Disciplinary Knowledge
This is a well-defined body of information based on research and conceptual frameworks (Stamler, 2018), it also involves ethical awareness and creative action (Kennedy, 2018).
What is Nursing knowledge?
Rationale: Nursing is a profession with an ever-developing well-defined body of knowledge and expertise; nursing practice, education, and research are guided by conceptual frameworks, which further nursing knowledge (Stamler, 2018). Nursing knowledge begins with specialized education which meets entry to practice standards and is kept up to date with accredited continuing professional development (Canadian Nurses Association [CNA], 2015). Nursing is a complex combination of art and science, based on empirical, personal, ethical, aesthetic knowing (Kennedy, 2018):
- empirical knowing is organized systematically into laws and theories,
- personal knowing is based on nursing as an interpersonal process involving the nurse and the client,
- ethical knowing encompasses how nursing practice involves judgement between right and wrong beyond ethical codes, and
- aesthetic knowing involves how nursing is individually created through empathy, compassion, holism, sensitivity, and creativity.
These boundaries of nursing care outline what activities RNs are authorized, educated, and competent to perform; outlined by legislation (CARNA, 2011).
What is the Nursing Scope of Practice?
Rationale: There are two distinct nursing Scopes of Practice, that of RNs as a professional group and that of individual RNs. Scope of Practice for the nursing profession includes activities that RNs are educated and authorized to perform as set out in legislation such as the Health Professions Act, the Registered Nurses Profession Regulation, in CARNA standards, and other regulatory documents (CARNA, 2011). The Scope of Practice of an individual RN is narrower than that of the profession. It is impacted by the client’s needs, practice setting, regulations and policies of the employer, and the individual RN’s level of competency (CARNA, 2011). Nurses often transition between activities and roles within their scope of practice throughout their day-to-day care of patients, as well as throughout their careers.
A nurse acknowledges that there are disparities in the health care system that perpetuate the inequitable quality of care which can lead to negative health outcomes (Abu, 2020).
What is social justice?
Rationale: This is reflected in nurses’ efforts to ensure equitable treatment under the law and access to quality health care (Ferguson, 2018). This relates to practices, policies, and systems that perpetuate unemployment, poverty, homelessness, discrimination, lack of education, and situations that can lead to negative health outcomes (Abu, 2020). Socially just actions are directed at balancing these health-related burdens and refers to the fair distribution of resources for positive health outcomes and the removal of social and political obstacles to improving health. (Abu, 2020). In nursing, it is critical to be aware of people and communities that have been traditionally disadvantaged by health care inequality and strategies to combat these obstacles (Abu, 2020).
This concept utilizes the nurse's voice to engage clients and communities, empower their rights and autonomy, and employ evidence to speak out against inequities and influence policies and practice (Ferguson, 2018; Canadian Nurses Association, n.d).
What is Advocacy?
Rationale: Advocacy is a vital role of the nurse that utilizes our voice to speak up for those unable to speak up for themselves through agency and activism (Ferguson, 2018). Agency includes acting within the systems we work to gain access to services for our patients who may not be able to acquire on their own, while activism includes working toward systemic change to increase access to patients and communities, decrease inequities, and empower their rights and autonomy (Ferguson, 2018).
This functions as a systematic guide to client-centered care that includes 5 phases: assessment, diagnosis, planning, implementation, and evaluation (Ferguson & Rohatinsky, 2018).
What is the Nursing Process?
Rationale: The Nursing Process is an important action that promotes a thoughtful, informed, evidence-based, and ethical nursing practice. This process can be used to guide nursing care when working with an individual, family, group, and community (Ferguson & Rohatinsky, 2018).
The phases include:
- Assessment: Systematic collection, organization, validation, and documentation of data.
- Diagnosis: Review assessment data to identify the client's concerns, strengths, and preferred health outcomes.
- Planning: Involves decision-making and developing a nursing care plan. This is where you will establish the client's goals and desired health outcomes.
- Implementation: This phase consists of doing, delegating, and recording.
- Evaluation: This is a planned, ongoing, and purposeful phase where health professionals evaluate the client's progress towards health goals.
(Ferguson & Rohatinsky, 2018).
This form of nursing practice is based on the values of right and wrong, upholding high moral standards, and respecting the principles of autonomy, nonmaleficence, beneficence, justice, fidelity, and veracity (Ferguson, 2018).
What is ethical practice?
Rationale: Nursing ethics are based on the values of right and wrong and the process of making decisions that uphold high moral standards (Ferguson, 2018). Ethical practice is contextual and often involves weighing priorities such as the client’s well-being, the law, the care of multiple patients, and respecting the client’s autonomy (Ferguson, 2018). Making ethical decisions for patients can be a highly complex process when distinguishing the right or wrong decision is unclear (Ferguson, 2018). One of the ways that nurses can address these complexities and show ethical accountability is by working with the healthcare team to resolve a moral dilemma (Canadian Nurses Association [CNA], 2017). A code of ethics often outlines ethical practice; it is a formalized statement of the group (or governing body’s) beliefs and serves to support nurses and the environments in which they work (Ferguson, 2018). Lastly, principle-based ethics include the ideals of autonomy, nonmaleficence, beneficence, justice, fidelity, and veracity (Ferguson, 2018)
The Canadian Nurses Association’s code of ethics is centered around 7 primary values and ethical responsibilities (CNA, 2017):
- Providing safe, competent, compassionate, and ethical care
- Promoting health and well-being
- Promoting and respecting informed decision-making
- Honoring dignity
- Maintaining privacy and confidentiality
- Promoting justice
- Being accountable
A component of the nursing paradigm that focuses on the quality and wellness of a patient (McIntyre, 2018).
What is Health?
Rationale: For good health outcomes to be achieved, nurses must take a holistic approach with patients (Mason, 2014). Holistic health encompasses the patients' health-related quality of life, physical illness, and social determinants of health. This concept includes physical, mental, emotional, social, and spiritual wellbeing (McIntyre, 2018). To achieve optimal health, individualized treatment plans and appropriate access to the health care system are needed (Mason, 2014). Health is contextual and relational; it is a dynamic process and is constantly changing (McIntyre, 2018). This implies continuous adjustments to stressors through optimal use of resources to achieve maximum health potential. (Mason, 2014). It is crucial to assess patients on their individuals need to provide them with adequate care (Branch et al., 2016).
This concept describes the shift in the thinking of nursing students needed to become a novice registered nurse (Canadian Nurses Association, 2015).
What is transition?
Rationale: Nursing students go through a significant transition in the thinking process throughout their nursing education. The nursing baccalaureate programs are designed to take students with insufficient nursing knowledge and transition their way of thinking by introducing and teaching skills related to critical thinking, clinical reasoning, and clinical judgment to achieve novice nurse knowledge (Canadian Nurses Association, 2015).
This is the most global philosophical framework of the nursing profession that includes these four central concepts of the discipline: person/client, environment, health, and nursing (McIntyre & McDonald, 2018).
What is the Nursing Metaparadigm?
Rationale: Nursing theories address and specify relationships among the four major abstract concepts referred to as the metaparadigm of nursing (McIntyre & McDonald, 2018). Consensus exists that the following four concepts make up the nursing metaparadigm, although others have proposed alternatives (McIntyre & McDonald, 2018). The concepts include:
- Person or client: The recipient of nursing care.
- Environment: The internal and external surroundings that affect the client.
- Health: The degree of wellness or well-being that the client experiences.
- Nursing: The attributes, characteristics, and actions of the nurse providing care on behalf of, or in conjunction with, the client
(McIntyre & McDonald, 2018).
Boundaries must be kept by the nurse when developing a relationship with a client to ensure it is safe, respectful, and therapeutic (CARNA, 2020; Ferguson, 2018).
What is Professionalism?
Rationale: Professionalism is one of the entry-to-practice competencies from CARNA. Registered nurses must uphold the professions’ code of ethics and practice standards while being committed to the health and well-being of clients (CARNA, 2019).
Professional boundaries must be kept ensuring a safe and respectful nurse-client relationship. These boundaries are a component of a nurse's professional practice. Professional values are the developed values that a nurse will have from codes of ethics, nursing experiences, mentors, and peers (CARNA, 2020; Ferguson, 2018).
This concept means that everyone has a fair and just opportunity to be healthy. However, social determinants of health can prevent someone from optimal health outcomes. Nurses work hard to overcome and reduce these obstacles (Lind et al., 2017).
What is health equity?
Rationale: Health equity means the absence of differences in health that are systematic and avoidable, which are unfair and unjust (Cohen et al., 2013, as cited in Lind et al., 2017). For example, A clinic only opens in the morning, however, people whose schedule is conflicted to work in the morning cannot schedule an appointment. Therefore, the clinic also offered alternative opening times in the evening and afternoon so everyone can have the opportunity to access health services. The definition of equity is not just treating people in the same way, which is equality, but having special measures and accommodation for differences (Graham, 2018).
This concept relates to the RN’s scope of practice and the degree to which RN consultation and collaboration are needed due to a patient's condition’s unpredictability and risk for negative outcomes. (Canadian Nurses Association, 2015).
What is complexity?
Rationale: Complexity relates to the degree to which a patient's condition is unpredictable and has risks for negative outcomes (Canadian Nurses Association, 2015). RN’s are specifically trained in professional knowledge and skills that allow them to successfully handle complex nursing care situations. (Huber et al., 2019) The more complex a patient’s care requirements are means the greater need for, “clinical expertise and judgment, critical thinking, analysis, problem-solving, decision-making, research utilization, resource management and leadership.” (Canadian Nurses Association, 2015, p. 16).
These are the four major domains of practice as defined by CARNA (2011).
What are clinical practice, research, administration, and education?
Rationale: There are four major domains of practice as defined by CARNA (2011):
- Clinical Practice: The focus and core of the registered nursing practice is the provision of direct care to clients.
- Research: Validate and refine existing knowledge and generate new knowledge to influence all domains of nursing practice.
- Administration: Direct and influence the work of others to enhance an organizational culture of professional and safe practices.
- Education: RNs use their in-depth knowledge and skills of education to support members of the healthcare team as they care for clients, advance their practice, and help nursing students enter the profession through planning, implementing, and evaluating nursing curricula.
(College and Association of Registered Nurses of Alberta [CARNA], 2011)
Each of these domains are fundamental to the profession, although clinical practice is fundamental to registered nursing, the other domains are essential to the contribution of the provision of client care by supporting and enabling direct care providers; developing and communicating knowledge and policy; and ensuring that the necessary resources are in place for safe, competent, and ethical care (CARNA, 2011).
________ is a document by CARNA that outlines foundational concepts for providing safe, competent, compassionate, and ethical care in the 4 domains of nursing practice, education, research, and administration (College and Association of Registered Nurses in Alberta [CARNA], 2013).
What are Practice Standards?
Rationale: The practice standards for registered nurses reflect philosophical values of the nursing profession, clarifies expectations of nurses in the profession, and informs the public of the minimal level of acceptable practice in nurses (Stamler, 2018). These standards include:
- Responsibility and Accountability: the nurse is personally responsible and accountable for their nursing practice and conduct,
- Knowledge-Based Practice: the nurse continually acquires and applies knowledge and skills to provide competent evidence-informed nursing care and service,
- Ethical Practice: the nurse complies with the applicable code of ethics,
- Service to the Public: the nurse has a responsibility to provide safe, competent, and ethical nursing care and service in the best interest of the public, and
- Self-regulation: the nurse fulfills the professional obligations related to self-regulation (CARNA, 2013)
It is not only medical treatments or behavioral choices that shape Canadian's health outcomes, but also the conditions that make up Canadian’s lived experiences (Yiu, 2018). These conditions are known as ______.
What are the Social Determinants of Health?
Rationale: There are 12 determinants of health based on health inequities that exist amongst individuals and populations (Yiu, 2018). These determinants reflect personal, social, economic, and environmental influences that can impact an individual or a population’s health (Government of Canada, 2020). As a health care provider, it is important to recognize that there could be non-medical factors impacting overall health and wellness.
This important component of nursing care is defined as “policies, programs, and practices that aim primarily to reduce the adverse health, social, and economic consequences of the use of legal and illegal psychoactive drugs without necessarily reducing drug consumption” (McPherson et al., 2017).
What is Harm Reduction?
Rationale: Examples of harm reduction are bicycle helmets, seatbelts, housing first theory, and supervised consumption sites (McPherson et al., 2017). However, harm reduction theory is most known for its use to reduce harm for people who use illicit drugs (CNA, 2017), it can also be used by Nurses as a lens through which they view all aspects of health promotion.
This concept is a respectful and reflective approach to guide inquiry into a patient’s lived experiences and health care needs within complex contexts (Zou, 2016).
What is relational Practice?
Through acknowledgement of contextual factors as well as self-reflection, nurses question their biases and assumption to better understand an individual’s lived experience (Zou, 2016). By utilizing these concepts in conjunction with ethical practice, advocacy, and social justice, nurses can empower their clients through relational practice (Zou, 2016). Relational practice utilizes five relational capacities vital to enhancing relational skills:
- Honouring complexity and ambiguity: involves learning to be curious and expanding the capacity to trust and acknowledge complexity and ambiguity within the human experience.
- Intentionality: includes questioning assumptions and beliefs and helping clients clarify the meaning of their health experience while fostering the ideals of freedom of choice and change.
- Initiative, authenticity, and responsiveness involve the desire and ability to form a relationship with another person, family, or community-based on a genuine concern for others and about others. This includes a focus on being holistically present with your client.
- Mutuality and synchrony: Mutuality includes establishing a common understanding of goals and characteristics while synchrony involves establishing connections in internal and external rhythms, between the nurse and their client, built on receptivity.
- Re-imagining: Re-imagining compels nurses to question hegemonic structures and influential life experiences and foster opportunities for clients to transform their health and healing experiences
(Hartrick, 1997)
To promote positive ______, it is important to educate the public about nursing, educate friends and family about your roles as a nurse, have a positive self-perception of nursing, and speak out when there are stereotypes involved (Bennett et al., 2020; Cleary et al., 2018 ).
What is Nursing image?
Rationale: The media and popular culture play a major role in shaping and reinforcing nursing stereotypes and images (Cleary et al., 2018) and nurses’ negative self-perceptions often weaken the nursing image and identity of nursing (Bennett et al., 2020). Understanding the nursing profession, the different roles of the nurse, and adopting proactive approaches is critical in combatting the myths and misperceptions regarding nursing image (Cleary et al., 2018). It is also important for nurses to stop and speak out about cases that devalue the nursing image and limit nurses' influence in the health care profession (Bennett et al., 2020).
This charter was created during the first international conference on Health Promotion in 1986 and emphasizes the need for a socio-environmental approach to achieve equity in health which empowers individuals and communities to be involved in their health (Yiu, 2018).
What is the Ottawa Charter?
Rationale: The Ottawa Charter empowers individuals and communities to be involved in their health and improve it by acting towards improved social, environmental, and economic conditions. It views health as a resource for everyday living (Yiu, 2018). Prerequisites for health include peace, shelter, education, food, income, social justice, equity, sustainable resources, and a stable ecosystem (Yiu, 2018). The Charter outlined these action strategies to promote health:
- Create Supportive Environments: Generate safe and enjoyable living and working environments and conditions.
- Develop Personal Skills: Support individuals to make informed choices so they can control their health.
- Build Healthy Public Policy: Adopt public policies to help make informed healthier choices.
- Strengthen Community Action: Empower communities to take initiative to improve their health.
- Reorient Health Services: Organize the different sectors: health, social, political, economic, and physical to focus on the needs of the individual.
(Yiu, 2018)
A nurse who successfully collaborates with their patients, community partners, and other multidisciplinary healthcare professionals to develop personalized, effective care plans is demonstrating this key role of the nurse (Hughes, 2018).
What is teamwork?
Rationale: One of the core roles of the nurse is a collaborator (CARNA, 2019). They work with other nurses and within multidisciplinary teams to communicate, manage, and coordinate patient care. Teamwork is an important part of nursing for many reasons, one of which being that research shows positive patient outcomes are more readily achieved through high-quality interdisciplinary teams that collaborate frequently to maximize a variety of skill sets (Jimenez et al., 2018). Nurses who can recognize and support the strengths of other team members are highly effective team players, work well on interdisciplinary teams, and often succeed in leadership roles (Clark et al., 2015). Lastly, nurses engage in teamwork with their patients as well. A nurse who collaborates with their client or community partners to work together in developing the most effective and sustainable plan of care is using teamwork and communication skills to maximize patient outcomes (Hughes, 2018).