N108: Transition to the Registered Professional Nurse

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NURSING 108 Transition to the Registered Professional Nurse

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ACHIEVE TEST PREP N108: Transition to the Registered Professional Nurse Role Study Guide 1st Edition 10/26/2017

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Acknowledgements We would like to thank the authors for their patience, support, and expertise in contributing to this study guide; and Christina Wulff for her invaluable efforts in reading and editing the text. We would also like to thank those at Achieve Test Prep whose hard work and dedication to fulfilling this project did not go unnoticed. Lastly, we would like to thank the Achieve Test prep students who have contributed to the growth of these materials over the years. Copyright © 2017 by Achieve Test Prep All rights reserved. This book or any portion thereof may not be reproduced or used in any manner whatsoever without the express written permission of the publisher except for the use of brief quotations in a book review. Printed in the United States of America First Printing, 2012 Achieve Test Prep PO Box 10188 #29831 Newark, NJ 07101-3188 Tel: 888.900.8380 Visit the Achieve Test Prep website at http://www.achievetestprep.com/student

Table of Contents Chapter One: Professional Role Development ........................................................................ 7 1.1 Definition of Nursing ............................................................................................................. 7 1.2 Early Images of Nursing........................................................................................................ 8 1.3 The Influence of World Events and Trends on the Development of Nursing..... 9 Impact of Religion and Religious Orders .......................................................................................... 9 Military Influences on the Development of Nursing.................................................................... 9 1.4 Significant Nursing Leaders and Their Contributions .............................................11 1.5 Influence of Major Studies and Reports on Nursing .................................................16 1.6 Nursing Organizations ........................................................................................................21 1.7 Educational Patterns in Nursing......................................................................................27 Historical Models......................................................................................................................................27 Academic Nursing Programs ...............................................................................................................28 1.8 Accreditation of Academic Programs ............................................................................33 1.9 Credentialing..........................................................................................................................34 1.10 Continuing Education .......................................................................................................34 1.11 Transition to the Professional Nurse Role ................................................................35 Role Transition..........................................................................................................................................35 Role Conflict................................................................................................................................................36 The Change Process.................................................................................................................................36 Change Theories .......................................................................................................................................37 Becoming a Registered Nurse .............................................................................................................38 The RN as Member of the Discipline of Nursing..........................................................................39 Professional Boundaries........................................................................................................................39 Role Differences Between the RN and LPN/LVN ........................................................................40 1.12 Nursing as a Profession....................................................................................................41 Characteristics of a Profession............................................................................................................41 Roles of the Professional Nurse..........................................................................................................42 Characteristic Behaviors of the Professional Nurse...................................................................43 1.13 Roles and Practice Settings Relative to Each Level of Education.......................44 Associate Degree Nurse .........................................................................................................................44 Baccalaureate Degree Nurse................................................................................................................47 Master’s Degree/Advanced Practice Nurse...................................................................................47 1.14 Competencies Shared by all Levels of Professional Nursing...............................48 NLN Core Values and Core Competencies......................................................................................49 Institute of Medicine’s (IOM) Core Competencies ......................................................................50

N108: Transition to the Registered Professional Nurse Role Study Guide Quality and Safety Education for Nurses ........................................................................................51 1.15 Critical Thinking.................................................................................................................52 1.16 Learning Concepts..............................................................................................................54 1.17 Chapter One Unit Review.................................................................................................56 1.18 Chapter One Practice Exam ............................................................................................57 Chapter Two: Ethical, Legal, Regulatory, and Professional Implications ....................59 2.1 Ethical Aspects of Nursing Practice ................................................................................59 Values Clarification..................................................................................................................................59 ANA Code for Nurses...............................................................................................................................61 International Council of Nurses (ICN) Code of Ethics ...............................................................62 Components of Ethical Reasoning .....................................................................................................62 Ethical Theories ........................................................................................................................................63 Ethical Dilemmas and Decision Making ..........................................................................................63 Bioethics.......................................................................................................................................................64 Ethics Committees ...................................................................................................................................64 Effects of Technological Advances ....................................................................................................65 End of Life Issues......................................................................................................................................66 Moral Distress............................................................................................................................................67 2.2 Rights and Responsibilities in Healthcare ...................................................................67 2.3 Legal Aspects that Impact Nursing Practice ................................................................70 Types of Laws ............................................................................................................................................70 Civil Law.......................................................................................................................................................71 Reducing Nursing Liability ...................................................................................................................73 Contracts ......................................................................................................................................................74 2.4 Legal Documents ...................................................................................................................75 2.5 Criminal Law...........................................................................................................................77 2.6 Statutory Law .........................................................................................................................79 State Statutory Law .................................................................................................................................79 Federal Statutory Law ............................................................................................................................82 Liability.........................................................................................................................................................84 2.7 The Legal Process of a Lawsuit.........................................................................................85 2.8 Standards of Nursing Care .................................................................................................85 The ANA’s Standards of Practice........................................................................................................86 State Nurse Practice Acts ......................................................................................................................87 Nursing Care Plans...................................................................................................................................88

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N108: Transition to the Registered Professional Nurse Role Study Guide Critical Pathways (Concept Mapping) .............................................................................................88 2.9 Socioeconomic Factors and Demographic and Cultural Trends in Healthcare ............................................................................................................................................................90 2.10 Types of Healthcare Plans...............................................................................................96 2.11 Quality and Affordable Care Act................................................................................. 100 2.12 Healthcare Access and Availability of Services for the Uninsured ................ 101 2.13 Educational Factors Influencing the Healthcare System................................... 102 2.14 Health Care Organizations ........................................................................................... 104 2.15 Accreditation/Recognition of Healthcare Agencies ............................................ 107 2.16 Regulatory Bodies ........................................................................................................... 109 State Agencies ......................................................................................................................................... 109 Federal Agencies.................................................................................................................................... 111 2.17 The Development of Healthcare Legislation and Policy.................................... 111 Role of the Individual Nurse ............................................................................................................. 111 Professional Nursing Organizations .............................................................................................. 112 Other Healthcare Organizations...................................................................................................... 112 Special Interest Groups....................................................................................................................... 113 2.18 Workplace Issues ............................................................................................................ 114 Environmental Exposure to Pathogens........................................................................................ 114 Hazardous Chemical Agents ............................................................................................................. 114 Needle Stick Injury................................................................................................................................ 115 Horizontal Violence .............................................................................................................................. 115 Whistle-Blowing .................................................................................................................................... 115 Harassment.............................................................................................................................................. 116 Disruptive Behavior ............................................................................................................................. 116 Adequate Staffing .................................................................................................................................. 116 2.19 Employment Rights ........................................................................................................ 117 2.20 Emerging Roles for Nurses........................................................................................... 119 2.21 Chapter Two Unit Review............................................................................................. 120 2.22 Chapter Two Practice Exam......................................................................................... 121 Chapter Three: Management of Patient Centered Care................................................... 125 3.1 Nursing Theory................................................................................................................... 125 Key Definitions ....................................................................................................................................... 126 The Four Concepts (Paradigms) of Nursing Theory ............................................................... 126 Types of Theories .................................................................................................................................. 126

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N108: Transition to the Registered Professional Nurse Role Study Guide 3.2 Nurse Theorists and their Influence on the Nursing Profession....................... 127 3.3 Evidence-Based Research ............................................................................................... 131 Types of Research ................................................................................................................................. 132 3.4 Quality Management and Quality Improvement .................................................... 133 3.5 The RN’s Role in Quality Improvement ...................................................................... 137 Nursing Sensitive Quality Improvement Indicators (NDNQI) ............................................ 137 Never Events ........................................................................................................................................... 138 Hospital Acquired Conditions (HACs)........................................................................................... 138 HCAHPS and Patient Satisfaction.................................................................................................... 138 3.6 The Nurse in the Health Care Organization.............................................................. 139 3.7 The Inter-Professional Health Team........................................................................... 141 Quality and Safety Education (QSEN) Teamwork and Collaboration .............................. 143 TeamSTEPPs............................................................................................................................................ 143 3.8 Communication Techniques .......................................................................................... 144 3.9 Organizational Patterns for the Delivery of Nursing Care................................... 145 3.10 Assigning, Delegating, and Supervising Care......................................................... 146 3.11 Leadership Theories and Styles ................................................................................. 149 3.12 Conflict Management ..................................................................................................... 150 3.13 Patient Centered Care.................................................................................................... 152 3.14 Informatics and Technology........................................................................................ 153 3.15 Chapter Three Unit Review.......................................................................................... 154 3.16 Chapter Three Practice Exam ..................................................................................... 155

Practice Exam................................................................................................................................. 157

Answer Keys ................................................................................................................................... 171

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N108: Transition to the Registered Professional Nurse Role Study Guide Chapter One: Professional Role Development Learning Objectives 1. Discuss significant leaders and their contributions to the profession of nursing. 2. Describe the influence of major studies and reports on nursing. 3. Discuss the purposes, functions, and impacts on nursing, healthcare, education, and politics of nursing organizations. 4. Discuss the educational patterns in nursing. 5. Understand and describe all aspects of the role transitioning process. 6. Describe the differences in roles between the LPN/LVN and the RN. 7. Discuss learning theory and learning domains and how they relate to the adult learner. 8. Identify activities involved in each part of the nursing process. 9. Describe the differences between independent, dependent, and collaborative nursing actions. 10. Describe the IOM and QSEN nursing competencies and their impact on quality nursing practice and patient safety. 11. Discuss the NLN competencies of the associate degree graduate and their significance to the associate degree nurse in practice. 12. Discuss the concepts and steps involved inmaking safe and effective nursing decisions, such as critical thinking and clinical judgment. 13. Describe the various change theory models and their impact on nursing practice. 14. Discuss the characteristic behaviors of the professional nurse. 15. Describe the future for nursing in the discipline and in life-long learning. 16. Identify self-care behaviors to reduce stress. 17. Discuss the roles and practice settings relative to each level of nursing education. 18. Describe the practice settings for the associate degree nurse. 1.1 Definition of Nursing The tradition of nursing has always highly valued the worth and dignity of all human beings. Altruism is the foundation of the nursing profession, a profession that serves the public in a variety of ways. Nurses are dedicated to holistic care, teaching about health maintenance, prevention of illness, and promotion of healthy practices, as well as caring for the person who is ill. The nurse identifies client’s needs in order to promote health and maintain wellness in all types of settings. Florence Nightingale stated that nursing is, “the act of utilizing the environment of the patient to assist him in his recovery.” Virginia Henderson said, “the unique function of the nurse is to assist the individual, sick or well, in the performance of those activities contributing to the health or its (his/her) recovery, or to a peaceful death.”

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N108: Transition to the Registered Professional Nurse Role Study Guide The American Nursing Association definition of nursing states, “Nursing is the protection, promotion, and optimization of health and abilities, prevention of illness and injury, alleviation of suffering through the diagnosis and treatment of human response, and advocacy in the care of individuals, families, communities, and populations.” Abraham Flexner was an American educator who reformed medical education in the United States. His message to nursing was that nurses had some obligation to use their knowledge, status, and power to benefit those who do not possess those attributes. In 1910, Abraham Flexner identified a list of professional characteristics specific to nurses. These included: • Research: Constantly striving to add knowledge • Education: Higher intellectual level • Service: Applied to the service of humanity • Life work: Practitioners have a career and put service above personal gain • Autonomy: Function independently • Status: Compensate practitioners with freedom, money, and growth 1.2 Early Images of Nursing Nursing carried forward three heritages from the past that some believe impeded the development of nursing as a profession. They are the folk image of nursing fromprimitive times, the religious image of the nurse inherited from the medieval period, and the servant image of the nurse created by the Protestant-capitalist perspective from the 16 th to 19 th centuries. • Folk image: Primary responsibilities focused on nourishing and nurturing children, caring for the elderly, and caring for aging family members. Skills were learned through trial and error and passed from one generation to another. This image presents the nurse as a caring person who uses common sense to help the sick individual. • Religious image: Groups were organized in conjunction with the establishment of churches in the Christian era with their primary concern focused on care for the sick, the poor, orphans, widows, the aged, slaves, and prisoners. The first hospitals were developed at this time, located close to monasteries. The Crusades witnessed the founding of military nursing orders. Nurses in this setting were expected to devote their lives to caring and to exhibit selfless commitment based upon religious faith. • Servant image: The Reformation, which began in Germany in 1517, brought with it a change in the role of women. Duties were those of bearing children and caring for the home. Hospital care was relegated to uncommon women, a group consisting of prisoners, prostitutes, and drunks who had no status in society and were treated as servants who did distasteful tasks. This began what was called the Dark Ages of nursing.

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N108: Transition to the Registered Professional Nurse Role Study Guide 1.3 The Influence of World Events and Trends on the Development of Nursing Impact of Religion and Religious Orders During the 17 th century, social reform began in Europe. Several nursing groups were organized to gave time, money, and service to the sick and the poor, visiting them in their homes and ministering to their needs. • The Reformation: The reformation brought a change in the role of women. Duties were those of bearing children and caring for the home. This image may have greatly influenced the development of nursing as a profession, as many capable and desirable persons were unwilling to enter nursing while it had this image. This era was known as the Dark Ages of nursing. • Sisters of Charity: Sisters of Charity was founded in Paris in 1633 and received help from St. Vincent de Paul. The Sisters of Charity recruited and educated intelligent young women to care for abandoned children, as well as provide hospital care. In 1809, the Sisters of the Charity established a nursing order in the United States under Elizabeth Bayley Seton. • Sisters of the Holy Cross: This Sisters of the Holy Cross was founded in France and the United States. It provided care to the sick in hospitals and orphanages. • Catholic Religious Orders in Mexico and South America: These were founded following the Reformation, as several Roman Catholic religious groups traveled to the Americas. In 1524 the first hospital on the American continent, the Hospital of Immaculate Conception, was built in Mexico City and mission colleges were founded. The first medical school in America was founded in 1578 at the University of Mexico. • Ursuline Sisters in Canada: This organized the first training of nurses on the North American continent, teaching the native women to care for their families during a smallpox epidemic. • The Christian Deaconess Movement: The Christian Deaconess Movement was revived in Germany in 1836. The Deaconesses cared for the sick, made visitations, worked in the parish, and taught. In 1849 Pastor Fliedner traveled to the United States to help establish the first Motherhouse of Kaiserwerth in Pittsburgh, Pennsylvania. The Deaconesses managed the Pittsburgh infirmary, which later became the Passavant Hospital, the first Protestant hospital in the United States. • Nursing Sisters in England and Ireland: The Nursing Sisters in England and Ireland established the Institute of Nursing Sisters, which was a secular group established in England by Elizabeth Fry. It was also established by the Sisters of Mercy, a Roman Catholic group formed by Catherine McAuley, and the Irish Sisters of Charity, a Roman Catholic group formed by Mary Aikenhead. Military Influences on the Development of Nursing The Crimean War The Crimean War began in 1853 when England and France joined forces to defend Turkey against Russia. The founder of modern nursing, Florence Nightingale, is known for her work during this war. Nightingale organized the care of the sick and wounded at Scutari, the British base hospital in Constantinople. After Nightingale returned from the Crimean War, she wrote about the need for training and education for nurses. In 1860, she founded a school of nursing at St. Thomas Hospital in London.

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N108: Transition to the Registered Professional Nurse Role Study Guide of 171 The American Revolution All of the English colonies scattered along the Atlantic Coast of the United States were involved in the American Revolution. The army existed without the benefit of a medical corps or trained nurses. The nuns of the Catholic Church, who also cared for those who were ill with epidemic diseases like scarlet fever, dysentery, and smallpox, nursed wounded soldiers. Women who had followed their husbands into the battlefield often cared for soldiers. Homes and barns near the battlefield were used for hospitals. When the war ended, the usual type of poverty existed, and invalids and the disabled needed care. However, the colonies were not sufficiently developed to have such services available. In response, a new type of institution evolved, which is perhaps the forerunner of today’s clinic or hospital outpatient department. American Civil War The Civil War began in 1861 after the southern states attempted to secede from the Union. During that time, the military did not include an organized medical corp. Volunteers cared for the injured in the nearest barn or building. The Red Rover, a steamer ship, became the first floating hospital. The Catholic Sisters of Mercy served as nurses aboard the ship. Clara Barton volunteered in the Sixth Massachusetts Regiment during the war to care for the injured. In 1882, Barton established the American Red Cross. Spanish-American War Begun in 1898, this war highlighted the need for military nurses. Many of those who died during the war died in camp of malaria, dysentery, and typhoid. As in previous wars, doctors objected to women nurses. The Daughters of the American Revolution (DAR) set up an examining board to determine who was fit to serve as a military nurse. In 1901, the Army Nurse Corp was established and the Navy created its Nurse Corp in 1908. World War I During the years of 1914-1918, WWI created a greater need for military nurses. This led to the acceptance of minorities andmen as nurses. A training course for nurses was established at the Vassar Training Camp. The nurses who finished the training later finished a course at their home schools. This helped to move nursing education to an academic setting. Annie Goodrich suggested an Army School of Nursing based on standard curriculum for schools of nursing. She became the first dean of the school. Goodrich also established duty hours for students of only six to eight hours. World War II Fought from 1941-1945, WWII saw many significant improvements in the field of nursing. For the first time, the Cadet Nurse Corps received public funding for nursing education. Schools of nursing for minorities were funded as well. Education time was reduced from 36 months to 30 months. Inactive nurses were recruited back to nursing. Older and/or married women were allowed to serve as nurses. A shortage of nurses was solved by training volunteer nurse aides. After WWII, Nurse Officers received full commissioned rank. This resulted in more power and more pay for them. ©2017 Achieve Test Prep Page 10

N108: Transition to the Registered Professional Nurse Role Study Guide Cadet Nurse Corps The Bolton Act of 1943 resulted in the creation of the Cadet Nurse Corps. The nursing shortage during WWII highlighted the need for more nurses. This was the first federal program to subsidize nursing education. The female recruits of the Cadet Nurse Corps received federal tuition money, uniforms, and a monthly stipend while they pursued their nursing education. After completing the program, nurses were required to serve a period of time in the military. This program proved that nurses could be trained successfully in a short period of time. During modern wars, such as those in Korea, Vietnam, and the Middle East, nurses served in Mobile Army Surgical Hospitals (MASH). There has also been an increase in the need for flight nurses to help the injured while they are being evacuated to a safe zone. 1.4 Significant Nursing Leaders and Their Contributions Florence Nightingale Nightingale was called “the lady with the lamp” because she carried a lamp on night rounds while visiting sick soldiers. She is given credit for being the founder of modern nursing. Nightingale was born in 1820 in Florence, Italy to wealthy English parents. Although she was raised to be a lady, she became a social reformer particularly in the care of hospital patients. She trained at Kaiserwerth, a German nursing school. In 1854, during the Crimean War, she and a group of her nurses reformed conditions at the military hospital that served British soldiers in Scutari. Nightingale gathered and published data on patient morbidity and mortality in British hospitals and established a training school for nurses. Nightingale emphasized following the doctor’s orders. She also wrote Notes on Nursing: What it is and What it is not for family members who nursed sick relatives. The major theme of Nightingale’s work focused on sanitation and the environment, with the goal of nursing to put the patient in the best condition for nature to act upon him, primarily by altering the environment. Nightingale wrote that the education of nurses should include both theory and practice which included the following: • Nurses would be trained in teaching hospitals associated with medical schools and organized for that purpose. • Nurses would be selected carefully and would reside in nurses’ houses designed to encourage discipline and form character. • The school matron would have final authority over the curriculum, living arrangements, and all other aspects of the school. • Teachers would be paid for their instruction. • Records would be kept on the students, who would be required to attend lectures, take quizzes, write papers, and keep dairies. Inmany ways, Florence Nightingale advanced nursing as a profession. She believed that nurses should spend their time caring for patients, not cleaning. She also believed that nurses must continue learning throughout their lifetime and not become stagnant, that nurses should be intelligent and use that intelligence to improve conditions for the patient, and that nursing leaders should have social standing.

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N108: Transition to the Registered Professional Nurse Role Study Guide of 171 Clara Barton Barton became known as “the angel of the battlefield” after she provided care to soldiers during the American Civil War. In 1882, she founded the American Red Cross. Barton was born in 1821 on Christmas Day in Oxford, Massachusetts. Her father, who was a farmer and soldier, told her stories about his time in the army. These stories instilled in her a lifelong interest in military affairs. Young Clara nursed her brother David, who had been injured in an accident, for two years. Barton became a teacher at the age of fifteen. She moved to Washington, DC in 1854 and began her war service when the Sixth Massachusetts Regiment arrived in Washington. The regiment had lost its baggage during battle, leading Barton to find ways to supply their needs. After the Battle of the Bull Run, reports of supply shortages in the field caught Barton’s attention. She advertised for provisions in the newspaper and established a distributing agency to handle the donations. In 1862, the government gave Barton permission to accompany sick transports and aid the sick and wounded. After the war, she supervised a federal search for missing soldiers and delivered lectures on her war experiences. She met Susan B. Anthony, which began her long association with the suffrage movement. She also met Frederick Douglass and became involved in activism for the rights of former slaves. In 1869, Barton was in Europe during the Franco-Prussian conflict and worked with the International Red Cross to distribute supplies in France and Germany. The German Emperor gave her the Iron Cross of Merit. When she returned home, she became involved in trying to establish the American Red Cross. Her efforts to educate the public and lobby cabinet heads and Congressmen were successful. In 1881, the National Society of the Red Cross was formed with Barton as the president. She directed the efforts of the organization for the next 23 years and was called “little lone lady in black silk.” Dorothea Dix Dix was appointed to supervise the Union “nurse” volunteers by the Secretary of War. She was a Boston schoolteacher well known for her humanitarian efforts on behalf of the mentally ill. The Civil War had opened work in hospitals to ladies of the upper class for the first time. There were 6,000 Union volunteers and only “plain-looking women” were allowed to be nurses. Louisa May Alcott and Walt Whitman were volunteers. “Mother” Mary Ann Bickerdyke was another who advocated on behalf of soldiers. Harriet Tubman Tubman, who was called “Moses” by the hundreds of slaves she helped escape slavery, was the most famous leader of the Underground Railroad. The Underground Railroad was an elaborate series of houses, tunnels, and roads set up by abolitionists and former slaves to assist slaves escaping to free states or Canada. Tubman was born a slave but escaped using the Underground Railroad. She decided to join the Underground Railroad after the Fugitive Slave Act was passed by Congress in 1850. Tubman’s first expedition was in 1851 when she brought her sister and sister’s children north. Between that trip and the start of the Civil War, Tubman travelled south 18 times and assisted close to 300 slaves, including her own parents in 1857. ©2017 Achieve Test Prep Page 12

N108: Transition to the Registered Professional Nurse Role Study Guide During the Civil War Tubman served mainly in South Carolina as a nurse, scout, and occasionally a spy. One military campaign in which she participated freed 756 slaves and damaged millions of dollars of property. Tubman continued her role in social issues, including the women’s rights movement. She was commended for caring for the sick and wounded without regard to color. In 1908, she founded a home in Auburn, NY for the elderly. That house later became known as the Harriet Tubman House. Sojourner Truth Truth was a former slave who lived in Florence, MA. She was named Isabella when she was born in approximately 1797 in upstate New York. Truth slaved for five different masters until slavery was abolished in New York State in 1827 and she became free. After winning a court battle for the return of her son from owners in Alabama, she moved to New York City where she worked as a housekeeper for the next 15 years. Isabella changed her name to Sojourner Truth and became a travelling preacher. She walked through Long Island and Connecticut telling people in her life about her relationship with God. After several months, she joined other progressive thinkers at the Northampton Association until it disbanded in 1846. She dictated the story of her life to Olive Gilbert, which was published in 1850 as The Narrative of Sojourner Truth : A Northern Slave . The book led to Truth becoming a popular speaker on the anti-slavery and woman’s rights lecture circuit. After the Civil War, she began working with and caring for former slaves in the newly created Freedman’s Village. Mary Mahoney Mahoney is credited with being America’s first trained African-American nurse. She graduated from the New England Hospital for Women and Children in 1879. Mahoney recognized the need for nurses to work together to improve the status of blacks in the nursing profession. She co-founded the National Association of Colored Graduate Nurses (NACGN) with Adah Belle Samuels Thomas and Martha Franklin in 1908. Isabel Hampton Robb Robb was an educator, leader, and founder of the nursing school at Johns Hopkins in Baltimore. In 1881, she entered the Bellevue Training School in New York. She recruited Lavinia Dock, another Bellevue alumnus, to teach at Hopkins as well. Robb reformed education at Johns Hopkins by limiting the amount of private duty the students were required to do and reducing the length of the student’s workday. After her marriage to Dr. Robb, her colleagues were upset to think she might give up nursing, but she did not. Lillian Wald Wald graduated from the New York Hospital School of Nursing. She left medical school to start an early public health nurse practice and institute school nursing in 1893. Wald worked with Mary Brewer to establish the Henry Street Settlement, a social welfare and nursing agency. Annie Goodrich Goodrich served as president of the American Nurses Association from 1915 to 1918. During her

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N108: Transition to the Registered Professional Nurse Role Study Guide career, Goodrich was also president of the Association of Collegiate Schools of Nursing, New York State Inspector for training schools, director of nursing service at Henry Street Settlement, professor of nursing at Teacher's College, Columbia University, and Dean of the Army School of Nursing. She developed the first nursing program at Yale University. She was responsible for developing the program into the Yale Graduate School of Nursing ten years later. Mary Adelaide Nutting Nutting was superintendent of the nursing school at Johns Hopkins. Nutting had also graduated from Johns Hopkins and became friends with Lavinia Dock and Isabel Hampton Robb. Isabel M. Stewart Stewart was the author of The Curriculum Guide for Schools of Nursing in 1937 while she served as chair of the NLN Education Curriculum committee. This guide was used for 25 years in many nursing schools. The guide emphasized the application of sciences, the role of the clinical instructor, and the use of new, creative methods for teaching. Virginia Henderson Henderson was a nurse leader who defined nursing as “assisting the individual [to do what] he would perform unaided if he had the necessary strength, will or knowledge.” This definition is still used by nurses worldwide. Dorothea Orem later based her theory on “self-care deficit” on Henderson’s idea. Henderson observed in the 1950s that the number of studies about nurses outnumbered studies about nursing clinical problems 10 to 1. The Virginia Henderson International Nursing Library is located at the International Center for Nursing Scholarship at Indiana/Purdue University. Hildegard Peplau Peplau developed a theory of nursing called the Interpersonal Relations Model, in which she theorizes that the purpose of nursing is to foster personality development in the direction of maturity. She outlined four stages of the therapeutic relationship: orientation, working, exploitation of the relationship, and resolution. Peplau theorized that tension arises from the failure to meet needs. She taught that nurses should prioritize their relationship with the patient, strategize to increase maturity, then evaluate whether or not tension was decreased. Martha Rogers Rogers created the nursing theory “Science of Unitary Human Beings.” Her theory describes a constant exchange of energy between humans and their environment. She believed that this exchange was essential for life. She also described the principles of homeodynamics as: helicy, resonancy, complementarity, and an indivisible energy field. Rogers promoted the idea that nurses use their intellect and knowledge to interact with patients in order to promote healthy patterns of living in harmony with their surroundings. Nurses interested in New Age therapies recognize this nursing theory.

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N108: Transition to the Registered Professional Nurse Role Study Guide Madeline Leininger Leininger created the theory of nursing known as the “Transcultural Care Model.” She believed the essence of nursing is caring. Leininger believed that the patterns of caring that develop can be seen and systematically observed. From these patterns, a “science of caring” is developed. In this theory, culture is defined as the learned, shared, and transmitted values, beliefs, norms, and life practices of a particular group. Mildred Montag Montag was a developer and leader of the Associate Degree in Nursing movement in nursing education. Her doctoral dissertation was published in 1951, in which she advocated and authored the education of a nursing technician. The nursing technician would function somewhere between the professional nurse and practical nurse. Faye Abdellah Abdellah developed 21 problems that have been used in teaching patient-centered nursing care. She also identified the five elements nurses must have that are the basis for nursing diagnosis and treatment: • Observation and communication • Interpretation of what is observed • Technical and other skills for practice and management • Analysis • Organization Loretta Ford Ford’s expertise is in the education of nurse practitioners. She has written extensively on the history of nurse practitioners, her predictions on the future of the field, and myths and misconceptions. Luther Christman Christman was a Dean Emeritus of Rush University in Chicago. He is recognized as a leader in nursing education, particularly nursing management. He supported the use of the unified educational process setting. Margaret Sanger Sanger was the founder of Planned Parenthood. As a public health nurse, Sanger worked on maternity cases involving underpaid industrial workers of New York where unwanted pregnancies flourished. After witnessing a woman’s death from a self-abortion, Sanger educated herself on birth control methods and started a clinic with her sister. Although she was nearly arrested, Sanger continued to fight for a woman’s right to information on birth control.

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N108: Transition to the Registered Professional Nurse Role Study Guide Lavinia Dock Dock was a nursing leader and women’s’ rights activist who was instrumental in the Constitutional Amendment giving women the right to vote. She was a key figure with community health nursing and introduced nursing into school settings. She believed that the advancement of nursing could only be achieved if women were treated equally. She worked with the Henry Street Settlement and was a community health nursing pioneer. Melinda Ann Richards Richards was America's first trained nurse and was a key figure in the development of nursing education. She campaigned for improvements in nursing schools and nursing service. Mary Breckenridge After WWII, Breckenridge established the Frontier Nursing Service in Kentucky and established the first midwifery training schools in the United States. She worked in France after WW11 (1918) distributing food and supplies and caring for the sick. 1.5 Influence of Major Studies and Reports on Nursing Winslow-Goldmark Report on Nursing and Nursing Education in the United States Published in 1923, this report was written by Josephine Goldmark with the primary sponsor being Goldmark and the Rockefeller Foundation. The study was originally aimed at education of public health nurses but was later expanded to all nursing education, including teachers and supervisors. It pointed out fundamental faults in hospital training schools and resulted in the establishment of the Yale University School of Nursing. Its recommendations included the following: • Public health nurses should have hospital training and a postgraduate course in public health • University nursing schools • Funds to endow university education • Public safety should be protected by legislation requiring educational standards in “progressive” states • Efforts should be made to recruit competent women to public health nursing • State legislation should provide for “subsidiary” nurses Due to this report, the Rockefeller Foundation endowed nursing schools at Yale and Vanderbilt. An endowment generates interest to pay for education. Yale became the first school of nursing as a separate university with its own dean. Also, Frances Payne Bolton endowed the school of nursing that was later named for her at Case Western Reserve University. Nursing for the Future (Brown Report) This report focused on determining society’s need for nursing. The report described inadequacies in nursing schools. The report resulted in recommendations that nursing education be placed in

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N108: Transition to the Registered Professional Nurse Role Study Guide universities and colleges, while encouraging recruitment of men and members of minority groups into nursing schools. A social anthropologist from the Russell Sage Foundation, Esther Lucille Brown, authored this report in 1948. Brown’s study attempted to analyze the changing needs of the nursing profession. She noted the slow progress and inadequacies in nursing education, urged the closing of several thousand weak schools, and recommended an official examination of all schools. She advocated the listing of accredited schools and eliminating non-accredited schools. Brown’s report noted that all nursing education should be in the “mainstream of education” and that nurses could be either practical or professional. Brown pointed out that most care given in hospitals was done by student nurses. The suggestion that nurses should have economic security threatened hospital employers and the report disputed the authoritarianism of hospital schools. Mildred Montag used information in Nursing for the Future to justify the proposal of educating a technical nurse. A Program for the Nursing Profession (The Ginzberg Report) This report, also called Eli Ginzberg’s Program for the Nursing Profession, was published in 1948. It outlined the current and prospective nursing shortage from an economic perspective. The Position Paper on Educational Preparation for Nurse Practitioners and Assistants to Nurses This report was prepared by the ANA in 1965 to address concern regarding the educational preparation of nurses. The position paper proposed that: • Those licensed to practice nursing should be educated in higher education institutions. • A baccalaureate degree should be the minimum preparation for entering professional nursing. • An associate’s degree should be the minimum preparation for entering technical nursing practice. • Education for nursing assistants should be in an intensive vocational program. An Abstract for Action (The Lysaught Report) This report looked at current practices and patterns of nursing, suggesting joint practice committees, master planning for nursing education, and funding for nursing education. This report was published in 1970. The committee that prepared it listed three priorities: • Research in both practice and education of nurses should be increased • Increased financial support for nurses and nursing • Educational systems should be enhanced and curriculum based on research Community College Education for Nursing (Mildred Montag) Part one of this report was authored by Mildred Montag in 1959 at Teacher’s College, Columbia University. The goal of the report was to educate a “bedside” nurse, a nursing technician who would work under the supervision of a “professional” nurse. This education would take place in junior colleges rather than hospital diploma schools. Because of this report, seven junior and community

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