Select a challenging nursing care issue (examples include falls, medication errors, pressure ulcers, and other clinical issues that can be improved by evidence in nursing). Do not select a medical issue (disease, medical treatment). Do not select a workforce issue (staffing, call-offs, nurse to patient ratios). Explain the following for the selected clinical issue.
LEDDY & PEPPER’S
Lucy Jane Hood, RN, PhD Professor and Department Chair, Pre-Licensure Nursing Education MidAmerica Nazarene University Olathe, Kansas
Professor Emeritus Saint Luke’s College of Health Sciences Kansas City, Missouri
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Library of Congress Cataloging-in-Publication Data
Names: Hood, Lucy J., author. Title: Leddy & Pepper’s professional nursing / Lucy Jane Hood. Other titles: Leddy & Pepper’s conceptual bases of professional nursing |
Leddy and Pepper’s professional nursing | Professional nursing Description: Ninth edition. | Philadelphia : Wolters Kluwer,  |
Preceded by Leddy & Pepper’s conceptual bases of professional nursing / Lucy Jane Hood. Edition 8. 2014. | Includes bibliographical references and index.
Identifiers: LCCN 2017020451 | ISBN 9781496351364 Subjects: | MESH: Nursing Theory | Nursing–trends Classification: LCC RT41 | NLM WY 86 | DDC 610.73–dc23 LC record available at https://lccn.loc.gov/2017020451
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To all professional nurses who have a passion for nursing that enables them to share their values, beliefs, and skills to make differences in the lives of others and to shape the nursing profession. To Dr. Susan Leddy and Dr. Mae Pepper, who saw the need for a textbook to meet the needs of registered nurses who were continuing their education. To all the readers of this text who have the courage to take the risk of returning to school or pursuing a professional nursing career. To the following persons whose actions, values, and beliefs enabled me to live out my dream of being a professional nurse: my parents, Bob and Helen Chamberlin; Mary Belle Hickey, RN, my first nurse manager, who always challenged me to be the best possible nurse and gave me the confidence to pursue higher education; my dear mentor, Dr. Susan Leddy, professor of nursing who showed me the essence of nursing scholarship; and my loving husband, Michael, who selflessly gives me the time, support, and humor to live out my dreams.
J. Mae Pepper January 18, 1936–March 19, 1997 For 20 years, Mae was Susan Leddy’s colleague, coauthor, mentor, and friend. In 1977, Mae joined the faculty at Mercy College in Dobbs Ferry, New York. Mae’s previous teaching experience at the University of North Carolina-Chapel Hill, New York University, and Bronx Community College, as well as her vision, wisdom, and dedication, was crucial to the development and accreditation of the new baccalaureate program for registered nurses and to the subsequent development of the first master’s program at the college.
Mae held the position of Chairperson of the Nursing program from 1981 until her sudden death in March 1997 from a ruptured aortic aneurysm. Although she talked for years about leaving administration in order to do more scholarly work, she continued to serve as Chair out of a sense of duty and responsibility. She was devoted to the students and faculty, and very conscientious in her service to the College and many civic and professional organizations.
Mae found time to read voraciously, listen to music, care for animals, and to enjoy outdoor white-water rafting, camping, and bird watching. She loved her garden, was a careful craftsperson in her furniture refinishing, and liked to go to garage sales and flea markets looking for collectibles. Mae had a good sense of humor and loved a good time. Devoted to her friends and family, she willingly gave time and attention to anyone who asked. She was a great listener, and her counsel was always wise and kind. Mae lived her belief in mutuality, genuineness, and respect for others.
Susan Kun Leddy February 23, 1939–February 23, 2007 For 14 years, Susan was my mentor and friend. We met in 1993 when I became a doctoral student at Widener University. Susan had a long distinguished career in nursing education. She set high academic standards for herself and also expected her students to attain them. Her favorite question posed to us was “So what?” thereby forcing us to verify the significance of what we said or wrote.
Susan earned a Bachelor of Science nursing degree from Skidmore College in New York in 1960. In 1965, she completed a master of science in nursing degree from Boston University. She completed a doctor of philosophy degree in 1973 at New York University. Never wanting to stop learning, she did postdoctoral work at Harvard University in 1985 and the University of Pennsylvania from 1996 to 1998.
During her first 4 years as a nurse educator, Susan taught in diploma schools and taught in the baccalaureate program at Columbia University before completing her doctoral studies. She and three other faculties founded the RN-BSN program at Pace University. In 1976, she was asked to do a feasibility study and generate a proposal to the state of New York to develop a new RN-to-BSN nursing program at Mercy College. As program chair, Susan and Mae Pepper both opened the program in 1977. The two of them realized the need for a textbook to meet the needs of registered nurses returning to school for baccalaureate education and co-wrote Conceptual Bases for Nursing Practice that was first published in 1981. After a trip to Wyoming, Susan became enthralled with the mountains. She moved to the state and became the first dean of the School of Nursing at the University of Wyoming in 1981. In 1984, she was appointed as the Dean of the reconstituted College of Health Sciences at the University of Wyoming. In 1988, she returned to the East Coast as the Dean of the School of Nursing at Widener University in Chester, Pennsylvania until 1993 when she gave up her administrative position to assume teaching responsibilities mainly in the doctoral program.
Susan was a prolific scholar and has many journal publications. After her retirement and while battling breast cancer, Susan continued to write. In addition to previous editions of this text, she authored Integrative Health Promotion: Conceptual Bases for Nursing Practice and Health Promotion: Mobilizing Strengths to Enhance Health, Wellness & Well-Being. Both of these books received Book of the Year Awards from the American Journal of Nursing.
Susan made time to travel and visited nearly every place in the world. She found her trips exhilarating and stimulating. She incorporated many of the ideas from her travels into her Human Energy Model. Susan also enjoyed quilting, weaving, and dabbling in watercolors. She was very energetic and always had a project to accomplish.
Susan deeply loved her daughters, Deborah and Erin, and made certain that they had what they needed to pursue successful lives. She adored her granddaughter, Katie, who always got her to laugh and smile even through some very rough times.
Susan exemplified the life of a true scholar, superb teacher, and devoted mother. It is my hope to live up to the standards of my beloved mentor and friend. I miss her great words of wisdom and support.
Karen D. Wiegman, PhD, MSN, RN Dean, School of Nursing and Health Science, Professor MidAmerica Nazarene University
Elizabeth W. Black, MSN, RN Assistant Professor Gwynedd Mercy University Gwynedd Valley, Pennsylvania
Billie Blake, RN, MSN, BSN, EdD, CNE (Retired) Associate Dean of Nursing St. Johns River State College Orange Park, Florida
Laura Blank, RN, MSN Associate Clinical Professor Northern Arizona University Flagstaff, Arizona
Annie Boucher, RN, MScN Professor Cambrian College Sudbury, Canada
Mary Boylston, EdD, MSN, BSN, AHN-BC Assistant Professor Eastern University St. Davids, Pennsylvania
Beryl K. Broughton, MSN, CRNP, CS, CNE Nursing Faculty ARIA Health School of Nursing Trevose, Pennsylvania
Jennifer Bryer, PhD Acting Assistant Dean, Chairperson, Associate Professor Farmingdale State College Farmingdale, New York
Kathy Burlingame, EdD, MSN, RN Dean of Nursing Galen College of Nursing Louisville, Kentucky
Paula Byrne, DNP, RN Assistant Professor and Chair The College of St. Scholastica Duluth, Minnesota
Ruth Chaplen, DNP, MSN, BSN Associate Professor Rochester College Rochester Hills, Michigan
Betty Daniels, PhD, RN Assistant Professor Brenau University Gainesville, Georgia
Karen Davis, DNP, RN, CNE Clinical Assistant Professor University of Arkansas for Medical Sciences Little Rock, Arkansas
Lori A. Edwards, DrPH, MPH, RN, PHCNS-BC Assistant Professor, Associate Director for Global Occupational Health University of Maryland Baltimore, Maryland
Marcus M. Gaut, DNP, RN Assistant Professor The University of Southern Mississippi Hattiesburg, Mississippi
Evalyn J. Gossett, MSN, RN Lecturer Indiana University Northwest Gary, Indiana
Debra Kantor, PhD, RN Associate Professor Molloy College Rockville Centre, New York
Coleen Kumar, PhD, RN Dean of Nursing SUNY Downtown Medical Centre College of Nursing Brooklyn, New York
Kathleen M. Lamaute, EdD, MS, FNP-BC, NEA-BC, CNE Associate Professor Molloy College Rockville Centre, New York
Debra Lee, PhD, BSN, RN Assistant Professor, Dean of School of Nursing and Health Sciences Malone University Canton, Ohio
Rosemary Macy, PhD, RN, CNE, CHSE Associate Professor Boise State University Boise, Idaho
Kari Mardian, MEd, BN, RN Instructor Medicine Hat College Medicine Hat, Canada
Tammie McCoy, BA, BSN, MSN, PhD Professor/Chair Mississippi University for Women Columbus, Mississippi
Valerie O’Dell, DNP, RN, CNE Associate Professor/MSN Program Director Youngstown University Youngstown, Ohio
Teresa O’Neill, PhD, APRN, RNC
Distance Education Coordinator, Professor Emerita University of Holy Cross New Orleans, Louisiana
Cheryl Passel, PhD Assistant Professor Marian University Fond du Lac, Wisconsin
JoAnne Pearce, MS RNC, APRN-BC Assistant Professor Idaho State University Pocatello, Idaho
Theresa T. Quell, PhD, RN Assistant Dean for Academic Programs Fairfield University Norwalk, Connecticut
Janet Reagor, RN, PhD Interim Dean, Assistant Professor Avila University Kansas City, Missouri
Debra Simons, PhD, RN, CNE, CHSE, CCM Associate Dean College of New Rochelle New Rochelle, New York
Diane Spoljoric, PhD, RNC, FNP Associate Professor Purdue Northwest Westville, Indiana
Nancy Steffen, MSN Instructor Century College White Bear Lake, Minnesota
Alicia Stone, PhD, MS, RN, FNP Professor Molloy College Rockville Centre, New York
Wendy Wheeler, RN, BScN, MN Continuous Nursing Faculty Red Deer College Red Deer, Canada
Sylvia K. Wood, DNP, APRN, ANP-BC Assistant Professor St. Joseph’s College Brooklyn, New York
Ronda Yoder, PhD, ARNP Faculty Pensacola Christina College Pensacola, Florida
Karen Zapko, PhD, CNS, MSN, RN Assistant Professor
Kent State University at Salem Salem, Ohio
Tamara Zurakowski, PhD Clinical Associate Professor Virginia Commonwealth University Richmond, Virginia
About the Author
Lucy Hood, PhD, RN is the daughter of an American auto worker. She graduated from St. Luke’s Hospital of Kansas City Diploma Nursing School. She returned to school and earned a BSN from Webster College (now Webster University), an MSN from UMKC, and a PhD in Nursing from Widener University, Chester, Pennsylvania. With 14 years of experience in the areas of medical-surgical and neuroscience nursing, she embarked on a career in nursing education. Dr. Hood currently serves as the Department Chair, Pre- Licensure Nursing Education in the School of Nursing and Health Sciences at MidAmerica Nazarene University in Olathe, Kansas. Prior to her current position, she has more than 25 years of teaching experience in traditional undergraduate, RN to BSN, and graduate nursing programs at Saint Luke’s College of Health Sciences in Kansas City, Missouri and MidAmerica Nazarene University. She also has taught in the Clinical Pastoral Education Program at St. Luke’s Hospital of Kansas City. Professional nursing activities include membership in the ANA, MONA, ONS, NLN, and AANN. She has been a member of the MONA Advocacy Committee which involves political activism. She is a volunteer musician for St. Margaret of Scotland Catholic Church. Currently, she and her husband enjoy antiquing, gardening, and caring for their dachshund, Yoda.
In the early 1980s, Susan Leddy and Mae Pepper realized the need for a professional development textbook for registered nurses who were returning to school to earn baccalaureate degrees in nursing. This edition builds on the previous contributions that Leddy and Pepper made in earlier editions of Professional Nursing. So that the memory of Susan Leddy and May Pepper will continue, their names have appeared as part of the book title since 2003.
I express my sincere appreciation to the following persons for their creativity and attention to detail during the revision process: Christina Burns, Senior Acquisitions Editor; Dan Reilly, Associate Development Editor; Amberly Hyden, Editorial Coordinator; Jennifer Clements, Art Director; Holly McLaughlin, Design Coordinator; and Karan Singh Rana and the Production Team staff. A special note of thanks to Dr. Cheryl Stetler for permission to reproduce the Stetler Model of Evidence-Based Practice.
The ninth edition is organized into the following sections.
Section 1, Exploring Professional Nursing Section 2, The Changing Health Care Context Section 3, Professional Nursing Roles Section 4, Envisioning and Creating the Future of Professional Nursing
Content revisions to the ninth edition include the following.
Chapter 1: The Professional Nurse Presentation of key core competencies essential for effective professional practice including the Massachusetts Department of Higher Education’s The Nurse of the Future Nursing Core Competencies© along with updates related to the Institute of Medicine’s recommendations for improving nursing practice and education has been updated.
Chapter 2: The History Behind the Development of Professional Nursing Presentation of changes from the early 21st century that continue to impact today’s professional practice.
Chapter 4: Establishing Helping and Healing Relationships Updates from The Agency for Healthcare Research and Quality program TeamSTEPPS® 2.0 has been added to this chapter.
Chapter 9: Health Care Delivery Systems Updated content on the changes made to health care delivery as the revisions to health care delivery in the United States that have occurred during the implementation of the Affordable Care Act.
Chapter 13: Environmental and Global Health Updated information on the state of the global environment has been added and the nurse’s role in disaster planning, mitigation, and recovery for natural and human disasters has been placed here.
Chapter 14: Informatics and Technology in Nursing Practice New and updated content presents more specific information about informatics in health care encountered by nurses in daily practice, improvements in technology for patient safety and other recent technologic advances that affect consumer health, professional practice, and health care delivery. Recognizing that all baccalaureate nursing programs contain a course in community health nursing, the chapter on Community Health Nursing was omitted.
Chapter 15: Nursing Approaches to Client Systems Expanded content on the concept as community as clients appears in this chapter along with career opportunities for nurses in community health settings.
Chapter 16: The Professional Nurse’s Role in Teaching and Learning Updated statistics related to health literacy of Americans is contained within this chapter with implications for nurses to consider when planning and implementing health education.
Chapter 18: Quality Improvement: Enhancing Patient Safety and Health Care Quality This chapter has been co-authored with Karen Wiegman, PhD, RN, CS and provides updated information on Accountable Care Organizations and value-based purchasing.
Chapter 19: The Professional Nurse’s Role in Public Policy This chapter contains updated information about current legislative issues, policies, and professional nursing organization initiatives to improve health care safety and advance the nursing profession. In addition, the chapter highlights specific nurses who have contributed and are currently representing professional nursing in the public policy arena.
Chapter 22: Shaping the Future of Nursing Revised information on the future of nursing practice and education based on predictions from the United States Health Resources and Services Administration and from current futurists who analyze current trends to predict the future.
Continued efforts have been made to make this book more “user-friendly” and to engage students in the learning process and in the application of this material to practice. The book received an updated look to facilitate reading and mastery of concepts essential for effective professional nursing practice. Features from the previous editions have been renamed and revised and new features added. In addition to such textbook standards as Key Terms and Concepts, Learning Outcomes, and References, each chapter also includes the following.
Real-Life Reflections (formerly Vignettes): Case studies are presented at the beginning of each chapter and revisited at chapter’s end, highlighting for students the application of the chapter’s content to practice and providing questions for thought as they read the chapter.
Questions for Reflection (formerly Think Time): Questions posed throughout the text help students think about their own life experiences in the context of their learning.
Focus on Research: Current journal articles are synopsized to relate research to learning and practice. Concepts in Practice: Hypothetical clinical situations teach professional nurses how they can best incorporate text concepts into real-life practice.
From Theory to Practice: End-of-chapter questions ask students to think about each chapter’s content in the context of their own lives.
Nurse as Author: Short writing exercises designed to strengthen critical thinking and writing skills. The nature of the written exercise in each chapter relates to and depends upon the nature of chapter content.
Your Digital Classroom: At the end of each chapter, online resources are brought together to provide students with opportunities for further study and reflection. These include Online Exploration (compilation of websites appropriate to each chapter’s content); Expanding Your Understanding (Internet-based exercises); and Beyond the Book (a link to and instructions for accessing the numerous online resources now available with this text).
Text boxes have been categorized to help students identify the purpose of their content.
Professional Building Blocks: Highlight clinical and professional implications. Learning, Knowing, and Growing: Provides students with information to help them grow both personally and professionally.
Professional Prototypes: Provide examples of documents, concepts, philosophies, and more with suggestions for personal and professional growth.
Students who follow the Beyond the Book link to the www.thePoint.lww.com can access
Fully searchable eBook Learning Objectives Literature Assessment Tool (includes current journal articles and questions for students at different experience levels)
Video interviews with RNs relating chapter concepts to practice Spanish–English Audio Glossary Web link exercises Time Management Strategies Nursing Professional Roles and Responsibilities supplemental reading
To facilitate reading, this edition is being printed in full color and photographs have been added to break up large chunks of printed material.
As Mae Pepper and Susan Leddy noted in the preface to the third edition,
During these changing times, we have been pleased with the utilization of our book in many educational settings, particularly in baccalaureate and graduate programs. Although the first edition of the book was targeted for upper division RN baccalaureate programs, we have become aware of its utilization in generic baccalaureate programs, masters programs, and practice settings.
It is my hope that this ninth edition of Professional Nursing will carry on the tradition of previous editions and continue to make a meaningful contribution to the profession.
Section 1 Exploring Professional Nursing
Chapter 1 The Professional Nurse Characteristics of Professional Nursing Practice: The Hood Professional Nurse Contributions Model Core Competencies for Professional Nurses The Multiple Roles of the Professional Nurse Challenges of the Professional Nursing Student Skills for Educational Success Image and Physical Appearance Socialization and Resocialization Into the Nursing Profession Developing a Professional Self-Concept Characteristics of a Profession
Chapter 2 The History Behind the Development of Professional Nursing Nursing in Ancient Civilizations (Before 1 CE) Nursing in the Early Christian Era (1–500 CE) Nursing in the Middle Ages (500–1500) The Establishment of Nursing in Europe, England, and the New World (1500–1819) The Movement of Nursing to a Respectable Profession (1820–1917) The Birth of Formal Nursing Education The American Public Health Movement Nursing During the Early 20th Century, the World Wars, and the Post–World War II Era (1890–1960) Nursing in the Modern Era (1960–1999) Media Portrayals of Professional Nurses Nursing in the Early Postmodern Era (2000–2010) Nursing in the Second Decade of the Postmodern Era and Beyond (2010–20 …)
Chapter 3 Contextual, Philosophical, and Ethical Elements of Professional Nursing Contextual Basis of Nursing Practice Nursing Philosophy Morality and Ethics in Nursing Practice Ethical Decision Making Major Contextual Elements Affecting Nursing Practice
Chapter 4 Establishing Helping and Healing Relationships Communication as Interaction Helping Relationships: The Nurse as Helper Healing Relationships: The Nurse’s Role in Healing Helping and Healing Relationships With Colleagues and Other Health Care Team Members
Chapter 5 Patterns of Knowing and Nursing Science The Evolution of Scientific Thought Philosophy of Knowledge Patterns of Nursing Knowledge The Development of Nursing Science
Chapter 6 Nursing Models and Theories Nursing Models
The Stability Model of Change The Growth Model of Change Complexity Theory as a Framework Nursing Models in Research and Practice
Chapter 7 Professional Nursing Processes Critical Thinking Cognitive Nursing Processes Interpersonal Processes Psychomotor Processes Patterning Nursing Processes
Chapter 8 The Health Process and Self-Care of the Nurse Worldviews of Health Health Protection and Promotion Health Patterning Implications of the Nurse’s View of Health for Role Performance Self-Care of the Nurse
Section 2 The Changing Health Care Context
Chapter 9 Health Care Delivery Systems Challenges of Health Care Delivery in the 21st Century Selected Current Health Care Delivery Systems Health Care Delivery Settings The Interdisciplinary/Interprofessional Health Care Team Nursing Care Delivery Models Nursing Challenges Related to Health Care Delivery Systems
Chapter 10 Developing and Using Nursing Knowledge Through Research The Research Process in Nursing Nursing Research Utilization and Evidence-Based Practice Creating a Public Image of the Nurse as Scholar
Chapter 11 Multicultural Issues in Professional Practice Diversity and Assimilation in a Shrinking World Establishing Cultural Competence Strategies and Challenges for Multicultural Nursing Practice Creating a Multicultural Nursing Profession
Chapter 12 Professional Nurse Accountability Definition of Accountability and Related Concepts Professional Accountability The Groundwork for Accountability Accountability in an Era of Cost Containment Accountability in the Future Checklist for Accountability
Chapter 13 Environmental and Global Health The Global Environment The Community Environment The Work Environment The Home Environment Comprehensive Environmental Health Assessment The Nurse’s Role in Disaster Planning, Mitigation and Recovery
Chapter 14 Informatics and Technology in Nursing Practice
Informatics and Health Care The Informatics Nurse Specialist Consumer Health Informatics in Practice Educational Informatics Technology in the Acute Care Clinical Setting Technologic Changes Affecting Nursing Practice and Health Care Challenges in Managing Health-Related Informatics and Technology
Section 3 Professional Nursing Roles
Chapter 15 Nursing Approaches to Client Systems The Individual as Client The Family as Client The Community as Client Hallmarks of a Healthy Community Community-Level Nursing Interventions Career Opportunities in Community Health Nursing
Chapter 16 The Professional Nurse’s Role in Teaching and Learning Health Literacy Philosophical Assumptions About Teaching and Learning Teaching–Learning Process Approaches Teaching–Learning as a Responsibility of the Advocate Learning Theories Implications of Change Theory on Teaching–Learning Strategies for Effective Teaching and Learning Specific Client Education Activities Client Education as an Interdisciplinary Process
Chapter 17 Leadership and Management in Professional Nursing Conceptual and Theoretical Approaches to Nursing Leadership and Management Leadership Development Key Leadership and Management Skills for Nurses Leadership Effectiveness Evaluating Leadership Effectiveness
Chapter 18 Quality Improvement: Enhancing Patient Safety and Health Care Quality History of Quality Improvement in Health Care The Need for Improved Patient Safety and Care Quality Quality Improvement Approaches Implementing Continuous Quality Improvement and Total Quality Management Efforts to Improve the Quality of Health Care Professional Nursing Roles in Quality Improvement An Integrated Approach to Quality Improvement and Safety in Health Care
Chapter 19 The Professional Nurse’s …
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