and education boundaries, they also
provide the link between school, home and the community
39. 39. Responsibilities of School Health Nurse Promoting healthy life style and school
Child and adolescent mental health. Chronic and complex health care need in
children and young people Vulnerable children and young people
40. 40. Activities of school health nurses Health assessment for children at entrance to the
school when required. Individual health interviews offered to young people aged 13 -14
years. Immunization programme. Child protection. Health education.
41. 41. TRENDS IN NURSING PRACTICE
42. 42. TRENDS IN NURSING PRACTICE Trends in nursing care closely tied to what is
happening to health care in general. Trends are fascinating phenomena, but they do
not existing in vacuums; Most are interrelated; one trend often spawns another, although
trends are more than fads, They are far from money back guarantees. We watch to
anticipate the direction that particular trends will take us, to remove the elements of
surprise, when we look back on trends, however, some will have permanent changes,
but other might have temporary.
43. 43. BROADENING FOCUS The focus of nursing has broadened from the care of the ill
person to the care of the people in illness and from care of only the patient to care of the
clients, the family, and in some instance the community. In the past, nursing like
medicine was oriented towards disease and illness. Today there is increasing
recognition of people needs for health care as distinct from illness care and of the nurses
independent functions in this area.
44. 44. CONTI. Another aspect of the broader nursing focus is to the movement of
nursing practice into the community. In a sense there is a return to the beginning of
nursing that is before it becomes a recognized occupation. Throughout most of this
century however nurse worked only in institution, increasingly nursing services are
provided in community often in homes and clinics. The nursing activity not only assists
those who are ill but also helps those who are healthy to maintain or continue their
health.
45. 45. Scientific Basis In the past nursing largely was either intuitive or relied on
experience or observation rather than on research, through trial and error the individual
nurses discovered with measures that would assist the client and many nurses become
highly skilled in providing care through experience.
46. 46. TECHNOLOGY Technology or mechanization is being applied in the health field
extensively. Certain areas of a hospital care most technologic than others. Nurses find
 themselves in the midst of rapidly changing, increasingly technologic environment in
hospital and in clients homes.
47. 47. Indication Of Increasing Technology The proliferation of the technologic equipment
used in case of client in hospitals and homes. The increasing home and self care
equipment. Use of computers in many areas of health care.
48. 48. Many nurses feel they need more education to obtain the knowledge and skills
necessary to use the new technology. High technology has enabled nurse to gather client
assessment data through non-invasive techniques (eg:- pulse oxymetry) rather than the
costly invasive procedure.
49. 49. Expansion of employment opportunities Nursing practice trends include a growing
variety of employment setting in which nurses have greater independence, autonomy and
respect as member of the health care team. Nursing role continue to expand and
develop broadening the focus of nursing are and providing a more holistic and all
encompassing domain. Nursing therapies are not only drawing from traditional nursing
and medicine, spiritual and emotional realms, but also expanding into alternative
therapies such as healing touch, massage therapy and use of natural herbs and vitamins.
50. 50. Nursing Public Perception The Johnson Foundation has developed compelling,
attention getting media campaign on nursing profession. This media clips show nursing
practice, and the nurses featured in the advertisement and described their satisfaction in
the profession, nursing is a pivotal health care profession, as frontline health care
providers, nurses practice in all health care setting and constitute the largest number of
professionals. Nurses are essential to provide skilled, specialized knowledgeable care, to
improve the health status of the public and to ensure safe effective quality care; in
addition, the American Public rated nurses high in honesty and ethics in their professional
role
51. 51. Nursing Impact on Politics and Health Policy The ability to influence or persuade an
individual holding a government office to exert the power of that office to affect a desired
outcome is known as Political power or influence. Nurse involvement in politics is
receiving greater emphasis in nursing curricular professional organization and health care
setting. Professional nursing organizations have employed lobbyists to urge state
legislature and the US congress to improve the quality of health care.
52. 52. CHANGING TRENDS IN NURSING Nursing has originated from the word
nurturing which means nourishing, helping in growth and development of a human
being, in the past nursing was family based work. Modern nursing began in the 19th
century under the leadership of Florence Nightingale. The aim of nursing was only to
promote the recovery of patients. Even now the central concern of nursing is nurturing
the human beings.
53. 53. The present day nurse provides care for the people in health services and illness.
Nursing is one of the health services which contribute to well being of an individual,
family and community. Therefore, nursing is defined as a humanistic science dedicating
to maintain and promote health preventing illness care for and rehabilitation of the sick
and disabled person
54. 54. Nursing process includes doing, thinking and interaction component. It is mainly and
basically a problem solving approach of nursing cares. The nursing process consists of
five steps Assessment Nursing Diagnosis Evaluation Implementation Planning
55. 55. MORDEN TRENDS IN NURSING PRACTICE . A Rekindled interest in Eastern
Religion, lifestyle and medicine has fueled the development of complementary holistic,
alternative complementary modalities. Client are seeking out alternative/complementary
therapies because most such therapies are non invasive, holistic and in many instance
less expensive than going to a physician.
56. 56. In 1993 a landmark survey found 1/3 of the US population had used some
nontraditional alternative method of treatment in addition to the standard medical
treatment. In 1993 the US Government established an Office of Alternative Medicine at
the National Institute of Health. One of the reason for the OAMs creation was the US
citizens are pursuing alternative methods of health care with unpredicted enthusiasm.
In 1992, the OAMs was allocated 2 million to investigate the use of nontraditional
treatment methods.
57. 57. A few therapies investigated by the OAMs -1995:- Biofeedback to control pain
Acupuncture to relieve depression Imagery to control Asthma Ayurvedic medicine to
treatment to treat parkinsons disease Music therapy to treat brain injured client Shark
cartilage to treat cancer
58. 58. Kozier, Fundamental Of Nursing 5th Edition, page no. 18-21, 40-41. Lois While
Fudamental of Nursing Mosby Publication, Page No.85, 224. Patricia A. Potter,
fundamental Of Nursing 3rd edition, Mosby Publication, Page no.- 29-31 Potter and
Perry, fundamental Of Nursing, 5th edition Mosby publication. Shabeer P. Basheer, A
Concise Book of Advanced Nursing Practice 1st edition, 2012, Emmss medical
publishers, page no. 648-675. Internet:- www.wikepedia.com www.ncbi.com
www.pubmed.com www.scribd.com www.slideshre.com www.sparknotes.com
www.ACN.org.com