Nursing as a profession
Definition of profession
A profession is an occupation based on specialized intellectual study and training, the purpose of which is to supply skilled services with ethical components to other for definite salary or fee.
Characteristics of a profession
A basic profession requires an extended education of its members, as well as a basic liberal foundation.
A profession has a theoretical body of knowledge leading to defined skills, abilities and norms.
A profession provides a specific service. Members of a profession have autonomy in decision-making and practice.
The profession has a code of ethics for practice.
The word nurse originated from the Latin word nutrix, meaning “to nourish.” Most definitions of nursing describe the nurse as a person who nourishes, fosters, and protects and who is prepared to take care of sick, injured, and aged people. With the expanding roles and functions of the nurse in today’s society, however, any one definition may be too limited.
Definition
The unique function of the nurse is to assist the individual, sick or well, in the performance of those activities contributing to health or its recovery or to peaceful death that he/she would perform unaided if he/she had the necessary strength, will or knowledge and to do this in such a way as to help him/her gain independence as rapidly as possible. - Virginia Handerson.
The International Council of Nurses (2002) captures much of what nursing means in its definition:
Nursing encompasses autonomous and collaborative care of individuals of all ages, families, groups, and communities, sick or well and in all settings. Nursing includes the promotion of health, prevention of illness, and the care of ill, disabled, and dying people. Advocacy, promotion of a safe environment, research, participation in shaping health policy and in patient and health systems management, and education are also key nursing roles.
Concepts of Nursing
A particular purpose:
the purpose of nursing is to promote health, healing, growth and development, and to prevent disease, illness, injury, and disability. When people become ill or disabled, the purpose of nursing is, in addition, to minimise distress and suffering, and to enable people to understand and cope with their disease or disability, its treatment and its consequences.
A particular mode of intervention:
Nursing interventions are concerned with empowering people, and helping them to achieve, maintain or recover independence. Nursing is an intellectual, physical, emotional and moral process which includes the identification of nursing needs; therapeutic interventions and personal care; information, education, advice and advocacy; and physical, emotional and spiritual support.
A particular domain:
the specific domain of nursing is people’s unique responses to and experience of health, illness, disability and health-related life events in whatever environment or circumstances they find themselves. People’s responses may be physiological, psychological, social, cultural or spiritual, and are often a combination of all of these.
A particular focus:
the focus of nursing is the whole person and the human response rather than a particular aspect of the person or a particular pathological condition.
A particular value base:
nursing is based on ethical values which respect the dignity, autonomy and uniqueness of human beings, the privileged nurse-patient relationship, and the acceptance of personal accountability for decisions and actions.
A commitment to partnership:
nurses work in partnership with patients, their relatives and other carers, and in collaboration with others as members of a multi-disciplinary team.
To develop an accurate philosophy of nursing, one must contemplate the qualities of the endeavors to which a nurse obligates their heart and soul to. A nurse commits to being of altruism, charisma, empathy, and knowledge applied to the enterprise of protection, promotion, and enhancement of the holistic health states of all persons. This includes, and is not limited to a nurse’s practice in the professional arena, but also a nurse takes this outside the workplace to uphold these ideals.
Nurses also must sustain an ever increasing knowledge base to allow for changes and improvements to the health care system. So to should nurses reflect on their own knowledge base and strive to become always yearning for new experiences and understanding to elevate the level of professionalism inherent in their application of nursing. Furthermore, nurses are obligated to their fellow professionals, as an integral part of the health care team, to aid and improve the ability of their peers. This collegiality is essential to the upkeep of the trusted image a nurse has among their colleagues and the public.
Finally, a nurse must always remember to whom they are ultimately accountable; their patient. This accountability is first and foremost in upholding the principles a nurse represents. A nurse should constantly be asking themselves whether or not the care they are providing is exceeding the expectations of their patients. Moreover, a nurse must remain vigilant of the duty to themselves in the same regard by being able to self-evaluate: “Am I providing the exceptional, empathic, and optimal holistic care that my patient deserves and that I can be proud of?”
All this and more make up a nurse. Not only does a nurse perform these duties in a professional sense but also in a personal sense. In order for a nurse to be the holistic provider of excellence , a nurse must champion the same ideals in their everyday life. This is what being a nurse is all about.
It is a specific aim planned by a nurse to decrease a person's stress, to improve the ability to adapt, or both.
A nursing objective may be physical, emotional, social, cultural or spiritual and may involve the person's family, friends, and other patients.
It is the purpose of any specific nursing order or nursing intervention. Some common nursing objectives are adequate understanding by the patient of certain details of the condition, adequate and comfortable daily elimination, a certain amount of rest, a balanced diet, and participation in specific items of self-care.
AIMS & OBJECTIVE OF NURSING
Four broad aims of nursing practice can be identified in the definitions of nursing:
To promote health
To prevent illness
To restore health
To facilitate coping with disability or death
•To meet these aims, the nurse uses knowledge, skills, and critical thinking to give care in a variety of traditional and expanding nursing roles.
•Nurses use four essential competencies: cognitive, technical, interpersonal, and ethical/legal skills to provide safe and knowledgeable care.
•Cognitively skilled nurses think about the nature of things sufficiently to “make sense” of their world and to grasp conceptually what is necessary to achieve valued goals.
•Technically skilled nurses manipulate equipment skillfully to produce a desired outcome or result.
•Interpersonally skilled nurses establish and maintain caring relationships that facilitate the achievement of valued goals while simultaneously affirming the worth of those in the relationship.
•Ethically and legally skilled nurses conduct themselves in a manner consistent with their personal moral code and professional role responsibilities.
• In the nursing profession, a variety of different types of caregivers exists. The term “scope of practice” is used to define the actions, procedures, etc. that are permitted by law for a specific profession. It is restricted to what the law permits based on specific experience and educational qualifications.
The roles and scope of Nurses:
Nurse Practitioner (NP). These professionals might work in primary care, long-term care, tertiary care, or community care venues. Nurse practitioners have the ability to write prescriptions and are involved in the management of health problems through examination, diagnosis, education, and counseling.
Clinical Nurse-Specialist (CNS). These professionals serve their patients in tertiary care centers, ambulatory care centers, home health care venues, and in community care settings.They are involved in the management of complex patient health care problems through direct care, consultation, education, and research roles.
Certified Registered Nurse Anesthetist (CRNA). These professionals work in hospital operating rooms, surgical settings, and in ambulatory care. They treat anyone undergoing surgical procedures, and they are involved in pre-operative assessments, the administration of anesthesia, and the management of post-anesthesia recovery.
Certified Nurse-Midwife (CNM). These professionals serve childbearing women in homes, hospitals, birthing centers, and ambulatory care arenas. Certified Nurse-Midwives teach their clients well-women health care, the management of pregnancy, health promotion, and antepartum and postpartum care.
Caregiver/ Care provider
the traditional and most essential role
functions as nurturer, comforter, provider
“mothering actions” of the nurse
provides direct care and promotes comfort of client
activities involves knowledge and sensitivity to what matters and what is important to clients
show concern for client welfare and acceptance of the client as a person
Teacher
provides information and helps the client to learn or acquire new knowledge and technical skills
encourages compliance with prescribed therapy.
promotes healthy lifestyles
interprets information to the client
Counselor
helps client to recognize and cope with stressful psychologic or social problems; to develop an improve interpersonal relationships and to promote personal growth
provides emotional, intellectual to and psychologic support
focuses on helping a client to develop new attitudes, feelings and behaviors rather than promoting intellectual growth.
encourages the client to look at alternative behaviors recognize the choices and develop a sense of control.
Change agent
initiate changes or assist clients to make modifications in themselves or in the system of care.
Client advocate
involves concern for and actions in behalf of the client to bring about a change.
promotes what is best for the client, ensuring that the client’s needs are met and protecting the client’s right.
provides explanation in clients language and support clients decisions.
Manager
makes decisions, coordinates activities of others, allocate resource
evaluate care and personnel
plans, give direction, develop staff, monitors operations, give the rewards fairly and represents both staff and administrations as needed.
Researcher
participates in identifying significant researchable problems
participates in scientific investigation and must be a consumer of research findings
must be aware of the research process, language of research, a sensitive to issues related to protecting the rights of human subjects.
Expanded role as of the nurse
Clinical Specialists-
is a nurse who has completed a master’s degree in specialty and has considerable clinical expertise in that specialty. She provides expert care to individuals, participates in educating health care professionals and ancillary, acts as a clinical consultant and participates in research.
Nurse Practitioner-
is a nurse who has completed either as certificate program or a master’s degree in a specialty and is also certified by the appropriate specialty organization. She is skilled at making nursing assessments, performing P. E., counseling , teaching and treating minor and self- limiting illness.
Nurse-midwife-
a nurse who has completed a program in midwifery; provides prenatal and postnatal care and delivers babies to woman with uncomplicated pregnancies.
Nurse anesthetist-
a nurse who completed the course of study in an anesthesia school and carries out pre-operative status of clients.
Nurse Educator-
A nurse usually with advanced degree, who beaches in clinical or educational settings, teaches theoretical knowledge, clinical skills and conduct research.
Nurse Entrepreneur-
a nurse who has an advanced degree, and manages health-related business.
Nurse administrator-
a nurse who functions at various levels of management in health settings; responsible for the management and administration of resources and personnel involved in giving patient care.
1.Self- Confident 2.Humble & honest 3.Loyal
4.Co-operative 5.Good listener 6.Keen observer
7.Good Administrator 8.Good Supervisor 9.Impartial
10. Workmanship 11. Responsible 12. Accountable
13. Competence 14. Judge 15. Care giver
16. Decision maker
•In India, we had the Ayurvedic system of medicine, which can be traced back to about 3000 B.C. Ayurveda stressed on hygiene, prevention of sickness, inoculation against small pox, sanitation, lavatories, good ventilation, kitchen, construction of hospitals, cultivation of medicinal plants and suitable building for housing animals.
•Atreya was the first great physician and teacher of Ayurveda. He lived about 800 B.C.
•During 700-600 B.C Sushruta and Charaka started practice of surgery and medicine.
•Sushruta Samhita is written by the great surgeon Sushruta, who says "the physician, the patient, the drugs and the nurse are four feet of `Padas' of the medicine, upon which the cure depends“. The nurse is a pada when he is kindhearted, strong, trustworthy and mindful of the physician's orders.
•The great physician Charaka has written the Charaka Samhita in which he explains details of the manner in which drugs should be prepared or compounded for administration.
•The Charaka Samhita states that attendants on the sick should have good behaviour and should be distinguish for purity and cleanliness of habits.
•Nursing treatments prescribed are baths, enema to evacuate the bowels, emetics to produce vomiting, vaginal and urethral infusion (introducing a fluid under pressure), venesection (reducing of blood volume by opening the vein), gargles, massages, rubbing or pressing the limbs etc.
•700-600 B.C - Thiruvalluvar in his songs speaks highly of medicine. He describes medical care as consisting of patients, doctors and nurses.
•264 B.C - King Ashoka made a great stride in the care of the sick, both human beings and animals. He not only founded a large number of hospitals for the sick but also made provision for the education and training of women for that purpose.
•The nursing of patients seems to have been devoted primarily to men, a great deal of unrewarded work. The qualities expected of nursing attendants were good behaviour, purity, cleverness, at kindness and skill.
NURSING IN INDIA
•The ancient records of India indicate the principles and practices of nursing. They are so clear, intelligent and scientific, that many of them might fit into any of the modern textbook.
•The nurses were usually young men, and only in special cases, women were taken for conducting childbirth. The progress of nursing in India was obstructed by the low state of women, the caste system, illiteracy and political unrest.
•Military nursing was the earliest type of nursing. In 1664 the East India Company started a hospital for soldiers in a house at FortSt.George, Madras. The first sisters were sent from St.Thomas Hospital, London to this military hospital. In 1797 a Lying - in - Hospital (maternity) for the poor of Madras was built with the help of subscriptions by Dr.John Underwood.
•In 1854 the Government sanctioned a training school for midwives in Madras.
Florence Nightingale was the first woman to have great influence over nursing in India and had a close knowledge of Indian conditions, especially army. She was interested in the nursing service for the civilian population, though her first interest was the welfare of the army in India.
•In 1865, Miss Florence Nightingale drew up some detailed "Suggestions on a system of nursing for hospitals in India“. Graduates were sent out from the Nightingale School of Nurses at St.Thomas Hospital, England to start similar schools in our country.
•St Stephens Hospital at Delhi was the first one to begin training the Indian girls as nurses in 1867.
•In 1871, the first School of Nursing was started in Government General Hospital, Madras with 6 months Diploma Midwives program with four mid-wife students.
•Four lady Superintendents and four trained nurses from England were posted to Madras. Between 1890 and 1900, many schools, under either missions or government, were started in various parts of India.
•In the yearly twentieth century, National Nursing Associations were started.
•In 1897, Dr.B.C.Roy did great work in raising the standards of nursing and that of male and female nurses.
•In 1908, the trained nurses association of India was formed as it was felt to uphold the dignity and the honour of nursing profession.
•In 1918, training schools were started for health visitors and dais, at Delhi and Karachi. Two English nurses Miss Griffin and Miss Graham were appointed to give training to and to supervise the nurses.
•In 1926, Madras State formed the first registration council to provide basic standards in education and training.
•The first four year basic Bachelor Degree program were established in 1946 at the college of nursing in Delhi and Vellore. With the assistance from the Rockfeller Foundations, seven health centers were set up between 1931 - 1939 in the cities of Delhi, Madras, Bangalore, Lucknow, Trivandrum, Pune and Calcutta.
•In 1947, after the independence, the community development programme and the expansion of hospital service created a large demand for nurses, auxiliary nurse midwives, health visitors, midwives, nursing tutors and nursing administrators.
•The Indian Nursing Council was passed by our ordinance on December 31st 1947. The council was constituted in 1949. In 1956, Miss Adrenwala was appointed as the Nursing Advisor to Government of India.
•The development of Nursing in India was greatly influenced by the Christian missionaries, World War, British rule and by the International agencies such as W.H.O. UNICEF, Red Cross, UNICEFetc.
•The first master’s degree course, a two-year postgraduate program was begun in 1960 at the College of Nursing, Delhi.
•In 1963, the School of Nursing in Trivandrum, instituted the first two years post certificate Bachelor Degree program.
•The associations such as International Council of Nurses, the nurses auxiliary of the CMA of India, T.N.A.I. Indian Nursing council and State level Registration Council are closely connected with promotion and the upliftment of the nursing profession.
NursNursing in Tamilnadu
•In 1664 the East India Company started the first hospital at St. George, Madras.
•In 1797 a Lying-in-hospital for the poor of Madras was started.
•In 1854, the government sanctioned a Training School for running mid-wives course in Madras.
Training School
•The first mid-wives School was started at the government hospital in 1871.
•The formal schools of nursing was started for conducting diploma in general nursing and mid-wifery programmes for a duration of 3 ½ years in Madras and in other parts of Tamilnadu.
•Schools of nursing offering diploma program increased slowly (there were 9 schools of nursing and 4 mid-wifery schools till 2001) conducted by government of Tamilnadu.
•The number of schools conducted by government of Tamilnadu is now increased to 17 in 2003 and now the government executed to start one school of nursing in every district hospitals. The numbers of private schools have also increased.
•Multipurpose health worker schools are also functioning in many places in Tamilnadu conducted by government and private bodies.
College of Nursing
•A teachers training program running for a duration of one year was functioning in government hospital. In 1967 an integrated 2-½ years Bachelor Science degree nursing program attached to Madras Medical College (for trained nurses) commenced replacing the then existing diploma program.
•In 1980, diploma in community nursing program was started.
•In 1983, Bachelor of Science Nursing, 4-year program was started in College of Nursing, attached to Madras Medical College.
•In 1995, Master of Science (Nursing) program was started in the College of Nursing, attached to Madras Medical College.
In 2001, a post of Principal for the College of Nursing was sanctioned and started functioning. Dr. Sumathi Kumar swamy was appointed as the first Principal.
•Many candidates have completed Doctoral degree in nursing.
•In 2003, a College of Nursing at Madurai started functioning by the government.
Services
•The cadre strength of nursing increased slowly and many categories in nursing services prompted up.
•In 1962, a post of Assistant to Director of Medical Services was created and filled at the state level.
A post of Deputy Director of Nursing at the state level was created in 1986, and Dr Sumathi Kumaraswamy was appointed as the first Deputy Director of Medical Education in Nursing in 1992
•The Development of Auxiliary Nurse Midwife Training (Rural Health Services).
•During the Second World War, there was a great demand for nursing personnel in the military hospitals as well as in the civil hospitals. So auxiliary nurses midwife services was founded in 1942.
•This course was simple and the duration of training period was shorter than the nursing course.
•The nurses under this course were posted to do useful work under supervision in the hospital, or in the health centre and to give domiciliary care. Auxiliary nurse midwives were prepared to meet the demands of the health personnel in the community development programmes.
•After the independence and in the Second Five Year Plan, it was decided to prepare six thousand auxiliary nurses and midwives. The private hospitals also were requested to co-operate with the Government to start such training institution. The government hospitals were given facilities to train the auxiliary nurse midwife since 1955.
•Today the auxiliary nurse midwife has a vital role in the health services of the rural health centers such as primary health centre, family welfare centre, Maternity and Child Health centers.
•They can work as a midwife and a health worker in the community. They are also given opportunity to be trained as health visitors or as nurses if they have the basic educational requirements.
•The practice of the auxiliary nurse midwife in the rural center had helped to improve the health status of the people, by health teaching, domiciliary care, and regular follow-up of patients and families.
• Auxiliary nurse midwife in the present health care delivery system functions as a Multipurpose Female Health Worker. With the present introduction of vocational courses such as nursing in the academic stream as one of the options, it is believed that it will contribute towards the basic nursing care of individuals, families and community for health and happiness. It will also be a foundation course for future diploma and degree programs in nursing.
Ethics is a branch of philosophy that deals with the broad issues of morality, moral problems or moral judgement. – Karen J Darger et.al.
Ethics is a science rating to moral action & one’s value system. Yoder Wise
It is a branch of philosophy which is concerned with human character and conduct.
Ethics are defined as the science of moral in human conduct.
Ethical Principles
1.Principles of respect for person
2.Principles of respect for autonomy
3.Principles of respect for freedom
4.Principles of respect for beneficience (doing good)
5.Principles of respect for non-maleficience (avoid harm to other)
6.Principles of respect for veracity (tell truth)
7.Principles of respect for Justice (fair & equal treatment)
8.Principles of respect for right
9.Principles of respect for fidelity (fulfill promise)
10. Principles of respect for confidentiality
The Florence Nightingale pledge, prepared by Greeter include the basic principles governing ethical practices.
Code of ethics
Ethical Concepts Applied to Nursing
•The fundamental responsibility of the nurse is fourfold: to promote health, to prevent illness, to restore health, and to alleviate suffering.
•The need for nursing is universal, inherent in nursing is respect for life, dignity and rights of individual. It is unrestricted by considerations of nationality, race, creed, colour, age, sex, politics or social status.
•Nurses render health services to the individual, the family and the community and coordinate their services with other team members.
ICN Code for Nurses (1973)
Nurses and People
The nurse’s primary responsibility is to those people who require nursing care.
The nurse, in providing care, promotes an environment in which the values, customs and spiritual beliefs of the individuals are respected.
The nurse holds in confidence personal information and uses judgment, in sharing this information.
Nurses and Practice
The nurse carries personal responsibility for nursing practice and for maintaining competence by continual learning.
The nurse maintains the highest standards of nursing care, possible within the reality of a specific situation.
The nurse uses judgement in relation to individual competence, when accepting and delgating responsibilities.
The nurse, when acting in a professional capacity, should at all times maintain standards of personal conduct which reflect credit upon the profession.
Nurses and Society
The nurse shares with other citizens the responsibility for initiating and supporting action to meet the health and social needs of the public.
Nurses and Co-workers
The nurse sustains a cooperative relationship with co-workers and other fields.
The nurse takes appropriate action to safeguard the individual when his care is endangered by a co-worker or any other person.
Nurses and the Profession
The nurse plays the major role in determining and implementing desirable standards of nursing practice and nursing education.
The nurse is active in developing a core of professional knowledge.
The nurse, acting through the professional organization, participates in establishing and maintaining equitable social and economic working conditions in nursing. The professional code of ethics in nursing serve as standards for the behaviour of nurses and provide general guidelines for nursing actions in ethical dilemmas.
Professional conduct for nurses (India - INC)
1.Professional responsibility and accountability
–Nurse appreciate sense of self worth and nurtures it
–Maintains standards of personal conduct reflecting credit upon the profession
–Carries out responsibilities within the framework of the professional boundaries
–Is accountable for maintaining practice standards set by INC
–Is accountable for own decisions and actions
–Is responsible for continious improvement of current practices
–Practices healthful behaviour.
2. Nursing practice
–Nurse provide care in accordance with set standards of practice
–Treats all individuals and families with human dignity in aspects of care
–Promotes participation of individuals and significant others in the care.
–Ensures safe practice
3. Communication & interpersonal relationships
–Nurse establishes and maintains effective interpersonal relationships with individuals, families and communities
–Upholds the dignity of team members and maintains effective interpersonal relationship with them
–Cooperates with other health professionals to meet the needs of the individuals, families & communities
4. Valuing human being
–Nurse takes appropriate action to protect individuals from harmful unethical practice
–Encourage & supports individuals in their for themselves on issues affecting their health and welfare
–Respects and supports choices made by individuals
5. Management
–Nurse ensures appropriate allocation and utilization of available resources
–Participates and supervision and education of students and other formal care providers
–Uses judgment in relation to individual competence while accepting & delegating responsibilities
–Participates in performance appraisal
–Participates in evaluation of nursing services
–Participates in policy decision, following the principle of equity and accessibility of services
6. Professional advancement
–Nurse encourages the protection of human rights while pursuing the advancement of knowledge
–Contributes to the development of nursing practice
–Participates in determining and implementation quality care
–Take responsibility for updating own knowledge and competencies
–Contributes to the core of professional knowledge by conducting and participating in research
Values: Definition, Types,
Values Clarification and
values in professional
Nursing: Caring and
Advocacy
Ethics:
- Definition and Ethical
Principles
- Code of ethics and
professional conduct for
nurses