What is Nursing?
evolved from unstructured method of caring
for ill to scientific profession
art and a science
critical thinking skills with caring behaviors
response to illness NOT illness
Clinical Judgments about care
are made based on fact,
experience, and
STANDARDS OF CARE.
HISTORICAL PERSPECTIVE
Florence Nightingale and Crimean War
Clara Barton and Civil War
WW II
Historical Timeline
300AD Women enter nursing
1100-1200 Charitable foundations
includes Alexian Brothers
1633 Sisters of Charity
1860 Nightingale Training
School in St. Thomas Hospital
Timeline
1860 Notes on Nursing:What It
Is And What It Is Not
1860-1865 Dorothea Dix
Harriet Tubman
1882 Clara Barton
1893 Lillian Wald/Mary Brewster
Henry Street Settlement
House
Timeline
1897 Initial discussion of Code of
Ethics
1894 Johns Hopkins Training School
1902 Sigma Theta Tau
1901 1st university affiliated training
school
1907 Mary Adelaide Nutting
1911 ANA
Timeline
1926 ANA Code of Ethics proposed
1952 Mildred Montag est 1st AD
program
1952 Nursing Research
1953 Graduate education
1965 ANA position paper defines
nursing
1975 NLN requires theory based
curriculum for accreditation
NURSING EDUCATION
LPN Licensed Practical Nurse
(Vocational)
Education
Diploma (RN)
Education
ADN Associate Degree of
Nursing
1950’s
Mildred Montag
Education
Baccalaureate BSN (RN)
bachelor of science in nursing
Education
GRADUATE EDUCATION
Master’s Education
Educator, administrator, researcher
Clinical nurse specialist, nurse
practitioner
Doctoral Preparation (DSN, DNSc,
DNE, PhD)
Research
Advance Practice Nurses
Clinical Nurse Specialist (CNS)
Nurse Practitioner (NP)
Certified Nurse Midwife (CNM)
Certified Registered Nurse Anesthetist
(CRNA)
NURSE PRACTICE ACT
Each state defines
the scope of
practice.
Tells you what you
can & cannot do.
OBTAIN COPY OF
ILLINOIS NURSE
PRACTICE ACT!
NURSING THEORY
Describe, explain, predict and/or
prescribe nursing care measures
Interdisciplinary Theories
SYSTEMS THEORY
SYSTEM IS MADE OF SEPARATE
COMPONENTS
Open vs. closed
Interaction with environment
Interdisciplinary Theories
OPEN SYSTEM- NURSING PROCESS
Input – client assessment
Output – client response to nursing
interventions
Interdisciplinary Theory
MASLOW BASIC HUMAN NEEDS
Physiological
Safety and security
Love and belonging
Esteem and self-esteem
Self actualization
HEALTH AND WELLNESS
MODELS
Health Belief Model
Nursing Theories
Nightingale’s Environmental Theory
VENTILATION
LIGHT
CLEANLINESS
NOISE
Nursing Theories
Orem’s Theory (1971)
Defined nursing as emphasizing the
client self-care needs
Nursing Theories
Roy’s Theory (1979)
ADAPTATION THEORY
Kishwaukee College School of
Nursing
Look at Student Handbook
What is/are the theories used in the
curriculum?
Are the theories nursing or general
theories?
NATURE OF INFECTION
Infection
Colonization
Communicable disease
Chain of Infection
Agent
Reservoir
Portal of exit
Mode of transmission
Portal of entry
Susceptible host
Chain of infection
Infectious Agent
Number
Virulence
Entry and survival in host
Susceptibility of host
Reservoir
Places where microorganisms
survive, multiply and wait for
transfer to host
Portal of Exit
Skin, mucous membranes, respiratory
tract, reproductive tract, blood
Modes of Transmission
Contact
direct
indirect
droplet
Air
Vehicles
Vector
Chain of Infection (cont’d)
Portal of entry
Same as exit
Susceptible host
Degree of resistance
Who would have decreased
resistance?????
Infectious Process
Local vs. systemic
LOCAL
SYSTEMIC
PREVENTION
Defenses Against Infection
Normal body flora
Body system defenses
Skin
Mouth
Respiratory tract
GI
Vagina
Urinary Tract
Eye
Defenses Against Infection
Inflammatory Response
Vascular response
DELIVERS FLUID, CELLS AND NUTRIENTS
INTO AREA OF INJURY
1. VASODILATION
2. INC. CAPILLARY PERMEABILITY
Defenses against infection
Cellular Response
Defenses Against Infection
Formation of Exudates
Serous
Sanguineous
Purulent
Defenses Against Infection
Immune response
Infectious Process
Lab Tests
WBC
ESR
CULTURES*******
Observations
Nosocomial Infections
Develops infection NOT present or
INCUBATING at time of admission
Surgical wound
Bloodstream (sepsis)
Pneumonia
Urinary - catheter
Skin
What’s in common????
Improper hand hygiene!!!!!
Nosocomial Infections
Why does it matter?????
Assessment
Status of body defenses
Client susceptibility
Age
Nutritional status
Stress – cortisol – stress response
Disease process
Medical therapy
Assessment (cont’d)
Clinical appearance
Laboratory data
SYSTEMIC/NONSYSTEMIC
WBC
ESR
CULTURES
Implementation
Prevention and treatment of infection
Asepsis: medical and surgical
Standard precautions
Hand hygiene
Personal protective equipment
Isolation/protective environments
Client and family education
MEDICAL ASEPSIS
CLEAN TECHNIQUE
Procedures to reduce and prevent the
spread of microorganisms
Control or eliminate infectious agents
Cleaning
Control or eliminate reservoirs
Portals of exit
Control transmission
HAND HYGIENE
Indications for hand hygiene
Visibly soiled handwashing for 15sec
ABHR alcohol based handrubs
Indications for ABHR (p.793)
Direct patient contact
Before sterile gloves for CVC
Before inserting urinary cath or other
invasive device not requiring surgical
procedure
After contact with intact skin
Indications for ABHR
After contact with body fluids or
excretions, nonintact skin, wound
dressings
Moving from contaminated body site to
clean site
After contact with inanimate objects in
proximity to patients
After taking off gloves
Hand Hygiene
Soap and water after the lavatory
Or visibly soiled hands
Hand Hygiene - ABHR
HOW????
OTHER
Artificial nails?????
Less than ¼” long
Gloves
*remove after caring for patient
*change during patient care if
moving from contaminated to clean
body site
CDC – Two Tiers of
Precautions
FIRST TIER Standard Precautions
IN ALL PATIENT CARE SETTINGS
Applies to blood, all body fluids,
secretions and excretions (except
sweat), nonintact skin, and mucous
membranes
CDC
STANDARD PRECAUTIONS
Handwashing (before, after and
during)
After contact with blood, body fluids,
secretions, excretions, and after contact
with equipment or articles contaminated
by them, immediately after glove
removal
CDC
STANDARD PRECAUTIONS
Gloves worn when touching blood, body
fluids, secretions, excretions, nonintact
skin, contaminated items.
Remove gloves and wash hands
between client care.
PPE if splashes possible.
CDC
STANDARD PRECAUTIONS
Equipment requirements?
Sharps Disposal?
Private Room?
CDC
SECOND TIER- TRANSMISSION
BASED PRECAUTIONS
AIRBORNE
DROPLET
CONTACT
IN LAB week 3
Transmission Based
Precautions
AIRBORNE
TB, chickenpox
Negative air pressure
Door closed
N95 mask
Transport????
Transmission Based
Precautions
DROPLET
Influenza, rubella
Gloves/gowns not required (unless contact
with infected item possible)
Masks within 3 feet
Private
Transmission Based
Precautions
CONTACT
C.difficile, hepA, chickenpox, RSV,
MRSA
Gown if soiling likely
Gloves when entering room
TBP
Some infections fall into more than one
category
TBP
Trash/linen
Transportation
Psychological aspects