1. NURS 2210-Roles II Unit 1: Role of the RN in the Health Care System Nancy Pares, RN, MSN

2. Levels of education Cert. Nurse Assistant, Med Aide LPN; LPN-C ASN BSN MSN; APRN PhD Specialists: Wound Care, Ostomy, Care Management, Diabetes,

3. Roles/Functions Direct care provider Communicator Educator Advocate Counselor Change agent Leader Manager/case manager Research consumer

4. Scope of Practice The practice of nursing is a process that occurs during interaction between the nurse and the patient. This process begins with a thorough assessment of the patient’s health care needs. The nurse assesses the patient’s needs by interviewing the patient and the family to determine health history and current health status, by physically examining the patient, and by reviewing the patient’s record including the results of diagnostic tests.

5. Following the assessment, the nurse works together with the patient to develop a plan designed to care for current conditions, improve health status and prevent future illness. The nurse provides a variety of services or interventions for the patient depending on his/her needs. These services range from support for activities of daily living to highly complex technological services necessary to support life and foster the return to health. The nurse has the responsibility to continually monitor the effects of the services being provided and make adjustments or changes as needed.

6. Throughout this process the nurse is accountable for a caring attitude with the best interests of the patient being the foremost concern. Visit NHHS web site http://www.hhs.state.ne.us/crl/nursing/rn- lpn/rn-lpn.htm http://www.hhs.state.ne.us/crl/nursing/rn- lpn/rn-lpn.htm Compact states:

7. Advisory Opinions – Pronouncement of death – Meds when pharm closed – PICC lines – Arterial lines – IV sedation – Casting – CPR – cardioversion

8. Evidenced based practice The integration of best research with clinical expertise and patient values Levels – 1 : evidence obtained of all randomized control trials (RCT) – 2: properly designed study-non RCT – 3:A: controlled trials/non randomized B: case controlled analysis/ > one center/group C: multiple time series with dramatic results – 4: opinions, clinical expertise reports

9. Research Design Quantitative Descriptive Exploratory Survey Historical Cross-section Longitudinal Retrospective Prospective Correlational experimental

10. Qualitative designs Biographical Case Study Ethnography Phenomenology Literature Review

11. Elements of Research Proposal Sampling Measurement techniques Data collection and analysis Results Implications for nursing

12. Implementation into practice Research utilization Changing of nursing practice Application of legal/ethical principles

13. Critical Thinking Multi dimensional skill, involves reasoning, systematic, reflective, rational, outcome directed thinking based on knowledge and available information.

14. Components of Critical thinking Ask questions Gather information to consider all factors Validate the information Analyze the information Draw on past experiences; acknowledge personal bias Maintain flexible attitude Consider options related to advantages and disadvantages Formulate decisions that reflect creativity and independent decision making

15. The inquiring mind What does this tell me? What is the most important? Is anything missing? Do I need more help? What are the risks? What are the complications? What do I want to happen? What should I do first? Do family dynamics have affect? Is culture an issue? Are my ethics in line? What does nursing research support?

16. Characteristics of Nurses with critical thinking skills Creative Logical, rational Prudent, inquisitive Self regulating judgment Intellectual humility Independent thinking Willing to take risks Action oriented Recognizes patterns in phenomenon Focused thoughts Blends logic and intuition Anticipates events Works collaboratively and respects perspectives of others