Concept of Nursing

Jogindra  Vati

Unit 1

1Framework of Nursing Management and Administration

Concept of Nursing
Nursing Management and Administration
Applications of Management Theories
Ethics and Ethical Issues in Nursing
Legal Foundation of Nursing Practice
Trends and Issues in Nursing
Quality Assurance and Quality Management
Nursing Service Standards
Regulatory Bodies
Accreditation
Nursing Audit

2

Concept of NursingCHAPTER 1

Competencies
Introduction
Evolution of nursing
The concept of modern nursing
Definitions of nursing
Nursing as a profession
- What defines a profession?
- Profession and vocation
- Characteristics of profession
- Criteria of a profession
- Is nursing a profession?
Nursing as an academic discipline
Nursing as a practice science
Nursing as a human science
Landmarks in hospital nursing services in India
Further readings

COMPETENCIES

After completion of this chapter, the learner will be able to:

Understand the evolution and changing concept of nursing
Identify essential components of modern nursing
Appreciate nursing as a profession
Describe essential characteristics of profession
Identify criteria of profession
Differentiate between profession and vocation
Enlist important landmarks of hospital nursing services.

INTRODUCTION

Nursing is a service to humanity. It is the oldest of arts and youngest of professions. It is compassion personified and has a long and rich heritage. The word ‘nurse’ evolved from the Latin word ‘nutritious’, which means nourishing. Nurses with their unique, divergent opinions and talents have made many valuable contributions to society. Nursing originated independently, existed many centuries without contact with modern medicine.

EVOLUTION OF NURSING

The history of nursing begins from the history of human kind. As long as there is a life, there is a need for the care and comfort to those suffering from illness and injury. From the dawn of civilization, evidences revealed that nurturing has been essential to the preservation of life. Therefore, survival of the human race is intertwining with the development of nursing.

There are no historical evidences available in ancient history on nursing care of sick in primitive times. However primitive man had the skill of massaging, fomentation, amputation, hot and cold bath, and applying heat to control hemorrhages. During ancient times, when medical lore was associated with good or evil spirits, the sick were usually cared for in temples and houses of worship.

Ayurvedic system of medicine in India was traced back about 3000 BC. Indian medicines were found in the sacred books of ‘Vedas’ and it was believed that Brahma gives the ‘Ayurveda’. Siddha system of medicine was also practiced in India.

Sushruta, known as ‘Father of Surgery’ wrote a book on surgery in 1400 BC and years later ‘Charaka’ wrote a book on internal medicine. They mentioned four wings of treatment in their writings named ‘chatushpada chikitsa’: physician (bhishak), nurse (upacharika); attendant (anuraktha), therapeutic drugs (dravya), and patient (adhyaya). The qualities of a nurse (upcharika) was described as: shuchi (pure or clean in physical appearance and mental hygiene), daksha (competency), anuraktha (willing to care), buddhiman (co-ordinator with the patient and doctor/intelligent).

Sushruta and Charaka started practice of surgery and medicine during 700-600 BC. The nurse was the one who attends the patient; was cool headed and pleasant in her demeanors; does not speak ill of anybody; is strong and attentive to the requirements of the sick and strictly follows the instructions of the physicians.

King Ashoka, during 264 BC, made a great stride in the care of the sick, both human beings and animals. He not only founded a large number of hospitals for the sick but also made provision for the education and training of women for that purpose.

Unani system of medicine developed during the Arab civilization (1000AD). It was practiced in Indo-Pakistan subcontinent. The basic framework consisted of blood, phlegm, yellow bile and black bile. Temperament, strengthening of body and nature cure was the real challenges for the physician.

After the Mogul period, the nursing was looked upon as servants work in India due to low status of women, pardha system of among Muslims, caste system among Hindus, illiteracy, poverty, political unrest, and language difference. During and after 16th century, nursing development in India has taken three dimensions: Civilian Nursing, Military Nursing, and Missionary Nursing.4

Civilian Nursing

Civilian nursing in India dates back in 1664 with upcoming of Government General Hospital at Madras during British Raj. Midwives training school granted certificates of ‘diploma in midwifery’ for passed students and ‘sick nursing’ for failed students in 1854. The civilian nurses were trained for the hospital in 1871. First batch of six nurses came out as ‘diploma in midwifery nursing’.

Military Nursing

Military nursing developed in India during the 1^st world war, when British officers informed need of nurses to take care of British officials and soldiers. On 21^st February 1888, 10 fully certified nurses from Florence Nightingales arrived to Bombay to lead nursing in India. In 1927, a description of Indian Military Nursing services formed with 12 matrons, 18 sisters, and 25 staff nurses. The 2^nd world war expanded nursing services in India and overseas under the direction of chief principal matron. A three-year training programme was carried out in preliminary training schools in selected military hospitals. Those who successfully completed training, were granted certificates as ‘Registered Nurse’ and considered members of Indian Military Nursing Services and Auxiliary Nursing Services.

Missionary Nursing

Missionary nursing started with the training of Indian nurses. Various other countries supported this move. This brought fully qualified Indian nurses. Those days, there were several obstacles in the development of nursing. The girls were not allowed to do work, there was degrading and unworthy attitude of people, Hindus girls were hold back due to deep rooted caste system, and Muslim girls were held under ‘pardha’ system, so Christian girls were encouraged to undergo training and were trained first.

THE CONCEPT OF MODERN NURSING

During Pre Christian times, religious beliefs had great bearing on the attitude towards the sick and the mode of caring for the sick and the suffering. During the middle ages, monks and nuns devoted their life to the care and services of the poor and sick. New thoughts and new ideas were introduced in the early Christian era. Christianity introduced a new aspect in nursing and transformed nursing to a higher level and raised it to a professional standing. The dawn of modern nursing dates from the late 1700s through 1853. It was in 1860, when professional nursing was established in the Nightingale School of Nursing.

Care, Core and Coordination Concept

The concept of modern nursing is based on ‘health maintenance’ and ‘restoration’ in Notes of Nursing: what it is and what it is not (Nightingale, 1860). Her views on nursing were derived from a spiritual philosophy (Macrae). She viewed ‘nursing as a search for truth in finding answers to health care questions and discovering and using Gods’ law of healing in nursing practice’. The main focus was on health maintenance through proper nutrition, hygiene and shelter. There are mainly three components of modern nursing: care, cure, and coordination as shown in Figure 1.1:

Figure 1.1: Components of modern nursing

Care

Care is required when human beings are under stress, frequently over long periods of time. This component is concerned with providing comfort and support.

Cure

The cure is also an important component of modern nursing. This part is concerned with promotion of health and healing.

Coordination

The concept of this part is applicable in nursing as its practice shares the responsibility for the health and the welfare of all the people in the community and participates in the programme designed to prevent illness and maintain health. It also coordinates and synchronizes medical and other professional and technical services that affect patient care. Professional nurse supervises, teaches and directs all those involved in nursing care.

So the role of professional nurse now ranges from patient care to planning and implementation of health services for direction and supervision of others who give care to the patients. Thus administrative skills have become indispensable in providing creative, need-fulfillment patient care.

Nursing as an Intellectual Activity

Clark J viewed nursing as an intellectual activity that needs the use of clinical judgment and skill in rendering the care to the clients through nursing process. According to her, there are two ways of looking at nursing: nursing as a collection of tasks as well an interpersonal interaction.

Nursing as a Collection of Tasks

According to the concept of nursing as a collection of tasks or procedures requires some skills which is initiated and directed by others particularly by doctors whose functions is to assist them.5

Nursing as a Kind of Interpersonal Interaction

Nursing is also described as a particular kind of interpersonal interaction, which has specific goals and involves particular kinds of activities. The specific goals are to enable people to maximize their potentials for health; enhance their ability to cope with the illness and disability and to promote physical and mental comfort, healing and recovery. The focus of nursing is on physical and emotional responses of people towards illness, treatment and disability.

DEFINITIONS OF NURSING

Various definitions have been documented in the literature as given below:

‘The unique function of nurse is to assist the individual sick or well, in the performance of those activities contributing to health, its recovery, or to a peaceful death that the client would perform unaided if he had the necessary strength, will or knowledge and to do this in such a way as to help the client gain independence as rapidly as possible’.

—Virginia Henderson (1966), International Council of Nursing (1973)

‘Nursing encompasses autonomous and collaborative care of individuals of all ages, families, groups and communities, sick or well and in all settings. Nursing includes the promotion of health, prevention of illness, and the care of ill, disabled and dying people. Advocacy, promotion of a safe environment, research, participation in shaping health policy and in patient and health systems management, and education are also key nursing roles’.

— International Council of Nurses

‘The use of clinical judgment in the provision of care to enable people to improve, maintain, or recover health, to cope with health problems, and to achieve the best possible quality of life, whatever their disease or disability, until death’.

— Royal College of Nursing UK

‘Nursing is a profession focused on assisting individuals, families, and communities in attaining, maintaining, and recovering optimal health and functioning. Modern definitions of nursing define it as a science and an art that focuses on promoting quality of life as defined by persons and families, throughout their life experiences from birth to care at the end of life’.

— Wikipedia

‘Nursing is the protection, promotion, and optimization of health and abilities; prevention of illness and injury; alleviation of suffering through the diagnosis and treatment of human responses; and advocacy in health care for individuals, families, communities, and populations’.

— American Nurses Association

‘Nursing is a unique profession because it addresses the responses of individuals and families to health promotions, health maintenance and health problems; Nurses assume many simultaneous roles: direct care provider; clinical decision maker, client and family advocate researcher and educator, evolved from the day of Florence Nightingale (1960); a professional registered nurse provides a specialized service according to standards of practice and follows a code of ethics; the foundation for professional practices arises from the theories of nursing, relevance to basic social values, education preparation, motivation, autonomy, a sense of commitment, a sense of community and a code of ethics

— Bernhard and Walsh (1995)

‘Nursing is a professional service for enabling a person to maintain and sustain health and well being’. Whereas Health is a state of dynamic balance of an individual's ability to perform personally valued roles and responsibilities, to deal and cope with physical, biological, psychological and social stresses and challenges throughout the life while continuing to maintain the sense of well being. Well-being is an active state of a person with maximum potential by maintaining balance and is at peace with inner and outer world. The word ‘Nurse’ means that a person who has completed prescribed course in nursing from an institution recognized by the Indian Nursing Council and registered herself/himself under the State Nursing Council as Nurse and Midwife.

— Indian Nursing Council (2006)

NURSING AS A PROFESSION

Nursing has been viewed from various aspects. A review of literature from late 1970's until the present poses a query whether nursing is a profession, a science, or an academic discipline.

What Defines a Profession?

The word profession is derived from ‘profess’ which means ‘to proclaim something publicly’. Professions profess to know something better than the people they serve and who thus need their service. There are various views of defining a profession:

Commitment by the Professionals

In the act of profession, the professional should have commitment towards the essence of a profession. The essence of profession is an organization of an occupational group based on the application of special knowledge, which establishes its own rules and standards for the protection of the public and professionals. Its emphasis is on the quality of performance rather than on the self-interest of the members.

Profession as an Occupation

A profession is also viewed as an occupation based on specialized intellectual study and training, the purpose of which is to supply skilled service with ethical components to others, for a definite fee or salary. In general terms, occupation requires widely varying levels of training or education, varying levels of skill, and widely defined knowledge bases. All professions are occupations, but not all occupations are professions (Logan, Franzen, Pauling, & Butcher, 2004; Schwirian, 1998).6

Profession as Non-competing Group with Normative Control

The Economists’ view is that the profession is a non-competing group. Whereas according to the sociologists, the professional worker is subject to institutional or normative control.

Profession as a Vocational and Occupational Group

A profession as a group of vocational and occupational requires specialized education and intellectual knowledge and as a group of people in a learned occupation, the members of which agree to abide by specified rules of conduct when practicing the profession.

Profession as a Disciplined Group of Individuals

According to Australian Council of Professions (2004), profession is ‘a disciplined group of individuals who adhere to ethical standards and uphold themselves to, and are accepted by, the public as possessing special knowledge and skills in a widely recognized body of learning derived from research, education and training at a high level, and who are prepared to exercise this knowledge and these skills in the interest of others’.

Profession with Scientific and Philosophical Bases

Professions are based on scientific and philosophical facts acquired through scholarly endeavor (Boone, 2001). Individuals who enter a profession distinguish them from other work or vocations. They understand that their work renders a unique public service with a scientific or philosophical basis. Professions are also based on specialized skills necessary for the professional to perform the public service.

Profession and Vocation

In order to differentiate between a vocation and a profession, sociological literature has proposed a ‘checklist’ method as given below:

If practicing it requires formal education
Its members enjoy control over their own training standards
Its members have their own disciplinary mechanisms
There is a scholarly journal devoted to its standards
Its practitioners enjoy relatively high social status, and
Its practitioners have secured protection from state regulation as well as from market pressures.

Characteristics of Profession

The characteristic of profession has a long list and various authors have their views as:

Viewpoint of Southern Illinois University

According to Southern Illinois University (2004), professions have the following common characteristics:

A profession is a great body of special knowledge.
A profession includes training in applying that knowledge.
The standards of a profession are maintained at a high level.
Each member of a profession recognizes his or her responsibilities to the public over and above responsibilities to clients or to other members of the profession.

Viewpoint of Burbules and Densmore

Burbules and Densmore (1991) identified following characteristics of a profession:

It should have professional autonomy
There should be a clearly defined, highly developed, specialized, and theoretical knowledge base
Profession has a control of training, certification, and licensing of new entrants
It has self-governing and self-policing authority, especially with regard to professional ethics
It has a commitment to public service
According to Pratte and Rury (1991) the characteristics of a profession include remuneration, social status, autonomous or authoritative power, and service.

General Characteristics of Profession

Professions are characterized by regulation, autonomy, status and prestige, and power. There are other characteristics of profession that may be applicable in one or other professions:

Regulation

Professions have their regulatory bodies, whose function are to define, promote, oversees, support and regulate the affairs of its members. There may be several such bodies.

Autonomy

Professions need to be autonomous. This means that the professions have a high degree of control of their own affair, have the freedom to exercise professional judgment and can make independent judgments about their work. Professional autonomy can be maintained if the activities and decisions of members of the profession are evaluated by other members of the profession. Thus the concept of autonomy is not only limited to judgment, but also include the self-interest and a continuous evaluation of ethics and procedures from within the profession itself.

Status and Prestige

Professions enjoy a high social status, regard and esteem conferred upon them by society. This high esteem arises primarily from the higher social function of their work. All professions require having technical, specialized and highly skilled work and needing professional expertise. Professional qualification, degree and licensure is required to enter in the profession.

Power

All professions have power. This power is used to control its own members, and also its area of expertise and interests. A 7profession is characterized by the power and high prestige it has in society as a whole.

Skill based on Theoretical Knowledge

Professionals are required to have extensive theoretical knowledge clinical skills that should be based on knowledge.

Professional Association

Professions usually have professional bodies organized by their members, which are intended to enhance the status of their members and have carefully controlled entrance requirements. Professional bodies are self-regulating and independent from government. Professions tend to be policed and regulated by senior, respected practitioners and the most highly qualified members of the profession. Professional bodies are active in negotiating remuneration packages for their members.

Extensive Period of Education

The most prestigious professions usually require at least three years at university.

Licensed practitioners

Professionals are required to enroll or register with licensing body to practice or to get a job in that profession.

Code of professional conduct or ethics

A code of ethics is important to govern the activities of each profession. These codes require behavior and practice including personal moral obligations of an individual. They define and demand high standards of behavior in respect to the services provided to the public and in dealing with professional colleagues. These codes are mandatory by the profession and are acknowledged and accepted by the community.

Exclusion, monopoly and legal recognition

In professions, the professional need to be competent and holding the qualified degree, and seeks to bar entry for the unqualified and to sanction or expel incompetent members.

High status, rewards and legitimacy

The most successful professions achieve high status, public prestige and rewards for their members and have clear legal authority over some activities.

Criteria of a Profession

In General

The following are the prerequisite or criteria for a profession:

It should have fundamental truth – a kind of truth that will make one free to think and act.
It should have the ability to apply truth in dealing with new problem for which there is no precise answer at the moment.
It should be able to meet the perplexities of changing knowledge; demands, social conditions or personal upsets courageously and wisely.

William Shepherd's Criteria

According to William Shepherd the criteria of profession include:

A profession must satisfy the social need and based on well-established and socially accepted scientific principles and has the responsibility for determining its own role and responsibility for meeting society's needs for its service.
It must demand adequate professional and cultural training.
It must possess a body of specialized and systematized knowledge.
It must give evidence of needed skills, which the public does not possess, i.e. skills that are partially native and partially acquired.
It must have developed a scientific technique.
It must require the exercise of excretion and judgment as to time and manner of performance of duty.
It must be a type of beneficial work.
It must have a group consciousness designed to extend scientific knowledge in technical languages.
It must have sufficient self impelling power to retain the members throughout life and it must not be used as a mere stepping stone to other occupation.
It must recognize the obligation to society by instituting that its members live up to an established code of ethics.
It needs to include in its code of ethics which particular profession needs.

Kelly's Dimensions of Profession

According to Kelly professions should have following criteria:

The work should be intellectual and distinguished by a substantial body of knowledge
There should be provision of unique service to society
It should have an expanded body of knowledge
Personal responsibility to the public for services provided
A long period of education including both theory and practice
Autonomy and the ability to develop policy about the discipline and control of the activity of one's members
Members share a common identity, values and attitudes
Career choice of its members is motivated by altruism and reflects a long term commitment to public
A code of ethics to which its member adhere

Is Nursing a Profession?

There have been many debates about whether nursing a profession rather than an occupation. However, for nursing to be recognized as profession by the society it serves, nursing must demonstrate an ongoing basis that meets the criteria of a profession.

Nursing is viewed as a profession that focuses on assisting individuals, families, and communities in attaining, maintaining, and recovering optimal health and functioning. Modern definitions of nursing define it as a science and an art that focuses on promoting quality of life as defined by persons and families, throughout their life experiences from birth to care at the end of life. Service to the mankind is the primary function of the nurses 8and the reason for the existence of nursing profession. Need for the nursing service is universal. Professional nursing service is therefore unrestricted by consideration of nationality, race, creed, color, politics or social status.

The followings are the criteria of a profession that support that nursing is a profession:

Nursing requires knowledge; judgment and skills based on biological, sociological, psychological and other allied sciences including medical and nursing sciences.
Nursing education is both theory and practical based. More emphasis is given to practical with scientific rationales; hence professional nursing is based on scientific knowledge, skills and abilities.
Nursing is having knowledge base. Nursing research, nursing theory, nursing publications, and accreditation and inspections of schools and colleges of nursing have contributed to the development of a nursing body of knowledge.
Nurses are providing unique services to public through hospitals, community and in other settings. They are licensed to practice in nursing through state nursing councils.
The registered nurses are accountable for their negligence in care and thus accountable for the public through legal regulations and licensures.
Nursing in India, though full autonomy is not achieved but there are positions at state level that are comparable with other medical administrators.
Professional nursing organizations have existed since the beginning of the 20th century. In India, Trained Nurses Association shares common values.
Today both men and other background groups are entering nursing. Registered nurses and employed nurses are appointed on regular basis like other government employees.
Indian Nursing Council has published its code of ethics for nurses. Many of the values are identified within the codes thus establishing them as legal requirements.
The aim of the nursing community is to develop the profession guided by continuing education based on nursing research, and to regulate standards of competency and ethics. Nursing theorists and nurse researchers are contributing to the knowledge bases and thus providing the evidenced based nursing.
The authority for the practice of nursing is based upon a social contract that delineates professional rights and responsibilities as well as public accountability. In almost all countries, nursing practice is defined and governed by law, and entrance to the profession is regulated at national or state level. New Zealand was the first country to regulate nurses nationally, with adoption of the Nurse Registration Act on the 12th of September, 1901. Ellen Dougherty was the first registered nurse. North Carolina was the first state in the United States to pass a nursing licensure law in 1903. In India, approval for the registration of nurses is under the Indian Nursing Council Act, 1947.
Each nurse irrespective of her qualification or position has a definite part to play as the member of nursing profession.
- Professional nurses ministers to the sick, assume responsibilities for creating a physical, social and spiritual environment, which will be conducive to recovery and stress the prevention of illness and promotion of health by teaching.
- They render health services to the individuals, the family and the community. They coordinate their services with members of other health professions.

NURSING AS AN ACADEMIC DISCIPLINE

A discipline is ‘a branch of knowledge ordered through the theories and methods evolving from more than one worldview of phenomenon of concern’ (Parse, 1997, p.74). It is also termed as a field of inquiry characterized by a unique perspective and a distinct way of viewing phenomena (Adam, 1985; Parse, 1999). It is also viewed as a branch of educational instruction or a department of learning or knowledge. Knowledge development within discipline proceeds from several philosophical and scientific perspectives or worldviews.

Characteristics of Discipline

A discipline is characterized by:

A distinct perspective and syntax
Determination of what phenomena are of interest
Determination of context in which the phenomena are viewed
Determination of what questions to ask
Determination of what methods of study are used
Determination of what evidence is proof (Donaldson & Crowley, 1978).

Areas that Identify Nursing as a Distinct Discipline

Nursing knowledge has been drawn from many disciplines like physiology, sociology, psychology, medicine, etc. In recent years, however nursing has been seeking what a unique to nursing and developing those aspects into an academic discipline. Following are the areas that can identify nursing as a distinct discipline:

An identifiable philosophy
Conceptual framework for delineation of what can be defined as nursing
Acceptable methodological approaches for the development of knowledge (Oldnall, 1995)
The body of knowledge is developed within designated boundaries and guides the pursuit, development, and dissemination of that knowledge.

NURSING AS A PRACTICE SCIENCE

Nursing is viewed as a practice science. The goal of basic sciences is the attainment of knowledge, whereas an applied science is one that uses the knowledge of basic sciences for practicing. In practice sciences, research is largely clinical and action oriented. 9According to Fawcett, nursing as a practice science requires research that should be applied and clinical.

NURSING AS A HUMAN SCIENCE

Nursing is also considered as a human science. Nursing as the discipline applies principles of sciences related to behavior and culture, as well as biology and physiology, in providing care to clients.

Thus nursing is an evolving profession, an academic discipline, and a science. Table 1.1 below depicts some of the similarities between the components of profession, discipline and science.

Table 1.1 Comparison of profession, discipline and science

Profession	Discipline	Science
Vocation/occupation	Education, research, service	Research experimental investigation
Specialized knowledge and skills	Defined knowledge boundaries	Unified body of knowledge
Methods based on scientific principles	Evidence based theory	Experimental investigation
Institution of higher learning	Pursuit, development, dissemination of knowledge	Observation, identification, and description of phenomena
Higher ethical standards	Academic freedom for faculty and students	Assurance of human rights
Expanding body of knowledge	Distinct theoretical body of knowledge	Unified body of knowledge
Autonomous functioning	The classroom and the laboratory	The laboratory
Continuous study	Pursuit of knowledge	Pursuit of solutions and answers
Service to society	For the betterment of society	Health needs of society
Source: Johnson BM, Webber PB. An Introduction to Theory and Reasoning in Nursing Philadelphia: Lippincott, 2001, p. 227

LANDMARKS IN HOSPITAL NURSING SERVICES IN INDIA

The ancient records of India indicate the principles and practices of nursing. They are so clear, intelligent and scientific, that many of them might fit into any of the modern textbook. Military nursing was the earliest type of nursing.

In 1664 the East India Company started a hospital for soldiers in a house at Fort St. George, Madras. The first sisters were sent from St. Thomas Hospital, London to this military hospital. A Lying - in (Maternity) Hospital for the poor was built in Madras in 1797.

In 1857 the India Mutiny turned Miss Nightingale's interest to the health of the Army in India. It was for this purpose the Royal Commission was appointed in 1859. St Stephens Hospital at Delhi was the first one to begin training the Indian girls as nurses in 1867. In 1868, a sanitary department was established. In 1871, the first School of Nursing was started in Government General Hospital, Madras with 6 months Diploma Midwives program with four mid-wife students. Four lady Superintendents and four trained nurses from England were posted in Madras In March 1888; ten qualified British nurses arrived in India to look after the British Army in India. In 1905, during the British rule in India, missionary nurses arrived as members of Missionary Medical Association. This was the very start of formalized nursing service in India.

Gradually, the increasing need of adequately trained nurses led to creation of South India Examining Board in 1911 and the North India Examining Board in 1912, the mid India Board of Examination was started in 1934. But this was not regulated for registration. State-wise councils started developing from 1935 onwards. (TNAI Yearbook, 2000–2001). However it is documented that Madras State formed the first registration council in 1926 to provide basic standards in education and training. Indian Nursing Council (INC) Act was passed by the Parliament in 1947.

Consideration thought has not given to the hospital nursing services before independence. Mostly the western nurses did care of sick in the hospitals. But after independence, the planned development of health services through five-year plans was initiated in the year 1952. There is a mention of recommendations of various committees, constituted time to time, regarding hospital-nursing services.

The Bhore committee in 1946, after its survey of health services in India, recommended a ratio of 1 nurse to 500 populations after realizing the inadequacy of health personnel. The Shetty committee in 1954, was appointed to review the conditions of service, emoluments, and employment, etc. of nursing professionals under the chairmanship of AB Shetty, then Minister of Health, Madras, in pursuance of resolution passed at the second meeting of Central council of Health held at Rajkot in Feb. 1954 advocated; appointment of nursing superintendent of nursing services in each state, provision of minimum standards of nursing in the existing hospital and public health services, decentralization in recruitment, qualified nurses for service, availability of 1 nurse for 3 patients in teaching hospitals, improvement in working conditions, and provision of regular staff meetings, refresher courses.

On recommendations of this report, the recruitments of nurses were increased to achieve the target at the office of directorates of health services, for strengthening the nursing education and nursing services in all the states.

After 1954, no concrete steps for the nursing services have been adopted despite committees being appointed from time to time for the health department, advice of WHO and the repeated articulation by Trained Nurses Association of India to the Government on the following issues: shortage of nursing personnel, shortage of equipment and supplies, communication gap between health policy makers and nurses, and management of nursing affairs by personnel other than nurses.

The Bajaj Committee on health manpower planning, prediction and management, held in 1987 recommended the staffing pattern for the hospital nursing services. A memorandum was submitted by the nurses Association on recommendations of Fourth Central Pay Commission regarding the anomalies of pay scales of nurses. On 25^th August 1987, the government of India announced the constitution of High power Committee on Nurses and Nursing profession. The main objectives were to review the conditions of service, status and allied matters 10pertaining to the nursing profession in the country in seven terms of references.

The convention on nurses at the national level was also organized by the government of India on 20–21^st August 1988, to know the: working conditions of nurses, staffing norms, training of all the categories and levels of nursing personnel, role of nursing personnel, and different aspects of organization of nursing services at national, states, districts and lower levels.

Time to time the nursing associations and Nursing Councils had made effort to uplift the standards of nursing practice and preparing the nurses of high quality. The shortage of manpower is the global problem. In India, the nurse to population ratio was 1:1264 and the nurse to doctor ratio is about 1.3:1 compared to a ratio of 3:1 in most developed countries in 2004. Most of the States have no system of re-registration of nurses. As on March 2003, 8,398.620 nurses were registered with the State Nursing Registering Councils. Only about 40% of registered nurses are active because of the small number of sanctioned posts, poor working conditions, low pay scales and migration, retirement or death, etc. The optimum nurse: patient ratio norms recommended by various committees for better patient care have not been implemented, thereby resulting in overload on the existing nurses, affecting the quality of patient care. The nursing mix in most of the hospitals renders the nursing care.

Chapter Notes

Concept of NursingCHAPTER 1