Chapter 1 Critical Care Nursing Practice 1 Chapter 22 Patient Management: Nervous System Essentials of critical care nursing: a holistic approach / Patricia Gonce Morton, Dorrie K. Fontaine. Related work: Critical care nursing / [edited by] Patricia Gonce Morton, Dorrie K. The 10th edition of Critical Care Nursing continues to focus on promoting a holistic view of critical care nursing, ensuring the patient and family are at the center. doi: /ccn Crit Care Nurse February vol. 33 no. 1 Show PDF in full window; Full Text;» Full Text (PDF).
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This books (Critical Care Nursing: A Holistic Approach [PDF]) Made by Patricia Gonce Morton About Books none To Download Please Click. Critical care nursing: a holistic approach by Patricia Gonce Morton. Critical care nursing: a holistic approach. by Patricia Gonce Morton; Dorrie K Fontaine;. Wolters Kluwer Health/Lippincott Williams & Wilkins, pages, , English, Book; Illustrated, 32 & Possibly online. Critical care nursing: a holistic approach.
Data gathered by interviewing 14 nurses from university hospitals in Iran were analyzed with a conventional qualitative content analysis method and by using MAXQDA professional software for qualitative and mixed methods data analysis software. Results: Analysis of data revealed three main themes as effective factors in providing holistic care: The structure of educational system, professional environment, and personality traits.
Conclusion: Establishing appropriate educational, management systems, and promoting religiousness and encouragement will induce nurses to provide holistic care and ultimately improve the quality of their caring. Holistic care includes a wide range of approaches, including medication, education, communication, self-help, and complementary treatment. Educating patients about self-care and helping them to perform their daily activities independently is part of holistic care. Palliative care is part of holistic care which improves the quality of a patient's life and their emotional and physical well-being.
It also improves harmony between mind, body, emotions, and spirit in an ever-changing environment;[ 10 ] The American Association of Holistic Nurses supports this belief and points out that holistic nursing includes all the nursing practices that heal the whole of a person. Ragers, Newman, and Parse have also emphasized holistic care.
A review of literature in this field shows that most studies have been limited to specific areas, such as operating rooms or older patients who were terminally sick. An investigation into this matter using a qualitative approach that includes multiple methods of data gathering and emphasizes reality experience[ 23 ] can help us to obtain meaningful and comprehensive data; it will also clarify the existing background and the real situation surrounding the formation of holistic care.
Thus, this is a qualitative study and is based on the experience of nurses, who form the core of holistic care provision. All the participants were informed of the aim of the study and a written consent was obtained from each of them. Participation in the study was entirely voluntary and the participants could withdraw at any stage of the study.
This method was used for describing the systematic and objective means of the phenomenon. The advantage of this approach to content analysis is obtaining direct data from participants without imposing pre-supposed categories or theoretical perspectives. Another important attribute of this approach is its emphasis on the subject, context, and differences and similarities among codes and categories. Three of the nurses selected were male and the others were female.
The participants were selected from various wards [intensive care unit ICU , emergency, general wards] in university hospitals in the Iranian cities of Tabriz, Uremia, Ardebil, and Tehran. Further characteristics of the participants are presented in Table 1.
The study lasted 6 months, from May until October In the first stage, participants were informed of the aim of the study by the researchers; if they agreed to participate in the research, they gave written consent. To respect the privacy of the interviewees, numerical codes are used instead of their names. Table 1 Open in a separate window The data were collected using unstructured interviews. Each interview lasted between 60 and 90 minutes and was performed in a private room in the hospital.
Based on the initial data analysis, additional questions were asked of the respondents. A second interview was conducted with four participants to help clarify the initial interpretations of the information and emerging results. To ensure accuracy of the data, the interviews were continued until data saturation: Data collection was ended when no new information could be collected and the data became repetitive. The interviews were tape-recorded, transcribed, and coded line-by-line by MAXQDA software which was used in the initial stages of coding.
In this way, themes and categories were generated inductively from the data. Rigor To increase the dependability of the study, data were collected and analyzed by one of the researchers; the other researchers checked and verified the data, codes, and analyses.
The transcripts were read several times and the categories and themes were discussed by the researchers until consensus was reached. The credibility of the results of the study was confirmed through prolonged engagement with participants in the wards. In addition, individual checking was used to examine the accuracy of the findings, and the results of the primary analysis were shared with the participants to validate the compatibility of the codes with their experiences.
Transferability of the findings was made possible by the variety of the characteristics of the participants. RESULTS Following an analysis of the data, three themes were identified as effective factors in holistic care provision: The structure of the educational system, professional environment, and motivational factors. The themes, sub-themes, and codes are shown in Table 2. Table 2 Open in a separate window The structure of the educational system The structure of the educational system was one of the issues which most of the participants talked about.
The content of educational programs If the content of educational programs is comprehensive and includes the philosophy of holistic care, it will enable nursing students to address the various needs of patients and provide holistic care. Participant 8 The above quotation points to the important role of designed courses in training nurses in holistic care. But I was interested and regarded it as a specialized part of nursing; I practiced a lot and gradually learned how to exercise it.
I wish the trainers had instructed us properly; then I would have realized the importance of it sooner. Unfortunately, the data show that the content of the educational program is poor and lacks material on the various needs of patients.
Participant 5 Another participant expressed: During the course, most of our education was about the physical problems of patients and dealing with them. Participant 13 Teaching methods Teaching methods are part of the educational structure and play an important role in holistic care formation.
But, according to the results, the teaching methods are not designed to demonstrate holistic care. In this regard, one of the participants said: The teaching methods were often educator-centered; a limited number of tasks were dictated and we were expected to do them only; we were not free to consider the other needs of patients and satisfy them. In our education, we were not told that a patient is a whole with many different aspects and whose treatment requires that we consider all those aspects; although some of the educators advised us to consider the secondary needs of patients, there was no practical training in this field.
A participant said regarding this issue: One of our educators was sensitive to the various needs of patients, treated them with respect and attended to their various needs. Her manners influenced my behavior. Now, I try to use her lessons in practice and provide my patients with comfort by addressing their various needs.
Participant 6 Similarly, a participant referring to her trainer's holistic perception and emphasis on holistic care remarked: One of our trainers always stressed that we view a patient as a whole that has different needs; she was trying to have us realize that well-being is the result of creating a harmony among the various parts of the whole and not just the physical dimensions.
I believe that meeting all these needs at the same time rather than separately is much more effective. But the results show that most of the participants had no practical model for learning holistic care during their education. Participant 6 An educator's good relationship with students is an effective factor in attracting attention to the educator's training, as well as motivation for learning.
This theme consists of three sub-themes: Workload, management, and the gap between clinical performance and academic learning. Workload Workload, one of the components of professional environment, was referred to by most of the participants as a restriction in holistic care provision. Participant 9 Management Management—with its different domains, such as evaluation, orientation programs for staff and management approaches—plays an important role in the formation of holistic care.
Most of the participants emphasized its impact on the quality of nursing. Ironically, the latter is more popular with the managers. Routine tasks are considered as evaluation criteria. But data show that the professional environment in Iranian hospitals lacks orientation programs for novice nurses and that most of the managers lack competence for their positions.
It was very difficult for me. I was under pressure and lost my motivation to continue my profession, provide proper care and pay attention to the patients and their needs.
However, the participants declared that upon entering the clinical environment, they were faced with the limited conformity of their environment with professional norms. Disregard for the principles of proper nursing forms a sub-category of this phenomenon. The participants stated that upon embarking on their careers, they were faced with a prevalent disregard for the principles of proper nursing, at both the professional and ethical level.
Attention to professional principles is the prerequisite of holistic care; but in most cases they are ignored. To quote a participant: When I started, I saw that many of the points that were stressed during our education were simply ignored here. Many novice nurses would adopt the same wrong practices and ignore the professional principles; the standards and techniques were pushed aside and the patients forgotten.
Combating these inequalities has shown to also lead to better public health outcome. In studies done by the World Bank on populations in developing countries, it was found that when women had more control over household resources, the children benefit through better access to food, healthcare, and education. However, 1.
Global Health Initiative was created in by President Obama in an attempt to have a more holistic, comprehensive approach to improving global health as opposed to previous, disease-specific interventions. The training typically requires a university degree with a focus on core disciplines of biostatistics , epidemiology , health services administration , health policy , health education , behavioral science , gender issues, sexual and reproductive health, public health nutrition, and environmental and occupational health.
Operational structures are formulated by strategic principles, with educational and career pathways guided by competency frameworks, all requiring modulation according to local, national and global realities. It is critically important for the health of populations that nations assess their public health human resource needs and develop their ability to deliver this capacity, and not depend on other countries to supply it. The report focused more on research than practical education.
By , schools of public health were established at Columbia and Harvard on the Hopkins model. By there were twenty nine schools of public health in the US, enrolling around fifteen thousand students. In the beginning, students who enrolled in public health schools typically had already obtained a medical degree; public health school training was largely a second degree for medical professionals. DrPH is regarded as a professional degree and PhD as more of an academic degree.
Professional degrees are oriented towards practice in public health settings. The Master of Public Health , Doctor of Public Health , Doctor of Health Science DHSc and the Master of Health Care Administration are examples of degrees which are geared towards people who want careers as practitioners of public health in health departments, managed care and community-based organizations, hospitals and consulting firms, among others.
Master of Public Health degrees broadly fall into two categories, those that put more emphasis on an understanding of epidemiology and statistics as the scientific basis of public health practice and those that include a more eclectic range of methodologies. A Master of Science of Public Health is similar to an MPH but is considered an academic degree as opposed to a professional degree and places more emphasis on scientific methods and research. The doctoral programs are distinct from the MPH and other professional programs by the addition of advanced coursework and the nature and scope of a dissertation research project.
Currently, there are approximately 68 chapters throughout the United States and Puerto Rico. Public health has early roots in antiquity.
From the beginnings of human civilization , it was recognized that polluted water and lack of proper waste disposal spread communicable diseases theory of miasma. Early religions attempted to regulate behavior that specifically related to health, from types of food eaten, to regulating certain indulgent behaviors, such as drinking alcohol or sexual relations.
Leaders were responsible for the health of their subjects to ensure social stability, prosperity , and maintain order. By Roman times, it was well understood that proper diversion of human waste was a necessary tenet of public health in urban areas.
The ancient Chinese medical doctors developed the practice of variolation following a smallpox epidemic around BC.
An individual without the disease could gain some measure of immunity against it by inhaling the dried crusts that formed around lesions of infected individuals. Also, children were protected by inoculating a scratch on their forearms with the pus from a lesion. In the Republic of Venice established a permanent Venetian Magistrate for Health comprising supervisors of health with special attention to the prevention of the spread of epidemics in the territory from abroad.
The three supervisors were initially appointed by the Venetian Senate. In it was assumed by the Grand Council, and in added two judges, with the task of control, on behalf of the Republic, the efforts of the supervisors. However, according to Michel Foucault , the plague model of governmentality was later controverted by the cholera model.
A Cholera pandemic devastated Europe between and , and was first fought by the use of what Foucault called "social medicine", which focused on flux, circulation of air, location of cemeteries , etc. All those concerns, born of the miasma theory of disease , were mixed with urbanistic concerns for the management of populations, which Foucault designated as the concept of " biopower ".
The German conceptualized this in the Polizeiwissenschaft " Police science ". Modern public health[ edit ] The 18th century saw rapid growth in voluntary hospitals in England. The practice of vaccination became prevalent in the s, following the pioneering work of Edward Jenner in treating smallpox. James Lind 's discovery of the causes of scurvy amongst sailors and its mitigation via the introduction of fruit on lengthy voyages was published in and led to the adoption of this idea by the Royal Navy.
In the first four decades of the 19th century alone, London 's population doubled and even greater growth rates were recorded in the new industrial towns, such as Leeds and Manchester. This rapid urbanisation exacerbated the spread of disease in the large conurbations that built up around the workhouses and factories. These settlements were cramped and primitive with no organized sanitation.
Disease was inevitable and its incubation in these areas was encouraged by the poor lifestyle of the inhabitants. Unavailable housing led to the rapid growth of slums and the per capita death rate began to rise alarmingly, almost doubling in Birmingham and Liverpool. Chapters include features such as case studies with discussion questions, patient teaching guides, considerations for older adults, collaborative care guides, relevant nursing diagnoses, and nursing interventions.
Critical Care Nursing is a good reference book for critical care nurses and nurses seeking to learn more about critical care nursing.
Additional student and instructor resources are available through a web-based portal from the publisher. User Name Password Sign In. Critical Care Nursing: Philadelphia, PA: Wolters Kluwer Health; This Article doi: Classifications Book Review.