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Lewis: Medical-Surgical Nursing, 10th Edition

Chapter 1

Professional Nursing Practice



 Nursing is the (1) protection, promotion, and optimization of health and abilities;
(2) prevention of illness and injury; (3) alleviation of suffering through the diagnosis and
treatment of human response; and (4) advocacy in the care of individuals, families,
communities, and populations.
 Nurses offer skilled care to those recuperating from illness or injury, advocate for
patients’ rights, teach patients to manage their own health, support patients and caregivers
at critical times, and help them navigate the complex health care system.
 A variety of nursing organizations offer certification in nursing specialties, such
as critical care, geriatric, emergency, psychiatric and mental health, and community
health nursing.
 Entry-level nurses with an associate or baccalaureate degree in nursing are
prepared to function as generalists. With additional preparation, nurses can assume roles
such as clinical nurse specialist and nurse practitioner.


 Rapidly changing technology and dramatically expanding knowledge are adding
to the health care environments. The health care environment is influenced by changes in
the structure and financing of health care systems, ever-changing laws and regulations,
and the increasing voice that patients have in their care.
 Healthy People is a broad-based program that involves government, private,
public, and nonprofit organizations in preventing disease and promoting health.
 Because nurses play such a vital role in providing safe care, major nursing
organizations promote research into the causes of errors, develop strategies to prevent
future errors, and address nursing work environments that affect patient safety.

 Health and nursing care are delivered by a variety of models. The nurse’s role in
most cases is one of interdependence and co-participation with the patient and other
health care team members.
 Complex health care environments require that you use critical thinking to make
decisions that lead to the best patient outcomes. These include applying the cognitive
skills of analyzing, applying standards, discriminating, information seeking, logical
reasoning, predicting, and transforming knowledge.
 The five elements of the nursing process are assessment, diagnosis, planning,
implementation, and evaluation. Three standardized nursing languages are used to
document the nursing process. Using these languages facilitates professional nursing
practice and provides the nurse with a consistent way to communicate nursing


 To collaborate effectively with members of the interprofessional team, you must
be aware of the knowledge and skills of other team members and be able to communicate
effectively with them.
 Delegation of nursing interventions to licensed practical nurses/licensed
vocational nurses (LPNs/LVNs) and unlicensed assistive personnel (UAP) is an important
function of the professional nurse.
 Assignment is the distribution of work that each staff member is responsible for
during a given work period. Assignments are frequently performed when the nurse directs
other nurses, LPNs, and UAP to perform care that is within their scope of practice.
 Supervision includes guidance and direction, oversight, evaluation, and follow-up
by the RN. When you delegate, you are responsible for supervision of UAP or

 By implementing various procedures and systems to improve communication and
health care delivery to meet safety goals, health care systems create a culture of safety
that minimizes the risk of harm to the patient.
 Nurses are a vital part of promoting this culture of safety by providing care in a
manner that reduces errors and actively promotes patient safety.

 The nurse’s role in quality improvement is to coordinate the complex aspects of
patient care, including the care delivered by others, and identify and correct issues
associated with poor quality and unsafe care.
 The National Database of Nursing Quality Indicators provides data on nursing
sensitive- measures. Patient outcomes are nursing sensitive if they improve with a greater
quantity or quality of nursing care.

 All nurses use informatics every day in practice. Information technology has
changed how you obtain and review diagnostic information, make clinical decisions,
communicate with patients and health care team members, document, and provide care.
 As a nurse, you must be able to help patients access and use appropriate health
information and to evaluate information as it relates to your own practice.

 Evidence-based practice (EBP) is a problem-solving approach to clinical decision
making that involves the use of the best available evidence in combination with clinician
expertise and patient preferences and values to achieve desired patient outcomes.
 EBP is a process that involves finding, examining, and using research conducted
by others in efforts to answer a specific clinical question.