Nursing Education BT Basavanthappa
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Introduction to Nursing ProfessionCHAPTER 1

Nursing has a fascinating history that parallels the history of human kind. For, as long as there has been life, so has there been the need to seek care and comfort from illness and injury. “From the dawn of civilization, evidence prevails to support the premise, that nurturing has been essential to the preservation of life. Survival of the human race, therefore, is inextricably intertwined with the development of nursing”. The nursing has been called the oldest of the arts and youngest of the professions”. The word ‘nurse’ evolved from the Latin word nutritious which means “nourishing”. The roots of medicine and nursing are intertwined and found in mythology, ancient cultures, religion and reasoned thinking. In looking at the historical development of nursing as a profession, time to time socio-cultural changes have shaped the profession of nursing.
Nursing today is far different from nursing as it was practiced 50 years ago, and it takes a vivid imagination to envision how the nursing profession will change in the next 50 years in an ever-changing world. To comprehend present day nursing and at the same time prepare for nursing in tomorrow's world, one must understand not only past events but also contemporary nursing practice and the sociologic factors affecting it.
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 trained in the care of the sick.
Virginia Henderson was one of the first modern nurses to define nursing. In 1960, she wrote, “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 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”. Like Nightingale, Henderson described nursing in relation to the client and the client's environment. Unlike Nightingale, Henderson saw the nurse as concerned with both well and ill individuals, acknowledged that nurses interact with clients even when recovery may not be feasible, and mentioned the teaching and advocacy roles of the nurse.
In the latter half of the 20th century, a number of nurse theorists developed their own views of nursing. Certain themes are common to many of these definitions: that nursing is caring, adaptive, individualized, holistic, family and community-interrelated; that it involves teaching and direct/indirect services; and that it is a science as well as an art concerned with health promotion, health maintenance, health restoration, and the care of the dying. For definitions of nursing by selected nurse theorists are shown in Table 1.1.
Professional nursing associations have also examined nursing and developed their definitions of nursing describes nursing practice as “direct, goal oriented, and adaptable to the needs of the individual, the family, and community during health and illness”. There is one scope of clinical nursing practice. The core, or essence, of that practice is the nursing diagnosis an treatment of human responses to health and to illness”. The new statement further describes the differences between professional and technical nurses: The depth and breadth to which the individual nurse engages in the total scope of the clinical practice of nursing are defined by the knowledge base of the nurse, the role of the nurse, and the nature of the client population within a practice environment”.2
TABLE 1.1   Definitions and descriptions of nursing
Nursing Theorist and Theory
Hildegard Peplau (1952): Psychodynamic nursing
Nursing is a therapeutic, interpersonal process. It functions cooperatively with other human processes that make health possible for people in communities. An educative instrument, a maturing force that aims to promote forward movement of the personality in the direction of creative, constructive, productive, personal, and community living.
Faye Abdellah (1960): Twenty-one nursing problems
Nursing is a service to individuals and families; therefore, to society. An art and science that molds the attitudes, intellectual competencies, and technical skills of the individual nurse into the desire and ability to help people, sick or well, cope with their health needs. May be carried out under general or specific medical direction.
Virgina Henderson (1960): Fourteen basic needs
Nursing is the unique function of the nurse: to assist clients, sick or well, in the performance of those activities contributing to health, its recovery, or peaceful death that clients would perform unaided if they had the necessary strength, will, or knowledge. Also, to do so in such a way as to help clients gain independence as rapidly as possible.
Martha Rogers (1971, 1981): Unitary human beings, an energy field
Nursing is a humanistic science dedicated to compassionate concern with maintaining and promoting health, preventing illness, and caring for and rehabilitating the sick and disabled. Nursing seeks to promote symphonic interaction between the environment and the person, to strengthen the coherence and integrity of the human beings, and to direct and redirect patterns of interaction between the person and the environment for the realization of maximum health potential.
Imogene King (1971, 1981): Goal attainment theory
Nursing is a helping profession that assists individuals and groups in society to attain, maintain, and restore health. If this is not possible, nurses help individuals die with dignity. Nursing is perceiving, thinking, relating, judging, and acting vis-a-vis the behavior of individuals who come to a nursing situation. A nursing situation is the immediate environment, spatial and temporal reality, in which nurse and client establish a relationship to cope with health states and adjust to changes in activities of daily living if the situation demands adjustment. It is an interpersonal process of action, reaction, interaction, and transaction whereby nurse and client share information about their perceptions in the nursing situation.
Dorothea Orem (1971, 1980, 1985): Self-care theory
Nursing is a helping or assisting to persons who are wholly or partly dependent infants, children, and adults - when they, their parents, guardians, or other adults responsible for their care are no longer able to give or supervise their care. A creative effort of one human being to help another human being. Nursing is deliberate action, a function of the practical intelligence of nurses, and action to bring about humanely desirable conditions in persons and their environments. It is distinguished from other human services and other forms of care by its focus on human beings.
Myra Levine (1973): Four conservation principles
Nursing is a human interaction; a discipline rooted in the organic dependency of the individual on relationships with other human beings. A subculture reflecting ideas and values unique to nurses, even mirror the social template that created them.
Sister Callista Roy (1976, 1984): Adaptation theory
Nursing is a theoretical system of knowledge that prescribes a process of analysis and action related to the care of the ill or potentially ill person. As a science, nursing is a developing system of knowledge about persons used to observe, classify, and relate the processes by which persons positively affect their health status. As a practice discipline, nursing's scientific body of knowledge is used to provide an essential service to people, that is, to promote ability to affect health positively.
Jean Watson (1979, 1985): Science of caring
Nursing is concerned with promoting and restoring health and preventing illness. Caring is a nursing term representing all the factors the nurse uses to deliver health care to the client. In contrast, curing is a medical term that refers to the elimination of diseases.
Dorothy E. Johnson (1980): Behavioral system theory
Nursing is an external regulatory force that acts to preserve to organization and integration of the client's behavior at an optimal level under those conditions in which the behavior constitutes a threat to physical or social health in which illness is found.
Rosemarie Rizzo Parse (1981): Man-Living-Health
Nursing is a human science that focuses on man as a living unity and man's qualitative participation with health experiences. The responsibility to society relative to nursing practice is guiding the choosing of possibilities in the changing health process. Nursing practice is directed toward illuminating and mobilizing family interrelationships in light of the meaning assigned to health and its possibilities as language in the co-created pattern of relating.
Bette Neuman (1982): Systems theory
Nursing is a unique profession in that it is concerned with all of the variables affecting an individuals response to stressors, which are intra-, inter-, and extrapersonal in nature. The concern of nursing is to prevent stress invasion, or, following stress invasion, to protect the client's basic structure and obtain or maintain a maximum level of wellness. The nurse helps the client, through primary, secondary, and tertiary prevention modes, to adjust to environmental stressors and maintain client system stability.
Madeleine Leininger (1984): Transcultural care theory
Nursing is a learned humanistic and science that focuses on personalized (individual and group) care behaviors, functions, and processes directed toward promoting and maintaining health behaviors or recovery from illness. Behaviors have physical, psychocultural, and social significance or meaning for those being assisted generally by a professional nurse or one with similar role competencies.
“Nursing” or “the practice of nursing” means the identification and treatment of human responses to actual or potential health problems and includes the practice of and supervision of functions and services that, directly or indirectly, in collaboration with a client or providers of health care other than nurses, have as their objectives the promotion of health, prevention of illness, alleviation of suffering, restoration of health and optimum development of health potential and includes all aspects of the nursing process.
Growth of Professionalism
Profession is defined as “a vocation requiring advanced training and usually involving mental rather than manual work, as teaching, engineering, especially medicine, law or theology” (Webster 1989). Abraham Flexner (1910) conducted study of medical education and went on to study other disciplines and later, in a paper about social work published a list of criteria that he felt were characteristics of all true professions. Flexner's believed in professional work:
  • Is basically intellectual (as opposed to physical).
  • Is based on a body of knowledge that can be learned.
  • Is practical rather than theoretical.
  • Can be taught through a process of professional education.
  • Has a strong internal organization of members.
  • Has practitioners who are motivated by altruism (the desire to help others).
The profession of nursing has evolved over centuries. The traditional nursing role was one of humanistic caring, nurturing, comforting and supporting. To these must be added specific characteristics of true professionalism, including education, a code of ethics, mastery of a craft, an informed membership involved in the organized profession, and accountability for actions.
There are a number of ways to differentiate a profession from an occupation. A profession is a calling that requires special knowledge, skill, and preparation. Medicine and law have consistently been recognized as learned professions. The terms vocation and occupation are often used synonymously. A vocation is the work that a person regularly performs or the work that especially suits him or her. An occupation is an activity in which one engages, e.g., a business. Thus, an occupation does not necessarily hold a special interest for the person and may be temporary, whereas a vocation often denotes employment in an area of interest on a regular basis.
A profession is generally distinguished from other kinds of occupations by (a) its requirement of prolonged, specialized training to acquire a body of knowledge pertinent to the role to be performed (b) an orientation of the individual toward service, either to a community or to an organization. The standards of education and practice for the profession are determined by the members of the profession, rather than by outsiders. The education of the professional involves a complete socialization process, more far-reaching in its social and attitudinal aspects and its technical features than is usually required in other kinds of occupations. In 1915, Abraham Flexner stated that professions are organized primarily for the achievement of 4social ends and secondarily for the assertion of rights and the protection of special interests.
Styles (1983) writes that nursing organizations must perform the following five functions for the preservation and development of the profession:
  1. Professional definition and regulation through the setting and enforcing of standards of education and practice for the generalist and the specialist. Regulation is also achieved through the adoption of codes of ethics and norms of conduct
  2. Development of the knowledge base for practice in its broadest and narrowest components. Major contributions to the development of nursing knowledge have been made by various theorists. The primary purpose of nursing theories is to generate nursing knowledge. The challenge for nurses in the future is to generate questions and formulate hypotheses from these published theories and then test the hypotheses through nursing research. Since only research can determine the usefulness of a theory, research makes a major contribution to the development of nursing knowledge. Another significant contribution to nursing knowledge is the work of the North American Diagnosis Association. This group is generating and expanding a taxonomy of nursing diagnoses. Research is required to determine the validity and reliability of these diagnosis.
  3. Treatment of values, norms, knowledge, and skill to neophytes and members of the profession for application in practice. This function is largely performed through the education of nurses and the socialization processes. Socialization is the development in the individual of those qualities (skills, beliefs, habits, requirements) necessary to belong to and function in a group.
  4. Communication and advocacy of the values and contributions of the field to several publics and constituencies. This function requires that nursing organizations speak for nurses from a position of broad agreement. It is essential of health legislation and policy.
  5. Attendance to the social and general welfare of their members. This function is carried out by the professional nursing organizations of the country. Professional associations give their members social and moral support to perform their roles as professionals and to cope with their professional problems through Associations journals, for example, disseminate updated knowledge, new ideas, and professional concerns. By participating in the collective bargaining process, nurse can improve their economic and working conditions.
In 1970, Moore and Rosenblum identified six elements of a profession. A profession should (a) have a systematic theory, (b) exert authority, (c) command prestige, (d) have a code of ethics, (e) have a professinal culture, and (f) be the major source of income by those who practice it.
Kramer (1974) identified the following characteristics of a profession:
  • Specialized competence having an intellectual component.
  • Extensive autonomy in exercising this special competence.
  • Strong commitment to a career based on special competence.
  • Influence and responsibility in the use of special competence.
  • Development of training facilities that are controlled by the professional group.
  • Decision-making governed by the internalized standards.
Miller (1985) stated that the critical attributes of professionalism in nursing are the following:
  • Gaining a body of knowledge in a university setting and a science orientation at the graduate level in nursing.
  • Attaining competencies derived from the theoretical base wherein the “diagnosis and the treatment of human responses to actual or potential health problems” can be accomplished.
  • Delineating and specifying the skills and competencies that are the boundaries of expertise.
In summary, the growth of professionalism in nursing can be viewed in relation to specialized education, knowledge base, ethics, and autonomy.
Professional Behaviors of Nurses
Miller (1985) states that the degree to which a nurse behaves as a professional is reflected in the following five behaviors. The professional:
  1. Assesses, plans, implements, and evaluates theory, research, and practice in nursing. This behaviors are reflected in the entire nursing process.
  2. Accepts, promotes, and maintains the interdependence of theory, research, and practice. These three elements make nursing a profession and not task centered activity.
  3. Communicates and disseminates theoretical knowledge, and research findings to the nursing community. Professionalism must be demonstrated by supporting, counseling, and assisting other nurses.
  4. Upholds the service orientation differentiates nursing in the eyes of the public. This orientation differentiates nursing from an occupation pursued primarily for profit. Many consider altruism the hallmark of a profession. Nursing has a tradition of service to others. 5This service, however, must be guided by certain rules, policies, or a code of ethics. The nursing code of ethics is formulated by national nursing associations. In addition, society is protected by licensure and certification of nurses. These self-regulatory provisions give nurses the autonomy to function in the public's best interests rather than in the best interests of an institution or other profession.
  5. Preserves and promotes the professional organization as the major referent. Operation under the umbrella of professional organization differentiates a profession from an occupation.
Genevieve and Roy Bixler, a husband and wife team of non-nurses who were nevertheless advocates and supporters of nursing, first wrote about the status of nursing as a profession in 1945. In 1959, they appraised nursing according to their original seven criteria, noting the progress made in nursing, as profession. Their criteria included the following:
  1. A profession utilizes in its practice a well-defined and well-organized body of specialized knowledge, which is on the intellectual level of the higher learning.
  2. A profession constantly enlarges the body of knowledge, it uses and improves its techniques of education and service by the use of the scientific method.
  3. A profession entrusts the education of its practitioners to institutions of higher education.
  4. A profession applies its body of knowledge in practical services which are vital to human and social welfare.
  5. A profession functions autonomously in the formation of professional policy and the control of professional activity thereby.
  6. A profession attracts individuals of intellectual and personal qualities who exalt service above personal gain and who recognize their chosen occupation as a life work.
  7. A profession strives to compensate its practitioners by providing freedom of action, opportunity for continuous professional growth and economic security.
A profession is different from an occupation in its preparation and commitment.
  1. Professional preparation: An usually takes place in a college or university setting. Preparation is prolonged in order to include instruction in the specialized body of knowledge and techniques of the profession. Professional preparation includes more than knowledge and skill; however, it also includes orientation to the beliefs, values and attitudes expected by the members of the profession. Standards of practice and ethical considerations are part of the process of socialization into a profession.
  2. Professional commitment: To their profession is strong. They derive their personal identifications from their work and consider it an integral part of their lives. People engage in a profession often consider it their “calling” usually they will not change professions.
Kelly L (1981) reiterated and expanded Flexner's criteria of profession as follows:
  1. The services provided are vital to humanity and the welfare of society.
  2. There is a special body of knowledge which is continually enlarged through research.
  3. The services involve, intellectual activities, individual responsibility (accountability) is a strong feature.
  4. Practitioners are educated in institutions of higher learning.
  5. Practitioners are relatively independent and control their own policies and activities (autonomy).
  6. Practitioners are motivated by service (altruism) and consider their work as an important component of their lives.
  7. There is a code of ethics to guide the decisions and conduct of practitioners.
  8. There is an organization (association) which encourages and supports high standards of practice.
Let us examine how well contemporary nursing fulfills these criteria:
  1. “The services provided are vital to humanity and the welfare of society”: If 10 students were asked why they chose nursing, most would reply. “To help people”. Certainly nursing is a service that is essential to the well-being of people an to society as a whole. Nursing promotes the maintenance and restoration of health of individuals, groups, and communities. Assisting others to attain the highest level of wellness of which they are capable is the goal of nursing. Caring, meaning nurturing and helping others, is a basic component of professional nursing.
  2. “There is a special body of knowledge which is continually enlarged through research”: In the past, nursing was based on principles borrowed from the physical and social sciences and other disciplines. Today, however, there is a body of knowledge that is uniquely nursing's. While this was not always so, the amount of investigation and analysis of nursing care 6has expanded rapidly in the past 50 longer based on task orientation, intuition, or trial and error but increasingly relies on research as a basis for practice.
  3. “The services involve intellectual activities; individual responsibility (accountability) is a strong feature”: Nursing has developed and refined its own unique approach to practice, called the nursing process. The nursing process is essentially a cognitive (mental) activity that requires both critical and creative thinking and serves as the basis for providing nursing care.
    Individual accountability in nursing has become the hallmark of practice. Accountability is “being answerable to someone for something one has done. It means providing an explanation to self, to the client, to the employing agency, and to the nursing profession”. Organized nursing has also demonstrated a commitment to accountability in the Standards of Nursing Practice. Through legal opinions and court cases, society has demonstrated that it, too, holds nurses individually responsible for their actions as well as for those of personnel under their supervision.
  4. “Practitioners are educated in institutions of higher learning”: Now all nursing education to take place in institutions of higher education. The majority of programs offering basic nursing education are now degree and baccalaureate programs located in colleges and universities. There are master's and doctoral programs in nursing, although the number of graduates is small compared with other health professions. Since professional status and power increase with postgraduate education, a legitimate question is, “How can nursing take its place as a peer among the professions when most nurses currently in practice hold less than a baccalaureate degree?” The differentiation between professional nursing and technical nursing is a challenging issue that nursing has not yet resolved. Diversity within the ranks of nursing has slowed the progress toward acceptance of the baccalaureate or higher degree as the prerequisite for professional practice. Lack of resolution of these differences threatens to undermine nursing's development as a profession.
  5. “Practitioners are relatively independent and control their own policies and activities (autonomy)”: Autonomy, or control over one's practice, is another controversial area of nursing. While many nursing actions are independent, most nurses are employed in organizations where authority resides in one's position. One's place in the hierarchy, rather than expertise, confers or denies power and status. Physicians are widely regarded as gatekeepers, and their authorization or supervision is required before many activities can occur. Nurse practice acts in most states reinforce nursing's lack of self-determination by requiring that nurses perform certain actions only when authorized by supervising physicians or hospital protocols.
    There are atleast three groups who wish to control nursing practice: organized medicine, health service administration, and organized nursing. Both the medical profession and health service administration are attempting to maintain control of nursing because they believe it is in their best interest to keep nurses dependent on them. Both are well organized and have powerful lobbies at state and national levels. Organized nursing, on the other hand, promotes independence and autonomy, but its power is fragmented by subgroups and dissension. Rivalry between diploma-educated, degree-educated, and baccalaureing organizations, and competition among them also diminish nursing's potential. The fact that most nurses are not members of any professional organization impairs nursing's ability to lobby effectively. These are major challenges for nursing if it is to realize its potential collective professional power and autonomy.
  6. “Practitioners are motivated by service (altruism) and consider their work an important component of their lives”: As a group, nurses are dedicated to the ideal of service to others, which is also known as altruism. This ideal has sometimes become intertwined with economic issues and historically has been exploited by employers of nurses. No one questions the right of other professionals to charge reasonable fees for the services they render; when nurses want higher salaries, however, others sometimes call their altruism into question. Nurses must take responsibility for their own financial well-being and for the health of the profession. This will, in turn, assure its continued attractiveness to those who might choose nursing as a career. If there are to be adequate numbers of nurses to meet society's needs, salaries must be comparable with those in competing occupations. Being concerned with salary issues does nothing to diminish a nurse.
    Another issue, consideration of work as a primary component of life, has been a thornier problem for nurses. Commitment to a career is not a value equally shared by all nurses. Some still regard nursing as a job and drop in and out of practice depending on economic and family needs. This approach, while appealing to many nurses and conducive to traditional family management, has retarded the development of 7professional attitudes and behaviors for the profession as a whole.
  7. “There is a code of ethics to guide the decisions and conduct of practitioners”: An ethical code does not stipulate how an individual should act in a specific situation; rather, it provides professional standards and a framework for decision making. The trust placed in the nursing profession by the public requires that nurses act with integrity. To aid them in doing so, both the International Council of Nurses (ICN) and the ANA have established codes of nursing ethics through which standards of practice are established, promoted, and refined.
  8. “There is an organization (association) which encourages and supports high standards of practice”: Nursing has a number of professional associations that were formed to promote the improvement of the profession. Foremost among these is the ANA, the purposes of which are to foster high standards of nursing practice, promote professional and educational advancement of nurses, and promote the welfare of nurses to the end that all people have better nursing care. The association is also the official voice of nursing and therefore is the primary advocate for nursing interests in general. Unfortunately, fewer than one out of ten nurses belong to the official professional organization. The political power that could be derived from the unified efforts of million registered nurses nationwide would be impressive; that goal has not yet been realized.
Now, nursing has several characteristics of true profession, which include a body of knowledge, specialized education, service to society, accountability, autonomy, code of ethics, professional association and organization. Although, nursing has the more brief history than that of some traditional professions and is still dealing with autonomy, preparation and commitment issues, great progress has been made in moving nursing toward full professional status. An awareness of the characteristics of professions and professional behavior will help nurses assume leadership in continuing that progress. It is important to remember that being a professional is a dynamic process, and not a condition or state of being. Professional growth evolves throughout the different stages of nurses careers.
Nursing leaders, armed with early studies of nursing education, wanted nursing education to move into the mainstream of higher education, that is, into colleges and universities, where other professionals are educated. Their belief was that nurses needed the baccalaureate degree to qualify nursing as a recognized profession and to provide leadership for administration, teaching, and public health nursing. Now, also it has been believed that education for all those who are licensed to practice nursing should take place in institutions of higher learning. The minimum preparation for beginning professional practice should be baccalaureate education in nursing, and the minimum preparation for beginning technical nursing practice should be “diploma in nursing”.
Today, baccalaureate programme provides education for both basic students who are preparing for licensure and those registered nurses returning to college to obtain a bachelor of science in nursing (B.Sc Nursing—Post certificate).
A variety of economic, educational, and professional trends are fueling the demand for registered nurses, with advanced degrees. The rapidly changing healthcare delivery system requires nurses to possess increasing knowledge, clinical competency, greater independence, and autonomy in clinical judgments. Trends toward community-based nursing centers, private care management, complexity of home care, increasingly sophisticated technologies and society's orientation to health and self-care are all rapidly raising the educational needs for nurses. Nurses who have advanced education (i.e. M.Sc Nursing/MN/M Phil/PhD in Nursing) can become researcher, nurse practitioners, clinical specialists, educators and administrators. It has been reported both masters and doctoral students are expected to achieve higher status, profession growth/knowledge/skill, autonomy in practice, increased self-esteem, and a sense of personal achievement as a result of their additional education. Certainly, having highly educated nurses will further strengthen the profession.
Nursing is a discipline, a career, rich in opportunities and variety. Entering the nursing profession gives one an enormous homes, hospitals, nursing homes, industries, doctors offices, health centers, private practices, schools, colleges, universities, government agencies, professional associations and insurance companies, etc. Education for nurses is as varied as working settings, certificate courses like ANM and LHV courses, diploma course like GNM course and degree courses or baccalaureate courses like B.Sc nursing, both basic degree of 4 years and post-certificate or post-basic degree of 2 years, the master's courses like MN, MSc N, M Phil and also PhD degree. Like this in nursing education, many courses are available from certificate to diploma and diploma to degree and also degree to master and doctoral degrees. There will be opportunities 8for most nurses to stay in nursing and change jobs several times over the course of their professional career, as challenged by their jobs. For example, many staff nurses return to school or college to get advanced degrees and more knowledge that will help them make the needed reforms and their work settings. Many nurses who intend to go on for advanced degrees become specialized in clinical areas of practice as opted by them.
Modern nursing was initiated and developed within the framework of hospital reform, but gradually it has been recognized that the potential scope of nursing service exceeded the kind and amount of knowledge that nurses possessed. Perhaps the most important new influence in health care delivery has been suggested need for change from a sickness to a health orientation in the service offered to community. Other major influence include economic constraints, which demand greater accountability for use of resources in healthcare, and increasing consumer involvement, both in planning and implementation of healthcare. In the light of these occurrences, nursing needs to clarify its stance on professionalism, since both preparation of nurses and methods of delivering nursing care are dependent to a large degree on where nursing sees itself in relation to this issue, i.e. is the art of nursing to be fostered or can it be content with being skilled practitioners? Does nursing needs professionals or nursing technicians sufficient to meet the requirement of nursing?
So, there is a need for skilled practitioners in nursing, but then such persons require specific preparation which is less broader than, and possibly different from that required by the professional nurse. The purpose of professional education is to provide the knowledge and tools whereby an individual may become an artist in his field. The problem is to describe the art sufficiently to define the knowledge and tools necessary to achieve it without imposing constraints which would restrict the creativity from which new art is born. The preparation of the professional must go beyond the teaching of skills and educate in a much broader sense to encourage development of the art of nursing.
In India, there are four main purposes of nursing education, which include:
  • Development of democratic citizenship
  • Improvement of vocational efficiency
  • Development of personality, and
  • Development of the qualities of leadership
The development of democratic citizenship: This means that the educational system must make its contribution to the development of habits, attitudes and qualities, character which will enable the citizens to bear worthily the responsibilities of democratic citizenship and to counteract all those fissure tendencies which hinder the emergence of a broad, national and secular outlook. A democratic citizen is required to develop many qualities—intellectual, social and moral.
Improvement of vocational efficiency: This means that to increase the productive or technical and vocational efficiency of our students, which includes the following:
  • Creating new attitude to work—an attitude that implies an appreciation of the dignity of all work, however ‘lovely’.
  • Making the students to realize that self fulfillment and national prosperity are only possible through work in which every one must participate and a conviction that when our educated men take any place of work in hand, they will try to complete it as efficiently and artistically as their powers permit.
  • Making attempts by all the teachers to ensure that such an attitude on the part of the students find expression in every activity of the school or college of Nursing.
  • Making attempts by all the teachers to ensure that such an attitude on the part of the students find expression in every activity of the school or college of Nursing.
  • Promotion of technical skills and efficiency at all stages of education so as to provide trained and efficient personnel to work out schemes of industrial and technological advancement in all the fields.
Development of personality: This includes the following:
  • Releasing the sources of creative energy in the students, so that they may be able to appreciate their cultural heritage.
  • Cultivating rich interests, which they pursue in their leisure and contribute, in later life, to the development of the heritage.
  • Giving a place of honor in the curriculum to the subjects like art, craft, music, dancing and the development of hobbies.
Nursing is a highly developed art, its practice is widespread in many localities. Today, the trained nurse is used to differentiate persons with basic vocational for nursing. There is need to improve the vocational efficiency in nursing to have real professional status for nursing. Since it has become recognized as a ‘profession’ by World Health Organization.9
Development of the qualities of leadership: This is an important aim of education, for the successful functioning of our democracy. Education must train our students for discharging their duties efficiently. They must be trained in the art of “leading” and “following” others. Our nursing education must train persons who will be able to assume the responsibility of leadership in social, political, industrial or cultural fields in their own small groups of community or locality.
Education for leadership calls for a higher standard of education, a deeper and clearer understanding of social issues and greater technical efficiency. Certain assumptions should be considered in any discussion of leadership in nursing which includes the following:
  • Nursing is viewed as an interpersonal process. It involves an encounter between nurse and client with the expressed purpose of fostering maximum well-being on the part of the client. Whether the client as an individual, a family or groups of individuals or families. Where recovery from illness is impossible, the nurse strives to add a dimension of comfort, compassion and care until life ends.
  • Leadership in nursing can be deliberately prepared. No particular combination or collection of traits and personality characteristics have been identified for leaders, which, in fact, are not found in the general population of persons who are not leaders. There seems to be a strong indication that the leadership process can be learned, therefore, the discourse presented on nursing leadership is expected to serve as a framework for the development of nursing leaders.
  • A shortage of nursing leadership behavior exists at the present time. Nurses have been known to ponder the few valiant leaders, who made impact on nursing in the past and are concerned that these types of individuals are not heard today. Atleast part of the reason for this lack can be attributed to the increased complexity of nursing today, so that few individuals have the opportunity to make a direct impact. Nursing leadership at the present time is much more diffuse than in earlier eras.
The only way to ensure that nursing will have the leaders it needs, is to prepare them, deliberately. Expecting leaders to develop spontaneously or to emerge automatically is unrealistic. The expectations and mechanisms for the preparation of nurse leaders already exist in nursing. Graduates, of baccalaureate and masters degree programme in nursing are expected to be leaders. However, this expectation, although clear, does not ensure that leaders will be prepared. A well though-out description of the behavioral expectation for the development of nursing leadership for each step in the academic preparation of nurses at the baccalaureate and master's degree levels must be determined. The need to prepare deliberately required leaders has long been encouraged by researcher, authors and thoughtful citizens across the nation. There seems to be strong evidence that a demonstration of leadership behavior in nursing school and college tends to predict leadership in adult life. Also there is strong evidence to support the concern that leadership is transferable from one situation to another.
Nursing must plan for and develop leaders by deliberately selecting persons who can be encouraged to develop their minds and to require sufficient nursing knowledge and wisdom so that their colleagues grant them the privilege of charting the course of the profession of nursing. Special effort should be made to identify these intellectually oriented, capable students early their college careers, preferably in the freshman year. Their specific arrangements should be made to involve them in the academic life of the university and to support and nurture them in their professionalization as well as to develop their leadership potential. It may be necessary to design individually tailored programs and to provide guidance services to help maintain interest, a willingness to serve, and a desire to pursue a leadership role.
Nursing has far too long been guilty of promoting conformists and of being punitive to those who are innovative and creative. The field suffers from a death of persons whose motivations and discoveries have visualized the profession. The demonstration of real leadership in nursing will come when those who are new leaders in the field identify, foster, and promote the deliberate preparation of their successor. A major task of nursing leaders today is the identification and development of nurse leaders who will vitalize society and a significant component of the society nursing.
The nurses can readily identify their role as provider, but the pragmatic bias in nursing establishes conditions which severely limit the freedom of creative behavior. Although, nursing is changing and will continue to change, there will probably always be some manual technical competent to the act of helping people get well and stay well. Nurses now face and will continue to face public that demands skill—physicians, patients, and hospital administration. 10Patients and physician tend to describe nurses primarily in terms of manual activities, they will probably continue to do so until they have experienced the kind of care that focuses on the patient as a person and consists of assessments, plans and actions that will make a difference in the patient's progress and well-being. Now it has come to a recognition that one cannot dichotomize nursing practice from nursing education. A scientific approach seems necessary for nursing. With development of a sound theoretical base being essential for public safety and the fulfillment of nurisng's obligation to a society.
Here, science is not seen to preclude art, but it is suggested that creative changes in nursing can come only from a strong intellectual base with a marriage of art and science. As applied to nursing, the art is concerned with the design provision and management of systems of therapeutic care for persons who need such care for health reasons. This art has an intellectual aspect—the discernment of and planning for what can and should be done. It also has a practical aspect—the giving of care and the overcoming of obstacle to care. Imagination, creativity, lateral as well as vertical thinking and innovations are all factors directly relevant to the art of nursing and especially to progress in this area.
There is a need for many education to reconceptualize the role of art in nursing, so that the art is at the core of the nursing curriculum and the heart of the educational experience. When learning in an environment which foster's creative thought, learners are able to maintain relevance with their own needs and purposes by expressing their new or altered concepts in their own fashion that is to say artistically. If education is recognized as a personal experience, then releasing personal potential is in essence what education is all about. The purpose of nursing is to assist man in moving as far as possible in the direction of maximum health. There is an immediate issue area here, because health is an abstract concept, yet nursing actions applied to meet health needs are often practical, more concrete different levels of phenomena and encourage growth of knowledge about health if the practice of nursing is to meet its primary purposes. One means of fostering the intellectual aspects of the art of nursing is to be found in the development and identification of a substantial organized body of theoretical knowledge fundamental to nursing.
Professional nursing education must be grounded in the health situation prevailing in the particular country and sound nursing research finding. It is the national health status—health needs and available resources—which forms the basis for planning national health strategies, or major component of which comprises the healthcare system. Professional nursing education, rather than passing an information, must demonstrate to students how to use resources for gaining new knowledge, and how to implement research studies relevant to their practice so that this can be validated and improved, and knowledge gained and shared. In so doing, it will create a climate conducive to the development of the art of nursing and to ensuring the continued relevance of nursing as a profession.
Healthcare personnel, of which “nursing” is usually the largest group, is developed to meet the requirement of the healthcare system for meeting the health needs of the populations.
Planning for nursing education may for the education for other health and development professionals, also take into account the characteristic of society as a whole, those characteristics of the recipients of healthcare which affect the healthcare needs or their ability to benefit from health services, and characteristics of the potential students in the particular educational programs.
Nursing education is the “production aspect” of nursing manpower development, and is coordinated with planning and management aspects of nursing manpower. Nursing education is also coordinated with the education of professionals in allied sectors of health and development.
National health strategies, together with health manpower development plans, determine the tasks and functions for which nurses are to be responsible, these form the basis for nursing education. The elaboration of nursing tasks and functions in any nations healthcare system require consultation among nurse-educators, nurse-administration, health planners community health nurses, community representatives and nursing students. Competence profiles (or concise outline of suitable skills and qualifications needed to perform functions) are developed on these functions. They serve as a basis for developing explicit learning or educational objectives. Such educational objectives are the first step in the educational process and are key to ensuring the relevance of the educational programs.
There is a need for far-reaching changes in attitudes, knowledge base, and skills for nurses and for commensurate changes in nursing education must be grounded in the health situation of the country and be planned, implemented and evaluated by nurses, in accordance with planning and managing nursing manpower. Although, the competencies required for nurses determined by national healthcare strategy and health manpower development 11plans, to effect the necessary changes, nurses must be involved in planning and policy making at all levels, and complete autonomy is essential for nurse educator to develop their own curriculum for various nursing courses at all levels which includes required competencies for nurses. The curriculum is the learning activities that are designed to achieve specific educational goals.
The curriculum development should be developed not only to meet the demands of the required competencies but also to form attitudes of social consciousness and develop such abilities as multidisciplinary problem solving and team leading, among others. Curriculum development should take into account the material and skills which must be mastered as well as the most appropriate teaching-learning methods, relevant experimental learning and evaluation of attitudes and abilities as well as of mastery of content and skill.
To provide such type of nursing education, all nurses who take up higher education in nursing must understand the concepts and components of education and integrate them into the nursing education and to be competent enough to handle or comprehend the subject of nursing education to produce nurse teachers, which in turn to produce required suitable nursing manpower to serve the humanity at highest level and increase the good image of the noble profession, i.e. nursing.
The concept of education is like a diamond which appears to be of a different color (nature) when seen from different angles-points of view of philosophy of life. Our ancient Indian thinkers, thought that vidya or “knowledge” or “learning” or “education” was considered the ‘third eye’ of man, which gives him an insight into all affairs and teaches him how to act; it leads us to our salvation; in the mundane sphere, it leads us to all round progress and prosperity. The illumination given to us by vidya shatters illusion, removes difficulties and enables us to realize the true value of life. The correct insight, which persons get from vidya, naturally increases their intelligence, power and efficiency. The advantages of vidya are too diverse to be enumerated exhaustively; it nourishes us like the mother; directs us to the proper ways of life like the father, and gives us delight and comfort like the wife. Education in ancient India aimed at the following.
Sarve bhavantu sukinah
— Let all be healthy and happy,
Sarve santu niramayah
— Let all be without disease and
Sarve bhadrani pashyanthe
— Let all should see good sight
Ma kaschit dukh bhay bhavat
— Let no body feel the pinch of sarrow.
Etymologically the word ‘education’ is derived from some Latin words educere (to lead out or to draw out), education (the act of teaching). Thus, education implies the act of drawing out, act of extracting out, act of leading forth, act of teaching and act of training.
Education is a process which draws out the best in the child or student with the aim of producing well-balanced personalities, culturally refined, emotionally stable, ethically sound, mentally alert, morally upright, physically strong, socially efficient, spiritually upright, vocationally self-sufficient and internationally liberal.
Nursing may be described “as a dynamic, therapeutic and educative process in meeting health needs of society. Its distinctive function refers to the physiological and psychosocial responses to health, which may or do result in a state of dependence upon others for meeting needs which are normally within the potential of the individual or family. In a therapeutic, educative relationship nursing assists the individual and/or family to achieve their potential for self-direction for health (Lambertson E. 1958).
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 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 (ICN 1973-Virginia Henderson definition).
Nursing is a helping profession and as such provides services which contribute to the health and wellbeing of people. Nursing is vital consequence to the individual receiving services; it fills needs which cannot be met by the person, by the family or by other persons in the community.
The essential components of professional nursing are care, cure and coordination. The care aspect is more than “to take care of”; it is “caring for” and “caring about” as well. By dealing with human being under stress, frequently over long periods, it is providing comfort and support in time of anxiety, loneliness, and helplessness. It is listening, evaluating and intervening appropriately.
The promotion of health and healing is the cure aspect of professional nursing. It is assisting clients to understand their health problems and helping them to cope with. It is the administration of medication and treatment. And it is the use of clinical nursing judgement in determining, on the basis of client's reactions. Whether the plan of care needs to be maintained or changes. It is knowing, when and how to use existing and potential resources to help clients toward recovery and adjustment by mobilizing their own resources.12
Professional nursing practice is this and more. It is sharing responsibility for the health and welfare of all those in the community and participating in programs designed to prevent illness and maintain health. It is coordinating and synchronizing medical and other professional and technical services as these affect clients. It is supervising, teaching and directing all those who give nursing care.
There were four dimensions identified in the educative process of schools or colleges of nursing which includes the following:
  • Substantive dimension
  • Procedural dimension
  • Environmental dimension
  • Human relations dimension.
Substantive dimension: It pertains to what is taught and what is learned. This is referred to as the curriculum. The curriculum refers to all the content (Knowledge, value skills) and the learning activities planned and directed by a faculty for a specific group of students for a particular purpose. Nursing curriculum is concerned with providing opportunities for acquiring the essential knowledge, skills and attitudes that will prepare the student to assume the roles and responsibilities and the functions in nursing at the level which they are being prepared.
Procedural dimension: If refers to the ‘way’ in which the teacher helps the nursing students to learn. It includes the learner, the groups of learners (the class), the teacher and also it includes all of the methods and the procedures used by learners and teachers.
Environmental dimension: The teaching includes the physical conditions, such as classroom, the hospital, ward, unit, laboratory, health agencies, etc., and the sociopsychological climate as a result of the type of institution, administration and organization of personnel, etc.
Human relation dimension: It includes all the personnel's such as the student, the teachers, the health personnels, the patients and others who may participate in the education of the nursing student. The interaction (human relation) of these individuals both in the school or college and in the educational settings outside the school or college exert an important influence on the effectiveness of the educative process.
The interaction among all of these components or dimensions constitute the process of education in nursing.
An educative process comprised of the following:
  1. Why to educate: This includes aims of education. The education and the educated must be clear about the aims of education, so that efforts are made on the right direction. The aims of education depend upon a host factor: Political, economic, social, geographical, religion, etc. In a nutshell, education must produce socially efficient individuals. So as to in nursing education of produces good, efficient nurses to serve the humanity.
  2. Whom to educate: This is concerned with the different strategies that motivational aspects may be handled and attended psychologically. During the nursing training courses every strange student has to be motivated to learn the theory and practice of nursing and to develop positive attitude for toward nursing to become honorable member of the noble profession, i.e. nursing to serve the humanity. The educator must understand the educand thoroughly his/her aptitudes, interests, temperaments etc. So there the “best of him/her” is draw out. In nursing the nursing educator must draw out best from Student nurses, by understanding thoroughly the aptitudes, interest, temperaments, and other things related to them as a good nurses of society.
Who is to educate: The teacher in nursing is to educate and he/she must thoroughly understand himself/herself also. They must get rid of all the blemistes and remember “woe to the teacher who teaches omitting with the lips and carries another in the heart.”
Where to educate: The students/pupils are to be educated in a school or college which must ‘simplify’, ‘purify’ and ‘idealize’ the environment. So in nursing education, students are educated in the ‘schools and colleges of nursing’ where they are provided with a proper infrastructure and environment for learning the nursing science and technology.
What to educate: This leads to the content of the curriculum which has described as “the environment in motion”. In a broader sense it includes all the courses readings, associations and activities that go in the school or college, i.e. in the classroom, library, laboratory, workshop, clinical settings, playgrounds and in the numerous informal contracts between teachers and students. In nursing also there are well-designed curriculum starting from the courses like Auxiliary nurses midwives (ANM/healthworker[F]), lady health visitors/health assistants [LHV/HA(F)], general nursing and midwifery (GNM), BSc 13Nursing (basic), BSc nursing (post-basic), BSc Nursing (IGNOU), MN/MSc nursing, MPhil (N), PhD (N).
How to educate: This involves the knowledge and technique of various methods of teaching for making the teaching-learning process dynamic, effective, and inspirational. In nursing education also there is well-developed and practical techniques, strategies, methods of teaching used both in classrooms and clinical settings.
This book gives all the information about educative process in nursing which includes aims, educand, educator, educational setting, curriculum, methods of teaching, etc. which will be discussed in detail in subsequent chapters.