Regents College Nursing
Study Guide Expanded Notes
Occupational Strategies in Nursing
Occupational Strategies in Nursing
I. Forces Influencing the Development of Nursing Practice (15%)
II. The Health Care Delivery System (15%)
III. Framework for Nursing Practice (45%)
A. Quality Assurance
B. Ethical Aspects of Nursing Practice
C. Legal Liability Affecting Nursing Practice
D. Educational Aspects of Nursing Practice
IV. Delivery of Nursing Care by the Associate Degree Graduate
(25%)
Content Outline
I. Forces Influencing the Development of Nursing Practice (15%)
A. World events and trends
1. Religion and religious orders (e.g., the Reformation,
deaconesses, knights, Sisters of Mercy, Sisters of Charity,
Benedictine order)
2. Wars (e.g., Crimean War, American Civil War, World War I,
World War II)
3. Socioeconomic factors (e.g., the Industrial Revolution,
immigration, women's movement, labour movements)
B. Major contributions of significant leaders in nursing practice,
theory, and education (e.g., Florence Nightingale, Isabel
Hampton Robb, Dorothea Dix, Lillian Wald, Linda Richards,
Lydia Hall, Adelaide Nutting, Lucille Petry Leone, Mildred
Montag, Martha Rogers, Faye Abdellah, Mary Mahoney,
Margaret Sanger, Virginia Henderson, Hildegard Peplau, Carrie
Lenburg, Madeleine Leininger, Reva Rubin, Jean Watson, Sister
Callista Roy, Dorothea Orem)
C. Significant studies
1. Nursing and Nursing Education in the United States. The
Goldmark Report (1923)
2. Nursing for the Future. The Brown Report (1948)
3. The Education of Nursing Technicians. The Montag Report
(1951)
4. An Abstract for Action. The Lysaught Report (1970)
5. The Study of Credentialing in Nursing: A New Approach.
(1979)
6. The National Commission on Nursing. The American Hospital
Association, The Hospital Research and Education Trust, and the
American Hospital Supply Corporation (1990)
D. Changing patterns in nursing education
1. Evolution from apprenticeship to college-based preparation
2. Influence of federal funding (e.g., Nurse Cadet Corps, Nurse
Training Acts)
3. Organizational influences
a. American Nurses' Association (ANA) position paper (1965)
b. American Nurses' Association (ANA) position paper (1985)
c. National League for Nursing (NLN) accreditation movement
E. Nursing organizations - origin, membership, purposes and
functions, publications, impact on nursing
1. American Nurses' Association (ANA)
2. International Council of Nurses (ICN)
3. National League for Nursing (NLN)
4. ANA Political Action Committee (ANA-PAC)
5. National Council of State Boards of Nursing
6. National Student Nurses' Association
7. National Organization for Advancement of Associate Degree
Nursing
8. National Black Nurses' Association (NBNA)
9. Special interest organizations (e.g., operating room nurses,
industrial nurses)
II. The Health Care Delivery System
A. Factors influencing the current system
1. Social
a. Changing roles (e.g., family roles, single-parent family,
working parents, adolescent parents, female-male roles)
b. Changing demographic patterns (e.g., increase in the aging
population, shift from rural to suburban to urban, shift in
immigration populations, increase in low-income groups)
c. Health problems related to changing lifestyles (e.g., substance
abuse, acquired immune deficiency syndrome [AIDS], sexually
transmitted diseases [STDs], persons who are homeless pr
displaced)
2. Cultural
a. Communication processes (e.g., language barriers, body
language)
b. Health practices (e.g., perception of illness, cultural healers,
use of traditional remedies, religious sanctions and restrictions,
nutritional restrictions)
c. Valued behaviors (e.g., territoriality, privacy, stoicism)
d. Spirituality
3. Economic
a. Cost-containment (e.g., focus on wellness, prospective
payment systems, shifts to community-based care, diagnostic-
related groups [DRGs])
b. Health insurance (e.g., lack of coverage, individual payment,
government insurance, private insurance, worker's
compensation, national health care plan)
4. Political
a. Role of the individual (e.g., voting, contacting congressional
leaders)
b. Role of professional organizations (e.g., lobbying, proposing
legislation)
c. Special interest groups (e.g., the tobacco industry, labor
unions, right-to-life groups, ANA-PAC)
5. Educational
a. Consumerism (e.g., participation in self-care, health
promotion, growing awareness of the individual's role as a
consumer, expectations for accountability)
b. Diversity in the educational background of the consumer
(e.g., persons who are illiterate, persons who are highly
educated)
c. Increased specialization among health care providers
6. Technological (e.g., computerization, lasers, imaging)
B. Current practices and trends in delivery of services
1. Organization and administration
a. Types of health care delivery
(1) Health promotion (primary)
(2) Illness prevention (secondary)
(3) Rehabilitation (tertiary)
b. Regulatory agencies
(1) Joint Commission on Accreditation of Healthcare
Organizations (JCAHO)
(2) State health departments
(3) Accreditation of home health agencies
2. Types of facilities
a. Ambulatory care facilities (e.g., community health centers,
health maintenance organizations [HMOs], clinics, emergency
care centers)
b. Hospitals (e.g., government, nonprofit, proprietary)
c. Long-term facilities (e.g., skilled nursing, intermediate,
personal care)
d. Home health care agencies (e.g., visiting nurses association,
public health agencies)
e. Other types of facilities/service (e.g., hospice, rehabilitation
centers, respite, day care)
3. The health team
a. Composition
b. Functions of each member
c. Responsibility of each member
d. Interdependence and communication among members
III. Framework for Nursing Practice
A. Quality assurance/risk management
1. ANA Standards of Nursing Practice (ANA)
2. Mechanisms for quality assurance/risk management
a. Peer review
b. Nursing audit
c. Certification of nurses
d. Record keeping
e. Adherence to instutional standards
B. Ethical aspects of nursing practice
1. Values clarification
a. Personal values
b. Codes of ethics
(1) ANA Code for Nurses
(2) ICN Code for Nurses (1973)
c. ANA Social Policy Statement
2. Rights and responsibility in health care
a. Consumers' rights (e.g., the American Hospital Association's
[AHA] Patient's Bill of Rights, informed consent, living wills)
b. Nurse's responsibilities (e.g., personal, professional, patient
advocacy)
3. Models for ethical decision making (e.g., Aroskar, Curtin,
Thompson and Thompson)
4. Ethical issues in nursing practice (e.g., informed consent,
code/no code decisions, abortion, organ transplants, privacy
and confidentiality, genetic engineering, euthanasia, right to
die)
5. Personal and professional accountability
a. Ethical committees and institutional review boards
b. Application of the ANA Code for Nurses in practice
c. Whistle-blowing (reporting illegal and unethical conduct)
C. Legal liability affecting nursing practice
1. Types of laws
a. Civil v. criminal
b. Statutory v. common and case law
2. Civil law
a. Torts
(1) Slander-libel
(2) Invasion of privacy
(3) False imprisonment
(4) Negligence-malpractice
(a) Components of a negligent act
(b) Comparative v. contributory negligence
b. Contracts
(1) Elements of a valid contract
(2) Rights and responsibilities of the nurse in a contractual
situation
c. Legal documents (e.g., wills, consent forms, health care
records)
3. Criminal law
a. Assault and battery
b. Criminal negligence
4. Statutory law
a. Licensure
(1) Purpose
(2) Legal source - nurse practice acts
(3) Implementation
(a) Current requirements
(b) Licensure by endorsement
(c) Grounds for revocation
(d) Role of state boards for nursing
(4) Developments affecting licensure legislation
(a) 1965 ANA position paper
(b) 1985 ANA position paper
(c) Mandatory continuing education as a condition for
continuing licensure
(d) Sunset laws
(e) Institutional licensure
b. Federal statues (e.g., controlled substance acts,
environmental acts, Privacy Act of 1974, Freedom of
Information Acts)
c. Nurse's responsibility
(1) Good Samaritan laws
(2) Reporting requirements related to the abuse of children and
adults
(3) Reporting injuries resulting from weapons
D. Educational aspects of nursing practice
1. Academic preparation of nurses
a. Doctoral degree
b. Master's degree
c. Baccalaureate degree
d. Associate degree
e. Diploma
f. Practical/vocational certificate
2. Alternative educational programs (e.g., assessment programs,
second-step programs, articulation programs)
3. Credentialing (e.g., ANA certification, other specialty groups)
4. Continuing education
5. Accreditation of academic programs (e.g., regional, state,
NLN)
IV. Delivery of Nursing Care by the Associate degree Graduate
A. Foundations for associate degree practice
1. The Education of Nursing Technicians (Montag Report, 1951)
2. Competencies of the associate degree nurse on entry to
practice as outlined in the NLN document titled Educational
Outcomes of Associate Degree Nursing Programs: Roles
B. Roles and functions of the associate degree nurse (e.g., scope
of practice; dependent, independent, and collaborate
[interdependent] functions)
C. Organizational patterns for the delivery of nursing care
1. Primary nursing
2. Team nursing
3. Functional nursing
4. Case method/managed care
D. Strategies employed by the associate degree nurse in
practice
1. Nursing process
2. Group process
3. Critical thinking/decision making
4. Assertiveness
5. Interpersonal conflict resolution
6. Time management
7. Collective bargaining
8. Nurse's rights