Making The Transition From LPN To RN, 1st Edition Class Notes

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Instructor’s ManualforMaking the Transition from LPN to RNRose Kearney-NunneryLECTURE NOTES

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Chapter 1Multiple RolesIn Chapter 1, students are challenged to consider the multiple roles they play during the pursuitof the degree. Returning to school is not an easy decision, and strategies for success in thedaunting process of returning to the student role are reviewed.Chapter Objectives1. Evaluate your reasons for continuing your nursing education.2. Examine the multiple and sometimes competing roles of the adult returning to school.3. Evaluate your knowledge, skills, and abilities.4. Identify your learning style and the strategies to best address your individual learningpreferences.5. Evaluate your personal and collegial resources to assist with your success.Key TermsTransitionthe psychological processes in three phases—Ending, Losing, Letting Go; TheNeutral Zone; The New Beginning—where people must “come to terms with thedetails of the new situation that the change brings about” (Bridges, 2003, p. 3).Transformativelearningadult development and education described by Mezirow (2000), who proposes thatadults learn in one of four ways:1. by elaborating existing frames of reference,2. by learning new frames of reference,3. by transforming points of view, or4. by transforming habits of mind (Mezirow, 2000, p. 19).Rolesorganized behavioral patterns and expectations for a given position and whichaccompany a specific situation or circumstance (Bailey & Yost, 2004, p. 1).Learningthe perception and assimilation of the information presented to us in a variety ofways.Knowledgethe accumulation of the appropriate information through learning and experience.Skillthe ability to retrieve this knowledge through mental and psychomotor activitiesand apply it appropriately to the situation.Abilitycompetence and proficiency in the demonstration of the knowledge and skill.Learning styleor preference is simply the way you best perceive, think, organize, use, and retainknowledge.Resourcestools or means of support.Key Points•In the process of change, Bridges (2003) looks at the psychological processes in three phasesof transition where people must “come to terms with the details of the new situation that thechange brings about” (p. 3).•Mezirow (2000) views adult development and education as transformative learning andproposes that adults learn in one of four ways:By elaborating existing frames of referenceBy learning new frames of referenceBy transforming points of view, orBy transforming habits of mind (Mezirow, 2000, p. 19).•Rolesare organized behavioral patterns and expectations for a given position and accompanya specific situation or circumstance (Bailey & Yost, 2004, p. 1).•Learning is the perception and assimilation of the information presented to us in a variety ofways.

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•Knowledge is the accumulation of the appropriate information through learning andexperience.•Skill is the ability to retrieve this knowledge through mental and psychomotor activities andapply it appropriately to the situation.•Ability is your competence and proficiency in the demonstration of the knowledge and skill.•Learning style or preference is simply the way you best perceive, think, organize, use, andretain knowledge.•Resources are tools or means of support. For your educational goals, consider those thingsand people that you will need to help you study, prepare assignments, succeed onexaminations, and thrive in your education.Thought and Discussion Questions1.Reflect carefully and identify your reasons for continuing your nursing education.2.Identify all your current roles. Which ones can be streamlined?3.In a three-column format, identify what you perceive to be your knowledge level and yourassociated skills and abilities in the following areas:•Medical-surgical nursing•Maternal-child health•Gerontological nursing•Mental-health nursing4.What resources can you classify as readily available, sometimes available, or in need oflocating?Interactive ExercisesOn the intranet site, students are directed to the following:INTERACTIVE EXERCISE #1-1:Your Cognitive Learning StyleCheck your style at one of the following free Internet sites:www.humanmetrics.com/cgi-win/JTypes2.aspwww.oswego.edu/plsi/taketest.htmAfter discovering your learning style, you will need to identify the strategies to best address yourindividual learning preferences. Complete the following information on your unique style andpreferences. Then, design a plan to capitalize on your assets.Learning Preferences:Identify your characteristics.Now, think of enhancements that you could make based on these preferences.Now, think of remedies for when the predominant style in your class does not match yours.Develop your plan to capitalize on your assets.INTERACTIVE EXERCISE #1-2: Time Enhancers and Wasters

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In the format provided, identify your unique time enhancers and time wasters and proposeenhancements to both.Time Enhancers:Identify your characteristics.Now, think of enhancements or remedies.Time Wasters:Identify your characteristics.Now, think of enhancements or remedies.INTERACTIVE EXERCISE #1-3: Your Personal and Collegial ResourcesIdentify resources to assist with your success.Personal Resources:Describe this resource.How can this resource assist with your success?Collegial Resources:Describe this resource.How can this resource assist with your success?INTERACTIVE EXERCISE #1-4: Your Plan for SuccessStart developing a personal plan for success in your continuing professional education. Developa personal timeline and predict future goals and accomplishments in 5-year periods. Your planshould be specifically designed for your situation. What are the particular factors in your life thatyou need to consider?List your educational goals:1.2.3.4.5.

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Identify a realistic timeline for each goal:1.2.3.4.5.Identify factors to promote your success:1.2.3.4.5.Now comparetime commitments:Describe family, work schedule, college schedule, andpersonal responsibilities. Refer to the Chapter 1 content in Box 1-3 to get started. Identify thetime required daily for each of these commitments. But remember, there are only 24 hours in aday. You may wish to do this on either a daily or a weekly basis.List commitments that you have for each of the categories below:FamilyTime RequiredWorkTime RequiredCollegeTime RequiredPersonalTime RequiredTotal of your daily or weekly commitments:What adjustments to your schedule will need to be made?

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What comments about returning to school are being shared with you? How do you plan to dealwith these comments or suggestions?What additional preparations do you need to make when you start your clinical courses?List enhancement content you identified as needed.What “questionable” work habits will you need to discard?Now, consider a cost analysis for the items you will need for your education:TuitionBooksUniforms/equipmentChild careOtherTotal costsConsider your available support systems:FamilyWorkCollegePersonal

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How will you take care of personal health needs?Incorporate your identified “time enhancers” and enhancement plan from InteractiveExercise 1-2 and place them in order of their priority for your action.INTERACTIVE EXERCISE #1-5:Web LessonComplete the Web lessonTime Management Strategies: What Works Best for You?Online ResourcesAmerican Nurses Associationhttp://nursingworld.org/nursecareer/Allnurses.comhttp://allnurses.com/National League for Nursingwww.nln.org/Careers/resources.htmReferencesBailey, J.R., & Yost, J.H. (2004). Role Theory: Foundations, Extensions, and Applications.BookRags. Retrieved November 24, 2006, from www.bookrags.com/other/sociology/role-theory-foundations-extensions--eos-04.htmlBridges, W. (2003).Managing transitions: Making the most of change(2nd ed.). Cambridge,MA: DaCapo Press.Mezirow, J. (2000). Learning to think like an adult: Core concepts of transformation theory. In J.Mezirow and Associates,Learning as transformation: Critical perspectives on a theory inprogress(pp. 3–33). San Francisco: Jossey-Bass.

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Chapter 2Professional Practice ParametersChapter 2 focuses on the characteristics of professional nursing as a profession and professionalpractice parameters. A focus on the core competencies for all healthcare professionals challengesboth professional and interdisciplinary practice. Provided is an analysis of personal perspectiveon transforming the role from a LPN to a registered nurse.Chapter Objectives1. Identify the components of professional nursing practice.2. Examine the scope of practice for licensed nurses in the state’s rules and regulations.3. Relate the core competencies for health professionals to professional nursing practice.4. Describe clients of professional nursing practice.5. Discuss responsibility and accountability in professional nursing practice.Key TermsProfessiona unique career, built on a distinct knowledge base and guided by systematic theorywith the authority to provide a distinct service in an ethical manner with prescribedstandards of practice.Parametera boundary or limit in professional practice.Licensurethe authority granted by the state board to practice within specified parameters aftermeeting specified requirements.Continuingcompetencya requirement for ongoing practice as a demonstration of the provision of safenursing care to the public. An assessment of continuing competence may requirecontinuing education, ongoing documentation of safe practice, certification, orperiodic assessment.Nursingeducationbasic education required for the RN varies, with differences among baccalaureate,associate degree, diploma education, and entry-level graduate programs.Code of Ethicsfor a profession requires the conduct of one’s practice in an ethical manner, includingcareful adherence to client confidentiality. The ANA’sCode of Ethicsfor Nursesisthe ethical standard for professional nursing practice.Professionalcultureincludes our professional groups and associations that guide practice, education, andsharing of mutual values.CorecompetenciesIOM identified these five competencies for all health professionals that “all healthprofessionals should be educated to deliver patient-centered care as members of aninterdisciplinary team, emphasizing evidence-based practice, quality improvementapproaches, and informatics” (Greiner & Knebel, 2003, p. 45).Autonomyinvolves independent judgment and self-governing within the RN scope of practiceand attention to changes in the healthcare needs of clients.Responsibilitybeing accountable for the performance of the duties associated with the professionalrole (ANA, 2001).Accountabilitybeing answerable to oneself and others for your judgments and actions in the courseof nursing practice, regardless of the organizations’ policies or providers’ directives(ANA, 2001).Self-regulationpersonal accountability for the knowledge for practice along with participation in thepeer review process (ANA, 2003, p. 11).Communityserviceextends beyond service to clients to include service as a professional to thecommunity and society at large.Theory use,development,and evaluationis a component of professional practice that guides practice and includes ongoingdevelopment and evaluation for expanding and refining our knowledge base.

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Evidence-basedpracticeintegration of the best research with clinical expertise and the client’s values foroptimum care as well as participation in learning and research activities (Greiner &Knebel, 2003, pp. 45–46).Key Points•A profession is built on a distinct knowledge base and guided by systematic theory with theauthority to provide a distinct service in an ethical manner with prescribed standards ofpractice.•A practiceparameter prescribes the boundaries of practice within specified areas and limits.•Licensure is the authority granted by the state board to practice within specified parametersafter meeting specific requirements.•The basic education required for a RN varies, with differences among baccalaureate, associatedegree, diploma education, and even some entry-level graduate programs.•Continued competency is an ongoing quest for best practices and expertise.•The ANA’sCode of Ethicsfor Nursesis the ethical standard for professional nursing practice.•Another characteristic of a professional community is our unique culture that includes ourprofessional groups and associations that guide practice, education, and sharing of mutualvalues.•The five competencies for health professionals are providing patient-centered care, working ininterdisciplinary teams, employing evidence-based practice, applying quality improvement,and using informatics (Greiner & Knebel, 2001).•Autonomyinvolves judgment and self-governing within one’s scope of practice. This self-governing requires ongoing evaluation of both responsibility and accountability inprofessional practice.•In the ANA’sCode of Ethics for Nurses, responsibility is defined as accountability forperformance of the duties associated with the professional role, and accountability is beinganswerable to oneself and others for one’s judgments and actions in the course of nursingpractice, irrespective of healthcare organizations’ policies and providers’ directives (ANA,2001, pp. 16–17).•Additional components of professional nursing practice include a commitment to communityservice, theory use, development and evaluation, and evidence-based practice.Thought and Discussion Questions1. Describe your current role in data collection and contributing to the client-centered plan ofcare. Interview your RN supervisor on his or her role in client assessment.2. Think about how you demonstrate the five core competencies of health professionals (Box 2-2), and compare your behaviors with your peers in a discussion scheduled by your instructor.3. Explain your views on responsibility and accountability.4. Imagine putting on a pair of glasses that allow you to look at the world differently. How canyou now see your work setting differently? Think of an innovation you would like to try toimprove care for clients in the setting.Interactive ExercisesOn the intranet site, students are directed to the following:INTERACTIVE EXERCISE #2-1: Your Practice ActGo to the National Council website at www.ncsbn.org. On the left side, click on Boards ofNursing and then contacts for your state. You should see a link to go directly to your State Boardof Nursing. Then, locate your state nursing practice act on their website. Analyze the powers,

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privileges, and responsibilities vested in the profession. Look for Advisory Opinions or PracticeAdvisory Statements provided by the Board. See if there is a list of Frequently Asked Questions(FAQs). Complete the information in the format provided, and be prepared to participate in anonline or class discussion to be scheduled by your instructor on how this act directsresponsibility and accountability in nursing practice.Identify the State:List the powers, privileges, and responsibilities given to the profession:Identify differences for RN and LPN practice as follows:Definitions:LPNRNEducation:LPNRNSupervision:LPNRNDelegation:LPNRNAdditional Acts:LPNRNNow see if there are any advisory questions on practice or FAQs provided by the Board.What are the differences between LPN and RN practice?LPNRN

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INTERACTIVE EXERCISE #2-2: What About Your State? Mutual Recognition forLicensureGo to the National Council website at www.ncsbn.org and locate information on the NurseLicensure Compact for mutual recognition for nursing licensure. (Again, look at the left side ofthe website and click on the link for the Nurse Licensure Compact [NLC].) Is your state a NLCmember? What does this involve? If your state is not a member of the NLC, go to the map of theparticipating states and read about the NLC and the FAQs provided. Complete the followinginformation. Be prepared to participate in an online or class discussion to be scheduled by yourinstructor.What determines primary licensure?What is the difference between licensure and privilege to practice?How many states are currently members of the NLC? Identify your neighboring states.What happens when a nurse in a NLC state relocates to another state?Identify a difference in practice between your state and a neighboring state which youwould need to know under the NLC.List important components of the NLC to discuss with the class.What else have you discovered?INTERACTIVE EXERCISE #2-3: Continuing Your Work on Your Transition PlanNow that you have thought about the State Practice Act and the issue of mutual recognition, howdoes this affect your transition plan? How are you thinking about your transition from a LPN to aRN? All thoughts aside, close your eyes and imagine a new role as a RN. What is different?Look at your world and imagine the things you can make different. Have you incorporated yourinner goals into your transition plan? Remember, this is your plan. There is no right or wrong. Itis your plan on how your career will change.INTERACTIVE EXERCISE #2-4: Web LessonComplete the Web lessonInitiatives for the Future of Nursing.Online Resources

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American Association of Colleges of Nursingwww.aacn.nche.eduAmerican Nurses Associationhttp://nursingworld.orgNational Council of State Boards of Nursinghttp://ncsbn.orgNational League for Nursingwww.nln.orgReferencesAmerican Nurses Association. (2001).Code of ethics for nurses with interpretative statements(Publication No. CEN21 10M 08/01). Washington, DC: American Nurses Publishing.American Nurses Association. (2003).Nursing’s social policy statement(2nd ed.) (PublicationNo. 03NSPS 15M 09/03). Washington, DC: American Nurses Publishing.Greiner, A. C., & Knebel, E. (eds.). (2003).Health professions education: A bridge to quality.Washington, DC: Institute of Medicine.

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Chapter 3Nursing TheoryThe theoretical basis for professional practice is introduced in Chapter 3 along with a review ofsome of the borrowed theories and classic nursing theories used in professional practice.Chapter Objectives1. Define basic terminology to understand the use of theory in nursing practice.2. Discuss how the hierarchy of needs and stages of development are used to guide practice.3. Identify selected theories and how they are used to guide practice.4. Review selected theories developed for use in professional nursing practice.5. Explain how theory defines and guides professional practice.Key TermsTheory“a set of interrelated constructs (concepts), definitions, and propositions that presenta systematic view of phenomena by specifying relations among variables, with thepurpose of explaining and predicting the phenomena” (Kerlinger & Lee, 2000, p. 11).Metaparadigmconceptsthe overall concerns to the discipline, including human beings, health, theenvironment, and nursing.Paradigm“universally recognized scientific achievements that for a time provide modelproblems and solutions to a community of practitioners” (Kuhn, 1970, p. vii).Modela graphic representation of some phenomenon.Frameworkanother means of providing a view of the concepts and relationships proposed in atheory. Again, use of words and narrative is limited, but the structure of the theory isillustrated and allows translation and interpretation of the narrative or text.ConceptualModel orFrameworkit represents some phenomenon of interest and contains concepts and propositions;however, the concepts and, especially the propositions, are broader, less defined, andless specific to the perceived reality than with a theory.Concepta view or idea that we hold about something.Propositionsexplain relationships—how the concepts are linked and relate to one another and tothe total model.Hierarchy ofneedsa humanistic theory proposed by Maslow (1970) which is viewed as a pyramid. Atthe base of the pyramid are the physiological drives. Higher needs progress upwardas safety, love and belonging, esteem, and self-actualization needs.Developmentaltheoriesmiddle-range theories that address personality, cognitive, and moral developmentusing a life span perspective.Systems Theorya grand theory concerned with interrelationships among the parts and the whole. Asystem generally contains the following basic components: input, output, boundary,environment, and feedback.Nursing modelsinclude theories and conceptual models specific to the discipline of nursing andaddress the metaparadigm concepts of human beings, health, environment, andnursing.Key Points•Metaparadigm concepts are the overall concerns to the discipline and include human beings,health, the environment, and nursing.•Kuhn (1970) described a paradigm as “universally recognized scientific achievements that fora time provide model problems and solutions to a community of practitioners” (p. vii).•Kerlinger and Lee (2000) define a theory as “a set of interrelated constructs (concepts),definitions, and propositions that present a systematic view of phenomena by specifying

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relations among variables, with the purpose of explaining and predicting the phenomena” (p.11). Theories are classified as grand, middle-range, or limited (practice) on the basis of theirscope or breadth of coverage of phenomena.•A theoretical model provides a visual description of the theory using limited narrative butdisplays components and relationships symbolically. A framework is another means ofproviding a structural view of the concepts and relationships proposed in a theory.•A concept is a view or idea we hold about something, ranging from something highlyconcrete to a highly abstract construct.•Propositions in a theory are the descriptions and relationships among the constructs (orconcepts) that propose how the concepts are linked and relate to each other and to the totaltheoretical structure.•Maslow’s theory and hierarchy of needs proposes a hierarchical structure for basic humanneeds.•Developmental theories are widely used in nursing and other healthcare disciplines andinclude Erikson’s ages of psychosocial development, Piaget’s theory of cognitivedevelopment, and Kohlberg’s theory of moral development.•A system generally contains the following basic components: input, output, boundary,environment, and feedback. Bertalanffy’s (1968) general systems theory is a grand theoryapplied to many disciplines.•Theory, practice, and research are interrelated and interdependent. When selecting a nursingmodel or theory on which to base practice, the theory must be compatible and correspond tothe phenomena of professional nursing practice.Thought and Discussion Questions1. Identify how the metaparadigm concepts apply in your practice setting.2. Identify individuals who you think are self-actualized, and explain why.3. Identify a theory used in your practice setting. Identify the concepts (constructs), how thecomponent concepts are defined, the propositions that link the concepts, and the aims of thistheory.4. Describe how systems theory can be used in a healthcare setting. Identify the inputs andoutputs of the system.Interactive ExercisesOn the intranet site, students are directed to the following:INTERACTIVE EXERCISE #3-1: Our Metaparadigm ConceptsThink about your current LPN practice setting. Complete the following, and define the conceptsof human beings, health, environment, and nursing as viewed first by others and then by you inthis setting.How others view these concepts:Human BeingsHealthEnvironment

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NursingYour Views:Human BeingsHealthEnvironmentNursingINTERACTIVE EXERCISE #3-2: Applying Theories of Growth and DevelopmentApply Erikson’s or Piaget’s Theory to each of the following client situations.A 7-month-old infant with failure to thrive and his mother who has started a mothers’ program topromote healthy development.An overweight school-age child who has been placed on a reduction diet and activity program tolose 10 pounds.A 45-year-old business executive who has started a cardiac rehabilitation program following amyocardial infarction.INTERACTIVE EXERCISE #3-3: Web Search for a Nursing ModelSelect one of the conceptual models or theories in nursing. Conduct a Web search and investigatehow the model is being applied in practice. Examine new information that is being discussed.See if the theorist is teaching or in practice and has a website or if one is being maintained on thetheory. How do you think this model could be used in your practice setting? Be prepared toparticipate in a class or online discussion to be scheduled by your instructor.INTERACTIVE EXERCISE #3-4: Web LessonComplete the Web lessonTheories of Human Behavior Used in Practice.Online Resources

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