History of Nursing — and Nursing as a 3 Profession vet 1 Unit Completion Time (Hrs): Time (Hrs): 12 hrs pl screens Teaching/Learning | Assessment esning Ourens 3 Cone ‘Activities methods Aspects of Nursing “1 Trace the fistory of = Concepts of Nursing sion ‘Nursing +1 Philosophy of Nursing Case discussion 1 Explainthe 1 Objectives of Nursing 1 Role plays concept, d 1 Characteristics of Nursing Practice : notre ends. Seopa of Nursing Pracice nursing “11 Functions of @ Nurse “1 Describe Qualities of a Nurse values, code | +! Categories of Nursing Personnel ofethies and | +1 Definition and Characteristics of a Profession : professional 1 Nursing oso Profession =! History of Nursing History of Nursing in India Trained Nurses Association of India 1 Indian Nursing Council 1 The International Council of Nurses State Nurses Registration Council Values 7 Ethics {1 International Council of Nurses Code of Ethics =! Indian Nursing Council Code of Ethics 7) Legal Aspects in Nursing Legol Safeguards in Nursing Ethical and Legal Issues in Nursing nurses in Indio Unit Test Record: | [Date of test: ‘Maximum marks:_____ Obtained marks: INTRODUCTION is based on a body of knowledge that is continually changing with new discoveries and innovations. When nurse integrate the science and art of nursing into practice, the quality of care is at a level of excellence that benefit patients and their families. Nursing is considered as an art and a science. Professional nurse deliver the health care artfully with ia mindfulness, and respect for each patient's dignity and personhood. As a science, nursing, practice‘Textbook of Nursing Foundation-| ‘The pationt is the center of nursing. practice. ‘The pationt includes the individual, family, and/or community. Pationts have a wide variety of healtheare needs, experiences, vulnerabilities, and expectations; Dut this is what makes nursing both challenging and rowanting, Nursing offers personal and professional rewards every day. This unit presents a contemporary view of the evolution of nursing and nursing practice and the historical, practical, social, and political influences on the discipline of nursing, ‘The word nune originated from the Latin word nurtix, the meaning of which is known as “to nourish’ ‘The nur is defined as the person who nourishes, protects, encourages and who is always ready to protect the sick, injured and elderly, Nowadays, the role of nurse has extended and expanded. Definitions of Nursing “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 hhad the necessary strength, will or knowledge.” Virgins Henderson, 1996 “Nursing is the protectio1 of health and abilities, alleviation of suff treatment of humai of individuals, = Amerie “Nursing encompasses auto: care of individuals of all ages, families, ‘communities, sick or well and in the promotion of health, the care of ill, disabled and dying people.” International Council of Nurs “Nursing is rearing or bringing up under cer conditions and certain environment, cherishing, managing economically, into a certain form, attending, t care of oneself.” “Nui service to the in assisting to develo} vying to cure by taking ~ Oxford Medical Dictionary idual w' of pain and discomfort. —Hemmer and Henderso1 At the time of providing nursing care to the patient nurse needs to make cli reasoning abilities, critical thinking skill help nurse in acquiring and interpreting. scienti knowledge from clinical encounters and become dee rooted learner. , promotion and optimization Prevention of illness sick, injury; fering through the diagnosis and in response; and advocacy in the care families, communities and population.” Nurses Association, ANA ynomous and collaborative groups and all settings. Itincludes the prevention of illness and tain fostering and ing is an art and science. It may be defined as h helps him/her to obtain or maintain a healthy state of mind or body and the relief ical judgments, utilize basic which further ASPECTS OF NURSING Nursing is not only limited to physical care, it involvg, following aspects as well (Table 1 Table 1: Aspects of nursing Spiritual + Nurse do provide spiritual care and while doing | so, she encourages patient to keep the faith and _ help to perform the routine or rituals related to | spiritual beliefs of the patient. ‘+ Purpose isto provide a support to patient and help to cope up with illness, loss grief or pal i Emotional Emotional care includes acceptance of the patient as an individual being empathetic and compassionate toward the individual in sickness, loss, grief or pain, + Nurses need to be emotionally stable and possess emotional intelligence to provide effective care. Social _* Social care is related to the interpersonal rela- tionship (IPR) with the patient and empowering the patient to maintain IPR in a healthy way. ‘+ Nurses need to be free from personal prejudices ‘and bias in order to capacitate the patient for better understanding of others’ mindset so that ‘empathetic approach is developed and conflict resolution occurs, j | | | Physical Physical car is most important ad responsible for disturbance of other dimensions of heath Pasens are mail focsed onthe psa (ad sickness, due to which the other aspects are | atected therefore mse provides cre cnet althe aspects leading to oision of hase oe | CONCEPTS OF NURSING Nursing is an art, science and a scientific knowledge, the nurse to do the profession that require Practice and skills, which enable Procedures of performing nursin, ily and community ¢ ‘des preventive, promotiv services to the patients, fami 200: care given to individual, fa in hospital. Nurse provi curativeand rehabilitative: or community in a profes: Philosophy of nursing is (Table 2): P sional manner. Concepts ‘based on the following as fas Falr and justice The delivery of care should be ‘e¢ardless of physical and psyehol Condition ofthe individual, their *2ce, belief and status in society, partial ic | Respect P Respect fundamental human rights while providing healthcare to the individu contBuild a helping relationship with the patient, his/her family and the society. ‘Ability to walk independently and in collaboration with the multidisciplinary team inview of developing skills and professional knowledge, ‘Timely and thoughtful implementation of the health policies. Participate in research-based nursing and ‘evaluation of research to propose evidence- ‘based practices. Respect the rights ofthe patient to accept and refuse the treatment. ‘Therapeutic collaboration sudicious Evidence-based practice patient autonomy Informed practices Disseminate appropriate information to patient and family members about health status, Investigations and procedures done, diagnosis, treatment and prognosis of the patient. Fundamental Nursing Concepts ‘The art and science of modern nursing, encompasses fundamental nursing concepts that include health, illness, stress and health promotion, Nurses work with physicians and other medical staff in a wide variety of ‘medical and community settings. Nursing care focuses on protecting and promoting physical and mental health for patients and for the community. Nursing Metaparadigm ‘Metaparadigm is set of concepts/ideas and propositions that provide structure for how a discipline should function. In nursing, there are four major concepts that are frequently interrelated and fundamental to nursing: person, environment, health, and nursing. These four are collectively referred to as metaparadigm for nursing: * Person: Person (also referred to as patient or human beings) is the recipient of nursing care and may include individuals, patients, groups, families, and communities. * Nursing: The attributes, characteristics, and actions of the nurse providing care on behalf of or in conjunction with, the patient. * Health: Health is defined as the degree of wellness or well-being that the patient experiences. Environment: Environment (or situation) is defined a the internal and external surroundings that affect the pa History of Nursing and Nursing as a Profession PHILOSOPHY OF NURSING Philosophy of nursing care states our thoughts that what wwe believe to be true about the nature of the profession of nursing and provide a basis for nursing activities. According, to philosophy, nursing is considered as ‘profession of charity’. It covers following aspects: Spiritual: Spirituality provides the motives for the nurse influenced by spiritual principles. It focuses ‘on developing a sense of meaning, purpose, and hope for the person in their current life experience. Spiritual interventions involve listening to the person's story and facilitating the person to connect to God using meditation or prayer. © Moral: Understanding of moral principles and actions that lead the nurses to study ethics. Nurse has to apply the right conduct in various situations of daily life, based on moral character, adequate understanding and application of moral standards. © Intellectual: Nurse should be intellectually sound. Nursing education provides training in memory development, communication skills, _ acting reasonably, judging wisely, strengthening and expansion of capacity. © Emotional needs: Nurse must be able to function as mature, self-depending personality. She must also be able to relate well to other people. Nurse should show emotional maturity to all the patients: * Affection and love # Feeling of belongingness = Achievement of self-esteem and others. © Physical: Nurse should have knowledge, ability and skills to guide and assist others in carrying out their physical activities. Nurse must have knowledge of, how to keep well and improve health. © Social: Nursing is linked to social culture, in which nursing care is carried out. Nurse is a social being, ‘who passes her life in society in relation to which she has privileges and obligations. Nursing is a support of individual, family and society. It depends on art and science, which form the position, intellectual fitness and showing abilities of the individual nurse, to help individuals, debilitated or well, to meet theit wellbeing needs in clinical way. © Other aspects of philosophy of nursing: * Genuineness: Professional nurse should be sincere and honest in therapeutic relation. SheTextbook of Nursing Foundation- | must have clear and concrete set of skills related to communications with the patient. * Respect: Nursing is based on unconditional positive regard to the patients, Nurse’s behavior toward patients should not depend on the patient's behavior. © Conereteness: Communicating a message in a clear language using specific terms, according to the patient's level of understanding, is the vital aspect of nursing, * Immediacy: Nursing encourages immediacy that involves sensitivity to the patients feelings and a willingness to deal with these feelings rather than ignore them. (Focus on here and now). * Advocacy: Nurse protect the fundamental rights. of the patients. OBJECTIVES OF NURSING Nursing is the art and science of professional caring that incorporating the professional values of the discipline in, its professional practices. A professional nurse performs their role and practice under ethical framework that incorporates, moral concepts, professional ethics, law and respects diverse values and beliefs. Following are the main objectives of nursing: * Apply principles of philosophy in nursing interventions. ‘© Apply scientific knowledge from nursing, natural sciences and general education courses as a source for making decisions in nursing, ‘© Use the nursing process to identify health potential of individuals, groups, families and communities and to meet their health needs. * Provide comprehensive nursing care without any discrimination related to race, sex, religion, and culture in a variety of settings. © Use community resources to achieve the goals of nursing. © Demonstrate utilization, integration and application of knowledge generated through research as evidence in practice, © Assume individual responsibility for decisions made and actions taken related to nursing intervention, ¢ Use information and communication technologies to care for the patient and to enhance one's own professional knowledge, © Apply principles of scientific investigation | testing nursing intervention as hypothesis fo, | improvement of nursing practice. © Employ appropriate actions to enhance pers, and professional growth in order to cope y, changes within the health care system. ¢ Evaluate therapeutic nursing care according accepted standards of practice. © Develop goals for continued — profess development, self-care, and lifelong learning, CHARACTERISTICS OF NURSING PRACTICE, Nursing is both an art where nurse skillfully estably therapeutic relationship with the patients and science where nurse utilize their skills for the purp. of prevention, promotion and restoration of he that promote patient's growth. Some of the impor characteristics of nursing practices are as follow. © Respects the diversity: Nursing practice respeq the diversity and is individualized to meet th unique needs of the patient, family and or community. All these are healthcare consumers and the main focus of attention for th registered nurses, }. * Coordination: The nurses establish coordinatis with the heathcare team and address the needs the patients and achieve the goals to deliver quality health care. Caring: Professional nursing promotes heali in such a way that builds a relationship betwee ‘ nurse and patient. Caring for individual, family al Population is the key focus of nursing. Caring central to the nursing practice. ke Systematic and scientific approach: Nurses us nursing process (cognitive skillsand evidence-bast practice) to make diagnosis, identify objective plan and implement and evaluate the care. Critic thinking underlines each step of nursing process. | Healing environment: Nursing practice is strong link between the professional work at environment to provide optimal level of health! services and to achieve optimal outcomes. i, Continuum of care: Professional nurse provid® hospital or community-based specialized care tot patients experiencing health problems. | ‘Therapeutic communication: It is a process 4 interacting with the patients that focuses JUnit 3 advancing their physical and emotional well- feing. With therapeutic communication, the nurse iderstands the response of the patient that is ‘tient’s mental_and_ physical ommunication is the backbone beneficial to the Pp health, Therapeutic ofthe nursing. Physical and biological i involves delivering or assisting in various physical and biological interventions such as medications, surgery’ and direct physical care (personal hygiene, nutrition, and sleep, etc.) of the patients having illness. terventions: Nursing Pychosocial interventions: Psychosocial interven- tions are increasingly used in healthcare settings. ‘These include psychotherapy interventions, such as cognitive behavioral therapy, family therapy, milieu therapy and psychodynamic approaches, These interventions are used by the nurses to a broad range of psychological problems. Spiritual interventions: It focus on developing a sense of meaning, purpose, and hope for the person in their current life experience. Spiritual interventions involve listening to the person's story and facilitating the person to connect to God using meditation or prayer. Therapeutic relationship: The fundamental elements of nursing care revolve around the interpersonal relations and interactions established between nurses and patients. Caring for people's demands, an intensified presence and a strong desire to be supportive. Empathetic nursing: Itis the core of nursing where nurses try to understand patient's perspective. Empathy reinforces a positive psychological and enhances patient's sense of importance. Individuality: Nursing is based on individualized care. Nurse must consider the patients as individual Person with lives beyond their illness. Seeing people as individuals with lives beyond their illness is imperative in making patients feel valued and respected, Patient with hypertension Patient with depression Hypertensive patient Depressive patient Supportive care: Successful therapeutic relation- ships between nurses and patients need to have Positive support. Minor activities, such as sitting with the patients or reading the newspaper together can improve the quality of support provided. ‘Therapeutic touch is intended to comfort and console patients, History of Nursing and Nursing as a Profession © Legal and ethical parameters: Professional nursing, takes place in legal and ethical boundaries. Nurses must have clear sense of professional ethics, one’s ‘own values that helps them to be honest and tted nursing professional. SCOPE OF NURSING PRACTICE ‘The scope of nursing, practice is defined as the range of roles, functions, responsibilities, and activities which registered nurses are educated and authorized to perform. The broad scope of nursing practice reflects all of the roles and activities undertaken by the nurses to address the full range of human experiences and responses to health and illness. This includes: * Health promotion, health protection and health maintenance. © Health restoration, rehabilitation, and palliative care. Nursing practice is directed towards the goal of assisting patients to achieve and maintain optimal health in order to maximize quality of life across the lifespan. Patient is defined as an individual, a family, a group of individuals, a community, or a population. ‘Nursing practice is accomplished through the following (Table 3). Table 3: Accomplishment of the nursing practice Creating quality healthcare systems, population health, and healthy public policy. Usiization Use scientific knowledge of nursing through the of nursing application of critical thinking, judgment and knowledge ski Use of « Itis used to define and organize practice ursing and the nursing process to comprehensively theories and assess, diagnose, plan, implement, evaluate, models ‘and document patient care. + Application of the model of nursing care elivery adopted within the agency or practice setting, Legal parameters Adherence to relevant legislation, professional Buidelines, including the standards for nursing practice Holistic ‘approach Adoption of a holistic approach to care, addressing the biologieal, psychological, social, and spiritual needs of patients. Active participation of patient Collaboration Promotion of patient self-reliance and self- ‘determination by actively involving the patient 5 a partner in all aspects of care. Collaboration with other members of the healthcare team and coordinating with diverse sectors of the community.Semester- | Textbook of Nursing Foundation- | On the basis of the nursing skills cited in Table 2, scope or area of the nursing can be studied as expanded or extended as depicted in Figure 3 Expanded Roles of Nurses Expanded role of nursing means “engagement of nurses role within the boundaries of nurse.” It is the Tesponsibility assumed by a nurse within the field of practice: B){tostttiona § School health nursing ]L = Disaster $ 1L_Geriatricnursing C +E nds naring | SY Nurseeducator Fig. 1: Expanded roles of nurses * Home care nursing: Nurses are coordinated with the home care services and assist the individuals of all the age groups, families and communities to enhance their health and social well-being. Home care services include maintaining, restoring and promoting their physical, psychological and social well-being, © Institutional nursing: A nurse working ina nursing home or hospital comes under institutional nursing She will provide direct patient care and counseling, services to the patients, * School health nursing: The school health nurses provide direct healthcare to students and staff. She facilitates positive normal growth and development, Promote health, treatment of common health problems, screening, healthy school environment and communication with parents for counseling and referral. * Geriatric nursing: Nursing care involves elderly. Geriatric nurses are trained in the special needs of the aging adult with emphasis on promotion, health maintenance and functional status and also promote independence and self-care, © Industrial nursing: An occupational nurse nee: be a registered nurse with the great deal of eli experience and expertise in dealing with sick and injured people. Nurses need to have certification in occupational health nursing, industrial hygiene, occupational medicine and safety. They are skilled in primary prevention of injury and disease, sp, identifies the needs and plans interventions, Fo, example, modify working environment and system, of work or change working practices in order 4, reduce the risk of hazardous exposure. * Nurse educator: Nurses are responsible for the planning, implementation of teaching. program, evaluation of students’ performanceand supervision of clinical teaching program, . © Nurse epidemiologist: These nurses are also called an infection control nurse who monitors standards and procedures for the control and prevention of infectious disease and other conditions of public health significance including nosocomial infection, © Rehabilitation nurses: Nurses, who are trained in providing care to the disabled and chronically il Patients to attain the optimal functioning and adapt with the altered lifestyle. Rehabilitation nurses can work in any inpatient rehabilitation centers, outpatient center, and long-term care facilities or in private practice, tary nursing: Military nursing promotes health and meet the healthcare needs of military personnel and their dependence. Military nurses are the part of Indian army, so nurses become commissioned officers who are given rank from lieutenant to major general. * Disaster nursing: It involves response to (and preparedness for) natural or manmade events that affect an entire community. The main function of disaster nurse is to provide first aid services and helping the victims of physical and mental trauma. * Nurse researcher: A nurse with an advanced degree who conducts research relevant to the definition and improvement of nursing practice and education. © Nurse entrepreneur: A nurse, usually with an advanced degree, who may manage a clinic of health-related business, conduct research, provide education, or serve as an adviser or consultant t0 stitutions, political agencies, or business (Tayloe 2012), © Forensic nurse is of evidence in m trained in collection and handling edico legal cases, assessment and care of sexually/physically abused patients, Two Year post graduation course is completed to be forensic nurse, Extended Roles of Nurses I is the respon traditional funetioy lity assumed by a nurse beyond 6 Of the nurse and itis the scope ofUnit 3 sing services outside the hospital. Nurse in extended ies, work in a wide array of areas like school/college, rae were, ltr, primary care center, prison PL home health agency, behavioral care company/ vnters, and disaster management campus (F {“Fatended roles of nurses ei - Pediatric nu fel pa | Oncotogy nurse practitioner [gemeere caren | — | Registered nurse lawyer Fig.2: Extended roles of nurses * Certified registered nurse anesthetist (CRNA): The nurse anesthetist is one who completes a course of study in anesthesiology. She carries out preoperative visits, assessment and administers general anesthesia for surgery under the supervision of a physician. The nurse anesthetist also assesses ‘the postoperative patients. Nurse practitioner: These are the primary health care providers who assume the responsibilities of the extended role to meet the health care needs of a group ina community. Psychiatric nurse practitioner: Psychiatric nurses ‘mustbe registered nurses with additional education; usually two-year Master of Science in Nursing Degree. They have special training in psychological therapies, building therapeutic relationship and administration of psychiatric medications. They have to complete a period of supervised clinical Practice before they are eligible for certification as a Specialist in adult or child mental health, Adult nurse practitioner: An adult nurse Practitioner isa nurse pra r joner that specializes in diagnosing and treating affliction specific to adults, me adult nurse practitioner choose to specialize in Specific fields such as AIDS assessment, pulmonary and vascular care or other health related fields. Pediatric nurse practitioner: A pediatric nurse Practitioner is a registered nurse with advanced History of Nursing and Nursing as a Profession © Nurse midwife practi training in pediatrics and can provide nursing care to infants, children and adolescent. The pediatric nurses perform physical examination, diagnose injuries and many common illnesses and have the training to provide the treatment, therapies, medications and perform procedures necessary for the chitd, ner: ‘These nurses are having registration, advanced education and clinical experience in midwifery. She does antenatal and postnatal management. These practitioners also provide quality maternal and newborn services in hospitals. © Oncology nurse practitioner: Oncology nurses provide and supervise care for cancer patients who are either chronically or critically ill. Oncology nurse practitioner monitors the cancer patient's physical condition, prescribe medication and formulate symptom management strategies. Nurse informatics specialist: These are the nurses who have combined their knowledge with the computer science. They work with data collection, organization and interpretation in order to make patient care more efficient and of higher quality. ‘They work in different settings such as insurance companies, hospitals and consulting firms. They may provide training to other nurses and healthcare worker for the proper use of computers. Registered nurse lawyer: A legal nurse consultant is a licensed registered nurse who performs a critical analysis of clinical and administrative nursing practice, health care facts and issues and their outcomes for the healthcare professionals, consumers of healthcare and legal services and other as appropriate. Factors Affecting the Scope of Nursing Practice Main factors affecting the scope of nursing practice are discussed in Table 4. Table 4: Factors affecting the scope of nursing practice Professional Role and functions of a nurse largely depends qualification on thelr qualifications, For example, to practice as independent practioner or clinical specialist, nurses must have doctorate degree in nursing Professional Another important factor is the professional experience experience that influences the role and functions of a nurse, For example, to practice as Independent counselor nurse not only require Qualification but also need to have experience In that area, f |“Jaisowias on!Textbook of Nursing Foundation- | Legoland Laws of the country determine the legal ethical boundaries of nursing practices. For example, Parameters nurses can work as independent practioner in LUSA and can prescribe medications but it is not «in India because Indian laws do not permit this, Professional very profession has guidelines of expected: code of ethics behavior ofits members known as professional ‘and code of cove of conduct. Every nurse needs to work conduct according to these codes of ethics Accountability Functions of a nurse also depend on level of {and autonomy professional accountability and autonomy given to the nurses, For example, nursing practices in ‘western countries are more autonomous, hence nurses function as independent practitioner {and also have broad scope of nursing practices Issues and challenges Issues such askind of infrastructure, comorbidity illness, cost of treatment, availablity of resources and manpower, ‘community awareness, stigma, etc, are the important factors affecting the roles and functions of a nurse, Practice ‘Trends such as deinstitutionalization, integrated trends and continuity of services, holistic aspects of care, use of information technology, evidence- based practice and pandemic such as COVID-19 ‘has broaden the roles and functions of the Professional These standards identify the competency practice ‘requirements for a nurse to practice and guide standard and them to function according to the expected quality of care norms. Personal Interest, altruism, professional competencies, characteristics emotional wellbeing, values and many personal ofanurse characteristics of a nurse influences their roles and functions. FUNCTIONS OF A NURSE Professional nurse is responsible for planning and providing support and nursing care to people who are in need of nursing care. They provide their services not only within the hospital premises but at multiple settings as discussed in the scope of nursing services. Following are the functions of the nurse (Fig. 3). ‘© Caregiver: Nurses assist the patients physically and psychologically. They provide direct care and concern towards the patient welfare, © Counselor: Nurses help the patient to recognize and cope with stressful psychological or social problems by establishing the interpersonal relationship with the patient and help them in their personal growth by contributing emotionally, intellectually and psychologically. Fig, 3: Functions ofthe nurse Clinical and ethical decision maker: Nurses act clinical and ethical decision maker and work forthe protection of rights and benefits of the patient and the family. Clinical advocate: Nurses protect the patients rights and involves concern for and actions on behalf of the patient to bring about the change. ‘Case manager: Medical caretakers decide, organize exercises of others, and allocate assets. He plars, provides guidance, manages staff and screen activities, gives the prizes decently, and addresses both staff and organizations depending on the situation, Comforter: Nurses help in promoting the comfot of patient and family during the period of care. Rehabilitation: Nurses play an important role in restoration of health of the patient. The nurse works with the patient to regain the health status as close as possible to the premorbid state. ‘Communicator: Nurses support the patient through healthcare team and support people in community. Teacher: Nurses provide information and help the Patient to learn or acquire new knowledge and technical skills, They interpret information to the patient, Researcher: Nurses participate in identifying significant researchable problems and_ scientific investigations,Unit 3 Leader: As a leader nurse performs the delegation work to supporting staff and workforce facilitates budgetary obligations regarding a nursing unit or ‘organization. Role and Functions of Nurse in Various Settings Nurses provide their services not only within the hospital premises but at multiple settings as described in Table 5. Table Inhospital + Safety: Maintain safety of the patients and Role and functions of nurse in various settings {out patient prevent them from harm or injury departments» Riskassessment: Perform risk assessment of 070) andthe patients and prioritize patient’ needs, inpatient « Provide physical and biological interventions: departments Provide care and assist in gaining the self (Woy) dependence, Counseling: Provide counseling the patient and family members, Case management: Work as case manager in interdisciplinary team, Discharge and referral: Pian patient's discharge planning and community referral an follow-up care, Patient assessment: Collect history, perform ‘mental status examination, and other /sychometric assessments of patients Peedic * Monitor the child's developmental level and | ward initiate supportive interventions as prescribed. | Provide a safe therapeutic environment. Teach living and social adaptive skils to the children, Home + Provide appropriate primary nursing services setting such as medication, health education, and symptoms management, skill to encourage self-efficacy, Evaluate patient's compliance to prescribed treatment. Provide all other required services such as. referral, connecting to local NGOs, etc. ‘Work asa liaison agent between patient and the health system, Community health centers Work as aliaison agent between the community and health system where nurse Identify the people with the health problems and provide appropriate care including referral. Conduct epidemiological survey related to ‘morbidity risk population, etc. Home visiting and follow-up care to the patients in the community. Organize public awareness camp or programs on health literacy, Training of other professionals in the community. Contd, History of Nursing and Nursing as a Profession Hospice care + Providing medical and nursing care to centers the chronic or terminally ill individuals, experiencing grieving. Emergency» Suicide preventive measures and crisis intervention. Direct care provider for vulnerable people. + Provide generic (universal) care to people under criss + Provide disaster management services. QUALITIES OF A NURSE Professional nurse pave the way for better patient outcomes, staff satisfaction, and hospital growth. They're crucial for developing the quality of care and inspire other members of the profession, to maintain high level of professionalism. Some of the important qualities of the nurses are discussed here: © Communication skills: The communication is an portant part of fulfilling the health care needs of the patient. The use of effective therapeutic interpersonal communication skills are helpful to identify the problems of an individual and the families, Emotional stability: A nurse should be emotionally strong enough to deal with the stressful job and should be able to encounter traumatic situations, sufferings and death. Empathy: It is the ability to perceive and directly experience the feeling of others, Nurses should not treat their patient as burden, rather they should focus on understanding the feelings of the patient. She should have empathy for pain and suffering of patients. Flexibility: A nurse should be adaptable with respect to working hours and duties. Frequently, nurses need to work for extensive stretch of time, late or overnight, Physical endurance: A nurse should have strong, physical endurance and be able to tolerate standing for long periods of time, lifting heavy objects (or people) and performing a number of taxing maneuvers on a daily basis, Problem solving skills: A nurse should have critical thinking skills to address problems as, or before they arise. Quick response: Attends to the demand or unmet needs of the patient and prioritize them to facilitate the care, | -Ja}sawesTextbook of Nursing Foundation: | a 3g 2 a a £ o a Respect: A nurse should have respect for people and rules. She should be mindful of confidentiality requirements, different cultures and trad respect the wishes of the patient, Economic: The nurse should take care of the equipment and supplies. She should be able to manage the resources effectively. Sense of responsibility: A nurse should have great sense of responsibility. She is responsible towards the hospital as well as patient. * Honesty and loyalty: This quality matters in every Profession. The nurse should be honest and loyal toward her profession, organization and patient care. * Discipline and obedience: A nurse must be self- disciplined and obedient. She should be well -behaved, calm and well-poised. Cooperative and considerate: A nurse learns to live in harmony with patients, doctors and other members of health team and tries to help them in times of need, therefore she should be cooperative and considerate. © Cleanliness: A nurse should always be neat and clean, personally and in her work. Her demands must be of high standards of cleanliness from those whom she is associated within her profession. Knowledgeable: A nurse must keep in touch with latest technology and developments in medicine and treatment and must maintain her knowledge and skill at a consistently high level. © Observant: A good nurse is always vigilant. She keepsaclose and constantwatchon the patients, their progress, their changes and reactions to treatment, etc. She gives timely report to the doctor. A nurse should anticipate and meet the patients’ needs. A nurse understands that every step in the medical field is one that can have far reaching consequences. A nurse should be careful in following the steps and. should skip the errors. * Self-confident: The nurse must have adequate skills and knowledge in providing care to the Patients, All care should be carried out effectively with confidence. The actions and communication should reflect confidence, this helps to gain trust from patient. ‘¢ Patience: Itis the quality of being patient and trying to have persistent courage and calmness in enduring the annoyance and pain, eg, when patient shows ins and anger and temper against the nurse, she ively tee understand the cause of anger and actively listen patients’ needs and feelings. CATEGORIES OF NURSING PERSONNEL Nursing field is constantly evolving, there are a vari of different categories of nurses according to thera, profile. The demand for nurses is continually grow and the nursing career path offers many worthwhiy, benefits. Common categories of nurses are discuss, here (Table 6). Table 6: Common categories of nursing personnel Staff nurse/ ‘nursing officer * She Is also called bedside nurse who is working at first level in the institution. She | provides direct patient care to the assigned patients during shift and assist in ward management, Ward sister Sheis the first level supervisor, accountable or nursing for nursing care management in the ward, supervisor/ __ She identifies the patient’s needs, assign senior nursing patient care and other activities to nursing officer ‘and non-nursing personnel working with her in a ward. She maintains inventories and records concerning to the patient care. Assistant ‘+ She reports to nursing superintendent and nursing deputy nursing superintendent for the superintendent nursing care management of wards and units ofthe hospital. Deputy nursing * Assists in the nursing administration of superintendent the hospital under supervision of nursing superintendent. 3 Nursing * She reports to medical superintendent, in superintendent the hospital, She is accountable for the safe ‘and efficient working of different nursing department. Publichealth © She usually deals with the families and nurse ‘communities for health promotion, disease Prevention and health restoration activities. ‘Nurse educator * Nurses, usualy with an advanced degree, are teaching in the clinical or educational settings. She teaches theoretical knowledge ‘and clinical skills, Bs * Various positions in nursing education are clinical instructor, tutor, senior tutor, lect or associate professor. ‘Nurse midwife A registered nurse, who has completed 2 program in midwifery and certified by license is qualified as 2 nurse midwife. Nus® midwives provide antenatal care, postnatal ‘are and conduct delivery. [______careandeonduet detvery,DEFINITION AND CHARACTERISTICS OF A PROFESSION = eee [A profession is an occupation with ethical components “hat is devoted to the promotion of human and social welfare, which also results in a definite foe or salary, ‘A profession_is always based upon the specialized Kavowledge and skills and preparation that have been dloveloped ina leamed and scientific manner. Nursing profession is not only about caring for the sick or assisting the doctor in care and treatment of patient ng is much more than this, It deals with the services to meet the health needs of the sick, family and relatives and entire community and society. A profession requires extensive education, _ Anonledge,skilland preparation, Profession is defined a5 job and practice requires mastery of a complex set of nowledge and specific skills through formal education’ and practical experience. Definitions A profession is a paid occupation especially one that_ involves prolonged training and formal education, =o — Oxford dictionary Professionis any type of work that needs special training ‘Sra particular skill, often one that is respected because it involves high level of education. ~ Cambridge Dictionary Characteristics of Profession ‘Common characteristics of a profession are as follow: * Well-defined body of knowledge: The profession should have specialized body of knowledge fer_guiding the practice “of profession. Specific knowledge, “befiavior, and skills related to Particular profession are not possessed by the non- professionals. Strong service orientation and services: The primary be to provide services Provide specialized aim of the profession should” to the society. A. profession renders specialized services to the society based on advanced body of knowledge and skill. Services are Provided in the interest of the general public for a definite salary or fees, Individual practitioners are characterized at by a strong service motivation and lifetime commitment to competence. Service must _ ,__ DeBuided by certain rules, policies, or code of ethics, * Standardized formal_educ: on; All professions are based on standardized education like diploma, Unit 3 History of Nursing and Nursing as a Profession degree, post-geaduation and doctoral education as per established norms and curriculum, Professional education is regulated by various regulatory bocies. Practice is based on professional standards and code of ethics: Professional practice is always based on code of ethics and professional standards set by various regulatory bodies. Profession will set_ minimum. standards for membership of the profession and procedures for detecting breaches. Members of the profession should have autonomy in decision making and practice: Members-of the profession should have freedom in making de related to client services ons Decisions made by the members are based on existing body of knowledge, practice standards and code of ethics. Profession is practiced in a specialized setting: ‘ach profession is concerned with an identified area of need or function and it is practiced in a specialized setting, NURSING AS A PROFESSION To keep the people healthy and to provide comfort, care and assurance to those Who are sick, nUFSINg Was developed and begun. Due to changing needs of the society, the general goals of nursing have changed over time and in today’s world’ the nursing has gradually evolved as a modern profession. Nursing is an art and science and it is caring, adaptive, individualized, holistic and family and community centered and is concerned with health promotion, maintenance and restoration, In earlier times, only medicine, law and engineering were accepted as profession. But in foday’s time, nursing has also attained the professional status as it fulfills the following crite ia (Fig. 4): Body of knowledge: Nursing requires a specific body of knowledge that is derived from experiences “and researches. Judgment made by a nurse and “a rationale for modifying actions according toa Specific situation is based on this body of knowledge. This knowledge is orderly and exact, A nurse keeps on constantly expanding this body of knowledge to improve techniques and skills for rendering nursing care, Specialized education: A nurse “education as well as trai ional requires specialized ng and itis an important Is and tus. Various schools 2 RESESnS ae1 ey 2 a o £ G na Body of knowledge anursing profession Autonomy, and (ndependen« Fig. 4: Criteria for a nursing profession Service to the society: Nursing is means to care. It is a service that is essential for the wellbeing of the person and of the society as a whole. It is concerned with health promotion, maintenance and restoration. The goal of nursing is to help others and attain the highest level of wellness of which they are capable. It is an altruistic profession in which an individual puts the life and well-being of patients above theirs. Accountability: Being accountable means being answerable to oneself-and-to-others for one's own actions, A nurse is accountable for making Judgments, taking actions, maintaining competency and upholding quality patient care. _ Autonomy and independence: Nurses deals with Various patients and provide car “quality care, the nurse has towork With physician, hospital administrations, pharmacists and essential others, Nursing has developed and refined its own approach to practice which is called nursing process, that requires logical, critical and creative thinking and serves as the basis for providing nursing” care. Therefore, nursing is an interdependent and independent practice. Code of ethics: According to Webster, “ethics are the morals concerned with or relating to what is right or wrong” in matters of human behavior. Codes of ethics provide professional standards ., framework based on which a nurse should ren the care, sesicle having a spec © Professional license: Beside having a special, aeeevi and advanced body of knowledge, nurse must have a professional license to practi Granting a license is a legal activity which sta, that the individual has passed a national licensy, examination and is now qualified to. practi nursing. fae © Representative organization: Various internatioy, and national professional _associations~ hay been formed for the improvement_of_nursin profession. The purpose is to promote and mains the standards of nursing, promote education advancementsand research in nursing and promo the welfare of nurses. In India, Trained Nurs Association of India (TNAl) and State Nur Registration Council (SNRC) are the representati organizations of nurses. © Evidence-based nursing practice: All interventio and care rendered by nurses are based_on”sor ‘evidence and data collected from various researche that have proven to be successful and appropriate Nursing is called a profession, because nurses thin for and about others first. For nurses, others inter is above self-interest and they leave behind their ow problems and issues and give the best care to the patie Nursing es a Profession Comprises of 3’H’s 1. The head-knowledge (cognitive skills) 2. The hand-skills (psychomotor skills) 3. The heart-atlitude (affective skills) HISTORY OF NURSING Nurses’ roles in healthcare delivery in tem of promotion, prevention, treatment, care ar rehabilitation are highly significant: Nursing today hi witnessed several changes, successes and challeng through a lot of stride and movement. Nurses fa widened their scope of their work, however while t roles and responsibilities have multiplied, there are st concerns with regard to development of nursing Nursing in Prehistoric Times There are no historical evidences available in ance history “on “ursing “¢are~of sick in primitive tim discovered through myths, songs and. archaeologists.Unit 3 $e ESSN ee get rclie rom ‘evil spirit, unpleasant conditioning like bathing, starving, magic rites, nausea medication, loud noises, and sudden fright methods were used. Primitive ‘man had the skills of massaging, fermentation, bone -eiting, amputation, hot and cold bath and to heal the hemorrhage. However, specific nursing interventions forcaring the patients are missing. ‘Role of Nurse in Primitive Period Women were protecting and caring for their children, aged, sick members of the family. Nursing evolved in Fesponse to the desire, to keep the individuals healthy as well as provide comfort to the sick. This was reflected in caring, comforting, nourishing and cleansing aspect ‘of the patient. This love and hope were expressed in Empirical practice of nursing, Modern Nursing The founder of the modern nursing, Florence Nightingale, was born in Florence, Italy on 12th May 11820. In March 1854, the Crimean War happened. During the period of war, she brought reforms in sanitation, hygiene, and nursing practice and reduces the mortality rate. At Turkey, in 1859, to spread her opinions on nursing, Florence published a book called ‘Notes in Nursing’. This laid down the principles of nursing, and bases for careful observation and sensitivity to the patient's needs, HISTORY OF NURSING IN INDIA Nursing has a long and rich international heritage filled withcolorful eventsand people. Nurses with their unique divergent opinionsand talentshave made many valuable individual and collective contribution to societies. A review of historical nursing literature reveals significant linkages between social events the development of nursing and the status of nursing. In ancient India, women enjoyed a high status and opportunities. With change in political, social, and economic situation in Medieval India the status of women received a great set back. The advent of independence brought a new_era and our constitution gave importance to the equality of status and opportunity to both the gender. In 1946 Bhore Committee recommended, opening, of more schools, so that nursing training with better facilities and supervision could be established. As healthcare facilities progressed the need was felt for raising the standard of care, by raising the level of Aursing education to university degree course. Thus two college of nursing were established. . midwifery (ANM). . History of Nursing and Nursing as a Profession In 1954, Shetty Committee recommended district training” centers for training for auxiliary nursing and In 1961, Mudaliar Committee approved three tier system of nursing education that is ANM, general nursing and midwifery (GNM) and BSc Nursing. In 1949, University Education Commission under chairmanship of Professor Radhakrishnan, gave a strong. Plea for raising level of nursing education in country and integrating into the system of higher education. Since then, the progress has been made, to some extent though it is slow. -Nursing education is professional education for the preparation of nurses to enable them to render proféssional nursing care to people of all ages, in all phases of health and illness, in a variety of settings. Purpose of nursing education is to meet the following nursing needs of the country: © Nursing manpower development Constructing body of knowledge Professional development Personality development Nursing research Historical Landmarks in Nursing First Indian lady to have the courage to become forward for training was Bai Kashibai Ganpat who was sent to Thane municipality Mumbai in 1891, followed by many. changes in India. Today, more and more women are being highly educated and many are taking nursing as a profession. The journey of nursing in India from 1947 till date is shown in Table 7. Table 7: Historical landmarks in nursing ‘As per the recommendation of board committee Indian Nursing Council Act was passed on 31st December 1947 and Indian Nursing Council (INC) was constituted in 1949, First meeting of INC was held in relation to uniform, standards of education, : 1950 # Decision was taken by INCto establish ANM program to meet the requirements of nurses. This program is. stil in working situation to prepare grassroots level health providers in healthcare delivery system. 1952 © Establishment of residential field teaching center for teaching Community Health Nursing (CH) inurl area under the Collegeof Nursing, Delhi in collaboration with Primary Health Centre (PHC), Najafgarh Til today students are posted in Nalafgarh and rural postings conducted for nursing internshi .‘Textbook of Nursing Foundation-| 1953 + Apost certificate course in Community Health Nursing was conducted at All ndia Institute of Hygiene and Public Neath, Calcutta, INC approved 8 guide for teachers and examiners in relation to health subjects and it was included in publication ‘with labors and regulation, A resolution was sent by Florence Nightingale Committee of Trained Nurses ‘Association of India to INC recommending the preparation of curriculum guide to general nursing and midwifery syllabus. This recommendation was accepted by the Council in 1957, + Posteraduate degree program was established at Rajkumari Amrit Kaur College of Nursing, New Oelhi under Delhi Universit in October 1959, ‘+ First MSc Nursing 2 years posteraduate program was begun at College of Nursing in Delhi * Post certificate in Community Health Nursing was introduced by Lady Reading Health School (LRHS) in Delhi, * India had established total 263 schools offering |ANM course, * School of Nursing in Trivandrum, Kerala instituted first 2-year Post Certificate BSe Nursing. * Indian Nursing Council set up a project with technical assistance of World Health Organization (WHO) forthe revision of sylabus for general ‘nursing and midwifery course and preparation of a Buide for School of Nursing in inca, 1959 1960 1962 1964 In Chandigarh, Post Basic BSe Nursing Program started as University program, ‘+ Renaming of Nurses League of Christian Medical Association of India from nurses auxiliary, which was found in 1931, at frst included members from Pakistan, Burma, Ceylon (now known as Sri Lanka) ‘+ AWHO publication guide for School of Nursing in India was published. 1965 1965 _« Trained Nurses Association publish research section Under the chairmanship of Ms Margaret Craig, 1977 « ANM curriculum was revised by INC to begin the ‘multipurpose health worker scheme. | 1979 « Satelite Conference of Neuro-nurses of india was established. The main objective of Association was to set high standard of neurosurgery in the country. ‘This originated as subsection of Neurological Society of india in 1979. * India healthcare needs of country in terms of primary healthcare a workshop was organized to review the syllabus of general nursing and midwifery, ‘+ Nursing Research Society of India was established to promote research within and around the environment. Dr Inderit Walla was the Founder President and Mrs Uma Honda was the Secretary, Membership is open to all nurses having. postgraduate qualification ‘© MPhill nursing program was started at Rajkumari ‘Amrit Kaur College of Nursing under Delhi University. 1982 1986 Contd... 889°) « First newsletter of Nursing Research Society cng was released. . 1 in pursing in india started at Jer + Mama rt Kor coegee NUSng unde Delhi University. | ‘Academy for Nursing Studies is an organization that alms at improving qualty of nursing in gh Started in 1993 at Hyderabad. The Indian Journal Nursing and Midwifery is offal publication of ye organization Indira Gandhl Open University launched Post Base | BSc fursing dere program for 3 Years dratin | | 1993 1994 all India level ‘October 2004 INC decided that School of Nursing ‘conducting GNM program especially attached tp Medical College and Hospital should be upgradeg | to College of Nursing as soon as possible. TNA) | supported the development of basic nursing degre| program and specialty program in MSc Nursing ie Cardiothoracic Nursing Neurosurgery Critical Care| Nursing and Oncological Nursing were started ‘= National consortium for PhD: INC collaborated with Rajiv Gandhi University of Health Sciences to formulate National Consortium for PhO nursing. ic prepared sylabi and identified 8 centers all over India. NIMHANS Bangalore is nodal Center for Pho uring. 2004 2006 + BSc & Post Basic Nursing sylabus revised 2008 MSc Nursing syllabus revised 2012-13 + ANM syllabus revised 2015-16 * GNM syllabus revised 2016» INCbecame part of International Council of Nurses. Started online register to identify the numberof ‘nurses working inthe nation | | | 2017 INCpprepared curriculum for nurse practitioner (NF Programs in critical care and primary care. NP in critical eare (NPCC) program commenced from 20 and NP in primary health care (NPPHC) from 2018 “Contributions of Florence Nightingale - refer Senvl, unit 16. TRAINED NURSES ASSOCIATION OF INDIA RES ASSOCIATION OF INDIA. Endowed in 1905,at Lucknow, this national organiza was initially Known as ‘Association of _Nursi ‘Superintendents, which was later changed to ‘Traine Nurse Association of India (TNAI),’ - Miss Allen-Martin was its first President and Mi Burn was its first Secretary. “Trained Nurses Associatitt Was established urider the decision taken in 1908 # Bombay during the annual conference of Association Nursing Superintendents, The Nursing Journal of India, founded in1910isth official publication of TNAI and is published month} TNA Was also contributory in the establishment of1NSE Unit 3 History of Nursing and Nursing as a Profession - in 1947 and the Act was passed by and Ordinance on “December 31, 1947, Now having 33 branches all over India, first TNAL branch was established in 1949 in Delhi. In 1947, TNAL became a member of Commonwealth Nurses Federation (CNF) and this association was - fruitful in many ways. Since the day of its foundation till today TNAT has made significant achievement in the field of nursing and educatior Objectives of TNAI Upholding every way, # Dignity and honor of the nursing profession. Promoting a sense of espirit de corps among all nurses. Tae # To advance professional, educational, economic and general welfare of nurses. 2 INDIAN NURSING COUNCIL The need to have a body to guide and protect nurses in their profession, felt by TNAI members served as a basis for the inception of Indian Nursing Council (INC). The Indian Nursing Council Act, passed by an Ordinance on December 31, 1947 made the provision for the establishment of Nursing Council. The INC is an autonomous body under the Government of India, Ministry of Health and Family Welfare was constituted by the Central Government under section 3(1) of the Indian Nursing Council Act, 1947 of Parliament. ‘The purpose of establishing this organization was to provide uniform standard of training for nurses, midwives and health visitors. The nurses registered in one state were not conceded for registration in other states before the constitution of INC. If uniform standards of nursing education were maintained, only then it was possible to have reciprocity, ie., a condition ‘of mutual recognition by the State Nurses Registration Councils, therefore to prescribe curricula for nursing education in all states and to recognize programs of nursing education or to disapprove recognition to the schools and colleges of nursing. The office of INC is is situated in New Delhi. Objectives of INC * To establish uniform standards of training for nurses, midwives and health visitors and monitor them. To prescribe the curricula; for nursing education. ‘To recognize the qualification for the purpose of registration and employment in India and abroad. To refuse or cancel the recognition to school and college of nursing if institution fails to maintain the standard as per INC Act, 1947. ‘To recognize degree/diploma/certificate awarded by Foreign Unive: To maintain Indian Nurses Register for registration of nursing personnel. To guide and advice State Nursing Councils, Examining Boards, State Government and Central Government in various important items regarding nursing education in the country. To promote research in nursing. Toprescribe code of ethics and professional conduct. To give approval for registration of Indian and Foreign nurses possessing foreign qualification. ‘Toregulate the training policies of nursing programs in the field of nursing education. ies. Activities of INC Establishing uniform education and training. Prescribe code of ethics and professional conduct. Maintenance of Indian Nurses Register. Holding meetings to plan further for betterment of nursing. Inspection of institutes recognized for nursing education and training, ‘Teaching Material for Quality Assurance Model. Development of curriculum for human immuno- deficiency virus (HIV)/ acquired immunodeficiency syndrome (AIDS) and antiretroviral treatment (ART) in collaboration with National AIDS Control Organization (NACO). National Consortium for PhD in nursing. Memorandum of understanding (MOU or MoU) signed between INC and Sir Edward Dunlop Hospitals Ltd. to develop strategic framework and investment plan for advancing standards of nursing ‘education and practices. Organizing research activities. Training of nurses in providing outreach services during disasters and facilitators nodule. International migration of Indian nurses. Conducting various workshops. standards for nursing webinars, seminars andTextbook of Nursing Foundation: Member Representatives of INC Council is composed of: State Registration Councils Central and State Health Departments Military Nursing Services Indian Red Cross Society University Schools of Nursing Health Schools Post Certificate Schools TNAI Members Medical Council of India Indian Medical Association ‘Members of Parliament Organizational Structure of INC (Fig. 5) President Vice President Secretary Joint secretary Deputy secretary Assistant secretary Office staff Fig. 5: Organizational structure of Indian Nursing Council * President is elected by the members of council for S years. ‘* Composed of INC honorary officers and President of National Members Associations, the council of national representatives in the governing body. * _INCis headed by the President who has the powers of Head of Department. Secretary of INC the head of office. © All the work is handled by Secretary assisted by Joint Secretary and staff. THE INTERNATIONAL COUNCIL OF NURSES eee The International Council of Nurses (ICN) was founded in 1899 by Mrs Bedford Fenwick. It is the federation itical and self-governing National Sate ICNis the global voice of vi ‘The main purpose of the ICN is to provide! ti through which the national associations can shows interests in the promotion of health and caro thx Objectives of ICN ¢ To promote the development ofthe strong Naty, Nurses Association. # To assist National Nurses Association to impr, the standards of nursing education and practice * To assist National Nurses Association to impiny the status of nurses within their countries, # To serve as the authoritative voice for nurses an nursing internationally. Activities of ICN © The ICN has published the code for nurses, © It makes the policy statement on health and soci issues. © It also maintains and improves the status of nurses and standard of nursing around the world, © Thecouncil works to improve the nursing education and practice by publishing the guidelines fe National Nurses Association. ° The governing body of the ICN is the council of national representatives, which is made up of the ICN honorary officers and the presidents of te National Member Associations (NMAs). * The ICN publishes the International Nursing Review and Newsletter, which give the news ofthe ICN and the National Nurses Association. STATE NURSES REGISTRATION COUNCIL RIE NURSES REGISTRATION COUNCIL _ For the purpose of better training of nurses, midwives and health visitors, State Nurses Registration Cound (NRC) was established. Because of sustained effots of TNAL, first SNRC was established at Chennai it 1926. Now there are 29 SNRC all over India. It is a autonomous, independent and recognized body th Work under INC. In spite of being an independ#! body, to make laws and decisions, SNRC has to obi approval from the state government. As per the name, SNRC, it is responsible for registration of students immediately after admission” Rursing education program and final registration aft the completion of course,l: Unit 3. History of Nursing and Nursing as a Profession _— Example of SNRC © SNRC makes sure that all facilities are available Panjab Nurses Registration Council (PNRC): It looks after the issues related to nursing in Punjab and Chandigarh. Council Members of SNRC (Fig. 6) _ Registrar Se Statt Fig. 6: Council members of State Nurses Registration Council When to get Registration Renewed? ‘After a specific period of time or after attaining higher education in nursing, the nurse needs to get her registration renewed. To keep a check and control on the nurse practicing the profession in the state; it is done. Dully filled form certified by the training institute along with the copies of all the academic certificates and required process fees, is sent to the registrar for renewing purpose. For the purpose of upgrading the status of the nurses within the state register, it is important to renew the registration, Functions of SNRC © SNRC is responsible for the registration of the students after admission in nursing education program and final registration after completion of course, * It inspects the institutes recognized for nursing education and training in the state to check if they fulfil the desired requirements. Conduction of examination and declaration of result of various nursing education program is also part of SNRC, * Functions of SNRC also includes regulation of ing program, prescribing rules of conduct and taking disciplinary actions, It issues the registration certificates which bears registration number. It is responsible for checking malpractice and maintaining professional ethics. It coordinates with INC and other government department and universities. for conducting any of nursing education program before granting permission for setting up any institute. © It keeps in touch with all the education institutes to notify them about the issues of importance to nursing and health. © It maintains various records and registers that includes name and address of all the registered nurses, midwives and health visitors. © Itisalso responsible for foreign verification. © It conducts in service education program and researches and publication also comes under the function of SNRC. © It is responsible for renewal and upgradation of registration. VALUES Nursing is considered to be protecting, promoting and optimizing health. It also involves prevention of illness and injury, also facilitating healing alleviating suffering and providing care to the individuals. According to the ICN, nursing encompasses autonomous and collaborative care of individuals of all ages, families, groups and communities sick or well and in all settings. With the help of professional values, nursing profession has credited the legacy of caring behavior embodied by the nurses. Types of Values Religious (obtains strength from religious beliefs) Theoretical (holds truth, rationality and respectable) Political (values power) Economic (values usefulness and practicability) Aesthetic (values beauty, harmony) Social (values human interactions, sympathetic and unselfish). © Values are goals or beliefs that we develop over a period of time and we reflect in our behavior. It helps us for decision making. For example, not lying to patient about his health. * Personal values are something that an individual has developed a standard or criteria or way to live, eg, being honest is personal value. It is a self-motivated discipline for oneself based on inner beliefs, for example, ‘I should not take bribe’. * Professional values are acquired values, learnt through socialization like in nursing code of areneTextbook of Nursing Foundation-1 ethics is the base of professional values, for example, nurse always keeps. the patient's ‘matter confidential, Value Clarification Identifying personal and professional values is, important because values are so entrenched into ones’ personality, thinking and behavior, which causes value reflection in an automatic fashion. Nurse need to be aware of personal values because jadvertently nurse may impose own point of view on others, Moreover, in order to plan effective care, nurse need to identify patient’s values as they are related to health issues. Therefore, value clarification of patient is essential, Raths, Harmin, and Simon (1966, 1978) described valuing process. According to them value is an outcome of a process that requires the following: © Choosing involves cognitive ability: It is the choice made with free will. For example, individual will not take bribe even if no one is watching, This is a choice made willingly without any compulsion (choosing freely) and this action of not taking bribe is chosen from different alternatives (alternative of monetary benefit or extra income). The choice made is a thoughtful analysis of alternatives and then decision is made (not taking bribe). © Prizing and cherishing: The choice made makes the individual feel proud and happy, which is considered as prizing and cherishing is done by publicly accepting it. Continuing theaboveexample, individual may feel proud of not taking bribe and may express his choice as medal of honesty in front of others and secking respect from others (prizing — respect in society or among friends)(cherishing — feeling proud of oneself). © Affirming acting and repeating: In this stage the action or choices made will reappear is affirming, This becomes positive commitment and exhibited in the behavior repeatedly and it lands to a stage where itis exhibited unknowingly. The valuing process helps the nurses to identify the patient values and enable to plan care accordingly, so that there is no inadvertent collision of values between the caregiver and patient. Professional Values in Nursing © Altruism is the intention or concern for others welfare and their well-being. Professionally nurses reflect it by caring for the patients’ health, belts, values, advocate on behalf of the patient, the ability 10 be sell-dependen aac aking decision specially related yoye health. Nurses in thelr practice exhibit autene by allowing patient to make decisions ang information of right to deny for any procedty make choices out of the given options, © Human dignity is dependent on the individu perception anc dignity is maintained in the sense, respeet toward the other and for self, Human digy isfortheconfidentiality of the patient and healtheay providers. Nurse exhibits the human dignj while providing care through her competency maintaining privacy and confidenti tY Of the patient. © Integrity is the ability to behave in accordance wig code of ethics and exhibit professional behavice Nurse shows this by strictly indulging in nurse. patient relationship only, following the code ¢ ethics like being honest, being responsible, and maintain confidentiality, ete. © Social justice is holding the moral and social, humanistic principles while practicing. nursing Nurses can be observed providing care without taking in consideration of color creed and religior, which means they provide care with fairness and nondiscrimination patter. © Advocacy means nurse rived to act on behalf of the patient as and when needed, Being an effective advocate for the patient involve assertiveness, recognition of right and values of person under care Ethics of Care © Protects human di eo nity. Perceived as a normal imperative. Require awareness of potential inequality in relationships, Spiritual: Being aware of an honoring patient's beliefs. * Presence: Physically present and demonstrating understanding the patient, avoid making assumptions and focuses on planned interventits Caring in Nursing Introduction Zhe dynamic essence of nursing is due to caring, Cat [rvolves a sense of self-identity and spit ofthe pero™ {Linvolvesa pure sense of dedication and commitmen!” the patient. A specific action of caring may transcend value because itis “grounded He i é od fo ondit creative nursa’ BTOUNded in the self-transceee Definitions of Caring "The moral ideal of nursing whereby the end is protection, enhancement, and preservation of human dignity, Human caring involves values, a will and a commitment to care, knowledge, caring actions, and consequences. All of human caring is related to intersubjective human response to health-illness; environmental-personal interaction; Knowledge of the nurse caring process self Knowledge, knowledge of one’s power and transaction limitations.” =Watson Caring as “a nurturing way of relating to a valued other toward whom one feels a personal sense of commitment and responsibility”. —Szvanson The essence of the value of human care and caring, may be futile, unless it contributes to a philosophy of action. Watson stated that nursing isa caring profession, its ability to sustain its caring ideal and ideology in practice will affect the human development of civilization and determine nurses’ contribution to society. Important Concepts of Caring in Nursing Care and love are the universal aspect of nursing. Caring and loving is essential to nourish our humanity. We have to treat ourselves with gentleness and ignity before we can respect and care for others with gentleness and dignity. Nursing has always held a human-care and caring, stance in regard to people with health-illness ‘concerns, Caring is the essence of nursing and the most central and unifying focus for nursing practice. Human care, at the individual and group level, has received less and less emphasis in the healthcare delivery system. Human care can be effectively demonstrated and practiced only interpersonally. Caring Aspect (Carative Factors) of Nursing Practice (Watson) Watson explains that the carative factors refer to how interventions are associated to the human care process. Important carative factors are as follow: * The formation of a humanistic-altruistic system of values, The installation of faith and hope. The cultivation of sensitivity to one’s self and to others. Unit 3. History of Nursing and Nursing as a Profession ‘© The development of a helping-trust relationship. : © The promotion and acceptance of the expression 0 positive and negative feelings. | © The systematic use of the scientific problem-solving methods for decision making. ; © The promotion of interpersonal teaching and learning, ; © The provision for a supportive, protective, and (or) corrective mental, physical, sociocultural, and spiritual environment. © Assistance with the gratification of human needs. Advocacy in Nursing Patient advocacy playsa central role in nursing, Through professional advocacy nurses are committed to improve the practice of nursing and maintaining the integrity of the healthcare profession. Advocacy role of the nurses suggest that the nurse is accountable for assuring that the at least minimum standard are met. Definition of Advocacy © Advocacy is the protection and support of another's right. sl Verbal support or argumentation for a cause. ANunse havecate © Defends or promote the rights of the patients. ‘Change system to meet the needs of the patients. Empowers and promote self-determination in others. Promote autonomy among patients. Ensures respect, equality and dignity for patients and others. © Cares for humanness of all. ‘Advocacy for Professional Practice (ANA, 1999) ‘© Promoting and protecting the occupational safety and health of the nurses. Using Nursing Practice Act and other legislative and regulatory protection. Using the political process to influence legislative and regulatory agencies for the protection of the nurses and patients. Providing education regarding employment rights and responsibilities. Developing skills related to public relations, media presentation and conflict resolution.Building coalitions and support groups 10 enable nurses to speak and advocate for their professional practices, © Participating in committee structures of the hospital to ensure a nursing voice in safety and workplace issues, wneeecas ~--€aeer) { Advocating for improved patient care and 1 exposing unethical practices Is not without risk. ETHICS The term ethics is derived from the word ‘ethos’ meaning custom or character. It is related to moral actions and one’s value system. These are expected standards of behavior of a particular group and it guides human character and behavior. Ethics is the branch of Philosophy which is concerned with human character and behavior. Definitions of Ethics * “Ethics refers to moral code for nursing and is based on the obligation to service and respect to human lite. Melanie and Evelyn © “Bthics is the science of moral duty or ideal human behaviour”. —Webster Dictionary Ethics in nursing explains duties and obligation of ‘nurses to their clients and other health care professionals, the profession and community. It provides standards for professional behavior. Itis the written list of professional values, particular code of behaviors, characters, conducts and relationship. The values of a profession are outlined in code of ethics. Ethical Principles Various ethical principles are depicted in Figure 7 * Autonomy: Autonomy is the right of self. determination or freedom to make choices. It refers to patient's right to make decision concerning health. Nurses should respect patient's right te make decisions about their health/care, without any judgment or coercion, Basically, nurses have to respect patient's wishes and decisions, even if you are not agreeing to it Patient has the right to accept or reject the care. So, adequate information about treatment options has to be provided to enable the patient to make decisions. Fig. 7: Ethical principles Principle of autonomy supports the follo rules: * Tell the truth. * Respect the privacy of others, * Maintain confidentiality. * Obtain consent, informed consent fg intervention and treatment. : wing mon © Beneficence: Bencficence refers to doing goa and right things for the patient. It includes tag Positive actions to help others. Nurses have te responsibility to implement good things for tie patients, Principle of beneficence has two aspects: 1. Providing benefits 2. Balancing benefits and risks/harms. Justice: Justice refers to treating all patients fly and equally. Nurses must be fair when they rendet their services and care to patients. Care must & equally and fairly distributed among patient. Nonmaleficence: Nonmaleficence is avoitt harm to patients, Harm can be either intentional unintentional, Fidelity: It involves faithfulness, loyalty, al honoring commitments. It basically cE healthcare professionals loyalty and faithfulness their professional responsibilities and aj oll fo provide quality care to patients. Nurses sh be faithful and fair in fulfill ig their responsi i and obligations. Fidelity require nurses to te! Patients with respect. > a© Veracity: This pri Unit 3 History of Nursing and Nursing as a Profession ple is concemed with being honest and telling truth, Nurses must honestly represent client’s perspective and wishes, Nurses need to communicate realistic picture clearly to the paticnts and families to prevent misunderstandings. Nurses should not withhold the whole truth from patients, although one may pelieve the truth will cause distress, defined being answerable to oneself and others for one’s own acti beingaccountableforourpractice, workenvironment, and patient safety. Nurses are accountable to patients, their family members, employees, nursing profession, society and organization in which they are working, Responsibility: Itis the obligation to perform duties and role assigned using scientific knowledge and professional judgment. © Confidentiality: It is the right of the patient to have all personal and heathcare information to be kept in confidence. Nurses have the responsibility to maintain confidentiality while providing care to patients. Code of Ethics Code of ethics is a set of ethical principles that are accepted by all members of a profession. Code of cthics act as guide for nurses to carry out high quality nursing care. Code of ethics serves as guidelines for nurses real ns. It means and other health care professionals when conflict ‘occurs about correct practice or behavior. It provides a framework for decision making for a profession. Purposes of Code of Ethics © Code of ethics provide standards for professional behavior and includes values and principles that govern decisions in nursing. * Inform the public about the profession minimum standards. * Demonstrate nurses commitment to the public they serve. Outline major ethical consideration of nursing. Provide general guidelines for professional behavior and professional development. Protects the right of individual, family, and community. Remind us of the special responsibility we assume in caring for the sick. © Basis for self-regulation and relationship with others. * Provide well-defined policy and procedures for dissolving ethical dilemma. Code of ethics defines professional standard and is an integral part of foundation of nursing. It makes explicit the primary goals, values and obligations in nursing, First formal code of ethics to guide the nursing profession was developed and published by American Nurses Association (ANA) in the 1950's. INTERNATIONAL COUNCIL OF NURSES CODE OF ETHICS ‘An international code of ethics for nurses was first adopted by the International Council of Nurses (ICN) in 1953. It has been revised and reaffirmed at various times since, most recently with this review and revision completed in 2012. ‘The ICN Code of Ethics for Nurses has four principal elements that outline the standards of ethical conduct. Elements of Code (Fig. 8) ‘Nurses and practice Nurses and the profession Fig. 8: Elements of code Nurses and People ® Thenurse’s primary professional responsibility is to provide care to people requiring nursing care. © In providing care, the nurse promotes an environment in which the human rights, values, customs and spiritual beliefs of the individual, family and community are respected. © The nurse ensures that the individual receives accurate, sufficient and timely information in a culturally appropriate manner on which to base consent for care and related treatment, The nurseet ier rien ia nee SE» 7 Semester- | ‘ee A Textbook of Nursing Foundation- | holds in confidence personal information and uses judgment in sharing this information. © The nurse shares with society the responsibility for initiating and supporting action to meet the health and social needs of the public, in particular those of vulnerable populations. * The nurse advocates for equity and social justice in resource allocation, access to healthcare and other socialand economicservices. Thenurse demonstrates professional values such as respectfulness, responsiveness, compassion, trustworthiness, and integrity. ‘Nurses and Practice ‘* The nurse carries personal responsibility and accountability for nursing practice, and for maintaining competence by continual learning, The nurse maintains a standard of personal health such that the ability to provide care is not ‘compromised The nurse uses judgment regarding individual competence when accepting and delegating responsibility. The nurse at all times maintains standards of personal conduct, which reflect well on the profession and enhance its image and public ‘confidence. ‘The nurse, in providing care, ensures that use of technology and scientific advances are compatible with the safety, dignity, and rights of people. ‘The nurse strives to foster and maintain a practice culture promoting ethical behavior and open dialogue. ‘Nurses and the Profession * The nurse assumes the major role in determining and implementing acceptable standards of clinical nursing practice, management, research and education. ‘The nurse is active in developing a core of research- based professional knowledge that supports evidence-based practice. The nurse is active in developing and sustaining a core of professional values, The nurse, acting through the professional organization, participates in creating a positive practice environment and maintaining safe, equitable social and economic working conditions in nursing ‘The nurse practices tosustain and protect the natural environment and is aware of its consequences on health. ‘¢ The nurse contributes to an ethical environment and challenges unethic settings. Organi al Prac Nurses and Coworkers # ‘The nurse sustains a collaborative and relationship with coworkers in nursing fields. © The nurse takes appropriate action to individuals, families and communities ype 9 heath i endangered by a coworker er ny person. z ‘©The nurse takes appropriate action to su 4 guide coworkers to advance ethical conduct, “| "y 2 INDIAN NURSING COUNCIL CODE OF ETH Code of ethies and professional conduct for nus ay very essential in building professionalism, Nurses ma | have professional competence, moral responsi} and obligations and are responsible for prov services to people even though itis in conflict with her personal beliefs and values. Indian nursing coin has set code of ethics for nursing practice in Inda ensure quality care and to identify obligations innars| esearch and practice in India (Fig. 9) Code of Ethics SS The nurse respects the uniqueness of anindividal| in provision of care. " Provides care to individuals witha! consideration of caste, creed, religion, cult ethnicity, gender, socio-economic and politi status, personal attributes, or any other groun’s Individualizes the care considering the bel values and cultural sensitivities. Appreciates the place of an individual # the family and community and facili Participation of significant others in the cae Develops and promotes trustful relations? with individual(s). Recognize uniqueness of response of individ to intervention and adapts accordingly: The nurse respects the rights of individu * Partner in care and help in making inf choices "Appreciate individual's right to make eco about their care and therefore gives ® and accurate information for enabling ‘make informed choices,Unit 3 History of Nursing and Nursing as a Profession ery 7 CEN * Professional : responsibility and. accountability, q Nursing care must be provided only by the registered nurse. Nurse strives to maintain quality nursing care and upholds the standards of care. ‘Nurse values continuing education, initiates and utilizes all opportunities for self-development. Nurses valuesresearchasameansofdevelopment of nursing profession and participates in nursing, research adhering to ethical principles. * The nurse if obliged to practice within the framework of ethical, professional and legal boundaries. * Adheres tocode of ethicsand code of professional conduct for nurses in India developed by INC. Familiarizes with relevant laws and practices in accordance with the law of the state. © Nurse is obliged to work harmoniously with members of the health team. * Appreciates the team efforts in rendering care. * Cooperates, coordinates and collaborates with members of the health team to meet the needs of people. © Nurse commits to reciprocate the trust invested in nursing profession by society. = Demonstrates personal etiquette in all dealings. *" Demonstrates professional attributes in all dealings. ‘uniqueness of an indiv provision of care + Themurse respects the rights of + Nursing practice an individuals as partner in care . and help in making informed choices + The nurse respects individual's right to privacy, maintains confidentiality, and shares information judiciously. * Communication and interpersonal relationships, + Nurse maintains competence in order to render quality nursing, are + The nurse if obliged to practice within the framework of ethical, professional and legal ‘boundaries. + Valuing human being. + Management. + Professional advancement. + Nurses obliged to work harmoniously with members of thehealth team + Nurse commils to reciprocate the trust invested in nursing profession by society. Fig.9: Code of ethics and code of professional conduct (INC) "Respects the decisions made by individual(s) | regarding their care. Code of Professional Conduct for Nurses in India " Protects public from misinformation and ne misinterpretations. Code of professional conduct for nurses in India is the + Advocates special provision to protect _®Pected national standards for nurses in India. Purpose of professional conduct is to inform the nurse and society about the minimum standards for professional practice. It provides a framework for legally and professionally accountable and responsible nursing practice in the vulnerable individuals/ groups. © The nurse respects individual's right to privacy, maintains confidentiality, and shares information judiciously. . country. Nurses must have the responsibility to provide * Respects the individual's right to privacy of their fe and competent care to the society. personal information. * Professional responsibility and accountability " Maintains confidentiality of _ privileged = Appreciates sense of self-worth and nurtures it. information except in life-threatening situations and uses discretion in sharing information. * Takes informed consent and maintains anonymity when information is required for quality assurance/academic/legal reasons. * Limits the access to all personal records written and computerized to authorized persons only. Nurse maintains competence in order to render quality nursing care. ® Maintains standards of personal conduct reflecting credit upon the profession. "Carries outresponsibilities within the framework of the professional boundaries. = Nurse is accountable for maintaining practice standards set by INC. "Nurse is accountable for own decisions and actions. = Nurse is compassionate and is responsible for continuous improvement of current practices.Textbook of Nursing Foundation: | "Provides adequate information to individuals that allow them to make informed choices. * Practices healthful behavior, Nursing practice * Provides care in accordance with set standards of practice, Treats all individuals and families with human dignity in providing physical, psychological, ‘emotional, social and spiritual aspects of care. Respects individuals and families in the context of traditional and cultural practices, promoting healthy practices and discouraging harmful Practices, Presents realistic picture truthfully in all situations for facilitating autonomous decision- making by individuals and families. Promotes participation of individuals and significant others in the care. Ensures safe practice. Consults, coordinates, collaborates and follow- UP appropriately when individuals’ care needs exceed the nurse's competence. ‘Communication and interpersonal relationships * Establishes and maintains effective interpersonal telationships with individuals, families and communities. Upholds the dignity of team members and maintains effective interpersonal. relationship with them. Appreciates and nurtures professional role of team members. Cooperates with other health professional to ‘meet the needs of the individuals, families and communities, Valuing human being * Takes appropriate action to protect individuals from harmful unethical practice. * Considers relevant facts while taking conscience "Uses judgment in relation ty , competence while accepting apy responsibility. - * Facilitates conductive work culture jy achieve institutional objectives, Orde * Communicates effectively abn, communication, * Participates in performance appraisa, * Participates in evaluation of nursin, = Participates in policy decisions, Principle of equity and accessibility of 8 * Works with individuals to identity they and. sensitizes policy makers and agencies for resource allocation, Professional advancement * Ensures the protection ofthe human righ pursuing the advancement of knowledge * Contributes to the development of a practice. i Parlcpates in determining and inplener quality care. 4 * Takes responsibility for updating on knowledge and competencies. * Contributes to core of professional knowles by conducting and partcpating inne Purpose of code of ethics and profesion, conduct is to guide nurses and midwives in te professional practiceand to help them to under their professional responsibilities in provid ‘competent, safe and effective nursing care. Code of professional conduct provides consure employing and professional bodies with a ks for decisions regarding standards for profes behaviour for nurses, i 8 Ocha, 1B Servic folonng LEGAL ASPECTS IN NURSING Legal responsibility play essential role in nursing ‘nurses must have an understanding of the law. NBS Must be knowledgeable about legal boundaries 0! a Practice in order to provide safe, competent ae i Guality nursing care. Nurses are accountable for . ee SMppons choles made by the Professional judgment and actions. Management Defi * Ensures appropriate allocation and utilization of available resources. * Participates in supervision and education of students and other formal care providers, decisions in the best interest of individuals, Encourages and supports individuals in their right to speak for themselves on issues affecting their health and welfare, ion of Nursing Law Nursing law is defined as a rule of conduct, & anders, regulations and legal precedents, whit! their objective, promotion and protection of indi and community by nursing practice.