Introduction to NursingCHAPTER 1

Introduction

Many people think of nurses only in connection with care given to the sick and injured because nurses as well as doctors have been chiefly concerned in the past, with treatment and cure only. In reality the present nurses and doctors are active in the prevention of disease and its cure. So, community health oriented programmes are preferred and offered while preparing medical and paramedical people. They serve as teachers helping to educate the public in regard to health measures. They care for the mind as well as the body and are deeply interested in the normal as well as in the abnormal or diseased human beings.

Nursing has been defined in many ways. The expansion of scientific knowledge and the changes in the social customs, alters definitions of nursing and that definitions designed for one age won't fit another age.

Nursing has long been recognised as an art. An art is a body of practical knowledge which tells how to work to produce certain results. An art does not involve any understanding of why things come out as they do. Florence Nightingale called nursing is the finest of all arts. Nursing as an art has been practised since the world began.

Nursing has been defined as a science. A science is a body of knowledge based on a large number of carefully collected facts. These facts have been arranged and classified in such a way to establish certain laws and principles. Such laws and principles explain the why of thing by finding out and describing the forces that are at work to produce the fact which have been observed. Nursing today involves many laws and principles of biological and physical nature as well as social and behavioural sciences. The needed laws and principles are, selected from pure sciences for doing the nursing procedures to meet the needs of the patient. So nursing is an applied sciences. Nursing as a service requires a sound and broad type of education and thorough knowledge of human nature. The better the scientific background the safer and more intelligent will be the care the nurse renders.3

A profession is an occupation with moral principles that are devoted to the human and social welfare. The services are based on specialised knowledge and skill developed in a scientific and learned manner. Professional nursing is a service devoted to the promotion of a human and social welfare. Nursing helps to attain this objective by giving care to the sick and injured, promoting and restoring the health and preventing diseases. Professional nursing has a legal aspect. Legally nursing duties consists of meeting the physical, emotional, spiritual and social needs of human beings under the supervision of licensed physician. Professional nursing has been defined by the American Nurses Association as a blend of intellectual attainments, attitude and mental skills, based upon the principles of scientific medicine acquired by means of a prescribed course in a school of nursing affiliated with a hospital, recognised by the state for such purpose, practised in conjunction with curative and preventive medicine by an individual licensed to do so by the state.

The word “Nurse” comes from the latin word nutritious which means ‘that nourishes, fosters and protects’. We find in the dictionary that Nursing has a wide range of 4meanings; it means to nourish, to protect, to prevent, (illness) to avoid (injury) to educate, to sustain and to give curative care and treatment to sick and infirm.

The word concept means an idea or general notion. So, concept of nursing means the idea or mental image of nursing. Concept formation results from better understanding of the knowledge. Everybody has their own concepts regarding nursing upon their understanding of the profession. It is important to have a clear concept of one's own profession to perform the duties and responsibilities efficiently because one's own concepts will control his action and attitude towards the profession. Concepts are building stones by which theories are made. According to some eminent experts nursing is an art, science and vocation for caring of the patient, which require head, heart and hand.

Nursing is a community service. Nurse should be familiar with the local health and social agencies in order that she may co-operative with them in preventive and educational aspects of health. Nurse is a very essential factor in health programme. She can refer the families to the available local health agencies to meet their health needs.

Academic study of Nursing may be certificate course or degree course as detailed below:

Schools of Nursing covering the four areas of sciences to prepare the nurse with knowledge and skill to do their works fulfilling the basic nursing principles. In doing every nursing procedures the knowledge and skill has to be integrated to cover the following principles:

ProcedureMeans a method of carrying out a treatment. Details of procedure differs in various hospitals, though underlying principles are the same.

Nursing techniquesIs the skillful handling of patient with the least discomfort, the skillful handling of sterile apparatus without contamination and the elimination of unnecessary movements so as to ensure the maximum speed with the highest efficiency.

Performing a nursing procedure is the art of nursing. Every procedure has a series of steps by which a desired result is accomplished. These steps are neither compartmental nor isolated, but it must be done constantly and correctly to get the desired results. The knowledge from the science of nursing itself will not develop the skill in doing procedures. The art of nursing; that is the skill in doing, is developed only by the practising the procedure repeatedly basing the scientific principles of its own. Skill means doing any procedure with speed and accuracy.

Being the first step the nurse will identify the patient. Then see the Doctor's order to note any specific instructions in doing the procedures. Meet the senior sister of the ward to get the further instructions of the patient and procedure. See the patient and note his general condition, ability of self help, his mood for acceptance, hygienic status, positions to be changed, need of the procedure and needs of assistant required or not. Then find out the availability of articles required in the unit, alterations to be made or improvisation of articles.

In this step the nurse has to remember three important points:

Whatever articles are prepared and how expert the nurse in doing procedure, if the preparation of patient is not done well the effect of doing the work is meaningless. Patient has to be prepared mentally and physically. As mental preparation is concerned, it makes the patient understand what we are going to do, the need of doing the same and the good effect to be expected. Thus win the co-operation and confidence of the patient.

Even though the materials of the procedure are arranged well, if the nurse is not thorough about actually what has to be done, it will not be accepted by the patient and the desired effect will not be obtained. This knowledge is obtained from the classrooms, books and demonstrations and by assisting the senior sisters in the ward in the beginning. The sincere effort in the part of students and junior staff in learning, observing and practising is the real method of developing knowledge and skill in doing procedures.

After the procedure is completed the patient is made comfortable. The effect of the treatment is observed, proper recording is made in the chart with signature of the nurse. All the articles are well cleaned and sterilized (if needed) and replaced in the proper places, ready for the next use.

According to dictionary A nurse is a person who is especially prepared in the scientific basis of nursing and who meets certain prescribed standards of education and clinical competence to provide services that are essential to or helpful in the promotion, maintenance and restoration of health and well-being.

First of all we should have a real attitude towards nursing. Nursing should not be viewed as an occupation or as a method of acquiring a mechanical job or profit making method only. Though it is a paid job, it is also a service to humanity and a sacred charitable work which need a very sympathetic heart. When we have a soft heart towards the human being we will have the spirit of nursing.

Pre-degree passed with science subjects as optional is the minimum general qualification required for the selection for the general nursing and midwifery course, at present in Kerala state.

The candidates who satisfy the prescribed basic requirements and general educational qualification, are selected by the authorities and they are given training in a recognised 10nursing school. There, she must complete a basic course of study according to the prescribed syllabus approved the State Council and Indian Nursing Council. The length of training period for General Nursing and Midwifery is 3 years. According to the present scheme the period of training for the General Nursing is 2 years and the last one year is utilised for community nursing and midwifery. For the male students and general nursing training is given in the first 2 years. In the next six months community nursing training is given and in the last six months they are given training in psychiatry, skin and venereology. After the successful completion of this, the candidates receive a certificate from the state Registration Council. If it is a university programme the duration of the course is 4 years after pre-degree passed and BSc degree in nursing is awarded from the university. In both cases they have to get their registration in the state as a “Registered Nurse Midwife” to work as junior nurse in the department. Nowadays male students are started studying midwifery in the final year like female students.

By the study of Anatomy and Physiology the nurse gains an understanding of the structure and function of the various parts of the body so that she can safeguard her own health and that of others. By the study of Pathology, one can recognise the changes and abnormalities occurring in the body due to diseases. By the study of physics and chemistry the nurse gains a better knowledge of the body processes such as digestion and the mechanical aspects of respiration. It also helps in the performance of procedures in her daily routine of nursing services. By the study of Microbiology the nurse develops an understanding of how pathogenic organisms are transferred and how this can be prevented so that she can protect herself and to help others from the spread of communicable diseases. The study of Nutrition gives an understanding of why certain food elements are essential in the diet and what food factors are required to keep her own health and the health of others and what changes in food are necessary during particular diseases.

The subject matter contained in the social sciences concerns with the study of human behaviour and includes all aspects of individual, family and group relationships.

This group deals with the causes, signs, symptoms, prevention, treatments and probable results of disease. The nurse is not expected to have a deep or thorough knowledge of the science of medicine or surgery. But she should be able to recognise the signs and symptoms of diseases and be familiar with the accepted remedial measures or treatment and some idea of the length of time the patient is likely to be ill in particular conditions.

In the nursing arts classes the student learns to apply the knowledge of the sciences gained through her studies. She learns to recognise the nursing needs of the patient and to develop skill through practice in various procedures designed to meet those needs. In the first part of her preparation, she is introduced to the fundamentals of nursing. With this preparation she is first assigned to give routine daily cares such as assisting the patient with all the body function like eating, elimination, bathing, regulating body temperature, protecting the body with clothing, sleeping, resting, moving and exercising. She also helps the person to provide for companionship, recreation and occupation. Working under the supervision of a competent graduate nurse, she is gradually able to assume more responsibility and perform more complicated nursing procedures for more seriously ill patient or the patients with social problems of increasing complexity. Through her work and study she becomes more experienced in caring for all types of diseases and injuries. Continuing her progress in nursing arts, she develops skill in doing the procedures in the special departments as paediatrics, psychiatry, etc. and gets her experience in that department under the supervision or guidance of persons with advanced education and experience in that particular field.

American nurses association defines the professional or registered nurse as one who has met all the requirements for registration in a state and who may practise nursing by virtue of her technical knowledge and practical ability. A professional nurse is the one who has received the maximum amount of education offered by a recognised and accredited school of nursing. Graduates of accredited schools may be licensed to practise nursing in schools, in industry, in private homes, in hospitals and in other institutions. In short a professional nurse is a graduate of a recognised nursing school who has met the requirements for enrolling as a “Registered Nurse” in a state, in which she is licensed to practise.

A curriculum guide for school of nursing lists thirteen characteristics of nurse. Mental and physical health, alertness, technical competence, dependability, ability to inspire confidence, resourcefulness, poise, consideration for others, co-operation, agreeableness, culture, satisfactions from work and professional responsibility.

The public expect a good ethical behaviour from every nurse which leads to a good relationship. The objective of good relationship is the welfare of the patient. Relationship of the nurse are reciprocal with the patient, the hospital and its workers, her nursing school and the nursing profession and the community with its social and health agencies. Besides these the nurse has certain duties and responsibilities to others and towards herself.

The success of the nursing service even in its simplest forms depends upon the personal relationship between the nurse and the patient. The patient expects the nurse to have scientific knowledge and the ability to apply it in many techniques. He expects her help to conserve and restore his strength. He expects the nurse to keep him comfortable and safe to relieve his pain and to carry out therapeutic measures with expert manual skill.

The physician expects the nurse to carry out his orders for treatment, to aid him in diagnostic procedures, to observe, to report and record accurately and to be loyal and co-operative.15

The family of the patient expects the nurse to report the patient's condition, to relieve their worry and strain and to teach them simple nursing and preventive measures.

The professional nurse owes herself to co-operate and uphold the standards and good name of her school and profession.

The nurse is a teacher of health. She gets many opportunities for teaching while she is at the bedside. The effectiveness of her teaching, depends upon the relationship and confidence of her patients upon her. The nurse speaks in terms the patient understands when she interprets the physician's orders, when she advises health points and when she demonstrates certain procedures. She can educate the patient and the relatives the laws of hygiene, sanitation and nutrition so that the regained health may be retained.

Any nurse who is junior to one should treat the senior with respect. Functioning of a ward is a team work and each member of the team is as important as the other. Nurse should co-operate and help each other when necessary.

A good relationship with the other workers of the wards and other departments of the hospital is essential for a better patient care. Even though the department and persons are different in the hospital, all are working for a common goal of the care of the patient. Nursing department is the coordinating link in the circle of patient care. So, nurse should co-operate with every worker. She must be decent and considerate.

Is the nursing superintendent or matron of the hospital. She has got the complete control and takes the responsibility of Nursing Staff of the hospital. Although she may appear as so strict and unapproachable, she is very much interested in the progress of every nurse. She has got a very vast experience in all types of nursing problems. Her relationship to the nursing staff and especially to the nursing students is that of a mother to the children. When she comes to the ward for supervision we have to greet her and report any important event about the patients as well as other matters.

She is responsible for the administration and supervision of the ward in which she is assigned. The junior nurses and students nurses of that ward are supervised by her. 16When the staff and students are posted in one ward they should report to the head nurse about their arrival and departure for duty and off duty. And during duty time all the staff and students should get the permission of the senior nurse to leave the ward even for a short time.

The nurse is a teacher of health to others and she should be example to others about her health and behaviour. She is responsible for maintaining her own health, for knowing the scientific background of her work, for developing desirable skills and attitudes, for providing some measures of economic security, for furthering her education by reading and attending professional meetings and for enriching her own personal life.

A professional nurse starts her nursing career as a nursing student. She gets her experiences in the hospital where different types of people are working for a common goal. After completing the prescribed course of study successfully she gets her registration from the state council (Kerala Nurse's and Midwive's Council) (K.N. and M.C.) and then she will be getting her post as staff nurse. After 12 years the next stage will be the post of a senior nurse or supervisory cadre. Among the supervisors the senior persons will get the posts of nursing superintendents or matrons. According to the bed strength of the hospital the number of nursing superintendents, senior nurses, junior nurses and nursing students may vary. Apart from the people of nursing profession, there will be technical and non-technical workers in the hospital team work other than doctors. They are also under the control of the nursing superintendent.

The fundamental core of nursing is the professional relationship that is established between the nurse and patient based on trust and mutual respect. The individual comes to the health agency for his health needs and the nurse and the other health professionals are to provide the needed help to him. To render such help the nurse should develop skill in communicating, since, without communication, no relationship is possible.

Communication involves both sending and receiving of a message. If a message is not received no communication has taken place.

These can be:

The usual forms of communications are:

Verbal communication means communication concerned merely with, either written or spoken. Listening, speaking, reading and writing, etc. are the means which communicate words from one person to another. An average person spends 70 per cent of his active time in communicating verbally. We spend about 10 to 11 hours everyday in verbal communication. Language is one of the code which we use frequently to express our ideas or emotions.

Formal communication is the communication according to the prescribed or fixed norms or rules or customs. It is regular or orderly in pattern. It is mostly unemotional and impersonal. For example: While greeting a person in the morning one may ask how are you? usually the answer will be fine. It is an unemotional formal communication

In mass communication, most of the time, the communication is over as soon as the message is given to the receiver. There is no way by which the sender will get instant return or feedback from the receiver, e.g. radio-talk.

Face to face interpersonal communication is direct and personal. The sender and receiver are in close-company to each other or are directly linked by the channel or communication. This is often two-way communication and the response is direct and immediate.

The word skill means expertness or great proficiency in doing something which comes from training and practice. Apart from knowledge and technical skills certain other skills are needed for communication.

They are:

Acquisition of such distinct social traits like courtesy, fact, friendliness, spokesmanship, etc. These traits are acquired by the individuals and by these traits, interpersonal relationship and adjustments, etc. are attained. It is not that, everyone possesses these traits. But there is room for improvement, if there are efforts on the part of the individuals to recognise these as essential social qualities. Human relation skills are not learned as such but are included during the formative stages of learning.

Means ability to listen others. It is an aural skill, and it requires alertness, attentiveness, inquisitiveness, etc. as essential qualities. One must listen well what is being said to him and recognise what tone connotes, what is the meaning of accompanying gestures, movement of the body, etc. Listening is not simply hearing. A good listener has to be a good observer.

To develop this skill, one must know the language and should have good vocabulary to clarify his thoughts which are expressed through writing. The words chosen should be simple but powerful to express the meaning correctly. Writing should be legible and devoid of ambiguity. The writing skill requires reading skill also. The tonal control, the pitch, etc. should be kept under control but audible. A touch of emotionally and concern should be there in writing and reading for an appeal but factual in all the cases.21

Drawing skill requires control of the hand movement and of fingers. Drawing should be simple with minimum of time and maximum of force in the line. There should be meaning and justification in selecting colours.

Regardless of where the nurse practises today and is engaged in independent practice, she function as a member of the health care team. The health team of today is composed of a variety of personals representing professional disciplines concerned with the health and welfare of people. Sometimes the team consists of only three members: the physician, the nurse and the patient. In others, there may be a dozen or more health professionals involved in the care of one individual, a family or a community. Each member of the team possesses knowledge and skills unique to his discipline, each one contributes his expertness to the care of the patient.

Health has been declared as the fundamental human right. This implies that the state has a responsibility for the health of its people. Government, allover the world are strictly adhere to expand to improve their health services.

23These five major sectors or Health agencies are the following:

Definition

A hospital is defined as an institution for the care of sick and injured. It is a community health agency because a person comes to the hospital from his section of community and return to it after the required hospital service.

Hospitals are classified in two ways:

According to the service offered, there are two groups:

According to the ownership, hospitals are divided into:

Government or public Hospital may be:

Nongovernment or Private Hospital may be:

In modern times, the chief functions of the hospital are doing the investigations, making diagnosis and giving care to the sick and injured persons. According to the condition of the patient, they are examined or the necessary investigations are done in the outpatient department for the diagnosis. Then they are treated either as an outpatient or inpatient. When the condition of the patient requires a detailed investigation or due to many other reasons, doctor advises the patient to stay as inpatient. In undiagnosed conditions—the patient may be admitted for observation only. For the care of the sick, the wards are of different types. According to the age of the patient, he is admitted in a general ward or paediatric ward. According to the type of disease, he may be admitted in a medical or surgical ward or in any special ward and according to the income and preference of the patient, he may select a general ward or payward.

The preventive aspects of medical work have been given so much emphasis in all aspects of medical practice, that, in hospitals and health centres are doing health supervision and preventive therapy. In the outpatient departments provisions are available for the routine health examinations and supervision of antenatal and postnatal mothers, health supervision and immunisation of sick and healthy children and other services to persons in normal conditions. Hospitals prevent the spread of diseases by isolating the patients with communicable disease and help to raise the standard of health in the community by health education. Hospital staff and other medical social workers render great services in dealing with the social problems and recurrence of psychiatric conditions and the adjustments of such persons in the community. Different types of home care is given to patients by community health programme. Modern hospitals extend their services in the community by arranging camps and clinics by specialised doctors and other health supervisors for the health supervision and prevention of diseases in the community, such as eye camps, detection of cancer, diabetic clinics, immunisation camps, family welfare programme camps, etc.

Doctors, nurses, dietitians, social workers, physical therapists, technicians, hospital administrators and other medical and paramedical people are taught within the hospital and much of what they must learn in order to practice their professions. The theoretical part of their learnings is conducted in an affiliated particular institution and they practise their knowledge in the actual situation of the hospital. Without hospitals or equivalent, it would be impossible to give an adequate preparation for almost any type of modern medical service, because such experiences are not available anywhere in the community other than a hospital or health clinic.

Hospitals offer medical workers opportunities for investigations by laboratory facilities, trained personals, patients and accumulation of records which are not available elsewhere. This research is thought to be such an important factor in the successful practise of medicine and the advancement of medical science. The modern trend is to establish a close association between the small rural hospitals and research centres and between all hospitals and other community health organisations in order that their personnel may have provision for an adequate research, diagnostic and therapeutic facilities. The large number of patient's and workers in these research centres and district hospital, should foster all kinds of medical research. The statistical side of the research works in the hospital help to evaluate the occurrence and prevalence of particular disease in locality or society and the health status of a country.27

Rehabilitation is an essential aspect of all health care and it is one of the functions of hospital. Helping a person to regain independence or restoration of a person to normal or near normal function during and after hospitalisation is considered as an integral part of nursing care. Rehabilitation involve the co-ordinated help of physicians, nurse, physical therapists, social workers, occupational counsellors and others. Such a comprehensive care restores each individual to his or her optimum physical, mental, social, vocational and economic usefulness. The modern concept of rehabilitation is only recently stated clearly and accepted generally.

The selection of site for a hospital is very important. If the plan is for a big hospital like medical college or district hospital, it should be in a place of large area. If possible it is better to select a place which is quiet with beautiful surroundings, away from the vicinity of town and free from air pollution by factories. The area should be wide and elevated enough. It should provide good light, ventilation, good water supply, facilities for drainage, accommodation facilities for essential staff, etc. Usually if it is a big hospital the town grow around the hospital soon, with all the institution to meet the basic needs of the public. There should be sufficient facilities of all types of transportation for the people.

Varieties of works are done in the hospital and they are carried out through different departments by trained and untrained people. If the work has to be carried out efficiently and harmoniously, all the departments have to be organised and managed well.

Medical section has various service within it: Medical, surgical, obstetrics, paediatrics, ENT, ophthalmology, dental, orthopaedics, gynaecology, urology, neurology, cardiology, communicable diseases and psychiatry. Doctors specialised in each fields are incharge of each section. According to the services and treatments given, certain, departments are designated as operation room, CSR, out patient department, emergency room, diet kitchen, X-ray, clinical laboratory and various special therapy departments.

Hospitals develop according to the health needs of the community. Every individual is an important fragment of a community. He comes to the hospital to meet his health needs. Modern hospitals serve as centres for meeting all health services of the members of the community. They are centres for health teaching also. In olden days, hospitals were rendering curative care of sick only. Now this trend has been changed. Hospitals provide all kind of medical and health services with various specialised branches and therapies as dental care, health education, medical education, paramedical education, community health services, etc. People get continuous health services even he is discharged from the hospital.

A team means a set of specially prepared persons working together for a common goal. Health team consists of particular group of health care professionals to provide total care for clients. In most practice settings, the nurse works with other members of the team. The involvement of many different persons in the client's health care have the risk of fragmenting care. Nurses have the greatest opportunity to interact with all the other professionals in the health care team. They co-ordinate and integrate various services within the care plan.

A physician is a professional who has earned a degree of Doctor of Medicine and has passed a licensing examination. Most physicians specialise their practice in medicine. Nurses work closely with physician under supervision or as co-workers.

Assistant physicians are junior doctors and they work under the direction of chief physicians in the hospital and clinic. Nurses work with them as they do with physician.

They are licensed to assist in the examination and treatments of clients in special ways such as physical, occupational, etc. Nurses collaborate with them and evaluate the work.

They are licensed to formulate and dispense drugs. They provide valuable informations to nurses about drugs, their uses and effects.

He is a member of the health team prescribes and manages to provide the nutritional needs of the client in consultation with the physician.

They are trained to counsel and refer clients to appropriate agencies. Nurses work with them to identify the best resources for the client.

Chaplains offer spiritual support and guidance to clients and their families. The client may request to chaplain about his spiritual need or the nurse many refer the client to the chaplain.32

In the hospital there is a nursing team for the care of patients. The team leader will be the nursing superintendent. She will delegate her responsibilities to the head nurses who are the team leaders of each ward. She is responsible for assigning duties to the other members of the team in the ward for the care of patients there.

The basic concept on holistic approach in nursing is the premise that an individual's health must be considered in terms of his total functioning. That is to say, man must be viewed as a whole, one cannot separate the physical, social and emotional aspects of his health. This concept is frequently referred to as the holistic approach to health care. As another one has stated. “Basic to the discussion of measuring, health is the functioning of the individual in terms of his family, his work, his recretion and his position in society........”. The real measure of health is the ability of the individual to function in manner acceptable to himself and to the group which he is a part.

Comprehensive nursing care has been defined as the care that is provided to the patient according to his needs in an appropriate, continuous and dynamic pattern. Accommodating the plan of care to the patient is the essence of comprehensive care. Helping the patient and his family to help themselves is an integral part of nursing. The present trend in nursing is to shift the emphasis from the disease centered model to attending the total care of the patient. The total care of the patient will include the physical, psychological, spiritual, social, economical and intellectual needs of the patient and to certain extend his relatives also.

Reduction of premature death, disease, disability, discomfort, delinquency and disruption. Such a care needs to be complete, competent, continuous, coordinated and compassionate for the individual and his family.

It includes the following: