References. Hood, L. J. and Leddy S.K. (2010). Conceptual bases of professional nursing (7th ed.). Philadelphia: Lippincott, Williams & Wilkins.

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1 History of Nursing Florence Nightingale influenced a social movement that impacted the development of professional nursing in the U.S. Prior to Florence Nightingale s time nurses were nuns doing their civic duties. They were also women who were considered uneducated, who worked on public workhouses and correctional facilities. Driven by her passion of nursing, Florence Nightingale led the movement to change the condition of the health care systems and also to institute nursing as a respected profession. She helped improve hospital conditions by raising funds and organizing resources. During the Crimean War she also helped not only by attending to the soldiers physical needs but also to their social and psychological necessities. In 1855 a school was established under her care in which she oversaw nurses formal education. Nightingale structured the nursing schools where she established protocols. She believed that nurses need to have good moral character and conduct (Hood & Leddy, 2010, pp ). With this change society began to perceive nurses as respected professionals. Another movement that impacted professional nursing is the American Public Health Movement. Public health is about working with other groups in the community to provide care to those in need (Hood & Leddy, 2010, p. 45). The movie Sentimental Women Need Not Apply showed how Lilian Ward in 1910 started visiting the poor and the needy and how that was the beginning of her new calling as a nurse. Like her, many women found that nursing is no longer just working in hospitals and private home settings. They would service the poor and the sick who were unable to go to the hospitals and to the rural areas that never had any health care. The movie also captured the flight of the African American women nurses. They struggled to be recognized as professional nurses. Often they would take on the doctors role in the poverty-stricken and impoverished African American community. With its popularity in the early 1900, public health nursing led to the demand for additional education for nurses (Hood & Leddy, 2010, p. 45). Other key social movement that affected professional nursing was the inclusion of the women in the military nurse corps. As depicted in the movie Sentimental Women Need Not Apply it is during World War I that women were first accepted into the military. However, they were not recognized as officers nor given the proper pay and often overworked. Overwhelming demand for nurses increased during World War II as well but women were still unrecognized as officers. In spite of this, women nurses still enlisted and underwent intense training. Also during this era where demand for nurses were high, African American women nurses were finally recognized and enlisted into the military. They had undergone discrimination but they prevailed after intense protest. It took a lot of hard work and sacrifices not only for the African American nurses but for all women military nurses to be recognized and be given their full officer status. This movement opened up more professional opportunities and roles for the nurses. Another movement that impacted the nursing profession was the demand for nurses to obtain higher education. Before 1960s most nurses had hospital-based diplomas which was

2 sufficient at the time to fulfill the nursing demand. In 1965 the American Nurses Association declared that nurses need to have at least a bachelors degree and at least an ADN for technical nursing practice. This they said would improve patient care outcomes. The U.S. Public Health Service also issued a report which outlined goals and needs towards quality nursing. They listed concerns which included the lack of nursing education, the need for university-based education and the need for research for the advancement of nursing profession. This report led to the creation of Nurse Training Act of 1964 and also for federal money for ADN and BSN programs (Kalisch & Kalisch, 2004). With this movement community colleges that offered ADN program increased. It was also the start of graduate programs that offered speciality areas in clinical and management. It opened up specialties such as nurse practitioner and research nursing. This resulted to an increase in students passing the nursing licensure exams which in turn increased the number of well trained and qualified nurses (Hood & Leddy, 2010, p, 48). References Hood, L. J. and Leddy S.K. (2010). Conceptual bases of professional nursing (7th ed.). Philadelphia: Lippincott, Williams & Wilkins. Kalisch, P.A., & Kalisch, B. J. (2004). The advance of American nursing (4th ed.). Philadelphia: Lippincott, Williams & Wilkins.

3 Nursing Models and Theory The nursing theory that appealed to me the most from the chapter is Neuman s systems model. The systems theory of nursing is based on the supposition that a person and his environment interacts constantly and therefore creates a complex situation. From this theory the nurses then can understand and plan care for their patients (Hood & Leddy, 2014). Hood and Leddy explained that Betty Neuman s system model facilitate optimal client system stability by reducing the impact of environmental stimuli or stressors (p. 131). Neuman (2002) explained that environmental stressors includes the internal, external and the created environment. Internal environment is something within the human body, external is anything outside of the body and created environment is what the person perceived of the internal and external environment (p. 18). She further explained that a person deals with these stressors by creating line of defenses. The first line of defense is flexible line of defense which includes physiologic state, mood, nutrition, and spiritual belief. The second is called normal lines of defense which is the person s basic hygiene such as health, exercise and relaxation strategies. The final defense is called the line of resistance which includes the person s immunological and emotional defense mechanisms (Neuman, 2002). Neuman (1996) intended nurses to assist client in achieving optimal health by balancing the stressors and that of the defenses (p. 69). Neuman s system is appealing to me because of the approach of how the nurses assist clients to achieve dynamic equilibrium. Hood and Leddy explained Neuman s prevention to include primary, secondary and tertiary prevention. Primary prevention is promotion of health, secondary prevention is when normal line of defense is used and tertiary prevention focuses on restoration of health (p. 132). I apply this concept everyday in my clinical practice. When a baby is admitted to the Neonatal Intensive Care Unit (NICU), part of my initial care is to assess what the stressors are for the baby and also for its family. Internal stressor for the baby would include either bacterial or viral infection and external stressors could be the loud noise or the temperature in the unit. For the parents of the patient, internal stressors could be the exhaustion due to the labor process. External stressors could include the fact that the baby has to be separated from the mother and be admitted in the unit and the busy and chaotic environment of the NICU. The uncertainty and fear of the unknown of the diagnosis are created environmental stressors for the parents. To apply Neuman s stages of prevention, the baby admitted to the unit will go straight to the secondary prevention. A rule out sepsis baby would receive antibiotics propylactically until laboratory results are in. The baby would also be assess for infection which would include checking the temperature at least every four hours, assessing for signs of physical stress by checking vital signs and by drawing blood for labs during and after 12 hours of admission. Also during the baby s stay in the unit, the focus is on the tertiary prevention which is restoration of health. When the baby s sepsis is ruled out, the care is then focused on the baby s wellness in order to be discharged. This could include feeding, maintenance of good vital signs, normal laboratory results and daily weight gain. For the parents, the secondary and tertiary prevention intervention would include allowing them to rest and recuperate from the labor experience. During the stay in the NICU, I would also educate the parents of the diagnosis and the treatment that the baby is receiving. This would reassure them that their baby is taken care of. Prior to discharge, I have to make sure that the patients health and the parents needs

4 are met. I have to make sure that baby s outpatient medication are filled and follow-up appointment with the pediatrician is scheduled. I would educate the parents of the baby s feeding protocol, how to administer medications and when to bring the baby to the pediatrician. Neuman s systems model is practical and easy to apply to my everyday clinical practice. Patients deal with internal and external stressors and it is my responsibility to assist them in balancing the stressors and the defenses. By doing so, the patient will ultimately achieve equilibrium and restoration of health. References Hood, L. J. and Leddy S. K. (2014). Conceptual bases of professional nursing (8th ed). Philadelphia: Lippincott, Williams & Wilkins. Neuman, B. (1996). The Neuman systems model in research research and practice. Nursing Science Quarterly, 9, Neuman, B. (2002). The Neuman systems model. In B. Neuman & J. Fawcett (Eds.), The Neuman systems model (4th ed.) Upper Saddle River, NJ: Prentice Hall.

5 Evidenced Based Practice The research article I chose is a study regarding very low birth weight infants and the effects of delayed cord clamping in their development. The article was titled Seven month developmental outcomes of very low birth weight infants enrolled in a randomized controlled trial of delayed versus immediate cord clamping. The study was conducted by Mercer and Oh (2010) and was published in the Journal of Perinatology. The electronic version can be found with the digital object identifier number /jp The research design that was used in the study is quantitative research. Quantitative research emphasizes discovery and meaning of theory by describing (Haase & Myers, 1988, p. 131). Hood and Leddy (2014) explained it as the process for discovering reality uses reductionism, which proposes that knowledge of the whole can be gained through knowledge of the parts (p. 244). In this study, researchers focused their work on specific group in an attempt to generalize the outcome. The participants used in this study was 72 infants with very low birth weight. The study was performed at Women s and Infants Hospital in Providence, Rhode Island. They looked at infants who were born between August 2004 and December Relevant demographics included mothers between 24 and 31.6 weeks gestation. They were then divided into block stratified with groups between weeks and weeks gestation. The research nurses attended the deliveries of these mothers and assigned randomization. The obstetrician in attendance were instructed by the researchers to either clamp the umbilical cord immediately (ICC) after birth (<10 seconds) or cord clamping was delayed (DCC) seconds while holding the infant inches below the placenta. The purpose of the study was based on the researchers previous trial of infants that also underwent delayed cord clamping. The subjects from that study showed significantly less intraventricular hemorrhage (IVH) and late onset sepsis (LOS). From this, the researchers then hypothesized that infants who undergo delayed cord clamping will have better motor function by seven month of corrected age. The results of the trial showed that there was no significant difference in Bayley Scales of Infant Development scores between the ICC or DCC groups. However, they found that male infants with DCC had higher motor scores than male infants with ICC. Their findings also suggested that brief delay in cord clamping had protective effect by the placenta. They argued that extra blood that the infants received from delayed cord clamping had neuroprotective and immunuprotective benefits on the subjects. The researchers recommended that further trial studies similar to this would be beneficial. They suggested that perhaps a larger sample size could be conducted in the future. They also added that subjects of the future studies should be followed up to four years of age when motor development is more stable. This study is essential to the care of the neonates. It serves as model and resource for future trials. At my work, there is a similar study being conducted that also focuses on delayed cord clamping. The trial compares delayed cord clamping on infants born via ceasarean-section versus vaginal delivery. Outcomes of these kinds of studies can change practices and protocols at different hospitals. They can be used as guidelines for evidence-based practice. At my

6 hospital, cords are clamped immediately after the infant is delivered. However, if more and more studies show benefits of delayed cord clamping then we might see our practice change toward this trend. References Haase, J. E., & Myers, S. T. (1988). Reconciling paradigm assumptions of qualitative and quantitative research. Western Journal of Nursing Administation, 29, Hood, L. J. and Leddy S. K. (2014). Conceptual bases of professional nursing (8th ed). Philadelphia: Lippincott, Williams & Wilkins. Mercer, J., Vohr, B., & Oh, W. (2010). Seven month developmental outcomes of very low birth weight infants enrolled in a randomized controlled trial of delayed versus immediate cord clamping. Journal of Perinatology, 30(1), doi: /jp

7 Spirituality and Nursing Care It is imperative that part of our nursing duty is to provide spiritual care to our patients. This is more significant to patients with terminal illness and at the end of life. Lianne Wynne (2013) in her article entitled Spiritual care at the end of life stated that death and dying are frightening and isolating concepts that people may have difficulty in understanding (p. 41). As nurses, we provide spiritual care as an integral part of our holistic care. The diagnosis of spiritual distress is noted to be related to anxiety and stress, losses and suffering, and separation from or challenges to a belief system (Delgado, 2007, p. 280). With patients who are at the end of life, our focus is ensuring that they die in the manner that they want it be. Assessing the spiritual needs of a terminally ill patients assist them to increase their focus on spiritual or religious concerns (Courtenay, Poon, Martin el. al, 1992, p ). Nurses can also assess spiritual beliefs and help identify spiritual support for these patients (Delgado, 2007, p. 280). Nurses can assist patients in identifying their wishes and spiritual needs before they die. The assessment of the patient s spiritual needs is also important in creating nurses plan of care. At Marie Curie Hospice in Liverpool, they utilize the assessment tool HOPE in developing their spiritual care plan (Wynne, 2013, p. 44). HOPE is a tool that identifies four key areas for discussion for patients at the end of life (Anandarajah & Hight, 2001). HOPE stands for: H-sources of Hope, strength, comfort, meaning, peace, love and connection, O-the role of Organized religion for the patient, P-personal spirituality and practices and E-Effects on medical care and end of life decisions. The three nursing interventions needed in addressing spiritual distress are assessment, communication and support (Delgado, 2007, p. 286). In conducting an assessment, the nurse identify the patient s faith, beliefs and practices. This could be as simple as asking an openended question such as Do you think yourself as a spiritual or religious person? (Delgado, 2007, p. 287). This allows patients to express themselves freely and openly. The second intervention essential to addressing spiritual needs is communication. According to Delgado (2007) communicating effectively with and facilitating the patient to connect with others through such actions as active listening, presence, actively exploring the patient s spirituality, comforting with words and physical contact, reminiscing, supporting, and demonstrating respect were the most frequently used interventions (p. 285). A spiritual dialogue is also important between the nurses and their patients in order to plan advance care. An effective communication with the patient s family or friends is essential in providing the holistic care. Lastly, the nursing intervention includes providing support either emotionally and physically. Emotional support could consists of establishing trust, unselfish attention, and comforting the patient. Careful use of humor is also a positive spiritual intervention (Delgado, 2007, p. 286). Physical support includes creating conditions for spiritual activities, being present and a simple touch. Providing competent physical care and help reducing physical pain are another physical support that nurses can provide (Delgado, 2007, p. 288). References

8 Anandarajah, G., & Hight, E., (2001). Spirituality and medical practice: using HOPE questions as a practical tool for spiritual assessment. American Family Physician, 63, Courtenay, B., Poon, L., & Martin, P., (1992). Religiosity and adaptation in the oldest-old. International Journal of Aging Human Development, 34, Delgado, C., (2007). Meeting clients spiritual needs. Nursing Clinics of North America, 42, doi: /j.cnur Wynne, L., (2013). Spiritual care at the end of life. Nursing Standard, 28,

9 Multicultural Issues Living in southern California, San Diego s residents consist mostly of hispanic population. Our hospital admits hispanic patients regularly. One particular patient I remember had a very traditional Mexican family. Jose was a 37 week gestational age baby admitted to our unit for rule out sepsis. Both Jose s parents spoke limited english. They were very religious people who practiced catholicism. They brought religious artifacts and pictures that they placed around the baby s bed for what they called spiritual protection. They had a strong belief that God controls their baby s illness and he s the only one who can heal Jose. They also valued opinions and support from their extended family. The parents preferred nurses who showed close personal relationship to them which is part of their culture called personalismo (Caballero, 2011, p. S12). Evaluating my cultural competence when I was taking care of Jose requires analyzing the steps that it entails. Hood and Leddy (2014) listed the following steps nurses need to follow to acquire cultural competence (p ). The first step is examining personal values, beliefs, biases and prejudices. Having my own set of values and beliefs, I examined myself by comparing and contrasting my values to that of Jose s family. We had similar religious beliefs and strong family orientation. I also shared their preference of having a good personal relationship with the caregivers. The second step of acquiring cultural competence is building cultural awareness. I believe that I had a good understanding of the hispanic culture while growing up in the Philippines. Our culture is very similar to that of Mexico. However, I still have the obligation to further understand the hispanic culture. I confirmed this understanding by asking Jose s parents of their values and beliefs. The third step is learning culturally specific communication strategies. I know a few words in spanish so I utilized that during my care. When I had to further explain things to his parents, I used an interpreter in the unit. I also used caring touches by sitting next to the mother or touching her hands when talking to her to express my sincere compassion. The fourth step is interacting with people from different cultures. I am fortunate that I work in a place with such cultural diversities. We have nurses from different areas of the world who I interact with everyday. I learn from them by sharing cultures and experiences with each other. I learned enough of the hispanic culture from my co-workers and friends that I applied it with my care for Jose and his family. The fifth step is identifying and acknowledging mistakes. One way of making mistakes is by assumption (Hood & Leddy, 2014, p. 278). I know that I have similar culture and beliefs as Jose s parents but I avoided assuming things when conducting my care. I made sure I verified things with his parents and put them into consideration when providing care. The sixth and last step is remediating cultural mistakes. Jose s parents left a rosary at the head of the bed of the baby. When I saw it I removed and taped it at the foot of the bed. The parents became visibly upset but did not say anything. I immediately explained to them that I understand the importance of having the rosary next to the baby but I had to remove it for safety reasons. The rosary would still be around the baby but away from the head so it was still safe. We came to a mutual agreement by thoroughly and carefully explaining the rationale of my actions. Having this dialogue with them allowed me to remediate my mistake.

10 References Caballero, A., (2014). Understanding the hispanic/latino patient. The Americal Journal of Medicine, 124, S10-S15. doi: /jamjmed Hood, L. J. and Leddy S. K. (2014). Conceptual bases of professional nursing (8th ed). Philadelphia: Lippincott, Williams & Wilkins.