NUR 3805 Politics and Policy Discussion

Professional Nursing Concepts & Challenges EIGHTH EDITION Beth Perry Black, PhD, RN Associate Professor, School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 2 Table of Contents Cover image Title page Copyright Dedication Reviewers Preface Acknowledgments 1. Nursing in Today’s Evolving Health Care Environment Nursing in the United States Today Nursing Opportunities Requiring Advanced Degrees Employment Outlook in Nursing Concepts and Challenges Ideas for Further Exploration 2. The History and Social Context of Nursing Historical Context of Nursing Social Context of Nursing Concepts and Challenges Ideas for Further Exploration 3. Nursing’s Pathway to Professionalism 3 Characteristics of a Profession From Occupation to Profession Nursing’s Pathway to Professionalism Collegiality in Professional Nursing Barriers to Professionalism in Nursing Final Comments Concepts and Challenges Ideas for Further Exploration 4. Nursing Education in an Evolving Health Care Environment Development of Nursing Education in the United States Educational Paths to Become a Registered Nurse RN-to-BSN, Accelerated BSN, Distance Learning: Alternate Paths in Nursing Education Accreditation: Ensuring Quality Education Taking the Next Steps: Advanced Degrees in Nursing Becoming Certified: Validating Knowledge and Proficiency Maintaining Expertise and Staying Current Through Continuing Education Challenges: Faculty Shortages and Quality and Safety Education in Today’s Complex Health Care Environment Concepts and Challenges Ideas for Further Exploration 5. Becoming a Professional Nurse: Defining Nursing and Socialization into Practice Defining Nursing: Harder than it Seems Becoming a Nurse: Shaping Your Professional Identity From Student to Nurse: Facilitating the Transition “Just Going Through a Stage”: Models of Socialization From Student to Employed Nurse: Socialization Specific to the Work Setting Concepts and Challenges Ideas for Further Exploration 6. Nursing as a Regulated Practice: Legal Issues American Legal System 4 State Boards of Nursing, Nursing Practice Acts, and Licensure Legal Risks in Professional Nursing Practice Confidentiality: The Challenge to Protect Privacy Evolving Legal Issues Affecting Nursing Protecting Yourself from Legal Problems Concepts and Challenges Ideas for Further Exploration 7. NUR 3805 Politics and Policy Discussion

Ethics: Basic Concepts for Professional Nursing Practice Definitions of Basic Concepts in Ethics Approaches to Moral Reasoning Theories of Ethics Six Ethical Principles Based on Human Dignity and Respect Codes of Ethics for Nursing Navigating the Gray Areas: Ethical Decision Making Exploring Ethical Dilemmas in Nursing Concepts and Challenges Ideas for Further Exploration 8. Conceptual and Philosophical Foundations of Professional Nursing Practice Understanding Systems: Connections and Interactions Person: An Open System with Human Needs Environment: The Suprasystem in which Persons Live Health: A Continuum Nursing: Forming the Meaningful Whole Beliefs: Guiding Nursing Behaviors Values Philosophies and their Relationship to Nursing Care Developing A Personal Philosophy of Nursing Concepts and Challenges Ideas for Further Exploration 9. Nursing Theory: The Basis for Professional Nursing Philosophies of Nursing 5 Conceptual Models of Nursing Theories of Nursing: From Grand to Middle Range Using Theory for Nursing Education, Practice, and Research Concepts and Challenges Ideas for Further Exploration 10. The Science of Nursing and Evidence-Based Practice Science and the Scientific Method Nursing Research: Improving Care of Patients Evidence-Based Practice: Evidence, Expertise, Patient Preference The Research Process The Relationship of Research to Theory and Practice Financial Support for Nursing Research Advancing the Profession Through the Use of Research Concepts and Challenges Ideas for Further Exploration 11. Developing Nursing Judgment through Critical Thinking Critical Thinking: Cultivating Intellectual Standards Critical Thinking in Nursing The Nursing Process: A Universal Intellectual Standard Steps of the Nursing Process The Dynamic Nature of the Nursing Process Developing Clinical Judgment in Nursing Concepts and Challenges Ideas for Further Exploration 12. Communication and Collaboration in Professional Nursing The Therapeutic Use of Self Communication Theory The Development of Human Communication Criteria for Successful Communication Developing Effective Communication Skills Effective Communication with Other Providers 6 Interprofessional Collaboration: Prescription for Improved Patient Outcomes Concepts and Challenges Ideas for Further Exploration 13. Nurses, Patients, and Families: Caring at the Intersection of Health, Illness, and Culture Acute and Chronic Illness Adjusting to Illness Illness Behaviors The Impact of Illness on Patients and Families The Impact of Caregiving on Nurses Concepts and Challenges Ideas for Further Exploration 14. Health Care in the United States Today’s Health Care System Financing Health Care Health Care Reform and Universal Access Concepts and Challenges Ideas for Further Exploration 15. Political Activism in Nursing: Communities, Organizations, Government Policy and Politics: Not Just in Washington, D.C Professional Organizations: Strength in Numbers Benefits of Joining a Professional Organization Political Activism in Government Getting Involved Nursing Needs Your Contribution Concepts and Challenges Ideas for Further Exploration 16. Nursing’s Challenge: To Continue to Evolve The Challenge: Caring for Yourself The Challenge: Caring for the Profession 7 The Challenge: Caring for the Environment The Final Challenge: Unite and Act Concepts and Challenges Ideas for Further Exploration Epilogue Glossary Index 8 Copyright 3251 Riverport Lane St. Louis, Missouri 63043 PROFESSIONAL NURSING: CONCEPTS & CHALLENGES, EIGHTH EDITION ISBN: 978-0-323-43112-5 Copyright © 2017 by Elsevier, Inc. All rights reserved. No part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, recording, or any information storage and retrieval system, without permission in writing from the publisher. Details on how to seek permission, further information about the Publisher’s permissions policies and our arrangements with organizations such as the Copyright Clearance Center and the Copyright Licensing Agency, can be found at our website: www.elsevier.com/permissions. This book and the individual contributions contained in it are protected under copyright by the Publisher (other than as may be noted herein). NANDA International, Inc. Nursing Diagnoses: Definitions & Classifications 2015-2017, Tenth Edition. Edited by T. Heather Herdman and Shigemi Kamitsuru. 2014 NANDA International, Inc. Published 2014 by John Wiley & Sons, Ltd. Companion website: www.wiley.com/go/nursingdiagnoses. In order to make safe and effective judgments using NANDA-I diagnoses it is essential that nurses refer to the definitions and defining characteristics of the diagnoses listed in this work. Notices Knowledge and best practice in this field are constantly changing. As new research and experience broaden our understanding, changes in research methods, professional practices, or medical treatment may become necessary. Practitioners and researchers must always rely on their own experience and knowledge in evaluating and using any information, methods, compounds, or experiments described herein. In using such information or methods they should be mindful of their own safety and the safety of others, including parties for whom they have a professional responsibility. 9 With respect to any drug or pharmaceutical products identified, readers are advised to check the most current information provided (i) on procedures featured or (ii) by the manufacturer of each product to be administered, to verify the recommended dose or formula, the method and duration of administration, and contraindications. It is the responsibility of practitioners, relying on their own experience and knowledge of their patients, to make diagnoses, to determine dosages and the best treatment for each individual patient, and to take all appropriate safety precautions. NUR 3805 Politics and Policy Discussion

To the fullest extent of the law, neither the Publisher nor the authors, contributors, or editors, assume any liability for any injury and/or damage to persons or property as a matter of products liability, negligence or otherwise, or from any use or operation of any methods, products, instructions, or ideas contained in the material herein. Previous editions copyrighted 2014, 2011, 2007, 2005, 2001, 1997, 1993 Library of Congress Cataloging-in-Publication Data Names: Black, Beth Perry, author. Title: Professional nursing : concepts & challenges / Beth Perry Black. Description: Eighth edition. | Maryland Heights, Missouri : Elsevier/Saunders, [2017] | Includes bibliographical references and index. Identifiers: LCCN 2016001024 | ISBN 9780323431125 (pbk. : alk. paper) Subjects: | MESH: Nursing | Vocational Guidance Classification: LCC RT82 | NLM WY 16.1 | DDC 610.73068–dc23 LC record available at http://lccn.loc.gov/2016001024 Senior Content Strategist: Sandra Clark Content Development Specialist: Jennifer Wade Publishing Services Manager: Jeff Patterson Senior Project Manager: Anne Konopka Design Direction: Ryan Cook Printed in China Last digit is the print number: 9 8 7 10 6 5 4 3 2 1 Dedication I dedicate this edition to the memory of my beloved husband, Tal, who lived his life in grace, peace, and love. —BPB 11 Reviewers Michele Bunning, RN, MSN, Associate Professor, Good Samaritan College of Nursing and Health Science, Cincinnati, Ohio Nancy Diede, EdD, MS, RN, PHCNS-BC, CNE, Department Head, Health Sciences, Associate Professor, Rogers State University, Claremore, Oklahoma Christine K. Finn, PhD, RN, FNP, MS, FNE, Associate Professor, Nursing Department, Regis University, Denver, Colorado Eileen M. Kaslatas, MSN, RN, CNE, Professor, Nursing Department, Macomb Community College, Clinton Township, Michigan Bobbi Shatto, PhD(c), RN, CNL, Assistant Professor, School of Nursing, Saint Louis University, St. Louis, MO 12 Preface Nursing is evolving, as is health care in the United States. With the debates and discussions, lawsuits, and legislation that surround the Affordable Care Act, health care has become a central feature of American political and social discourse. With their increasing response to calls to advance their education and their strong record of safety and quality care, nurses are positioned to take a leadership role in the provision of health care in the United States. To be effective leaders, nurses must master knowledge about health and illness and human responses to each, think critically and creatively, participate in robust interprofessional collaborations, be both caring and professional, and grapple with ethical dilemmas that are complex and that challenge providers in a time when health care resources are not unlimited. As leaders, nurses must have an understanding of their history, because the past informs the present, and have a vision for the future that builds on the lessons of today. The eighth edition of Professional Nursing: Concepts & Challenges reflects my commitment to present current and relevant information. Since the last edition, the Affordable Care Act (ACA) has withstood repeated attempts in Congress to repeal it. Importantly, the ACA has withstood two significant challenges brought before the U.S. Supreme Court. The provisions of the ACA have been implemented, and more Americans than ever have health insurance. The 2016 presidential election is 1 year away as this is being written, with one side arguing for the repeal of the ACA, while one candidate on the other side is arguing for a single-payer health care system. This early posturing almost certainly foreshadows a continuing lively debate on critical questions of health care in America. In this edition, the order of the chapters has been changed considerably to reflect a more cohesive view of nursing, its history, education, conceptual and theoretical bases, and the place of nursing in the U.S. health care system. Faculty are encouraged, however, to use the chapters in any order that reflects their own pedagogical and theoretical approaches. This edition has additional examples from nurses, especially textboxes featuring compelling stories from nurses who have shaped their careers in creative, innovative ways. The effects of the Internet and social media on nursing are addressed extensively with regard to their legal and ethical implications and their role in professional socialization and communication. There are fewer figures and statistics than in previous editions because students respond more favorably to narratives and examples. With the easy and free availability of health-related statistics from 13 .gov websites, I decided that today’s students would benefit more from narrative and less from pages of statistics. I have rarely met a nurse engaged in practice who didn’t start a story with, “I had a patient once who…” These narratives teach us about what is important in nursing. Throughout the book, I have been very careful to be inclusive, to avoid heteronormative and ethnocentric language, to use examples that avoid stereotypes of all types, and to include photographs that capture the wonderful diversity of American nursing. A note about references: older references refer to classic papers or texts. There are a few references that don’t reach the level of “classic” texts, but the author turned a phrase in a clever or elegant way that needed to be cited. No manner of updated paper could replace these interesting comments or points of view. Research and clinical works are relevant and contemporary. As with the last three editions, the eighth edition is written at a level appropriate for use in early courses in baccalaureate curricula, in RN-to-BSN and RN-to-MSN courses, and as a resource for practicing nurses and graduate students. An increasing number of students in nursing programs are seeking second undergraduate degrees, such as midlife adults seeking a career change and others who bring considerable experience to the learning situation. Accordingly, every effort has been made to present material that is comprehensive enough to challenge users at all levels without overwhelming beginning students. NUR 3805 Politics and Policy Discussion

The text has been written to be engaging and interesting, and care has been taken to minimize jargon that is so prevalent in health care. A comprehensive glossary is provided to assist in developing and refining a professional vocabulary. As in previous editions, key terms are highlighted in the text itself. All terms in color print are in the Glossary. The Glossary also contains basic terms that are not necessarily used in the text but may be unfamiliar to students new to nursing. Some features from previous editions have gotten significant “makeovers.” Some self-assessment exercises were retained, but the language was updated. Several chapters contain Challenge boxes that typically, but not always, are related to an issue of culture. Some older textboxes from previous editions have been eliminated to make room for fresher content. To be consistent with the focus of the book—concepts and challenges—I have changed the former “Key Points” content to address major concepts from each chapter with a corresponding challenge for the student or for nursing as a profession. I have included “Ideas for Further Exploration” to replace “Critical Thinking Questions” with the hope that these ideas will generate a spark of curiosity in students as they consider some of the challenging aspects of the profession. I sincerely hope that the eighth edition continues to reach the high standards set forth by Kay Chitty, who edited the first four editions of this book. I hope that students and faculty will find this edition readable, informative, and thought provoking. More than anything, I hope that Professional Nursing: Concepts & Challenges, Eighth Edition, will in some way contribute to the 14 continuing evolution of the profession of nursing. Beth Perry Black 15 Acknowledgments With each new edition of Professional Nursing: Concepts & Challenges, I find myself increasingly in awe of the intelligence, creativity, humility, and work ethic of the nurses who continue to inspire me. I am so grateful to the many people whose support and assistance have made this book possible, each in different ways: • To the faculty who used earlier editions and shared their helpful suggestions to make this book better. • To students who sent e-mails, expressing their gratitude for an interesting and readable textbook while offering ideas for improvement. • To the many nurses who were generous in sharing their experiences when I asked for an example or a story. Nurses narrate their work like no others. • To my colleagues in the School of Nursing at the University of North Carolina at Chapel Hill, and to our extraordinary nursing students and alumni who make us proud. • To Trish Wright and Rana Limbo, my “grief buddies,” who are also my dear friends and writing companions. • To my friend Paula Anderson, who assisted me in the preparation of this text and whose warm, generous spirit infuses everything she does with light. • To my dear friends Jen and Rick Palmer, whose loving support has been and continues to be a lifeline. • To my incredibly smart, funny, and supportive daughters, Amanda Black and Kylie Johnson, and to their respective partners, Hudson Santos, Jr., and Pierce Johnson, who serve to both buoy and anchor them. Thanks, schweeties! I am deeply indebted to each of you. 16 Nursing in Today’s Evolving Health Care Environment LEARNING OUTCOMES After studying this chapter, students will be able to: • Describe the demographic profile of registered nurses today. • Recognize the wide range of settings and roles in which today’s registered nurses practice. • Identify evolving practice opportunities for nurses. • Consider nursing roles in various practice settings. • Explain the roles and education of advanced practice nurses. To enhance your understanding of this chapter, try the Student Exercises on the Evolve site at http://evolve.elsevier.com/Black/professional. 17 Chapter opening photo used with permission from iStockphoto. Nurses comprise the largest segment of the health care workforce in the United States and have increasing opportunities to practice in an enormous variety of settings. The profession of nursing is more than ever requiring the education of well-trained, flexible, and knowledgeable nurses who can practice in today’s evolving health care environment. Recent legislation, demands of patients as consumers of health care, and the need to control costs while optimizing outcomes have had a great influence on the way that health care is delivered in the United States. Nursing is evolving to meet these demands. One of the most notable influences on today’s health care environment is the Affordable Care Act (ACA), passed in 2010 by the 111th Congress. The ACA is actually two laws—the Patient Protection and Affordable Care Act (PL 111-148) and the Health Care and Education Affordability Reconciliation Act (PL 111152). Signed into law by President Barack Obama, this combination of laws is sometimes referred to as simply “health care reform” by the public. These laws provide for incremental but progressive change to the way that Americans access and pay for their health care. In an important report of the opportunities this legislation affords nurses, the Committee on the Robert Wood Johnson Foundation Initiative on the Future of Nursing at the Institute of Medicine no …