Nursing education

CHAPTER ONE
INTRODUCTION
TO NURSING
EDUCATION
9/18/2015Lecturer: Omar Osman

Definition:
 “It is the diagnosis and treatment of human
responses to actual or potential health
problems”.
 It is assisting the individual, sick or well in
the performance of those activities
contributing to health or its recovery that he
will perform unaided, if he had the necessary
strength, will or knowledge (Virginia Henderson)
 Nursing is using the patients environment for his
or her healing

 Licensed practical (vocational) nursing
 Diploma nursing program
 Associate degree program
 Baccalaureate program
 Masters degree program and
 Doctoral programs

 Central to nursing education is curriculum
and instruction.
 Curriculum: is the overall structure of
nursing education programs that reflect
school’s mission and philosophy, course of
study, outcomes of learning and methods of
program evaluation.
 Instruction: is the teaching and learning
strategies and experiences faculty and
students engage in to achieve the elements
of the curriculum

 Patients safety
 Cultural competency
 Gerontology
 Evidence- based practice
 Technology and informatics
 Interprofessional education

 New pedagogies: pedagogy is a term used in
nursing education that means the process of
teaching and learning
 In 1980s nursing education experienced what
was known as the curriculum revolution
 Critical Thinking: critical Thinking is
variously defined, but simply, it is the ability
of nursing students to make sound clinical
judgments and to provide safe patient care

 Distance Education: with the advent of new
technologies there has been a tremendous
growth of distance education.
 Distance education is instruction students
receive in a location other than that of the
faculty providing the instruction.
 Simulation: is a clinical situation that allows
student nurse to function in an environment that
is as close as possible to a real life situation
 Teachers use this form of simulation to foster
critical thinking , an understanding of pt’s values
and needs, decision making and hands on skills

Patient safety

 Patient safety is a discipline in the health
care sector that applies safety methods
toward the goal of achieving a trustworthy
system of health care delivery.
 Patient safety is also an attribute of health
care systems; it minimizes the incidence and
impact of, and maximizes recovery from,
adverse events

 Adverse medical events are widespread and
preventable.
 Much unnecessary harm is caused by health-
care errors and system failures.
 Ex. 1: Hospital acquired infections from poor
hand-washing.
 Ex. 2: Complications from administering the
wrong medication.

 Prevent and/or minimize the adverse events
and eliminate preventable harm in health
care.
 To prevent cross infection
 To facilitate patient comfort and safety
 All health care professionals including nurses
are responsible for ensuring patient safety

According to WHO
 On average, 8.7% of hospital patients suffer
health care-associated infections (HAI).
 In developed countries: 5-10%
 In developing countries:
 Risk of HAI: 2-20 times higher
 HAI may affect more than 25% of patients

 HAI is also called “nosocomial”.
 HAI is defined as:
 an infection acquired in hospital by a
patient who was admitted for a reason
other than that infection.
 an infection occurring in a patient in a
hospital or other health-care facility in
whom the infection was not present or
incubating at the time of admission.

HAI can:
 Increase patients’ suffering.
 Lead to permanent disability.
 Lead to death.
 Prolong hospital stay.
 Increase need for a higher level of care.
 Increase the costs to patients and hospitals.

Requires health care providers who have:
 Knowledge of common infections and their
vectors
 An attitude of cooperation and commitment
 Skills necessary to provide safe care
 Application of safety methods to prevent cross
infections

Required knowledge
 Knowledge of the extent of the problem;
 Knowledge of the main causes, modes of
transmission, and types of infections.
Required Skills
 Apply universal precautions
 Use personal protection methods
 Know what to do if exposed
 Encourage others to use universal
precautions
 Report breaks in technique that increase
patient risks
 Observe patients for signs and symptoms of
infection

Protect Yourself
Be sure you have been immunized against
Hepatitis B since it is very easy to transmit!

 Person to person via hands of health-care
providers, patients, and visitors
 Personal clothing and equipment (e.g.
Stethoscopes, flashlights etc.)
 Environmental contamination
 Airborne transmission
 Hospital staff who are carriers

 Urinary tract infections (UTI)
 Catheter-associated UTIs are the most frequent,
accounting for about 35% of all HAI.
 Surgical infections: about 20% of all HAI
 Bloodstream infections associated with the
use of an intravascular device: about 15% of
all HAI
 Pneumonia associated with ventilators:
about15% of HAI

1. Maintain cleanliness of the hospital.
2. Personal attention to hand washing before
and after every contact with a patient or
object.
3. Use personal protective equipment
whenever indicated.
4. Use and dispose of sharps safely.

 Hand washing: the single most important
intervention before and after patient
contact.
 Required knowledge and skills:
 How to clean hands
 Rationale for choice of clean hand practice
 Techniques for hand hygiene
 Protect hands from contaminants
 Promote adherence to hand hygiene guidelines

 Before patient contact
 Before an aseptic task
 After body fluid exposure even if wearing
gloves!
 After patient contact
 After contact with patient surroundings

 Remove all wrist and hand jewelry.
 Cover cuts and abrasions with waterproof
dressings.
 Keep fingernails short, clean, and free from
nail polish.

 Wet hands under tepid running water
 Apply soap or antimicrobial preparation
 solution must have contact with whole surface
area of hands
 vigorous rubbing of hands for 10–15 seconds
 especially tips of fingers, thumbs and areas
between fingers
 Rinse completely
 Dry hands with good quality paper towel.

 Gloves, aprons, gowns, eye protection, and
face masks
 Health care workers should wear a face mask,
eye protection and a gown if there is the
potential for blood or other bodily fluids to
splash.

 Masks should be worn
 if an airborne infection is suspected or confirmed
 to protect an immune compromised patient.

Gloves must be worn for:
 all and especially in invasive procedures
 contact with sterile sites
 contact with non-intact skin or mucous
membranes
 all activities assessed as having a risk of
exposure to blood, bodily fluids,
secretions and excretions, and handling
sharps or contaminated instruments.
Hands should be washed before and after
gloving

 Keep handling to a minimum
 Do not recap needles; bend or break after
use
 Discard each needle into a sharps container
at the point of use
 Do not overload a bin if it is full
 Do not leave a sharp bin in the reach of
children

Nursing students need to:
 apply universal precautions
 be immunized against Hepatitis B
 use personal protection methods
 know what to do if exposed
 encourage others to use universal
precautions

Students may routinely observe staff who:
 apply inadequate technique in hand washing
 fail to wash hands
 routinely violate correct infection control
procedures

Culturally Competency
Nursing

Culture:
 A set of beliefs, attitudes, behaviors, and
policies to which people identify and
adhere.
 Is the sum total of ways of living including:
 Behavioral norms
 Language
 Communication style
 Patterns of thinking
 Beliefs and Values

Defined by:
1. Grouping / Setting
 ethnic, racial, religious, corporate,
professional, age, socioeconomic status,
sexual orientation
2. Self-identification
3. Stereotyping by others

 Even though we may share a general
culture with other people, each of us has
a special set of experiences and
influences that makes us unique.
 Active Culture is fluid – it changes with
time, experience, and circumstances

 Attitudes and behaviors about health and
illness
 Beliefs about causes of disease
 Possible Treatments
 Communication among all participants
 Expectations that older adults have about
care provider
 Expectations that providers have about older
adults and their cultural identification

Cultural Competence implies having the
capacity to function effectively as an
individual and an organization within the
context of the cultural beliefs, behaviors,
and needs presented by consumers and their
communities.
Cultural Humility – commitment to
developing mutually beneficial and non-
paternalistic clinical relationships with
patients and communities.

 More accurate diagnosis
 More effective care plans and patient
adherence
 Earlier participation in health care
 Cost-saving - More effective use of health
care services
 Decreased litigation
 Enhanced communication and satisfaction of
patients and providers
 Respond to health care disparities

1. Beliefs
2. Expectations
3. Stereotyping
4. Language
5. Health Literacy
6. Genetic Trends
7. Professional Prisms
8. Mistrust
9. Provider Dominance
10. Geriatric Syndromes
11. Life Experiences

 Respect
 Who gets respect - how old age is respected; influence of healers, religious
leaders, medical professionals - RNs MDs; appropriate or inappropriate
behaviors to show respect– personal space, body language, words.
 Nutrition/Medication
 Level of acceptance of Western medicine; cultural foods and medicines used,
alternative medicines.
 Pain
 How it is interpreted – a biological phenomenon or a punishment from God?
 Death
 Definition of death - when is a person dead; what happens when a person dies
- where do they go; what happens to those remaining; attitudes about
interference in dying process --“assistance” toward death or “prolonging” life,
advance directives; quality of life issues.
 Time
 Ability to “tell time” – Use of a clock and the concept of an hour, respect for
time and what time implies – adhering to regimens, being prompt or late.

Barrier 2: Expectations of behavior based on
beliefs
 Need to know each other’s beliefs so that we can
have comparable expectations about behavior.
Barrier 3: Stereotyping
 Misuses of individual characteristics and trends.
 “Exaggerated beliefs or fixed ideas about a
person or group and sustained by selective
perception and forgetting.

 Barrier 4: Language differences
 Barrier 5: Low health literacy of older adults and
families
 Science literacy – understanding how the body
works; the concept of a therapeutic dose; the
difference between viruses and bacteria.
 Barrier 6: Older Adult and family Mistrust of
health care system
 Based on collection of poor health care
experiences
 Lack of patient/provider cultural concordance

Barrier 7: Provider lacking of understanding of genetic trends –
physiological and biological
 Diseases that are prevalent in certain races and ethnic
groups
 Trends in responses to medications based on race or ethnic
identity
Barrier 8: Provider’s Professional Prism
 MD, RN, MSW, Pharm
 the culture of medicine
 Lack of understanding of non-Western medicines
Barrier 9: Provider Dominance instead of collaboration
 Use of provider-focused compliance approach (rather than
collaborative adherence)
 Conciliatory resistance – patient response to dominance
 Resistance seen as “bad” rather than as a source of
additional information

Barrier 10: Cultural responses to Chronic/Geriatric
Syndromes
 sensory losses -- hearing, vision
 cognitive losses -- executive function, depression,
dementia
 syndromes that affect activities of daily living
Barrier 11: Cultural Responses to Life Experiences
of older adults–
 historical events, levels of assimilation, socio-
economic factors

Solution 1: Recognize the barriers that
influence the clinical encounter –
cultural and geriatric
Solution 2: Ask about beliefs as relevant to
goal of particular encounter –
respect, nutrition, pain, death,
time
Solution 3: Work within the belief system
when possible
Solution 4: Use language interpreters –
professional preferred over family

L
 Listen with empathy and understanding to the
patient’s perception of the problem
E
 Explain your perceptions of the problem
A
 Acknowledge and discuss the differences and
similarities
R
 Recommend treatment / solution
N
 Negotiate agreement

E
 Explanation – older adult explains view of illness and causes
T
 Treatment – older adult explains utilization of personal
treatments
H
 Healers – older adult explains alternative influences for advice
and medication outside of healthcare provider
N
 Negotiate – negotiate health care plan based on beliefs and
readiness
I
 Intervention – finalize an agreed upon plan of care for a specific
period of time
C
 Collaboration – work with patient, family, and healers to
maximize adherence to agreed care plan. Readjust as needed.

Gerontological
Nursing care

 Gerontology is the broad term used to define
the study of aging and/or the aged.
 Today, the older age group is often divided
into the young old (ages 65–74), the middle
old (ages 75–84), and the old, very old, or
(ages 85 and up).

 Geriatrics is often used as a generic term
relating to the aged, but specifically refers
to medical care of the aged.
 Social gerontology is concerned mainly with
the social aspects of aging versus the
biological or psychological.
 Geropsychology is a branch of psychology
concerned with helping older persons and
their families maintain wellbeing, overcome
problems, and achieve maximum potential
during later life.

 Geropharmacology is the study of pharmacology
as it relates to older adults.
 Financial gerontology is another subfield that
combines knowledge of financial planning and
services with a special expertise in the needs of
older adults.
 Gerontological rehabilitation nursing combines
expertise in gerontological nursing with
rehabilitation concepts and practice. Nurses
working in gerontological rehabilitation often
care for older adults with chronic illnesses and
long-term functional limitations such as stroke,
head injury, multiple sclerosis,

Provider of Care
 In the role of caregiver or provider of care,
the gerontological nurse gives direct, hands-
on care to older adults in a variety of
settings. Older adults often present with
atypical symptoms that complicate diagnosis
and treatment. Thus, the nurse as a care
provider should be educated about disease
processes and syndromes commonly seen in
the older population. This may include
knowledge of risk factors, signs and
symptoms, usual medical treatment,
rehabilitation,

Nursing education

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