Textbook on Nursing Foundation for PB BSc Nursing I Clement
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1Basic Concepts of Nursing
 
GLOSSARY
  1. Models: These are graphic or symbolic representations of phenomena that objectify and present certain perspectives or points of view about nature or function or both.
  2. Concept: These are the elements or components of a phenomenon necessary to understand the phenomenon and derived from impressions the human mind receives about phenomena through sensing the human environment.
  3. Philosophy: It is statement of belief and values about human being and their world.
  4. Theory: It refers to a set of logically interrelated concepts, statements, propositions and definitions, which have been derived from philosophical beliefs of scientific data and from which questions or hypothesis can be deduced, tested and verified.
  5. Health: A state of physical, mental and social well-being and the absence of disease or other disorders. It involves constant change and adaptation to stress.
  6. Community: A group of inhabitants living together in a somewhat localized area under the same general regulations and having common interests, functions, needs and organizations.
  7. Nursing: It is an art, science and profession by which we render, serve to human being to help to regain or to keep a normal state of body and mind and when it cannot accomplish this, it help for the relief from physical pain, mental anxiety or spiritual discomfort.
  8. Community health: Public community health is a science and art of preventing disease, prolonging life and promoting health and efficiency through organized effort.
  9. Community health nursing: This is a synthesis of nursing and public health practice applied for promoting and preserving the health of people. The practice is general and compressive. It is not limited to a particular age group or diagnosis, and continuing, not episodic.
  10. Profession: It is an occupation with moral principles that are devoted to the human and social welfare. The service is based on specialized knowledge and skill developed in a scientific and learned manner.2
  11. Career planning: The process of establishing career objectives and determining appropriate educational and developmental programs to further develop the skills required to achieve short- or long-term career objectives.
  12. Ethics: Refer to the study of philosophical ideas of right and wrong behavior.
  13. Expanded role: This role of nursing means enlargement of nurse role with the bonders of nurse.
  14. Empathy: Intellectual and emotional awareness and understanding of another persons thoughts, behaviors and feelings.
  15. Nurse anesthetics: A nurse who completed the course of study in an anesthesia school and carries out preoperative status of clients.
  16. Nurse practitioner: He/she is a nurse who has completed either as certificate program or a Master's degree in a specialty and is also certified by the appropriate specialty organization. Nurse practitioner is skilled at making nursing assessments, performing physical examination, counseling, teaching and treating minor and self-limiting illness.
  17. Professional conduct: This is behaving with a real sense of dignity and respect for the service given for the patient and for them with whom one works.
  18. Sympathy: It is balancing someone's feeling especially in sorrow or trouble.

Introduction to NursingCHAPTER 1

 
INTRODUCTION
Nursing has been called the oldest of the arts and the youngest of the profession. The word nurse evolved from the Latin word nutritious, which means nourishing. The roots of medicine and nursing are intertwining and found in mythology, ancient eastern and western cultures and religion.
Nursing is defined by various authors at various times. Henderson says “Nursing is primarily assisting the individuals (sick or well) in the performances of those activities, contributing or its recovery (or to a peaceful death) that he would perform unaided, if he had the necessary strength, will or knowledge.
The unique contribution of nursing is to help the individual to be independent or such assistance as soon as possible.
Nursing, besides being a honorable profession, is one of the oldest arts and an essential modern occupation. Nursing is one of the greatest of humanitarian services and all people whether ill or well, rich or poor, literate or illiterate, young or old, at work or at play, in or out of hospital, are in some way or other, directly or indirectly closely associated with it. Nursing has its own body of knowledge scientifically based and humanitarianism that promises expanded benefits to people and society. It assists the individual or family to achieve their potential for self-direction for health.
 
DEFINITION
  1. The International Council of Nurses defines “Nursing is to assist the individual, sick or well in the performance of those activities contributing to health or to its recovery (or to peaceful death) that he would perform unaided if he had the necessary strength, will or knowledge”.
  2. Florence Nightingale: Nursing defined as the act of utilizing the environment of the patient to assist him in his recovery.
  3. Canadian Nurses Association 1987: Nursing practice is a dynamic, caring and helping relationship in which the nurse assists the client to achieve and obtain optimal health.
  4. American Nurses Association: Nursing practice is direct goal oriented and adaptable to service the needs of the individual, the family and community during health and illness.
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Figure 1.1: Definition of nursing
 
HISTORICAL DEVELOPMENT OF NURSING IN INDIA
1905: Association of Nursing Superintendents was constituted/formed.
1908: Trained Nurses Association of India was established/formed.
1909: Bombay Presidency Nursing Association was formed. Missionary Nurses North India Board set up under Medical Missionary Association of India.
1911: The South Indian Board was established Trained Nurses Association of India (TNAI) affiliated to International Council of Nurses.
1912: The First Nurses Registration Act was enacted in Madras Presidency.
1930: The Christian Nurses Auxilliary formed by the missionary nurses.
1934: The Bengal Nurses Act was enacted for the nurses, midwives and health visitors (HV) of undivided Bengal.
1936: The Mid India Board of Education affiliated to Christian Nurses League, Christian Nurses Auxilliary Association was affiliated to TNAI.
1941: Standardized pay scales and terms of services were established in Chennai. State Nursing Superintendent, appointed at state level (Chennai).
1942: The Auxiliary Nursing Service (ANS) was established. One Nursing Superintendent was appointed as nursing advisor at Directorate General of Health Services (DGHS), Government of India, to organize nursing services.
51943: Establishment of School of Nursing Administration for Military Nursing Services Health Survey and Development Committees (Bhore) constituted by Government of India. Study groups worked on proposal for university education in nursing in India. Christian Medical College (CMC) Vellore and Madras General Hospital started courses to train nursing tutors. Commissioned rank was given to the Indian Military Nursing sisters.
1946: Bhore Committee submitted report, recommendations made on improvement of various aspects of nursing profession: Nursing education, working conditions, nursing services in hospital and community and deputing nurses for higher education to abroad, etc. Establishment of the College of Nursing at Delhi (now Rajkumari Amrit Kaur College of Nursing) under the Union Ministry of Health to start university nursing education program for the first time in India leading to Bachelor's degree in nursing, i.e. BSc (Hons.) Nursing.
1947: Indian Nursing Council Act was passed (31.12.1947) on the basis of recommendations of Bhore Committee. Degree program for nursing started in Vellore.
1948: The first meeting of Indian Nursing Council (INC) was held.
1950: The INC took decision to establish Auxiliary Nurse Midwife (ANM) program to meet the requirement of workers in nursing.
1951: Establishment of urban field teaching center is started at College of Nursing, Delhi in collaboration with existing Medical Center Hospital (MCH) centers of Municipal Corporation, Delhi for teaching of Urban Community Health Nursing.
1952: Establishment of residential field teaching center for teaching Community Health Nursing in the rural area under College of Nursing, Delhi in collaboration with Primary Health Center, Najafgarh.
1953: Ms Edith M Buchanan, Vice-Principal, Rajkumari Amrit Kaur College of Nursing (RAKCON), Delhi was sent to Columbia University to earn her Doctorate in Education (DEd) through WHO fellowship.
1954: Government of India constituted committee to review conditions of services, emoluments, etc. of nursing profession (Shetty committee). Shetty Committee Report was published, recommended nursing staff norms of hospital community and other improvements in nursing.
1955: Establishment of child guidance clinic at Rajkumari Amrit Kaur College of Nursing. (RAKCON) for providing services and strengthening community health nursing and pediatric nursing. Ms Margaretta Craig, Principal, College of Nursing, Delhi attended ICN meeting in France, to present a paper on the need for nursing research in India.
61959: Dr Edith M Buchanan, succeeded in establishing the long cherished Master of Nursing (MN) degree program at RAKCON, New Delhi under University of Delhi (October 1959). Healthy Survey and Planning Committee (Dr LN Mudaliar) was constituted by Government of India to review the progress made in health since, Bhore committee recommendation.
1961: Mudaliar Committee report published made some recommendations to improve nursing profession.
1963: A WHO assisted technical project was undertaken at the INC to revise the General Nursing and Midwifery (GNM) course. Dr Buchanan, succeeded in sending Mrs Sulochara Krishnan, one of the first graduate of this newly established, MN degree program, to earn the DEd degree from Columbia University.
1964: Dr Marie Furguson, a public health nurse came to the College of Nursing, Delhi was able to create greater appreciation and understanding of the need and value of research in planning nursing administration and education with senior leaders of the country conducted ‘activity studies to define the nursing and non-nursing functions of nursing personnel’.
1965: A WHO publication on ‘Guide for School of Nursing’ in India was published.
1966: The TNAI established research section under the Chairmanship of Ms Margarata Craig. TNAI conducted ‘Time study’ with the co-operation of Ms Anna Gupta, Principal, RAKCON, under the supervision of Dr Sulochana Krishnan.
1969-1971: TNAI and Voluntary Health Agencies in India (VHAI), conducted study on survey on the socioeconomic status of nurses in India.
1973: Kartar Singh Committee report on multipurpose workers and Health and Family Planning department published and recommended auxiliary nurse midwife (ANM) and lady health visitors (LHVs) were redesignated and health workers (F) and health assistant (F) to cover the required population at rural area for providing proper health services.
1975: Shrivastava Committee report on three tier-plan of health care delivery system to rural area was recommended.
1976: Dr Marie Farell and Dr Aparna Bhaduri of Rajkumari Amrit Kaur College of Nursing, New Delhi, conducted seminars on nursing research for educationists at Delhi, Mussoorie (Uttarakhand) and Yercaud to strength the nursing research in India.
1978: Government Nurses Association of Karnataka established.
71981: Dr Farrel and Dr Bhaduri's book ‘Health Research’: A Community- based Approach’ published by World Health Organization.
1986: The Nursing Research Society of India (NRSI) was established to promote research within and around nursing environment. Dr (Mrs) Inderjit Walia was founder President. Mrs Uma Hunda was its Secretary. MPhil in nursing program started at RAKCON, under Delhi University.
1987: Reports of the expert committee on health and manpower planning, production and management (Bajaj Committee) published. This committee also dealt with nursing service conditions norms and nurse's emoluments, etc.
1988: The RAKCON, New Delhi was designated as World Health Collaboration Center for Nursing. Developments reports of the high power committee on nursing and nursing profession published. Dr Ruth Hurner book ‘Nursing Education in India’ published on the basis of survey.
1992: PhD in nursing program started at RAKCON, under Delhi University. Mrs Asha Sharma got registered for the Doctoral course.
 
SCOPE OF NURSING
There was a time when professional nurses had very little choice of service because nursing was centered in the hospital and bedside nursing. Career opportunities are more varied now for a numbers of reasons. The list of opportunities available are:
  1. Staff nurse provides direct patient care to one patient or a group of patients, assists ward management and supervision. Staff nurse is directly responsible to the ward supervisor.
  2. Ward Sister or Nursing Supervisor is responsible to the nursing superintendent for the nursing care management of a ward or unit. Takes full charge of the ward. Assigns work to nursing and non-nursing personnel working in the ward. Responsible for safety and comfort of patients in the ward. Provides teaching sessions if it is a teaching hospital.
  3. Department Supervisor/Assistant Nursing Superintendent is responsible to the Nursing Superintendent and Deputy Nursing Superintendent for the nursing care and management of more than one ward or unit, e.g. surgical department, outpatient department.
  4. Deputy Nursing Superintendent is responsible to the Nursing Superintendent and assists in the nursing administration of the hospital.
  5. Nursing Superintendent is responsible to the Medical Superintendent for safe and efficient management of hospital nursing services.
  6. Director of Nursing is responsible for both nursing service and nursing educations within a teaching hospital.8
  7. Community Health Nurse (CHN) services rendered mainly focusing Reproductive and Child Health Program.
  8. Teaching in nursing. The functions and responsibilities of the teacher in nursing are planning, teaching and supervising the learning experiences for the students.
    Positions in nursing education are clinical instructor, tutor, senior tutor, lecturer, associate professor, Reader in nursing and Professor in nursing.
  9. Industrial nurses are providing first aid, care during illness, health educations about industrial hazards and prevention of accidents.
  10. Military Nurse: Military Nursing service became a part of the Indian Army by which means nurses became commissioned officers who are given rank from Lieutenant to Major General.
  11. Nursing service in abroad: Attractive salaries and promising professional opportunities, which cause a major increase for nursing service in abroad.
  12. Nursing service administrative positions: At the state level, the Deputy Director of Nursing, and the State Health Directorate. The highest administrative position on a national level is the Nursing Advisor to the Government of India.
 
NURSING AS A PROFESSION
The Code points out very clearly the role of the nurse as a leader and an active participator in professional activities by setting up and carrying out desirable standards of nursing practice and nursing education.
 
QUALITIES OF A PROFESSIONAL NURSE
For an efficient discharging of nursing duties and for a satisfactory fulfillment of all the aims and aspirations that nursing profession stands for, the following qualities in a nurse are inevitable:
  1. Love: With all other attendant qualities like mercy, kindness, gentleness, patience and understanding, love is must in a successful nurse. All services for the sick and disabled are sponsored by these qualities. Without these essential characteristics the nurse becomes only a mechanical aid.
  2. Willingness and self-sacrifice: These two qualities are complimentary to each other. Because nurses are willing to serve under any trying situation, they sacrifice their time, comfort and even material benefits, e.g. Florence Nightingale at Scutari.
  3. Reliability: A nurse is one who can be depended upon for a faithful discharging of her/his duties, the patients under her/his care, their families, doctors and members of the ‘health team’ depend on her/him, for she/he is trustworthy and competent.9
  4. Resourcefulness: In critical circumstances nurse uses her/his wisdom and knowledge and performs her/his duties to the best of her/his ability with whatever means that are at her/his disposal. She/he tackles situations with alacrity.
  5. Courage: In times of confusion, calamity or catastrophe, the nurse manages her/his work with compassion and is ready to meet any problem with courage. She/he is cool and level-headed and does not get agitated easily.
  6. Loyalty and honesty: Nurses’ relationship with the patient, the doctor and associates are marked by utmost loyalty and honesty.
  7. Observant: A good nurse is always vigilant. She/he keeps a close and constant watch on the patients, their progress, their changes and reactions to treatment, etc. and gives timely reports to doctor. A nurse should anticipate and meet the patients’ needs.
  8. Willingness to learn: A nurse must keep in touch with the latest discoveries and developments in medicine and treatment and must “maintain her/his knowledge and skill at a consistently high level”.
  9. Cooperative and considerate: A nurse learns to live in harmony with patients, doctors and other members of the health team and tries to help them in times of need.
  10. Cleanliness: A nurse is always neat and clean personally and in her/his work. She/he must be tidy and demand high standards of cleanliness from those whom she/he is associated within her/his profession.
  11. Spirituality: A nurse must learn to create a spiritual atmosphere for the patient and must try and help the patients to put their confidence and trust in a ‘Power’ that is higher than any other power in the world.
 
NEW PERSPECTIVES OF NURSING PROFESSION
Historically, only medicine, law and the ministry were accepted as profession.
Criteria of a profession:
Genevieve and Roy Bixler first wrote about the status of nursing as a profession in 1945. These criteria include the following:
  1. The services provided are vital to humanity and the welfare of the society. Nursing is the service that is essential to the well-being of the people and to the society. Nursing promotes, maintains and restores the health of individuals, groups and communities. Assisting others to attain the highest level of wellness is the goal of nursing. Caring, meaning nurturing and helping others are the basic components of professional nursing.
  2. There is a special body of knowledge that is continually enlarged through research. In the past, nursing was based on principles borrowed 10from the physical and social sciences and other disciplines. Today there is a unique body of knowledge to nursing.
  3. The services involve intellectual activities. Individual responsibilities (accountability) are a strong feature. Nursing has developed and refined its own unique approach to practice. Nursing process is a cognitive activity that requires both critical and creative thinking and serves as the basis of providing nursing care.
    Individual accountability in nursing has become the hallmark of practice. Accountability is being answerable to someone for something one has done.
    Through legal opinion and court cases, society has demonstrated that nurses are individually responsible for their actions as well as for those of personnel under their supervision.
  4. Practitioners are educated in institution of higher learning. There are Basic Nursing Program, Baccalaureate Program, Master's and Doctoral Program in nursing
  5. Practitioners are relatively independent and control their own policies and activities (autonomy). Autonomy or control over one's practice is another controversial area for nursing. Although many nursing actions are independent, most nurses are employed in hospitals, where authority resides in one's position.
  6. Practitioners are motivated by service (altruism) and considered their work an important component of their lives. Nurses are dedicated to the ideal of service to others, which is known as altruism.
  7. There is a Code of Ethics to guide the decisions and conduct of practitioners. The International Council of Nurses (ICN) has established Code of Nursing Ethics through which standards of practice are established, promoted and refined.
  8. There is an organization (association) that 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 Trained Nurses Association of India (TNAI ). The purposes of TNAI are to foster high standards of nursing practice, promote professional and educational advancement of nurses and promote the welfare of the nurses.
 
CONCEPT OF PROFESSIONALISM IN NURSING
 
ART OF NURSING
Professional nursing practice is grounded in the art of nursing, described as taking a holistic, client-centered focus; being caring and ethical in interactions with patients, families and colleagues; having above average 11interpersonal skills; and making sound judgments based on experience and knowledge, thus averting potential problems.
 
COMPETENCE
Professional practice demands competence in relation to knowledge and technical skills. This requires not only a broad base of knowledge, but also depth of knowledge in a chosen area of practice, a desire and ability to continue developing that knowledge base and to share it with others and critical thinking in decision making.
 
ATTRIBUTES OF PRACTICE
Professional practice reflects a particular approach to one's work with collaboration by far most salient characteristic. Professional nursing practice means working in partnership with other nurses and health professionals in providing client care, being highly organized in managing activities and time, having the ability to manage many complex tasks simultaneously, working autonomously as appropriate and having an open mind and non-judgmental manner.
 
PERSONAL COMMITMENT
In describing this element of professional practice, respondents referred to the importance of having confidence in one's abilities and taking responsibility for one's actions, including having a sound understanding of the boundaries and limitations of nursing practice. Having a balanced lifestyle and supporting the advancement of the profession were also considered important characteristics of a professional nurse.
 
VALUES OF A PROFESSIONAL NURSE
To be successful, nurses must be equipped with certain tools and abilities. These skills are developed over time as a nurse gains experience and confidence. These are as follows:
  1. Confidentiality and autonomy: Nurses should have an awareness of legislation on patient confidentiality and the policies of their own organization. Nurses should not breach confidentiality, unless the circumstances are exceptional. For instance, if the patient is threatening harm to himself/herself or others. Nurses must not discuss patients’ details outside of the care setting, and must take care of notes, paper and computer files. Nurses should make all efforts to promote the patient's rights to make his/her own decision whenever possible.
  2. Protection from harm: The nurse's conduct must protect the patient from harm. Nurse must not undertake something he/she thinks might cause harm to the patient even if he/she has been told or asked to 12do so by another person. The nurse is accountable for his/her own actions and might be asked to explain these in later proceedings. If the nurse sees anything he/she fears may endanger the patient, he/she must immediately report this to management.
  3. Professional development: The nurse has a duty to keep up-to-date with all developments that may have an impact on his/her job. He/she must attend professional development and training activities. Part of his/her duty may involve training and mentoring new and junior staff. Nurses must meet training requirements and pay any fees needed to maintain licensing.
  4. Dedication: Professional nursing is a difficult profession with many stressful scenarios. Nurses must work long shifts and deal with many vastly different issues on a daily basis. The combination of long work hours, constant care of patients and the stress of seeing death can cause nurses to unravel. Thus, professional nurses need to be calm and level-headed, able to quickly handle a multitude of problems effectively. Nurses are responsible for patient quality of care and the execution of the health care plan. A dedication to the job is essential for a nurse to fulfill the nursing duties.
  5. Systems thinking: A nurse is faced with a plenty of situations throughout each workday. Each patient has individual problems and requires a different approach. Nurses are expected to develop individualized decisions of care depending on the patient and the specific circumstances.
  6. Caring: Nurses are required to take care of the patient throughout the entire healthcare process. Their goal is to make the healing process painless and comfortable as possible, without inflicting any unnecessary grief for the patient. In the case of imminent death, nurses must console the patients and the families in order to ease the transition. According to the American Association of Critical Care Nurses, duties of caring include ‘vigilance, engagement, and responsiveness of caregivers, including family and healthcare personnel.’
  7. Ethnic and religious sensitivity: Nurses take care of patients from a variety of ethnic and religious backgrounds. Professional nurses must be sensitive to the specific requirements of various cultures and religions in order to facilitate the patient's health care. Nurses must demonstrate a desire to respect various practices while continuing to adhere to professional standards.
 
ROLES AND RESPONSIBLITIES OF PROFESSIONAL NURSE
 
ROLES
The professional nurse occupying the position by accepting responsibility and accountability in:13
  1. Provide quality nursing to the clients in their care, placing emphasis on the medical psychosocial, spiritual needs of the clients and be mindful of the needs of the relatives or attendants.
  2. Cooperating with the nursing units and all other departments within the hospital.
  3. Understanding all activities in relaxation to patient care and other assigned duties.
  4. Actively participating in the nursing team.
  5. Actively pursuing and continuing self education.
  6. Actively providing appropriate health education to the individuals, families and groups and community at large in various settings.
 
FUNCTIONS AND RESPONSIBLITIES
 
Client Care
Providing safe and effective nursing care within a healthcare setup or community. It includes participating in the delivery of nursing care based on the best practice principles stated by statutory body, maintaining nursing standards, observing and participating in quality improvement programs, fostering congeniality between all members of the healthcare team, assisting with cost containment by utilizing resources effectively, participating in appropriate meetings, workshops or committees related to improving nursing care.
 
Professional Practice
In professional practice the aspects included are maintaining confidentiality, taking reasonable care in health and safety of persons on the unit, being familiar with the resources to be used in case of any emergency or disaster, adhering to all infection control policies and safety rules, cooperating with management for health, safety and welfare provisions, actively seeking knowledge of the diagnosis and treatment given, actively participating with a zeal as a member of multidisciplinary team, complying with the professional Code of Ethics, demonstrating accountability and responsibility for the professional conduct, practicing with limits of own abilities and qualification, initiating and maintaining effective communication with others.
 
Management
There are three kinds of management roles, i.e. in planning and in organizing, in implementation and in evaluation. These are the following:
  1. In planning, the management roles are to describe the planning process in the assigned clinical area, to assess client's needs, work environment and available resources, to set appropriate priorities for day's work, to anticipate and plan for potential problems or unpredictable events.14
  2. In organizing, the management roles are to organize work activities, to delegate tasks and share responsibilities, to adhere to organizational policies and procedures, to describe instances of the incorporation of risk management concepts in the assigned clinical setting.
  3. In implementation, the management roles are to perform nursing procedures safely, accurately and scientific knowledge based, to describe the decision-making process, to assure continuity of care, to communicate effectively with patients, families and other health personnel, to show sensitivity to the patients’ needs, to bring change in the status quo of the organization as required.
  4. In evaluation, the management roles are to analyze the flow of communication in the unit and within the organization, to describe the Nurse Manager's role as evaluator of personnel performance, to assess patient care evaluation activities that are done in clinical setting.
 
CONCLUSION
Nursing has been called the oldest of the art, and the youngest of the profession. As such, it has gone through many stages and has been an integral part of social movements. Nursing has been involved in the existing culture, shaped by it and yet being to develop it. Nursing is known as one of the noblest among all the professions based on spirit and devotion to the services to humanity at large. Nursing is a unique blend of art and science of skill and knowledge. It is a science because it needs vast specialized knowledge in science for its background and it adopts the scientific methods in its application. Nursing is an art as it implies skillful application of this specialized knowledge in approaching the patient as an individual considering his emotions, feelings and environment. Therefore, the primary responsibility of the nurse to help the individual in his daily pattern of living with those activities that are ordinarly performed without assistance.