1

Concepts and Theories Guiding Professional

Practice

2Objectives And Activities

Describe the importance of having a theory for professional nursing practice.

Identify the scope and standards for nurse administrators as a framework for practice.

Define the terms executive, manager, managing, management, and nursing management.

roles for nurse managers and nurse executives. Illustrate selected principles of nursing management. Discuss general systems theory. Discuss the use of nursing theory in managing a clinical practice. Differentiate among concepts, principles, and theory.

3CONCEPTS

1. Aim of health care.

2. Scope of practice.

3. Standards of practice for nurse administrators.

4. Management theory.

5. Nursing management theory.

6. Critical theory.

7. General systems theory.

8. Nursing management.

9. Management principles.

10.Management development.

11.Nursing management roles.

12.Role development.

13.Cognitive styles.

14.Intuitive thinking.

15.Rational thinking.

16. Management levels.

17.Modalities of nursing.

4A. Nurse Manager Behaviors:

1. Applies postmodern management theory to organizational operations.

2. Assesses the impact of ethnic, political, social, financial, economic, and ethical issues perspectives.

3. Share ideas and conduct mutual problem solving.

4. Activities as certification and participation in professional organizations.

B. Nurse Executive Behaviors:

1. Examines the application of a nursing and management theory.

2. Works with the professional nursing staff to develop and test the pilot study.

3. Pursues continuing education, certification, professional development.

4. Seeks experiences to advance one’s skills and knowledge base including the art and science of nursing.

5Aims For Improvement In Health Care

1. Health care must be safe: “First, do no harm”.

2. Health care must be effective.

3. Health care should be patient centered.

4. Health care should be timely.

5. The health care system should be efficient, constantly seeking to reduce the waste—and hence the cost.

6. Health care should be equitable. Race, ethnicity, gender, and income should not prevent anyone in the world from receiving high-quality care.

6Core Competencies Apply To All Health Care Professionals

1. Provide patient-centered care.

2. Work in interdisciplinary teams.

3. Use evidence-based practice.

4. Apply quality improvement.

5. Utilize informatics.

7

Professional Practice Model Of Nursing

8American Nurses Association (ANA) notes work environments that support professional practice:

1. Magnet hospital recognition.

2. Preceptorships and residencies.

3. Differentiated nursing practice.

4. Interdisciplinary collaboration.

9Scope and Standards for Nurse Administrators provides Framework to:

1) Nursing services management, philosophy, and practices.

2) Adherence to standards for improving the quality of patient care.

3) Leadership of the chief nurse executive and competence of nursing staff.

4) Attention to the cultural and ethnic diversity of patients, their significant others, and the care.

5) Providers in the health care system.

10Interdisciplinary Collaboration

The ANA outlines components of a professional nursing practice environment:

1. Manifests a philosophy of clinical care emphasizing quality, safety and continuity of care.

2. Recognizes contributions of nurses’ knowledge and expertise to clinical care quality.

3. Promotes executive level nursing leadership.

4. Empowers nurses’ participation in clinical decision making and organization of clinical care systems.

5. Maintains clinical advancement programs based on education, certification, and advanced preparation.

6. Demonstrates professional development support for nurses.

7. Creates collaborative relationships among members of the health care provider team.

8. Uses technological advances in clinical care and information systems(in that documentation).

11Scope And Standards For Nurse Administrators:

Framework For Practice

1) Core abilities necessary for nurses in administrative roles.

2) Management skills.

3) Team-based learning to advocate for patients and community.

4) Strategic management, policy development, financial management, cost analysis, leadership, organizational development and business planning.

5) Evidence-based management (effectiveness of care, cost of care, and patient outcomes).

12The Nurse Administrator The nurse administrator has been described as a “registered nurse whose

primary responsibility is the management of health care delivery services and who represents nursing service.”

Nurse administrators can be found in a wide variety of settings: hospitals, home health care, community health services, residential care, and adult day care.

1. Level of nursing administrative practice.

2. Magnet recognition program and scope and standards for nurse administrators.

3. Qualifications of nurse administrators certification of nursing administration.

4. Certification of Nursing Administration.

131.Level of nursing administrative practice:

The ANA conceptually divides nursing administration practice into two levels, nurse executive and nurse manager:

1) The nurse executive’s scope includes overall management of nursing practice, nursing education and professional development, nursing research, nursing administration, and nursing services.

2) Nurse managers are responsible to a nurse executive and have more defined areas of nursing service. A nurse manager performs these management functions to deliver health care to patients. Nurse managers or administrators work at all levels to put into practice the concepts, principles, and theories of nursing management.

142. Magnet recognition program and scope and standards for nurse administrators:

This program’s purpose is to recognize health care organizations that have demonstrated the very best in nursing care and professional nursing practice. Such programs have been recognized for having the best practices in nursing, and they also serve retain quality employees. A key objective of the program is to promote positive patient outcomes.

“Magnet designation helps consumers locate health care organizations that have a proven level of nursing care.”

153.Qualifications of nurse administrators certification of nursing administration:

In the nurse manager’s role, preparation should be a minimum of a bachelor’s degree with a major in nursing. A master’s degree with a focus in nursing is recommended along with nationally recognized certification in nursing administration with an appropriate specialty. “The experience backgrounds of professional nurses who serve as nurse administrators must include clinical and administrative practice, which enables these registered nurses to consistently fulfill the responsibilities inherent in their respective administrative roles.”

164.Certification of Nursing Administration

Both certification examinations include the following domains: organization and structure, economics, human resources, ethics, and legal and regulatory issues. The domain of organization and structure accounts for

the highest percentage of questions for the advanced level.

For the nurse manager level, the domain of human resources ranks highest.

17Management

Historical Perspectives

Mary Parker Follett is credited with being the “mother of modern management.”

Taylor, Fayol, and Weber have had considerable influence on modern management and are called the “fathers of modern management.” Scientific management (efficiency) provided information on standards, time/motion studies, task analysis, job simplification, and productivity incentives.

Modern management theory evolved from the work of Henri Fayol, who identified the activities or functions of the administrator as planning, organizing, coordinating, and controlling.

18The principles of management described by Fayol are:

1)Division of work.

2)Authority.

3)Discipline.

4)Unity of command.

5)Unity of direction.

6)Remuneration.

7)Centralization.

8) Scalar chain (line of authority).

9) Order.

10) Equity.

11) Stability or tenure of personnel.

12) Initiative.

13) Subordination of individual interests to the general interests.

19Five essential management practices in nurses’ work environment and health care These five practices have not been consistently applied, adding

further evidence to their importance in today’s health care environment:

1) Balancing the tension between efficiency and effectiveness.

2) Creating and sustaining trust. Trust and honest, open communication are critical to successful organizational change.

3) Actively managing the process of change. This management practice is related to human resource management.

4) Involving workers in work design and workflow decision making. Additionally, nurses’ autonomy and control over practice are positively related to trust in management.

5) Creating a learning organization.

20

Theory, Concepts, And Principles

21Critical theory aims to do the following:

1. Critique the ideology of scientism, the institutionalized form of reasoning that accepts the idea that the meaning of knowledge is defined by what the sciences do and thus can be adequately explicated through analysis of scientific procedures

2. Develop an organizational science capable of changing organizational processes. These aims are compatible with a theory of nursing management. Nurses use science to legitimize the practice of clinical nursing and nursing management.

22levels of a general systems theory Kenneth Boulding describes nine levels of a general systems theory:

1. A static structure: the framework.

2. A moving level of necessary predetermined motions.

3. A control mechanism.

4. An open system or self-maintaining structure.

5. The genetic–societal level.

6. The “animal” level: designing or purposeful behavior, and self-awareness.

7. The “human” level: The nurse manager can process the knowledge and skills of management to produce specific results.

8. The level of social organization.

9. Transcendental systems.

23Nursing Theories in Professional Practice Each result of nursing research adds tested facts to nursing theory that

can be learned by nursing students and active practitioners.

1.Watson’s Theory of Caring.

2.Orem’s theory of self-care.

3.Roy’s adaptation level theory to nursing intervention.

4.Margaret Newman’s theory of health as expanding consciousness.

5.Johnson’s Theory: Johnson incorporated the nursing process (assessment, diagnosis planning, intervention, and evaluation)

6.Peplau’s theory defines nursing as a “significant, therapeutic, interpersonal process.”