Nurses working in the field of obstetrics must have a greater depth and breadth of genetic knowledge over any other subspecialty. In gestation, nurses should include education on the effects of teratogens, prenatal screening options, and prenatal diagnoses. After delivery, early recognition of genetic disorders is important for immediate initiation of potentially life-saving therapies. Preconception education is a critical component of health care for women of reproductive age. The Centers for Disease Control and Prevention (CDC) recommend that all women of childbearing age consume 0.4 mg of folic acid daily to prevent neural tube defects (NTDs). Counseling can still be useful in terms of optimum pregnancy management in a setting best able to cope with any anticipated problems. Complex and multifaceted maternal and fetal factors influence the consequences of drugs, radiation, and chemical and infectious agents to the developing fetus.
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This chapter provides a guide to conducting a life history from conceptualization to dissemination. Life history is used to explain an individual’s understanding of social events, movements, and political causes, that is, how individual members of groups or institutions see certain events and how they experience and interpret those events. As it is unlikely that nurses will be conducting traditional fieldwork to gather life histories because of the extensive periods of time involved, the chapter describes the process for collecting focused life histories by researchers whose only purpose is to document the story of the participant and not to frame this life history within a broader ethnography. It considers life history as a sociocultural methodology and leave oral history on historical research and life review to the one on clinical literature.
The Minimum Data Set (MDS) provides a uniform approach to conducting a comprehensive assessment that is recorded on a standardized tool. This chapter identifies the times when an MDS assessment must be completed. A registered nurse (RN) must conduct or coordinate the assessment with the input of other health team members and the resident. Upon completion, the MDS is electronically transmitted to the quality improvement evaluation system assessment submission and processing system designated by Centers for Medicare and Medicaid Services (CMS). The MDS offers a standardized approach for collecting assessment data. The chapter describes the data that are collected in the MDS assessment tool and explains the Care Areas and their purpose. It also describes the time period for which MDS assessments must be maintained by the nursing home.
The CARES tool, in addition to assisting nurses with delivery of evidence-based care of the dying and viewing the care of the dying as an acute event, also needed to be portable and readily accessible. An extensive review of the literature found the most basic common needs of the dying included pain management and comfort measures, breathing assistance, control of delirium, emotional and spiritual support, and self-care for caregivers. This chapter discusses some issues: Nurses receive little to no education on care of the dying and feel they have minimal time to attend in-services, and can be resistant to learning new skills; communication is the foundation for end-of-life care; the nurses’ past personal and professional experiences with death can greatly impact the care they provide dying patients and their families. These issues and concerns helped organize and shape the final version of the CARES tool.
This chapter provides examples of programs and services beyond the foundational elements and global resources that can be used to overcome traditional nursing research barriers. It is assumed that at least one doctorate-prepared nurse researcher is available to facilitate research opportunities and educate nurses about research and evidence-based practice. Many clinical nurses fully understand their clinical roles but are completely unaware of opportunities and resources in nursing research within their hospital. Since contributions of nursing research are vital to the science and art of nursing and provide foundation for evidence-based practices, it is important to overcome the traditional cluster of barriers that include problems with nursing research visibility/priority, time and money, and research education. Nurses need confirmation that nurse leaders support research; when it is visible, it is valued. Moreover, nurses need time, education, and resources to complete rigorous research that leads to discoveries and answers to important clinical problems.
This chapter addresses the need for dissemination of research and focuses on dissemination both inside the hospital organization and outside. Disseminating results of research is often the most exciting phase of the process, as it is the culmination and highlight of countless hours of work. Common areas for dissemination internally include presentations to colleagues on people’s unit, as well as across hospital organization. Internal presentations offer a direct way for people to provide new evidence for practice in their hospital organization. In addition, however, it is important that results of their research reach nurses and other health professionals nationally and internationally. Thus, people want to participate in media dissemination of their research, systematically look for calls for abstracts to present at professional conferences, and disseminate their research through professional publications. Disseminating results, whether internally or externally, by media, poster, oral presentation, or publication, requires effort and attention to detail.
This chapter talks about monitoring equipment, and procedural sedation and analgesia (PSA). In addition to respiratory suppression, the medications used for PSA may suppress the autonomic nervous system’s ability to adequately respond to hypovolemia; therefore, close monitoring of vital signs is important for the well-being of patients. PSA medications promote a rapid recovery stage with minimal postprocedure impairment. Patients need to be observed until there is no risk of cardiorespiratory depression or compromise; monitoring vital signs, including level of consciousness (LOC), with ability to intervene quickly with resuscitation efforts if needed. The rapid response system (RRS) provides critical care expertise when intensive care unit (ICU) level care is needed for compromised patients outside of the ICU, including radiology. The RRS is the radiology nurse’s resource when patients have adverse reactions to sedation, procedures, or diagnostic tests.
This chapter provides the doctor of nursing practice (DNP)/nurse leader with knowledge of the financial, scheduling, staffing, reporting tools, and leadership commitment required to be successful in the management and retention of their workforce and the delivery of care to the patients. The DNP/nurse leader has ultimate accountability for the cost center budget for labor resources, salary and expense dollars, staff satisfaction, and the delivery of care to the patients on the unit. Accountability and teamwork are crucial to achieving best practices, engagement by frontline staff to improve patient safety and the quality of care. There is no question that nursing care and quality patient care are inseparable. Safe staffing saves lives and a growing body of evidence documents that adequate nurse staffing improves patient outcomes, resulting in shorter lengths of stay, fewer complications, and patient deaths.
This chapter opens with the challenge Nightingale and her close colleagues faced in establishing nursing as a profession when the ethical standards of the existing (secular) nurses were (generally) so low. The ethical issues she had to deal with in her own school, soon after it opened, are discussed three thorny problems with appointments. Anyone reading Nightingale’s writing on nursing will be struck by how often and how forcefully she insisted on high ethical standards. The reason for the emphasis on ethical standards is obvious enough in the task Nightingale faced in raising the new profession from its disreputable past. The International Council on Nursing (ICN) established its Code of Ethics in 1953, again based on Nightingale principles. It identified four responsibilities: to promote health, to prevent illness, to restore health, and to alleviate suffering. The code asks nurses not only to act ethically themselves, but to challenge unethical practices.
This chapter examines the evolution of caring in nursing and nursing curricula. It explores the philosophies and theories of being and becoming that anchor a Caring Science curriculum. The chapter helps the caring-healing nurse able to understand how alternative educational pedagogies support the values of a Caring Science curriculum. It summarizes the ways in which a Caring Science curriculum can help nurses develop Caring Literacies through various classroom pedagogies, development of a community of caring/learning, and self-care. It identifies ways to embody (through being/becoming) Caritas Literacies in nursing education to promote the development of caring-healing nurses. The chapter discusses the meaning and values of being and becoming a nurse grounded in Caring Science. Finally, it proposes the many benefits of framing a nursing curriculum in Caring Science, including student affirmations of this process.