Unit 2:Nursing as profession Prepared by : Christian RavinaM.Sc.(N), 2nd year M.T.I.N.Changa

Nursing Definition

• Nursing is rearing or bringing up under certain conditions and certain environment, fostering and cherishing, managing economically, assisting to develop into a certain form, attending, trying to cure by taking care of onself(oxford medical dictionary)

• Nursing is in effect, helping the person to keep well or regain his health if he is ill(curriculum guide for schools of nursing, 1937)

• Providing an environment that allow nature to act on behalf of the client( Florence nightingale, 1946)

Nursing definition

• Virginia Henderson defined nursing in functional terms: "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 a peaceful death) that he would perform unaided if he had the necessary strength, will or knowledge. And to do this in such a way as to help him gain independence as rapidly as possible."

Nursing definition • Florence Nightingale defined nursing over 100

years ago as "the act of utilizing the environment of the patient to assist him in his recovery( Nightingale,1860). NIghtingale considered a clean,well-ventilated, and quiet environment essential for recovery. Often considered the first nurse theorist. Nightingale raised the status of nursing through education. Nurses were no longer untrained housekeepers but people educated in the care of the sick.

Nursing definition

• In 1987,the Canadian Nurses Association(CNA) described nursing practice as a dynamic,caring,helping realtionship in which the nurse assists the client to achieve and obtain optimal health(CNA,1987).

• Nursing is an art of applying scientific principles in an intelligent humanitarian way to the care of people experiencing potentially maladaptive stress. (Toronto, 1980)

Nursing profession

• Profession – is a calling that requires special knowledge, skill and preparation.

• An occupation that requires advanced knowledge and skills and that it grows out of society’s needs for special services.

•Criteria of Profession:• To provide a needed service to the society.• To advance knowledge in its field.• To protect its members and make it possible to

practice effectively.

•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.

• NURSING >is a disciplined involved in the delivery of health care to the society.

• >is a helping profession

• >is service-oriented to maintain health and well-being of people.

• >is an art and a science.

• NURSE – originated from a Latin word NUTRIX, to nourish.

• Characteristics of Nursing:

• Nursing is caring.

• Nursing involves close personal contact with the recipient of care.

• Nursing is concerned with services that take humans into account as physiological, psychological, and sociological organisms.

• Nursing is committed to promoting individual, family, community, and national health goals in its best manner possible.

• Nursing is committed to personalized services for all persons without regard to color, creed, social or economic status.

• Nursing is committed to involvement in ethical, legal, and political issues in the delivery of health care.

Philosophy •The study of the fundamental nature of

knowledge, reality, and existence, especially when considered as an academic discipline.

•A theory or attitude that acts as a guiding principle for behavior.

The philosophy that guides Careful Nursing is framed by three principles:

• The nature and inherent dignity of the human person

• Infinite Transcendent Reality in life processes 

• Health as human flourishing

The nature and inherent dignity of the human person• Although the terms human being and human person are often used

interchangeably, the term human person is used in Careful Nursing because the meaning of person encompasses more fully the nature of human life.

• Taken the natural unity of ourselves and our patients as persons, there are four important points about who we are: • as persons we are, in our deepest reality, spiritually oriented, related to all other

persons; and have inherent dignity and worth

• as substances we are unitary beings

• as individuals we are each distinctive

• as rational beings we have a highly developed potential to think and reason

Infinite Transcendent Reality in life processes• Broadly speaking, Infinite Transcendent Reality in life processes is the

source of the spiritual being in human persons and the source of the spiritual in nursing.

• The words used in the term Infinite Transcendent Reality reflects its characteristics as we perceive them. Infinite means something that is limitless and exists everywhere but is beyond our ordinary, measurable experience.

• Transcendent means something timeless and divine. Both words, Infinite and Transcendent, refer to a being outside our objective, finite world. At the same time, this is a reality for us in our inward lives.

• Reality means 'that which is there' and includes our experience.

Health as human flourishing

• Health as human flourishing has been defined as: 'the person's unitary experience of personal dignity, harmony, relative autonomy, contentedness and sense of purpose in life includes the ability, or potential, to experience a personal relationship with an infinite transcendent reality through inner reflection, contemplation, meditation or prayer; and to express this experience in loving relationships with others and in seeking to fulfil a perceived purpose in life .the ability to accept with equanimity influences and circumstances which are seemingly unjust but may be very difficult to alter"

Philosophy of nursing • Nursing is viewed as both an art and a science, reflecting

upon the concepts of the nursing metaparadigm. Nursing is an applied discipline which expresses itself in practice, and has its foundation rooted in scientific/empirical knowledge, theory, and research. Nursing is also expressed as a caring, therapeutic and teaching discipline.

• The goal of nursing is optimum client wellness, and the maximum level of functioning.  The nursing interventions are evidence-based and stem from their core knowledge.  The professional nurse must appreciate the role of informatics-both acquisitions of knowledge, as well as, timely electronic record keeping.

Philosophy of nursing • Theoretical and empirical knowledge from nursing, biological, social

sciences, and the humanities are synthesized in utilization of the nursing process (an evidence-based series of activities employed by the nurse in an on-going effort toward achieving desired outcomes for humans, environment and health). The steps of the nursing process include assessment, nursing diagnosis, planning, implementation, and evaluation.

• The therapeutic component of nursing is realized by providing health care or knowledge of health care practices to enhance one’s level of wellness. The teaching component of nursing includes providing information to make health care decisions, acquire skills, and to change behavior. When it is not possible to promote wellness, nursing seeks to enable individuals to adjust to illness and/or relieve suffering.

Philosophy of nursing

• When it is not possible to promote a healthy life, nursing seeks to enable individuals to adjust to the loss and a peaceful death.  The nurse must assume a leadership role as she/he designs nursing systems to meet their patient’s overt and covert health care needs.  The nurse must collaborate with the multi-disciplinary health care teams which are an innate part of professionalism.  The nurse must also understand the role of health care policy as it relates to patient care as well as having an appreciation for the health care needs from a global perspective.

Four basic concept that affect and determine nursing practice

• (1) Human being

• (2) Environment

• (3) Health

• (4) Nursing

Human being

• The human being is a uniform whole

• The uniform whole of human being• Physiological • Psychological• Social• Spiritual • Cultural

Human being • The scope of human being in nursing• (1) Individual

• (2) Family

• (3) Community

• (4) Society

• Basic goal of human being: • To maintain the balance of organism

• Balance among subsystems of an organism

• Balance between organism and its environment (internal environment and external environment)

Human being

•Basic need of human being • Physiological need• Social need• Affective need• Cognitive need• Spiritual need

Environment

• Roy’s definition of environment: the summation of all factors that surround and affect the behaviors and development of individual or collectivity.

• Henderson’s definition of environment: a general name of all external factors that affect the life and development of organism.

Environment

• Classification of environment• (1) Internal environment: the environment in the organism• (2) External environment

• 1) Natural environment• (a) Physical environment: air, water, sunlight, soil • (b) Biological environment: animal, plant, microorganism

Environment • 2) Humanistic-social environment• (a) the number of population

• (b) cultural education

• (c) interpersonal relationship

• (d) scientific management

• (e) medical care services system

• 3) Therapeutic environment• It is an environment that created by professionals aimed to fit the recovery

of clients’ physiological and psychological health

Environment

• Relationship among environment, human being and health• (1) Human being and its environment are interdependent

and interacted • (2) Human being’s health is closely linked with the

environment

Health •WHO--- The World Health Organization: • “A state of complete physical, mental and social well-being,

and not merely the absence of disease or infirmity.” (holistic view of health)

• Factors that affect health

• 1) Biological factors:• (a)Pathogenic microorganism • (b) Biologic-heredity factor• (c) Other factors: age, sex, growth and development

Health • 2) Environmental factors• (a) Natural environment: air pollution, climate, water pollution, soil

pollution, radiation, noise.

• (b) Social environment: • a) political and economic system in the society• b) social and cultural system

• 3) Life style:

• 4) Psychological factors• Psychological factors→emotion, feelings → Physiological function

Nursing

• The nursing science is an independent applying science that synthesizes natural and social science.

• Nursing is a profession that helps human being and serves for health of human being

• Nursing can assist individual to meet the basic needs of human being and enforce the ability of self-care.

Concept of nursing • The tasks of nursing are:• (a) to promote health

• (b) to prevent disease

• (c) to help ill-person to healing (to assist healing)

• (d) to assist the dying patient to pass away with quietude, peace, and dignity. (to ease suffering)

• 5) The client is a holistic human being, including suffering person and healthy person.

Concept of nursing • 6) The working place is not only in the hospital, but also in family,

community and whole society.

• 7) Nursing is not only a science, but also an art.

• 8) The nursing science attaches importance to human being’s living environment and the interrelation between human being and its environment.

• 9) The nursing science is a gradually perfect and developing science.

Nature and scope of nursing practice

• Nurses contribute to health care within a multidisciplinary team. They are individually accountable for their actions and practise within a statutory regulatory framework established to protect the public and assure the quality of nursing services.

• The role of the nurse is constantly changing and developing. This means that nurses may add new functions to their work. When deciding to do so, nurses must be sure that patients will benefit and that they are competent for the new role.

Nature and scope of nursing practice

• Nursing is a service which:• Helps individuals, families and communities to achieve and

maintain good health• Supports, assists and cares for people during illness or

when their health is threatened• Enhances people's ability to cope with the effects of illness

and disability• Ensures, as far as possible, that death is dignified and free

from pain.

Nature and scope of nursing practice

• Nursing achieves these goals by applying knowledge and skills gained through education and training, updated and tested by research. It is the combination of professional knowledge and skills, with the desire to care for others, which provides the base of nursing. Nursing practice includes:

• Assessing people's health, their health problems and the resources they have to cope with them; deciding what nursing help is needed and referring them to other sources of expertise when necessary

• Planning, giving and evaluating programmes of skilled nursing care

Nature and scope of nursing practice • Teaching individuals, families and communities about healthy lifestyles.

This involves helping them gain the knowledge and skills to control their own health

• Teaching and enabling people to attain, maintain or recover their independence

• Acting as the patient’s advocate and communicating the patient’s needs to others

• Co-ordinating care where other health care workers are involved

• Maintaining an environment conducive to health or recovery.

Nature and scope of nursing practice

• Nursing is concerned, in particular, with:• Situations in which people’s ability to maintain the normal activities

of life, such as breathing, feeding, elimination, mobility, rest, sleep and personal cleanliness may be impaired

• Alleviating pain and discomfort

• Assessing physical and emotional responses to illness, trauma, treatment and disability. These responses may include anxiety, loss, loneliness and bereavement.

• Managing disordered intellectual responses, learning difficulties and mental illness.

Functions of a nurse

• Caregiver

• The caregiver role has traditionally included those activities that assist the client physically and psychologically while preserving the client’s dignity. Caregiving encompasses the physical, psychosocial, developmental, cultural and spiritual levels.

• Communicator

• Communication is an integral to all nursing roles. Nurses communicate with the client, support persons, other health professionals, and people in the community. In the role of communicator, nurses identify client problems and then communicate these verbally or in writing to other members of the health team. The quality of a nurse’s communication is an important factor in nursing care.

• Teacher

• As a teacher, the nurse helps clients learn about their health and the health care procedures they need to perform to restore or maintain their health. The nurse assesses the client’s learning needs and readiness to learn, sets specific learning goals in conjunction with the client, enacts teaching strategies and measures learning.

• Client advocate

• Client advocate acts to protect the client. In this role the nurse may represent the client’s needs and wishes to other health professionals, such as relaying the client’s wishes for information to the physician. They also assist clients in exercising their rights and help them speak up for themselves.

• Counselor

• Counseling is a process of helping a client to recognize and cope with stressful psychologic or social problems, to developed improved interpersonal relationships, and to promote personal growth. It involves providing emotional, intellectual, and psychologic support.

•Change agent

•The nurse acts as a change agent when assisting others, that is, clients, to make modifications in their own behavior. Nurses also often act to make changes in a system such as clinical care, if it is not helping a client return to health.

• Leader

• A leader influences others to work together to accomplish a specific goal. The leader role can be employed at different levels; individual client, family, groups of clients, colleagues, or the community. Effective leadership is a learned process requiring an understanding of the needs and goals that motivate people, the knowledge to apply the leadership skills, and the interpersonal skills to influence others.

• Manager

• The nurse manages the nursing care of individuals, families, and communities. The nurse-manager also delegates nursing activities to ancillary workers and other nurses, and supervises and evaluates their performance.

• Case manager

• Nurse case managers work with the multidisciplinary health care team to measure the effectiveness of the case management plan and to monitor outcomes.

Qualities of a nurse

• Caring nature: • Nurses deal with the sick and injured and their families on a daily

basis, and must be able to show thatthey truly care about the situation.

• Empathic attitude• Nurses must be able to put themselves in their patients’ shoes to

provide the quality care needed.

• Detail oriented• Nurses must remember to make entries on patients’ charts and to

bring medications at the correct times.

• Emotionally stable• Nurses feel the joy of seeing a new baby born as well as the

pain of losing a long-term patient. Emotional stability is crucial to deal with the wide range of emotions nurses must endure.

• Adaptable• People are unpredictable at the best of times, but become

even more so under stress, so a nurse’s typical workday will require flexibility and adaptability.

• Hardworking• Nursing is a never ending job. It is unusual for a hospital or

medical center to be overstaffed, which of course means more workload on each nurse in the unit.

• Quick thinker• When a nurse notices something is not right with a patient,

they must be able to make decisions quickly and put their plans into action instantly, because a fraction of a second can mean the difference between life and death.

• Physical endurance• Nurses are on their feet all day, sometimes 12 or more

hours at a time, and are often required to assist patients with activities that require physical strength.

• Good judgment• A nurse must be able to look at a patient’s current state

and accurately assess what is needed, especially during emergencies.

• Good communication skills• Nurses must communicate with other nurses, doctors,

patients, and patients’ families clearly.

• Responsible• Good nurses know how to perform all of their

responsibilities with the utmost accuracy and detail. They play a major role in assessing and treating patients’ medical conditions, and when dealing with the health of another human being, there is little room for error, so nurses must responsibly carry out their duties at all times.

• N – Nobility, Knowledge

• U – Usefulness, Understanding

• R - Righteousness, Responsibility

• S – Simplicity, Sympathy

• E – Efficiency , Equanimity

Categories of nursing personnel

• Staff nurse

• Senior staff nurse

• Nursing superintendent grade II

• Nursing superintendent grade I

• Nursing tutor/clinical instructor

• Principal, school of nursing

• Lecturer, college of nursing

Categories of nursing personnel

• Assistant professor, college of nursing

• Professor, college of nursing

• Principal, college of nursing

• Senior assistant director of nursing

• Public health nurse- district family welfare bureau

Thank you …