NSC219 Foundation of Professional Nursing Practice 1 PDF

NSC219 MODULE 1 Course Code NSC219 Course Title FOUNDATION OF PROFESSIONAL NURSING PRACTICE 1 Course Team Course Material developer and Writers Dr Reuben Fajemilehin (Course Developer/Writer) - OAU Mr. Olufemi Ayandiran (Co-developer/Co-writer) - OAU Mr Kayode S. Olubiyi (Co-developer/Co-writer) – NOUN Prof. (Mrs) O. Nwana (Programme Leader) - NOUN Course Reviewer Dr Elizabeth Joseph-Shehu – NOUN Course Coordinator Dr Elizabeth Joseph-Shehu – NOUN 1 NSC219 FOUNDATION OF PROFESSIONAL NURSING PRACTICE 1 © 2021 by NOUN Press National Open University of Nigeria Headquarters University Village Plot 91, Cadastral Zone Nnamdi Azikiwe Expressway Jabi, Abuja Lagos Office 14/16 Ahmadu Bello Way Victoria Island, Lagos e-mail: [email protected] URL: www.nou.edu.ng All rights reserved. No part of this book may be reproduced, in any form or by any means, without permission in writing from the publisher Printed 2010 Reviewed 2022 ISBN: 978-978-058-277-7 2 NSC219 MODULE 1 STUDY UNITS There are thirteen study units in this course as follows: Module 1 Nature of Nursing I………………………… 1 Unit 1 Historical Development of Nursing I………... 1 Unit 2 Historical Development of Nursing II……. 7 Unit 3 Concepts of Nursing………………………… 18 Unit 4 Nursing as an Art and a Science………… 26 Unit 5 Nursing as a Profession ………………...… 33 Module 2 Nature of Nursing II………………………... 42 Unit 1 The Role of the Nurse…………………… 42 Unit 2 Nursing Care Deliver…………………… 49 Unit 3 Nursing and Society …………………….. 58 Unit 4 Nursing and Human Environment………….. 68 Module 3 Health and Human Environment…………. 80 Unit 1 Concept of Health and Illness……………….. 80 Unit 2 Health and human needs I……………….….. 91 Unit 3 Health and human needs II…………….…… 103 Unit 4 Health Promotion……………………………. Module 4 Fundamentals of Nursing…………………. 127 Unit 1 Vital Signs I……………………………… 127 Unit 2 Vital Signs II……………………………. 145 Unit 3 History Taking and Physical Examination 167 Unit 4 Diagnostic Measures in Patients Care….. 181 Unit 5 Providing Safety and Comfort…………... 200 3 NSC219 FOUNDATION OF PROFESSIONAL NURSING PRACTICE 1 CONTENT PAGE Introduction........................................................................ iv What you will Learn in this Course……………………… iv Course Aims....................................................................... iv Course Objectives............................................................... iv Working through this Course............................................. v Course Materials………………………………………… vi Study Units........................................................................ vi Textbooks and References……………………………… vi Assignment File Tutor Marked Assignment Final Examination and Grading Presentation Schedule Course marking Scheme Course Overview How to get the most from the course INTRODUCTION Welcome to NSC 211 – Foundation of Professional Nursing Practice I is a four-credit unit course for students pursuing BNSc. It is one of the courses meant to lay your desired foundation for the choice of nursing as a course of study and profession. The course consists of 4 Credit units (60 hours of instruction online; 48 hours of laboratory & Clinical Practice). This is a second-year first- semester concurrent BNSc degree programme course. The course comprises the bedrock of acquiring necessary elementary skills amidst health care reforms. The changes in response to social, political, economic factors, health technology, and advances in the health care system call for reform in health care delivery have greatly influenced the setting where nursing is practised coupled with the recipient of care itself. 4 NSC219 MODULE 1 WHAT YOU WILL LEARN IN THIS COURSE The overall aim of this course is to introduce you to the ability to assess the nurse's patient skills regardless of the practice setting. All settings where nurses provide care, eliciting complete history and using appropriate assessment skills are critical to identifying physical and psycho- emotional problems experienced by the patient. The course will provide you with a broad understanding of nursing and what made up nursing as a profession. COURSE AIMS The aim of the course is to give you a better understanding of the fundamental of the nursing profession. The aim of the course will be achieved by:  Providing you a comprehensive historical development of Nursing  exposing you to the concept of Nursing  helping you to understand the various factors that affect health and the human environment  giving you insight into the fundamentals of Nursing practice. COURSE OBJECTIVES To achieve the aims set out above, the course sets overall objectives. In addition, each unit also has specific objectives. The unit objectives are always given at the beginning of a unit; you should read them before you start working through the unit. You may also want to refer to them during your study of the unit so as to check on your progress. You should always look at the unit objectives after completing a unit. In this way, you can be sure that you have done what was required of you by the unit. Below are the wider objectives of the course as a whole. By meeting these objectives, you should have achieved the aims of the course as a whole. On successful completion of the course, you should be able to:  define History and state the stages of nursing development in Nigeria  describe the events that occurred in the past that positively moved Nursing forward to the present date  explain the nature of Nursing 5 NSC219 FOUNDATION OF PROFESSIONAL NURSING PRACTICE 1  explain the importance of nursing to the health and human environment  examine the role of the nurse as a teacher, counsellor, caregiver, manager and researcher  explain what integrated approach of health, wellness, and illness is  describe physical assessment and diagnostic measures in the care of patients  explain the problems militating against nursing development  proffer solutions to these problems. WORKING THROUGH THIS COURSE To complete this course, you are required to read the study units and other related materials. Each unit contains self-assessment exercises, and at certain points in the course, you will be required to submit assignments for assessment purposes. At the end of the course, you are going to sit for a final examination. The course should take you about fifteen weeks, in total, to complete. Below you will find listed all the course components, what you have to do and how you should allocate your time to studying the course. You will be expected to read every module and all assigned readings to prepare you to have meaningful contributions to all sessions and complete all activities. It is important that you attempt all the Self-Assessment Questions (SAQ) at the end of every unit to help your understanding of the contents and to help you prepare for the in-course tests and the final examination. You will also be expected to keep a portfolio to keep all your completed assignments. Specifically, each unit has activities and videos that will guide your ability to learn health history and physical assessment skills. COURSE MATERIALS STUDY UNITS There are thirteen study units in this course as follows: Module 1 Nature of Nursing I………………………… 1 6 NSC219 MODULE 1 Unit 1 Historical Development of Nursing I………... 1 Unit 2 Historical Development of Nursing II……. 7 Unit 3 Concepts of Nursing………………………… 18 Unit 4 Nursing as an Art and a Science………… 26 Unit 5 Nursing as a Profession ………………...… 33 Module 2 Nature of Nursing II………………………... 42 Unit 1 The Role of the Nurse…………………… 42 Unit 2 Nursing Care Deliver…………………… 49 Unit 3 Nursing and Society …………………….. 58 Unit 4 Nursing and Human Environment………….. 68 Module 3 Health and Human Environment…………. 80 Unit 1 Concept of Health and Illness……………….. 80 Unit 2 Health and human needs I……………….….. 91 Unit 3 Health and human needs II…………….…… 103 Unit 4 Health Promotion……………………………. Module 4 Fundamentals of Nursing…………………. 127 Unit 1 Vital Signs I……………………………… 127 Unit 2 Vital Signs II……………………………. 145 Unit 3 History Taking and Physical Examination 167 Unit 4 Diagnostic Measures in Patients Care….. 181 Unit 5 Providing Safety and Comfort…………... 200 TEXTBOOKS AND REFERENCES  Berman, A., Snyder, S. J., Kozier, B., Erb, G. L., Levett-Jones, T., Dwyer, T., Hales, M., Harvey, N., Moxham, L., & Park, T. (2014). Kozier & Erb's fundamentals of Nursing Australian edition (Vol. 3). Pearson Higher Education AU.  Berman, A., Snyder, S., & Frandsen, G. (2016). Study Guide for Kozier & Erb's Fundamentals of Nursing: Concepts, Process, and Practice, [by] Berman, Snyder. Pearson.  Brooker, C., & Waugh, A. (2013). Foundations of Nursing Practice E-Book: Fundamentals of Holistic Care. Elsevier Health Sciences.  Cherry, B., & Jacob, S. R. (2016). Contemporary nursing: Issues, trends, & management. Elsevier Health Sciences. 7 NSC219 FOUNDATION OF PROFESSIONAL NURSING PRACTICE 1  DeLaune, S. C., & Ladner, P. K. (2011). Fundamentals of nursing: Standards and practice. Cengage learning.  Dolan, J. A., Fitzpatrick, M. L., & Herrmann, E. K. (1983). Nursing in society: A historical perspective. WB Saunders Company.  Donahue, M. P. (2011). Nursing, the finest art: An illustrated history. Mosby.  McCormack, B., & McCance, T. (2011). Person-centred nursing: theory and practice. John Wiley & Sons Mortimer, B. (2004). Introduction: the history of nursing: yesterday, today and tomorrow. In New Directions in Nursing History (pp. 17-37). Routledge.  Potter, P. A., Perry, A. G. E., Hall, A. E., & Stockert, P. A. (2009). Fundamentals of nursing. Elsevier Mosby. EQUIPMENT AND SOFTWARE NEEDED TO ACCESS COURSE You will be expected to have the following tools: 1. A computer (laptop or desktop or a tablet) 2. Internet access, preferably broadband rather than dial-up access 3. MS Office software – Word PROCESSOR, PowerPoint, Spreadsheet 4. Browser – Preferably Internet Explorer, Mozilla Firefox 5. Adobe Acrobat Reader NUMBER AND PLACES OF MEETING (ONLINE, FACE-TO- FACE, LABORATORY PRACTICALS) These details will be provided to you at the time of commencement of this course. DISCUSSION FORUM There will be an online discussion forum, and topics for discussion will be available for your contributions. It is mandatory that you participate in every discussion every week. Your participation links you, your face, your ideas and views to that of every member of the class and earns you some mark. ASSIGNMENT FILE 8 NSC219 MODULE 1 The assignment file will be the Tutor Marked Assignment (TMA), which will constitute part of the course's continuous assessment (CA). There are 20 assignments in this course, with each unit having an activity/exercise for you to do to facilitate your learning as an individual. Assessment There are two aspects to the assessment of the course. These are the Tutor marked assignments and written examinations. In tackling the assignments, you are expected to apply information, knowledge and strategies gathered during the course. The assignments must be turned in to your tutor for formal assessment in accordance with the stated presentation schedules. The works you submit to your tutor for assessment will count for 30% of your total course work. At the end of the course you will need to sit for a final written examination of three hour’s duration. This examination will also count for 70% of your total course mark. Tutor-Marked Assignment (TMA) There are 30 tutor-marked assignments in the course. You are advised in your own interest to attempt and submit the assignments at the stipulated time. You will be able to complete the assignments from the information and materials contained in your reading and study units. There is other self activity contained in the instructional material to facilitate your studies. Try to attempt it all. Feel free to consult any of the references to provide you with broader view and a deeper understanding of the course. The assignment accounts for 30% of the total assessment pack for the course. Continuous self- assessment materials will be enclosed with the instructional materials so that you can monitor your progress through the course. GRADING CRITERIA Grades will be based on the following percentages Tutor- Marked Assignments Computer- marked Assignment 30% Group assignments 5% 40% Discussion Topic participation 5% Laboratory practical End-of-Course examination 60% GRADING SCALE A = 70-100 B = 60 - 69 C= 50 - 59 F = < 49 HOW TO GET THE MOST FROM THIS COURSE i. Read and understand the context of this course by reading through this Course Guide paying attention to details. You must know the requirements before you will do well. 9 NSC219 FOUNDATION OF PROFESSIONAL NURSING PRACTICE 1 ii. Develop a study plan for yourself. iii. Follow instructions about registration and master expectations in terms of reading, participation in discussion forum, end of unit and module assignments, laboratory practical and other directives given by the course coordinator, facilitators and tutors. iv. Read your course texts and other reference textbooks. v. Listen to audio files, watch the video clips and consult websites when given. vi. Participate actively in online discussion forum and make sure you are in touch with your study group and your course coordinator. vii. Submit your assignments as at when due. viii. Work ahead of the interactive sessions. ix. Work through your assignments when returned to you and do not wait until when examination is approaching before resolving any challenge you have with any unit or any topic. x. Keep in touch with your study centre and Department of Nursing Science website as information will be provided continuously on this site. xi. Be optimistic about doing well. MODULE 1 NATURE OF NURSING I UNIT 1 HISTORICAL DEVELOPMENT OF NURSING I CONTENTS 1.0 Introduction 2.0 Objectives 3.0 Main Content 3.1 Significance of the Study of History 3.2 Pre-Nightingale Development of Nursing 3.3 Florence Nightingale Era (1820-1910) 4.0 Conclusion 5.0 Summary 6.0 Tutor-Marked Assignment 7.0 References/Further reading 1.0 INTRODUCTION Where are we coming from? What developments have brought us to the present state? What problems were encountered during the journey? What factors have facilitated or obstructed our movements? When we delve 10 NSC219 MODULE 1 into the events of the past for one reason or the other, we are concerned with history, with past events. There are many advantages to the study of history. It provides foundation for the present and the future. It helps us to plan strategies for a smooth transition. It provides us with the knowledge of persons and resources that had supported and strengthened our course over the past years. This is a general phenomenon of any development in life. There are two dimensions to the study of history, the process and the content. In this unit you will be studying the content of the historical development of nursing. The events that occurred in past that positively moved Nursing forward to the present date. You will learn the contents of the events in chronological order. The discussions shall cover the following periods: Pre-Nightingale Era; Nightingale era, Pre and Post First World War; Pre- and Post-2nd World War; and the modem times. United Kingdom, North America and Nigeria shall receive the most attention. The content enumerated shall be presented in two units (Units 1 & 2). 11 NSC219 FOUNDATION OF PROFESSIONAL NURSING PRACTICE 1 2.0 OBJECTIVES By the end of this unit, you will be able to: explain the significance of the study of history summarise the development of nursing in Pre-Nightingale in Europe and the UK identify the major areas of society and nursing that Florence Nightingale's impact was felt. 3.0 MAIN CONTENT 3.1 Significance of the Study of History Try to recall a history course you had at High School or the historical aspects of one of your courses in your school of Nursing. The course titled History dealt with the process of reviewing events. There are subjects such as History of Political Movements in Nigeria; History of the Church Missionary Society in Nigeria; History of Education - all these examine the content of events. By the same token, when we talk about the historical development of Nursing, we are concerned with the content of development over a period: and how one developmental state influences the subsequent stages. What is the significance of History in Nursing? History allows us to link the past with the present. It shows the achievements at each milestone. Knowledge of history serves as reference points for the future. You will now study the development of nursing during the different eras stated in the introduction. 3.1.1 Pre-Nightingale Development of Nursing Nursing was distinguished in its early history as a form of community service and was originally related to a strong instinct to preserve and protect the family (Donahue 1985). The desire to keep people healthy and provide comfort, care and comfort for the sick were the initial focus of nursing. This focus has remained relatively the same over the centuries, but the practice of nursing has been modified because of societal influence and changing needs. Nursing has evolved into what we now know as modern nursing. Nursing is as old as medicine. Nursing and 12 NSC219 MODULE 1 medicine have been interdependent throughout history. During the era of Hippocrates, Medicine was practiced without Nursing. While in the Middle Ages, nursing was practiced without medicine. In ancient cultures, religious leaders assumed responsibility for health and medical care because the causation of illness was tied to myths and religion. Hence nurses were seen to be below religious leaders. Nurses then worked under priests and physicians, performing custodians and personal hygiene care. The physician directed nursing activities, except the role of midwifery where nurses had always been accepted. Throughout this period, nurses did not participate in activities to promote health or teach the families how to care for the sick. Under the influence of Christianity, nurses began to gain respect and the practice of nurses expanded. The order of Deaconesses, a group similar to today’s public health or visiting nurses was one of the earliest records of Christian nursing. According to Dolen et al. (1983), (Brooker & Waugh,m2013)., the order’s goals included the meeting of the following needs: Feeding the hungry Giving water to the thirsty Clothing the naked Visiting the imprisoned Sheltering the homeless Caring for the sick Burying the dead Historically, men and women held the role of the nurse. The entry of women into nursing could be traced to AD 300 because of the improvement in the social position of Roman women. Christianity taught that men and women are equal before God. There was an appeal to women to carry on God’s work towards those who were in distress. The Benedictine Order comprising men was founded in the 6th century, and this increased the number of women in nursing. During the Middle Ages, the Crusades became a stimulus for expanding nursing and healthcare. Military nursing orders for men were formed, and hospitals were established. After the Crusades, and with the decline 13 NSC219 FOUNDATION OF PROFESSIONAL NURSING PRACTICE 1 of the feudal system, large cities began to develop and grow. This extensive growth of cities resulted in associated health problems. SELF-ASSESSMENT EXERCISE Nigeria is experiencing a similar population shift from rural to urban. List five health hazards associated with an extensive population growth of cities. Example of an answer: Overcrowding, poor ventilation; Hot and humid environment, poor sanitation, inadequate water supply, air, food and water contamination; disregard of personal and environmental hygiene, inter-personal feuds. Because of the enormity of the health problems, secular groups were formed and nurses to meet specific health care needs in the Middle Ages. In response to the serious health problems of the 15th to 17th centuries, which were the consequence of societal factors, nursing responded by founding the Sisters of Charity in AD 1633 by St. Vincent de Paul. The Sisters cared for the people in hospitals, asylums, and poor houses. In addition, they cared for sick people in their homes, hence labelled 'visiting nurses' The first supervisor of the Sisters of Charity was Louise de Gras, a widow of high social standing. She established perhaps the first educational programme associated with a nursing Order. She recruited intelligent, refined and compassionate women. The programme included experience in the care of the sick in hospitals as well as home visits. The sisters of Charity were introduced in America in 1809, but their name was later changed to Daughters of Charity. The 18th Century saw further growth of cities in Europe, including the United Kingdom, and consequently, an increase in the number of hospitals and more roles for the nurses. Nursing skills and knowledge were generally passed on by experienced nurses because there was still little formal education for them. While nursing in continental Europe, especially in Germany, was beginning to make progress, the UK could not say the same. Hospitals in the UK were built in response to similar health problems, but the 'nurses' 14 NSC219 MODULE 1 came from the low social status, lacked responsible leadership, and were illiterate. 3.1.2 The Florence Nightingale Era (1820-1910) Florence Nightingale went to study with the sisters of Charity in 1853 and was later appointed superintendent of the English General Hospitals in Turkey. During this period, she instituted major reforms in hygiene, sanitation, and nursing practice, thereby reducing the mortality rate at the Barracks Hospital in Sentari, Turkey, from 42.7% to 2.2% in 6 months (Woodham Smith, 1983). Florence Nightingale was a proficient bedside nurse with a great concern for the soldiers she nursed. Her ward round at night with the lamp earned her the title "The Lady with the Lamp". Organised nursing began in the mid-1800s under the leadership of Florence Nightingale; before her era, nursing care was done by paupers and drunkards and persons unfit for any work. Florence Nightingale's beliefs about nursing form the basic foundation of nursing practice today. Her religious convictions and experience in nursing during the Crimean War influenced her approach and beliefs about the care of the sick. She came from the upper social class, was educated and possessed a good communication ability as judged by her various letters and book, Notes on Nursing: What It Is and What It Is Not. She travelled widely and had the ability to deal with government and politics. Florence Nightingale possessed many outstanding qualities. By today' s terminology, she would be called an epidemiologist and statistician. She was a researcher, a politician and a caring nurse of the sick and the well. Her philosophy of nursing practice reflected the changing needs of society. She saw the role of Nursing as having 'charge of somebody's health' based on the knowledge of "how to put the body in such a state to be free of disease or to recover from disease" (Nightingale, 1860). Considering the role women were expected to assume during her time, Florence could be regarded as an activist of some sort. She was the one who vehemently objected to the female Victorian role of indolence and marriage and viewed the development of nursing as a "respectable livelihood and constructive utilisation of women". She saw activities as being based not only on compassion but also on observation and experience, statistical data, knowledge of sanitation and nutrition, and 15 NSC219 FOUNDATION OF PROFESSIONAL NURSING PRACTICE 1 administrative skills (Donahue 2011). The greatest achievement to the world of nursing was the establishment of the first organised programme for training for nurses: The Nightingale Training School for Nurses at St. Thomas' Hospital in London in 1860 AD. The professionalisation of nursing commenced from henceforth, and nursing began to be accorded some respectability in society. Educated ladies from the respectable social backgrounds were selected for training. A distinct body of knowledge was developed for nursing, and this was based on observed societal health needs. 4.0 CONCLUSION The writings of Florence Nightingale which are over a century old, remain the reference points for all aspects of nursing development today. Her focus of nursing was directed at the client, sick or well; the environment for nursing, the knowledge and expertise required by nurse, and the interactions of these parameters towards the achievement of desired goals. Florence Nightingale's thrusting forces were Religion, Science, and Society. Could there have been a better combination to initiate change and sustain progress? 5.0 SUMMARY In this unit, you have learnt that the importance and advantages of studying history and the historical development of nursing in particular were examined. Contributions of various individuals and groups to public health and the care of the sick and less privileged in societies in Europe and the UK were highlighted. The extraordinary contributions of Florence Nightingale to Nursing, society, and science were fully discussed. 6.0 TUTOR-MARKED ASSIGNMENT 1. Explain 'historical development' in the context of nursing history. 2. Briefly summarise the place of nursing in pre-Nightingale Europe. 3. Highlight the impact of Florence Nightingale on the following: -Victorian women -Nursing science -Nursing education -Care of the sick -Nursing management. 16 NSC219 MODULE 1 7.0 REFERENCES/FURTHER READING  Brooker, C., & Waugh, A. (2013). Foundations of Nursing Practice E-Book: Fundamentals of Holistic Care. Elsevier Health Sciences.  Cherry, B., & Jacob, S. R. (2016). Contemporary nursing: Issues, trends, & management. Elsevier Health Sciences.  DeLaune, S. C., & Ladner, P. K. (2011). Fundamentals of nursing: Standards and practice. Cengage learning.  Dolan, J. A., Fitzpatrick, M. L., & Herrmann, E. K. (1983). Nursing in society: A historical perspective. WB Saunders Company.  Donahue, M. P. (2011). Nursing, the finest art: An illustrated history. Mosby.  McCormack, B., & McCance, T. (2011). Person-centred nursing: theory and practice. John Wiley & Sons Mortimer, B. (2004). Introduction: the history of nursing: yesterday, today and tomorrow. In New Directions in Nursing History (pp. 17-37). Routledge.  Nightingale, F.: Notes on Nursing: what it is and what it is not, London, 1860, Harrison and sons.  Potter, P. A., Perry, A. G. E., Hall, A. E., & Stockert, P. A. (2009). Fundamentals of nursing. Elsevier mosby 17 NSC219 FOUNDATION OF PROFESSIONAL NURSING PRACTICE 1 UNIT 2 HISTORICAL DEVELOPMENT OF NURSING II CONTENTS 1.0 Introduction 2.0 Objectives 3.0 Main Content 3.1 Historical Development of Nursing in the USA. 3.2 Historical Development of Nursing in Nigeria 3.2.1 Religious Influence 3.2.2 British Colonial Service 3.2.3 Nursing education within the university system 3.2.4 Nursing education in Nigerian universities 3.3 Globalisation of nursing 4.0 Conclusion 5.0 Summary 6.0 Tutor- Marked Assignment 7.0 References/Further Reading 1.0 INTRODUCTION You will recall that unit 1 of this course dealt with the first part of the Historical Development of Nursing in Europe and the UK. The last part of the presentation focused on Florence Nightingale, who heralded major reforms in nursing. The concept of nursing proposed and practised by Florence Nightingale became the foundation for professional nursing in the UK, USA, and British colonial territories. The dominant functions of nursing have been modified as an inevitable consequence of changes in the social, economic, political, educational, and scientific-technological value in which the consumers and the practitioners of the nursing meeting. With the above changes and facilitation by information/communication media, nurses worldwide are now in better positions to share ideas and strategies and move nursing forward globally. By the beginning of the 20th Century, the Florence Nightingale concept of nursing and the various implementation strategies have crossed oceans and seas to the USA and British colonial territories. In this unit, we shall continue with the historical development as the events occurred in the USA and Nigeria. As in the previous unit, significant developments shall be addressed. 18 NSC219 MODULE 1 2.0 OBJECTIVES By the end of this unit, you will be able to:  describe the historical developments of nursing in the USA and Nigeria  discuss factors that influenced these developments  explain factors that facilitated nursing education within Nigerian universities  discuss the influence of globalisation of nursing-on-nursing development. 3.0 MAIN CONTENT 3.1 Historical Development of Nursing in the USA Like the Crimean War in Europe, the Civil War in the USA stimulated the growth of nursing. The women in the American Red Cross played important nursing roles. Clara Barton, founder of the American Red Cross attended to or cared for soldiers on the battlefields, cleansing their wounds, meeting their basic needs, and comforting them at points of death. The American Red Cross was ratified by the United States Congress in 1882 after 10 years of lobbying by Clara Barton. Dorothea Synde Dix, Mary Anne Ball (Mother Bickerdyke) and Harriet Tubman also influenced nursing during the civil war. As superintend- ent of the female nurses of the Union Army, Dorothea Dix organised hospitals, appointed nurses, and oversaw and regulated supplies to the troops. Mother Bickerdyke organised ambulance services, supervised nurses, and walked abandoned battlefields at night looking for wounded soldiers. Harriet Tubman was active in the Underground Railroad movement and assisted in leading over 300 slaves to freedom. After the Civil War nursing schools in the USA and Canada started to pattern their curricula after the Nightingale School. Many nurses contributed to the development of nursing in the USA and Canada, but a few will be highlighted. Isabel Hampton Robb graduated from St. Catherine's School of Nursing, Ontario, Canada, a school which was 19 NSC219 FOUNDATION OF PROFESSIONAL NURSING PRACTICE 1 patterned on Florence Nightingale curriculum. She became the first superintendent of the Johns Hopkins Training School, Baltimore Maryland. She contributed immensely to the professionalisation of nursing through publications of nursing textbooks and formation of a professional nursing association that became the American Nurses Association in 1911. She was one of the original founders of the American Journal of Nursing. The textbooks she authored were: Nursing: Its principles and Practice for Hospitals and Private Use (1894); Nursing Ethics (1900), and Educational Standards for Nurses (1907). Advances were made in hospital care, public health, and nursing education in the early 20th century. Mary Adelaide Nutting, a member of the first graduating class of Johns Hopkins Training School was instrumental to affiliation of nursing education with universities. She became the first professor of nursing at Columbia University Teachers College in 1907. The journey towards the placement of nursing education into universities was quickened in 1923 when the Rockefeller Foundation funded a survey of nursing education, popularly known as the Goldmark Report. The report recommended that nursing education needed increased financial support and suggested that the money should be given to University Schools of Nursing. Five universities benefited from the financial support. University schools of Nursing were able to expand, increasing opportunities for more nurses to have university education. As nursing education developed, nursing practice expanded. More clinical specialty programmes were started and so also were specialty nursing organisations that were concerned with quality care. In 1965, the National Commission on Nursing and Nursing Education explored issues that included: the supply and demand of nurses, clarification of nursing roles and functions, education of nurses, and career opportunities available to nurses. The Lysaught Report, named after the study director called for clarification of nursing roles and responsibilities in relation to other health professionals; advocated greater financial support for nurses; and more career opportunities to attract nurses and retain them in the profession. (Lysaught 1970). 20 NSC219 MODULE 1 As nursing education and practice evolved to meet the changing needs of society, Nurses' code of Ethics also evolved. In 1926, American Nurses Association proposed its code of Ethics. The purpose of this code was to "create a sensitiveness to ethical situations and to formulate general principles which result in the formation of conscious and critical judgement resulting in action in specific situations" (ANA 1926). As technology and needs of society changed, the code of ethics was revised to provide code of ethics for nurses with interpretative statements (ANA 1985) Nurses in the USA and Canada had made giant strides in the development of nursing. The resolve to move nurse’s education into Universities and Colleges, and away from hospitals affiliated schools facilitated the: development of more nurse scholars who are committed to developing nursing science and theory. Developing science and theory in nursing involves generating knowledge from the nursing field and other disciplines. One method for creating nursing scientific knowledge base is through the development and use of nursing theory through the research process. A significant milestone influencing the development of concepts and theory was the establishment of the Nursing Research Journal in 1952. The journal has encouraged scientific productivity and has helped to provide the framework for a questioning attitude that has set the stage for further enquiries into theoretical nursing (Meleis, 1985). These have produced theorists whose theories are influencing all aspects of nursing worldwide. Such persons are Peplau, Henderson, Roy, Orem, Johnson. Nurses in North America, particularly in the USA, have developed nursing to a truly professional status. You have spent the past few minutes studying the historical development of nursing in the USA, the events that occurred and the persons responsible for these events. We have also seen how the social, economic, political, science and technological development of society as a whole affected the development of nursing in the USA. Discuss one developmental factor with American society that facilitated the development of nursing. 21 NSC219 FOUNDATION OF PROFESSIONAL NURSING PRACTICE 1 3.2 Historical Development of Nursing in Nigeria The following factors influenced the development of nursing in Nigeria. Religion, British colonial administration, inter-professional communication, and the world wars. Traditionally caring for the sick took place at home and care is given by women and family members. The concept of a nurse in the European sense was not part of the traditional community set up. It was considered to be the responsibilities of the families to care for their members both in health and sickness. But the midwife had been a constant figure in all traditional societies. Nigeria had and still has the traditional midwives who care for pregnant women from conception, through labour and delivery. Post-natal care is also given to both mother and baby. Caring includes provision of basic comfort, feeding, bathing and also the care of other siblings in the family. 3.2.1 Religious Influence When the missionaries arrived in Nigeria from the UK in the 19th Century, their objectives were to convert (evangelise), to educate and to provide health care. Hence you find the church, the school and the hospital/clinic clustered in the mission grounds. With trained missionary nurses, some of them products of Florence Nightingale School of Nursing or curriculum. They recruited young men and women mostly with primary school education for on-the-job training in nursing- procedures and skills. The emphasis was on skills training starting from simple to complex. It was purely task-oriented training. Initially, there was no organised curricula, hence no central certification. The missionary Nursing sisters provided physical, psychosocial and spiritual care for their followers. The health care. needs of the communities were constantly assessed and appropriate health care facilities were provided. The first set of nursing personnel in the country were those trained on the job by UK trained missionary Nursing sisters. These locally trained nursing personnel also imbibed the tenets of the Christian religion and served as local contacts for evangelism. The two McCarter sisters ran the mother and child health centers in Abeokuta and its environs, while Mary Slessor was known in Calabar for her work with abandoned twins. 22 NSC219 MODULE 1 3.2.2 The British Colonial Service The British colonial service in conjunction with the Royal Niger Company provided health care services for their serving citizens and their families in Nigeria. Medical teams were also brought from the UK to run the medical services. The medical teams included professional nurses trained in the UK. Two parallel health care services were provided: one for those in the colonial service Administration and the other for the local Nigerians. Hence, there were the European and African Hospitals. The nursing sisters in the Medical Teams also trained women and men on-the-job and supervised their work. They were taught a lot of task and skills but with little theory. These young women and men were referred to as 'probation nurses' and they worked under supervision, mostly in the African Hospitals. There was no formal curriculum, each Nursing sister taught from her experience. There was no certification as there was no controlling or Examination body. After the Second World War, which ended in 1945, many Nigerian girls with High School Education traveled to the UK, to train as professional nurses. Upon their return, most of them were employed in the Civil Service. The working environment was hostile, and many found that they could not put to practice the knowledge and skills they had acquired in the UK. Some left nursing for other disciplines, but others persevered. As more nurses returned from the UK, they collectively resolved to improve the standard of nursing education and practice in the country. These standards pioneering nurses included Adetoun Barley who later became the first Nigerian Registrar of the Nursing Council, Francis Oguntolu the retired Director of Nursing, Lagos University Teaching Hospital; Kofoworola Pratt, first Nigerian Matron of University College Hospital, Ibadan; Oluyinka Sofenwa, retired Deputy Director of Nursing, University College Hospital lbadan. First on the list of improving standards was the inauguration of the first Nursing Council for Nigeria and the appointment of an interim Registrar in 1947 -an expatriate. The changes effected in nursing were facilitated by the political climate in the country. It was the period of negotiation for the country's independence from Britain. During this period there were plans for the 23 NSC219 FOUNDATION OF PROFESSIONAL NURSING PRACTICE 1 improvement of health care. The Richards constitution which divided the country' into three regions (East, West and North) and the capital Lagos created a School of Nursing for each region located at Enugu, Ibadan and Kaduna, plus the one in Lagos. These schools started to function in 1949 with formal syllabus to direct the educational programme. Qualified nursing tutors were employed from the UK to direct the programmes. Preceptors were employed from amongst Nigerian nurses trained in the UK to supervise the practical training of students in government hospitals. The Health Policy also stipulated those Nigerian boys and girl with good high School education be sponsored to study general nursing, midwifery and other nursing sub-specialties of National needs in Great Britain. This was a great departure from the traditional practice of training individuals with only 6 to 8 years of primary education. The new direction encouraged boys and girls with good high school education to choose nursing as a career. The Health Policy also directed that a School of Nursing be established at the University College Hospital, Ibadan in 1952. It was patterned after the Nightingale School of Nursing at St. Thomas' Hospital London. Girls with good education also qualified for admission into the school. From all indications, the government was bent on changing the poor image of nurses and consequently improving the quality of nursing. This was linking good general and professional education with qualitative nursing practice. With the Nursing Council in place and the instrument of authority approved, the Council proceeded to set minimum standards for, nursing curricula in Schools of Nursing, clinical teaching facilities, and the minimum educational qualification for entry into the Schools of Nursing. The authority of the Nursing Council was felt more in nursing than in midwifery. This was probably due to the fact that midwifery services were less organised than the nursing services. Fewer of the highly trained professional nurses went into midwifery practice. Furthermore, midwifery practice was more controlled by nongovernmental organisations. 24 NSC219 MODULE 1 3.2.3 Nursing Education within the University System in Nigeria The developments in nursing education in Canada and the USA started to influence nursing education development in Nigeria especially in the old Western Region. In line with its health manpower development and to meet its expanding health care services, the Western Region government embarked on a programme of sending qualified nurses overseas to train as Nurse Tutors. In 1960, the Canadian government offered to educate nurses at university degree level. In 1960, there were technical aids from the British and Canadian Governments to prepare nurse tutors at diploma and degree levels respectively. Nursing administration and nursing clinical specialisations were not left out of the development; there were German and British technical assistance for those areas. The immediate post-independence period saw nursing in Nigeria enriched with new ideas from the USA, UK, and Western Germany. Impressed by the Professional performance of the nurses trained abroad, many men and women went to these countries for their nursing education. The return of the five graduate nurses from McGill University in 1962, was the turning point for university education in Nigeria. These graduates were deployed to different schools of nursing where through their interpersonal relationships, influenced students' attitudes to nursing. By 1966, twelve graduate nurse teachers sponsored by the Canadian government, had taken up appointments with the Western Region government and later with other governments and health care institutions. This crop of nurse teachers were able to impress on the governments, formal and nonformal groups the benefits of university education in nursing and especially at the administrative and education levels. There was also a world- movement through Inter- National Nursing Organisations to move nursing education from hospitals schools to universities. The first stage was sourcing for funds, followed by staff development, then programme development, identification and negotiation with institutions and government, student's selection and admission. These processes were embarked upon consequently. In 1965 the University of Ibadan after creating a Department of Nursing admitted the first set of 10 students into the post-basic Bachelor of Science (Nursing) programme with options in Nursing Education and Nursing 25 NSC219 FOUNDATION OF PROFESSIONAL NURSING PRACTICE 1 Administration, and Clinical Electives in Medical Surgical Nursing, Material and Child Health and Midwifery, Psychiatric Nursing, and Community Health Nursing. The Rockefeller Foundation provided the building, the World Health Organisation (WHO) provided fellowships for students and teaching aids and other teaching materials, and Boston University admitted students for post graduate studies. WHO also provided supporting staff for the first five years of the programme. The University provided the administrative support, pending the take-over after five years. By the time the first set of students graduated many more nurses wanted university education. The number of applicants increased every year, even when financial support was no longer available. In 1971, the University of Ife (now Obafemi Awolowo University) started a Faculty of Health Sciences with a philosophy of educating the health professions students together, since they were expected to work together in real situations. Based on this philosophy, a generic degree BNSc. was started in 1973. More and more nurses and individuals who want to become nurses want university nursing education. More universities now run the generic nursing programme. Those Nigerian nurses and other persons who spearheaded nursing education within the University system include the late, Professor Frida O. Adebo, Olufemi O. Kujore" Adetoun Bailey, Ayodele Tubi, Lola Alade, Stella Savage Vye. Okusoga, Late Grace Afamefuna, Adebisi Fabayo and Later Professor T.A.I. Grillo 3.3 Globalisation of Nursing Florence Nightingale through her definition of nursing has shown the universality of nursing. She showed how the role of nursing is to utilise the laws of nature to facilitate health and recuperation from illness. Long before Maslow's hierarchy of human needs, Nightingale has called nurses' attention to the manipulation of the elements in the environment in order to meet Man's health needs. Nurses in different countries have evolved concepts and theories from Nightingale's concepts. Nurses, through research, are identifying global problems and issues that affect man and sharing or offering solutions. The communication media for the sharing could be by the printed materials in the form of journals, 26 NSC219 MODULE 1 books; electronic materials and software; face-to-face communication as occurs at meetings and conferences. We can now access information on nursing issues from the Internet. Nursing is no longer a calling shrouded in secrecy. The ability to produce knowledge by the scientific process through the fastest possible means is a work of professional growth and development of the 21st century. Globalisation of nursing is also fostered through communication among various national nursing associations and specialty nursing groups. At international conferences issues and/or phenomena of common concerns are discussed, for example the International Council of Nurses (ICN). The ICN is an organisation focused on 'Advancing Nursing World Wide'. In 1998 identified three key areas as crucial to the improvement of nursing and health. These are known as ICN Pillars and they are: Professional Practice, Regulation, and Socio-economic welfare. The International Classification for Nursing Practice (ICNP) and Leadership for Change are two significant ICN projects which come under the professional practice pillar, Negotiation in Leadership is a project which comes under the socio-economic welfare pillar. EXERCISE 2 Access the Websites of: i. International Council of Nursing (ICN), ii. World Health Organisation (WHO), Summarise the nursing roles within the organisations Regional nursing organisations (RNO). The trend in the past 20 years is for nurses within a geographical location to corporately develop nursing. A typical example is the West African College of Nursing (WACN) which is also an agency of the West African Health Organisation (WAHO). It is concerned with the nursing and health needs of people in countries of WAHO. The West African College of Nursing (WACN) is composed of five faculties offering fellowship programmes in specific nursing specialties Community Health Nursing, Nursing Education and Administration, Maternal and Child Health, Medical Surgical Nursing, and Mental Health and Psychiatric Nursing. Its responsibilities include inauguration of the nursing and midwifery councils, with the appropriate instruments of authority, the establishment 27 NSC219 FOUNDATION OF PROFESSIONAL NURSING PRACTICE 1 of better equipped secondary, tertiary and specialist and teaching hospitals and the provision of articulated health policy. The cumulative effects of all the above resulted in communication between Nigerian nurses outside, particularly in the UK, Canada, and the USA. 4.0 CONCLUSION From the presentation in this unit, it is clear that nurses in North America, particularly in the United States, were the main force in the development of nursing. The immediate pre and post independent periods in Nigeria witnessed a formalisation of nursing education and nursing practice through government policies on health; the raising of the educational standard for entry into the nursing profession; the starting of formal schools of nursing in all the political regions and at the University College Hospital, Ibadan and other University Teaching Hospitals in the Nation; government support for deserving students to study nursing in the United Kingdom with scholarships, employment of many British trained Nigerians and British nurses into the health services whereby much higher quality of nursing education and nursing practice were demonstrated, and these serving as encouragement to well-educated persons to come into the nursing field. 5.0 SUMMARY This unit examined the historical developments of nursing in the United States of America. Discussions showed you how the development has moved nursing to a high professional status. It also examined the development of Nursing in Nigeria and the factors that influenced the historical development. Lastly, globalisation of information in nursing through various communication media are highlighted. 28 NSC219 MODULE 1 6.0 TUTOR-MARKED ASSIGNMENT 1. List three major areas of development of nursing in the USA during the first five decades of the 20th century. 2. Discuss the relationship between the development of the Nightingale Era and post Nightingale Era in the US. 3. Describe two factors that influenced Nursing history and development in Nigeria. 7.0 REFERENCES/FURTHER READING  Dolan, J. A., Fitzpatrick, M. L., & Herrmann, E. K. (1983). Nursing in society: A historical perspective. WB Saunders Company.  Donahue, M. P. (2011). Nursing, the finest art: An illustrated history. Mosby.  McCormack, B., & McCance, T. (2011). Person-centred nursing: theory and practice. John Wiley & Sons Mortimer, B. (2004). Introduction: the history of nursing: yesterday, today and tomorrow. In New Directions in Nursing History (pp. 17-37). Routledge.  Potter, P. A., Perry, A. G. E., Hall, A. E., & Stockert, P. A. (2009). Fundamentals of nursing. Elsevier Mosby  International Council of Nurses (ICN) http://www.ICN/ch/progrtam.htrn 29 NSC219 FOUNDATION OF PROFESSIONAL NURSING PRACTICE 1 UNIT 3 CONCEPTS OF NURSING CONTENTS 1.0 Introduction 2.0 Objectives 3.0 Main Content 3.1 Concepts of Nursing 3.1.1 Florence Nightingale 3.1.2 Virginia Herderson 3.1.3 Hildegard E. Peplau 3.1.4 Myra Levine 3.1.5 Dorothea Orem 3.1.6 Calista Roy 4.0 Conclusion 5.0 Summary 6.0 Tutor-Marked Assignment 7.0 References/Further Reading 1.0 INTRODUCTION I hope that you have read and understood the course guide. You are therefore in a better position to appreciate how this unit (Concept of Nursing) fits into the course as a whole. Concept of Nursing focuses on the idea and meaning of nursing as a professional occupation. Different people express different ideas as to what nursing actually is. The unit will describe the ideas of nursing by six distinguished nurse leaders who had influenced the development of nursing worldwide. 2.0 OBJECTIVES By the end of this unit, you will be able to: define the word 'concept' from the point of a general usage and from the point of nursing as a concept mention at least three concepts of nursing stated by distinguished nurse leaders from the time of Florence Nightingale to the contemporary time 30 NSC219 MODULE 1 identify the common focus of nursing activity for concepts of nursing compare and contrast your concepts of nursing before and after the study of this unit. 3.0 MAIN CONTENT 3.1 Concepts of Nursing The concept of nursing expresses the opinion of recognised practitioners of nursing as a profession. It is seen by some people as an art, and by others as a science, skill or as a calling. But, here, we shall consider the opinions of only six distinguished nurse leaders. These include: -Florence Nightingale, -Virginia Henderson, -Hildegard E. Peplau, -Myra Levine, -Dorothea Orem, and -Calista Roy. These people have been specifically chosen because of the uniqueness of the statement each of them has made. You are expected to study at least three of the six statements from the point of view of uniqueness and focus. EXERCISE 1 1. Think and state your concept of nursing that had influenced your decision to choose nursing as a career. 2. State the focus of nursing activity that could be derived from your statement. Very often, the way a situation, a thing, or an event is conceptualised directs the type and focus of activity that would be engaged in it. For example, Imogene M. King's concept of nursing is that it is 'a process of human interaction between nurse and client'. This statement when examined shows that the focus is on communication whereby both nurse and client share information, recognise each other, agree on set goals and take actions for their attainment. This type of concept of nursing demands collaborative interaction aimed at attaining planned set of goals. 31 NSC219 FOUNDATION OF PROFESSIONAL NURSING PRACTICE 1 There is a thread of ideas which connect from one nurse leader to another. As we examine the concepts of nursing of different nurse leaders, we should look out for the linking ideas. The attempt to define nursing started before the 20th century. 3.1.1 Florence Nightingale Florence Nightingale, the founder of professional nursing espoused nursing to be a profession for women, the goal of which is to discover and use nature's law governing health in the service of humanity. In addition, nursing was stated to be an art and a science and required an organised scientific and formal education to care for those suffering from disease. Both sick nursing and health nursing are to "put the patient in the best condition for nature to act upon him". From this concept of nursing, it is possible to deduce the actions, activities, educational preparation, and organisational support for the concept. Nightingale concept of nursing dominated the development of nursing for nearly 100 years roughly from late 19th century to mid-20th century. It gave birth to the professionalisation of nursing. The concept of nursing continued to receive attention of nurse leaders after Florence Nightingale. The dominant functions continue to be modified as an inevitable consequence of changes in the social, economic, political, educational, scientific and technological milieu in which the consumer and practitioner of nursing meet. Positions in the first half of the 20th century on the nature and contribution of nursing have resulted more often from deductive than from inductive reasoning. 3.1.2 Virginia Henderson The relatively stable essence of nursing is captured in one of the most widely quoted concepts of nursing by Virginia Henderson: The unique function of the nurse is to assist the individual, sick or well in the performance of those activities contributing to health or its recovery (or to peaceful death) that he would perform unaided if he had the necessary strength, will or knowledge. And to do this in such a way as to help him gain independence as rapidly as possible. This aspect of her 32 NSC219 MODULE 1 work is thus part of her function. She initiates and controls. She initiates and masters. In addition, she helps the patient to carry out the therapeutic plan as initiated by the physician. She also, as a member of a medical team, helps other members, as they in turn help her, to carry out the total programme whether it be for the improvement of health, or the recovery from illness or support in death. Henderson proposed 14 activities contributing to health which nursing is responsible for -assisting the individual and suggested that existing or potential loss of the power to control or perform those activities signals the existence of a nursing problem. The 14 proposed components are: 1. Breathing normally. 2. Eating and drinking adequately. 3. Eliminating body waste. 4. Moving and maintaining desirable postures. 5. Sleeping and resting. 6. Selecting suitable clothes -dressing and undressing. 7. Maintaining body temperatures within normal range by adjusting clothing and modifying the environment. 8. Keeping the body clean and well-groomed and protecting the integument. 9. Avoiding changes in the environment and avoiding injuring others. 10. Communicating with others expressing emotions, needs, fears or opinions. 11. Worshipping according to one's faith. 12. Working in such a way that there is sense of accomplishment. 13. Playing or participating in various forms of recreation. 14. Learning, discovering, or satisfying the curiosity that leads to normal development and health and using the available health facilities. -(Henderson, pp 16-17, 1966). The above components guide the selection of educational content and practice/intervention activities either in health or sickness. 3.1.3 Hildegarde Peplau Hildegarde Peplau came into limelight in 1950s. She was one of the nurse leaders dedicated to the development of nursing as a recognised 33 NSC219 FOUNDATION OF PROFESSIONAL NURSING PRACTICE 1 professional discipline, focusing much of her effort on the development of knowledge base to guide clinical practice. Peplau differentiated nursing and medicine by stating that physicians address themselves to within person phenomena, to dysfunctions, deficits, defects and the like, in relation to the organism. Physicians define the diseases of a person and prescribe treatment for them. In contrast to this statement, Peplau defines nursing as "a significant therapeutic interpersonal process which functions cooperatively with other human processes that make health possible for individuals". Peplau's definition of nursing as a "nurturing force and educative instrument", represent her view of the facilitative nature of the discipline. Its primary purpose is the application of scientific principles in facilitating human health.; Initially, Peplau viewed nursing as an applied science and as a process which aids patients to meet their own needs and recover from illness. More recently, her conceptualisation of nursing is that of a social and scientific force in the exploration and organisation of factors relevant to the maintenance of health. Although Peplau considers nursing as a collaborative part of the health profession team, all the same, she sees a' unique focus for nursing as resting in the reactions of the patient or client to circumstances of illness or health problem. This is helping patients to gain intellectual and interpersonal competences. Nursing activity is, more specifically, depicted as six identified roles which the nurse assumes at various times during inter-personal encounters with the patient. Details of the roles as components of Peplau' s Model will be discussed in subsequent units of this Course. The next three nurse leaders produced their concepts of nursing during the last three decades of the 20th century. Previous ideas by earlier nurse leader were expanded upon. 3.1.4 Myra Levine Myra Levine defines nursing as: a human interaction -an exchange between individuals. Nursing is regarded as a sub-culture, processing ideas and values which are unique to nurses, and which reflect society. 34 NSC219 MODULE 1 Nursing knowledge allows for a sensitive and productive relationship between the nurse and the individual needing care. Levine, like Nightingale, place great emphasis on observation. Observation allows the nurse to evaluate the patient's condition as well as anticipate the patient's future course of events. Levine sees Nursing as a human interaction between individuals and for which nursing has an extant body of knowledge. 3.1.5 Dorathea Orem Dorathea Drem defines nursing as: a human service that is different from all other human services. She indicates that nursing's special concern is man's need for the provision and management of self-care action on a continuous basis in order to sustain life and health or to recover from disease or injury. Of those who preceded Orem, Henderson's and Orem's definitions/concepts appear to be closely related. Both focus primarily on the individual stress, assisting the individual with activities he/she can no longer do for himself/herself and extending the defined boundaries of nursing to include assisting the individual toward independence from nursing or assistance toward a peaceful death. Nursing's special concern or uniqueness rests with the individual's need for self-care action and the provision and management of it on a continuous basis in order to sustain life and health, recover from disease or injury, and cope with their effects. Nursing is characterised as action and as assistance. For activities to be considered as nursing, they must be consciously selected and directed by the nurse toward accomplishing nursing goals. 3.1.6 Callista Roy Callista Roy defines nursing as: a theoretical system of knowledge which prescribes a process of analysis and action related to the care of the ill or potentially ill person. Nursing 35 NSC219 FOUNDATION OF PROFESSIONAL NURSING PRACTICE 1 is concerned with the person as a total being, interacting with a changing environment and responding to stimuli present because of his/her position on the health-illness continuum. When unusual stressors or weakened coping -mechanisms make a person's usual attempts to cope ineffective, then, the person needs a nurse. Nursing consists of both the goal of nursing and nursing intervention. Although the above statements of concepts of nursing originated from different nurse leaders, nevertheless they share at least one focus. SELF-ASSESSMENT EXERCISE 1. Read each concept of nursing statement again and identify one common focus. 2. You have decided to study professional nursing as a career. -State your idea/concept of nursing -Mention two factors that influenced your idea/concept of nursing. You will recall, as pointed out earlier, that a concept of nursing directs and guides the nurse in her focus, choice of nursing activities and basis for model and theory development. For example, Nightingale's concept of nursing focused on the manipulation of the environment in line with the laws of nature. The concept environment is further broken down into less abstraction, whereby we now have physical, psychological and social environment. As these are further broken into observable activities, they provide further direction for the intervention activities. This process will be further developed in subsequent nursing courses. SELF-ASSESSMENT EXERCISE Think again of your own concept of nursing: List five specific nursing activities that you can generate from it. The activities should be things you can do (for example, making a patient's bed, feeding). 36 NSC219 MODULE 1 4.0 CONCLUSION In this unit you have been introduced to the concept of nursing. The unit started with a general introduction to the topic, followed by statements of specific objectives to be achieved at the end of the interaction. The definition of concept as a general term was discussed and followed by definition of 'concept of nursing'. The concepts of nursing of six renowned nurse theorists were presented. The importance of concepts in the derivation of nursing activities, as foundations for nursing models and nursing theories was mentioned. Exercises were given to assist you to monitor your learning. 5.0 SUMMARY In this unit, you have learnt about concepts, and concepts of Nursing. Definitions from selected nurse theorists were made for illustrations, starting from Florence Nightingale who is regarded as the founder of Modem Nursing. This Unit serves as a theoretical foundation for the subsequent Units in this and other nursing courses. 7.0 TUTOR-MARKED ASSIGNMENT 1. Define the term concept in the context of its general usage, and state briefly how concepts evolve. 2. Define a concept of nursing and describe the roles concepts of nursing play in the development of nursing. 7.0 REFERENCES/FURTHER READING  Brooker, C., & Waugh, A. (2013). Foundations of Nursing Practice E-Book: Fundamentals of Holistic Care. Elsevier Health Sciences.  Berman, A., Snyder, S., & Frandsen, G. (2016). Study Guide for Kozier & Erb's Fundamentals of Nursing: Concepts, Process, and Practice, [by] Berman, Snyder. Pearson  Cherry, B., & Jacob, S. R. (2016). Contemporary nursing: Issues, trends, & management. Elsevier Health Sciences 37 NSC219 FOUNDATION OF PROFESSIONAL NURSING PRACTICE 1  Fitzpatrick, J. J., & McCarthy, G. (2014). Theories guiding nursing research and practice: Making nursing knowledge development explicit. Springer Publishing Company.  Henderson, V. (1966) The Nature of Nursing. New York: The MacMillan Co. 38 NSC219 MODULE 1 UNIT 4 NURSING AS AN ART AND A SCIENCE CONTENTS 1.0 Introduction 2.0 Objectives 3.0 Main Content 3.1 Definitions 3.2 Nature of Nursing as an Art and a Science: Historical development 3.2.1 Nursing as an Art 3.2.2 Nursing as a Science 4.0 Conclusion 5.0 Summary 6.0 References and other resources 7.0 Tutor-marked assignment 1.0 INTRODUCTION Historically, the practice of nursing concentrated on groups of activities identified, organised and practiced in such ways that the sick would have succour and comfort. These activities are based on the natural needs of man for survival. These natural needs are air, water, food, excretion (elimination), stimulation, exercise, rest, sleep, comfort, safety, love and belonging, self-esteem, and self-fulfillment. Nursing initially was equated with mothering; hence activities were centred on these parameters. The focus of nursing historically centered on the sick and the injured that were unable or incapable of providing for themselves the natural needs which Abraham Maslow later identified as basic human needs. Nursing, as a human service, designed activities and skills (tasks) that facilitated recovery from sickness and injury. The skills constituted nursing knowledge; hence the memorisation of the various skills formed the process for learning nursing. The consumers also view competent performance of the technical skills as the focus of nursing. The greater the automaticity with which a task is performed, the higher the competency rating. 39 NSC219 FOUNDATION OF PROFESSIONAL NURSING PRACTICE 1 This initial interpretation of the art of Nursing was very narrow. It assumes that this task-oriented nursing does not require an understanding of why the tasks are necessary, how they work, or what the effects will be. This view assumes that nursing has no knowledge base of its own, nor does it need one. The skills are regarded to be essentially manual and technical and reflect the knowledge of other disciplines, especially medicine. Hence the common expression: "Nursing is tied to the apron string of medicine". This might have been true for much of the pre-and early Nightingale era. Nursing as a science, on the other hand, views nursing as an intellectual process and activity. " In current professional nursing art and science are not discrete entities. They are on a continuum of interpersonal interaction, which has specific goals and involves particular kinds of activities/tasks. A universally accepted process is applied in the practice of nursing science. Some aspects of this topic have been discussed in units 2 and 3 and will also be expanded in unit 5, Nursing as a Profession. 2.0 OBJECTIVES By the of this unit, you will be able to: i. define the concepts art and science as in general usage ii. describe the historical development of art and science in Nursing iii. enumerate at least two factors that influenced the art and science of nursing iv. discuss the application of art and science in the content and process of nursing. 3.0 MAIN CONTENT 3.1 Definitions Most of the general definition of ‘Art’ are applicable to Nursing. The Oxford Advanced Learner's Dictionary defines Art as: The Oxford Advanced Learner's Dictionary defines Art as: Skill acquired by experience, study, or observation. An occupation requiring knowledge or skill 40 NSC219 MODULE 1 The conscious use of skill and creative imagination; A skillful plan The faculty of carrying out expertly what is planned or devised. An ability or skill that can be developed with training and practice. Science is defined as:  Possession of knowledge as distinguished from ignorance or misunderstanding.  Knowledge attained through study or practice  Something that may be studied or learned like systematized knowledge.  Knowledge covering general truths, or the operation of general laws especially as obtained and tested through scientific method.  Such knowledge concerned with the physical world and its phenomena  A system or a method based or purporting to be based on scientific principles. The realisation of these definitions may not be fully experienced by you at the end of the study of this unit. But, as you progress in your nursing studies, each definition will unfold with a variety of nursing situations. You need to keep this foundation information in constant perspective. EXERCISE 1 Select one definition each from the Art and the Science. Think of your past experiences in nursing (education, practice/care, management), March the definition with narration of your experience. 3.2 Nature of Nursing as an Art and a Science: Historical Development 3.2.1 Nursing as an Art Nursing as an art encompasses the organisation and care of the clients' environment communication, general care of clients, and performance of clinical procedures and miscellaneous nursing skills. All these are performed with the application of Levine's four conservation principles which are: conservation of energy, Conservation of Structural Integrity, 41 NSC219 FOUNDATION OF PROFESSIONAL NURSING PRACTICE 1 conservation of Psychological Integrity and Conservation of Social Integrity. These principles consider the clients, Nurses, families, community members, and other health professionals. Historically, the practice of nursing concentrated on groups of activities identified, organised, and practiced in such ways that the sick would have succour and comfort. Nightingale described two different types of nursing, sick nursing or "nursing proper" and healthy nursing, which required an organised, scientific, and formal education. Nightingale meaning of nursing activity was a departure from the previous common belief that nursing is a collection of tasks or procedures requiring some skills, and are initiated and directed by others, particularly physicians whose functions they exist to assist. So, there were no independent nursing functions. Because they required skill, some training was necessary. But competent performance did not require an understanding of why the task is necessary, how it works, and what the effect would be. Nursing had no knowledge base of its own; its skills were essentially technical. Nightingale saw nursing proper as both an art and a science that require organised scientific formal education. She perceived nursing as being distinct from medicine, asserted that nursing concern was with the client who was il1, rather than the illness which was the focus of medicine. Although nurses were to carry out physicians' orders, they were to do these only with an independent sense of responsibility for their actions. talking about Nursing as an Art, one needs to examine the various activities in nursing, of goals of securing comfort and succour to the clients be it in health or sickness. Nightingale in her book Notes of Nursing discussed various activities of the nurse and how these could be artistically organised that the goals of care are achieved. Safety, comfort, pleasing to the sense, are essentials of a nursing activity, which are to be directed towards the environment as well as the client. The basic nursing focus, activities and procedures identified by Nightingale and taught to her students of St., Thomas Hospital, School of Nursing London, are still the Nursing Arts of professional nursing today. Why? Because the process has consistently focused on clients personal and universal needs in the context of the human environment. However, the process of arriving at needs had been greatly influenced by knowledge 42 NSC219 MODULE 1 and the scientific method: Nightingale emphasised the importance of observation and documentation in the nurse-client interactions. SELF-ASSESSMENT EXERCISE 1. You are asked to apply a bandage dressing to the forearm and wrist of a client who sustained a soft tissue injury. Describe your activity in terms of Nursing as an Art. 2. List two factors that have aided your skill development of a chosen nursing care task. 3.2.2 Nursing as a Science In the bid to achieve the professional status nursing has striven hard in the 1st 100 years to fulfill the characteristics of a profession. A very important requirement for professional status is that the profession has a theoretical body of knowledge leading to defined skills, abilities, and norms. Nursing knowledge has been developed through nursing theories. Theoretical models serve as frameworks for nursing curricula and clinical practice. Nursing theories also lead to further research that increases the scientific basis of nursing practice. Although the outward and visible signs of nursing care are what the nurse does for, with or on behalf of a client, her actions are based on a series of intellectual processes that are not directly visible. Together these intellectual activities and nursing actions are called the nursing process. Essentially, the nursing process is a systematic method of problem solving applied to nursing situations and based on scientific method. Other non-systematic problem-solving methods such as intuition, experience, tradition, trial and error are used in nursing. But the reliability under is often low. The purposes of the nursing process are to meet the general objectives towards which the nursing care of all clients is directed. The objectives may include:  Personalising the care of each client.  Ascertaining, supporting, and maintaining client's capacity for meeting the physiological, psychological, social and spiritual needs, as well as recognising the client's strengths and limitations 43 NSC219 FOUNDATION OF PROFESSIONAL NURSING PRACTICE 1  Protecting the client from threats to his safety comfort and wellbeing  Supporting, comforting and sustaining the client and to ease his suffering during all phases of illness.  Assisting in the restoration of the client to the fullest capacity of which he/she is capable.  Considering the client's family members and friends as persons with legitimate interest and roles to play in his well-being  Assisting the client and the family in planning for the required care. For these general objectives to be achieved, there must be a complementarity between the type of problems presented by the clients and the goal the nurse pursues in an effort to help the client meet an otherwise unmet need (patient problems). It is at the point of intervention that nursing art manifests. The relevance, quality quantity and organisation of the art as an outcome of a scientific process that confirms nursing care as scientific and nursing as a profession. In addition to the process knowledge from relevant disciplines would be consulted and utilised. 4.0 CONCLUSION In essence Nursing as an Art and as a science could be described as two faces of a coin. Just as the task, skill or procedure is an outcome of a scientific process, the task, skill, or procedure may become a source for scientific investigation. The emphasis on nursing as an art without obvious intellectual activity might have been responsible for the view that nursing is just a collection of tasks and procedures, which requires some skill and therefore some training. The competent performance does not require understanding of why the task is necessary, how it works, and what the effects would be. But the intellectual activity of nurses by the application of the scientific process, clinical judgement based on knowledge, and research in nursing and publications in nursing journals continue to strengthen the professional image of nursing. 5.0 SUMMARY In this unit, you have examined nursing as an art, and as a science. Definitions of the concept’s art and science in the broad general usage 44 NSC219 MODULE 1 were presented. Discussion of each concept from the professional perspective was presented, and the relationships in terms of the scientific process and practice of nursing were also presented. 6.0 TUTOR-MARKED ASSIGNMENT 1. Define the concepts art and science. 2. Explain briefly the development of (i) nursing as an art (ii) nursing as a science. 3. Explain how nursing as an art and nursing as a science could be considered as the two faces of a coin. 7.0 REFERENCES/FURTHER READING  Benner, P. (1984). From Device to Expert: Excellence and Power in Clinical nursing practice, Men! Park, Calif, 1. Addison-Wesley.  Benner, P., Tanner C (1987). How Expert Nurses Use Intuition. Am. J. Nurse 87 (1): 23,1987.  Berman, A., Snyder, S. J., Kozier, B., Erb, G. L., Levett-Jones, T., Dwyer, T., Hales, M., Harvey, N., Moxham, L., & Park, T. (2014). Kozier & Erb's fundamentals of Nursing Australian edition (Vol. 3). Pearson Higher Education AU.  Berman, A., Snyder, S., & Frandsen, G. (2016). Study Guide for Kozier & Erb's Fundamentals of Nursing: Concepts, Process, and Practice, [by] Berman, Snyder. Pearson.  Brooker, C., & Waugh, A. (2013). Foundations of Nursing Practice E-Book: Fundamentals of Holistic Care. Elsevier Health Sciences.  Cherry, B., & Jacob, S. R. (2016). Contemporary nursing: Issues, trends, & management. Elsevier Health Sciences.  Clark, J. Nursing: An Intellectual Activity, International Nursing Review 39, 2, 1992.  DeLaune, S. C., & Ladner, P. K. (2011). Fundamentals of nursing: Standards and practice. Cengage learning.  Dolan, J. A., Fitzpatrick, M. L., & Herrmann, E. K. (1983). Nursing in society: A historical perspective. WB Saunders Company.  Donahue, M. P. (2011). Nursing, the finest art: An illustrated history. Mosby. 45 NSC219 FOUNDATION OF PROFESSIONAL NURSING PRACTICE 1  McCormack, B., & McCance, T. (2011). Person-centred nursing: theory and practice. John Wiley & Sons Mortimer, B. (2004). Introduction: the history of nursing: yesterday, today and tomorrow. In New Directions in Nursing History (pp. 17-37). Routledge.  Potter, P. A., Perry, A. G. E., Hall, A. E., & Stockert, P. A. (2009). Fundamentals of nursing. Elsevier mosby. 46 NSC219 MODULE 1 UNIT 5 NURSING AS A PROFESSION CONTENTS 1.0 Introduction 2.0 Objectives 3.0 Main Content 3.1 Definition 3.2 Characteristics of a Profession 3.3 Progress of Nursing Towards Professional Status 3.3.1 Elements of Professionalism in Nursing 3.3.2 Education 3.3.3 Theory Development 3.3.4 Specific Service 3.3.5 Autonomy of Decision Making and Practice 3.3.6 Accountability 3.3.7 Code of Ethics 3.3.8 Professional Organisations 4.0 Conclusion 5.0 Summary 6.0 Tutor-Marked Assignment 7.0 References/Further reading 1.0 INTRODUCTION You will recall that the science and art of nursing are important contributors to the professionalisation of Nursing. In this unit we shall discuss nursing as a profession. Take a few minutes off to review your last lesson before starting on todays. It will help you to appreciate the close inter-relatedness of the two units. The discussion will start with the definition of 'profession' as a general concept; some disciplines that are usually referred to as professions will be identified; how nursing in its practice and development has been progressing towards the attainment of an ideal profession will be examined and attempts made by nursing in Nigeria towards professionalism will be highlighted. 47 NSC219 FOUNDATION OF PROFESSIONAL NURSING PRACTICE 1 You will be requested to respond to tutor-marked assignment and exercises in the text to help monitor your progress, and a Tutor -Marked Assignment (TMA) will serve as the summative evaluation for the unit, References to further reading and resources are also provided. The following unit objectives indicate what you should accomplish at the of this unit. 2.0 OBJECTIVES At the end of this unit, you will be able to: i. define 'profession' ii. enumerate the characteristics of a professional discipline iii. discuss how nursing is progressing towards the ideal professional status iv.identify the efforts being made towards realisation of professional nursing status in Nigeria. 3.0 MAIN CONTENT 3.1 Definition You might have read and heard discussions about some occupations being referred to as professions. How about the occupations such as accountancy teaching? There are many more. Although the occupations mentioned many others are distinct in emphasis and activities, they share the recognition being professions. What then does being a profession mean? Is your dictionary with you? Check the dictionary meaning of the word 'profession'. The Webster New Collegiate Dictionary states a few definitions, but those found to be most relevant are Profession being: 1. A calling requiring specialised knowledge and often long and intensive academic preparation. 2. A principal calling. Vocation or employment. 3. The whole body of persons engaged in a calling. 48 NSC219 MODULE 1 Do you have similar statements in your dictionary? Remember! That I mentioned that there are a few statements, but that those quoted appear to be the most relevant composite. The statements can be reconstructed to read: "Profession is the whole body of persons engaged in a principal called, vocation or employment requiring specialised knowledge and often long and intensive academic preparation". It is worth noting that unlike many concepts, profession is not defined with a single statement but with a construct. Hence it is from the construct or characteristics that the meaning can be inferred. To construct is to make or form by combining parts. Which means that all parts are necessary for a meaningful whole. Some authors have also offered descriptions of the concept -profession. Let us examine the one described by Etzioni (1961). He describes professions in terms of the following primary characteristics. SELF-ASSESSMENT EXERCISE List five occupations that are of professional status applying the definitions/constructs. 3.2 Characteristics of a Profession The primary characteristics of a profession as described by Etzions (1961) are as follows among others:  It requires an extended education of its members as well as a basic liberal foundation.  It has a theoretical body of knowledge leading to defined skills, abilities, and norms.  It provides a specific service.  Members of a profession have autonomy in decision-making and practice.  The profession has a code of ethics for practice. EXERCISE 2 Can you find similarities in the two sets of characteristics of a profession and an occupation? Try to match them. 49 NSC219 FOUNDATION OF PROFESSIONAL NURSING PRACTICE 1 3.3 Progress of Nursing Towards Professional Status Most occupations do not acquire the elements of a professional status over-night. It is a gradual developmental process. Hence in reality, any specific occupational group might be placed or ranked along a continuum ranging from 'non-professional to professional status, according to the degree which the occupational group manifested the elements of professionalism. In Nursing, the bid for professional status started with Florence Nightingale reforms. It has taken nursing over a century to travel to its present profession status. Let us examine the occupation of Nursing. It is a professional occupation Having been part of the development in nursing for over hundred years, a witnessed and participated in various development, I want you to know that nursing is not simply a collection of specific skills and the nurse is not simply a person trained to perform specific tasks only. Nursing has come a long way to becoming a profession. No one factor absolutely differentiates an occupation from a profession; because the difference is important in terms of how nurses practice. When we say that a person acts professionally, we are implying that the person is conscientious in actions, knowledgeable in the subject, and responsible to self and others. Therefore, when one examines both the various descriptions of a profession one would see that nursing clearly possesses to some extent, the characteristics. However, nursing is still evolving as a profession and faces controversial issues as nurses strive for greater professionalism. 3.3.1 Elements of Professionalism in Nursing If one says that Nursing is a profession, then it is necessary to discuss the activities that support such an assertion. 3.3.1.1 Education Nursing requires that its members possess a significant amount of education The issue of standardisation of nursing education is a major discussion today in the wide world of nursing. Most nurses agree that nursing education is important to practice and that it must respond to 50 NSC219 MODULE 1 changes in health care created by scientific and technologies advances. The race for education for nurses started by Florence Nightingale in the 19th Century in the United Kingdom and Germany had moved to different parts of the world where it has developed and is still developing. Nurses in North America and Canada started the movement of nursing education into universities, and this movement is influencing nursing education in practically all countries of the world. It is a universal agreement that education is important to the type of practice that would meet today's client’s needs. As discussed in Unit 2, Historical development of nursing, nursing in the USA has led the world in lifting nursing education to unprecedented heights by relocating nursing education from sole apprenticeship system in hospitals to universities. The American Nurses Association (ANA) in 1984 directed that professional nurse require the Bachelor of Science in Nursing before practicing nursing. Many universities offer higher degrees in nursing making it possible for nurses to undertake research and develop nursing theories. Research facilitates the development of new knowledge and modes of nursing practice. Continuing education programmes are available for older nurses. In the UK, the Royal College of Nursing and the UKCC embarked on various advanced and continuing education programmes inside and outside the universities. Universities and other higher institutions of learning offering nursing courses at degree levels have risen by over 60 percent the past twenty years. In Nigeria, the Nursing and Midwifery Council of Nigeria, the National Association of Nigerian Nurses and Midwives and the Ministry of Health have been working towards the improvement in nursing education through curricular reviews, support for undergraduate and graduate programmes in nursing, and the enabling legislation. Today in Nigeria we have numbers of universities offering nursing programmes 3.3.1.2 Theory Development As nursing emerged as a profession and with the quality of education improving, nursing knowledge began to develop through nursing theories. Theoretical models serve as frameworks for nursing curricula and clinical practice, nursing theories also lead to further research that increase the scientific bases of nursing practice. A theory is a way of 51 NSC219 FOUNDATION OF PROFESSIONAL NURSING PRACTICE 1 understanding a reality, and in this general sense all practicing nurses use the theories they have learnt. You have come across the word’s 'model' and 'theory' in Concepts of Nursing, where they were mentioned in passing. They will be discussed in detail next semester in NSC212 - Foundation of Professional Nursing Practice II 3.3.1.3 Specific service A profession is expected to provide a specific service relating to identified needs of clients. The clients also recognise the need for the service being rendered. Nursing has always been a service profession, although usually viewed as a charitable one. The nurse is no longer primarily limited to the hospital environment but has increasingly moved out into the neighbourhood and community in identifying health care needs and planning and executing appropriate interventions. In addition to effecting change, nursing is offering an increasing number of services to society. You will recall from discussion in unit 2 - Historical Development of Nursing, ‘service' form the major emphasis of all the definitions of nursing. The focus of activities in the-Nightingale and post- Nightingale era was service to humanity. You should review the Units again. 3.3.1.4 Autonomy in Decision Making and Practice Autonomy is the quality or state of being self-governing. Have you experienced autonomy before? When you had to look after your own affairs without someone looking over your shoulders, think of how you felt. The same applies to Nursing. Autonomy means that a person, group or organisation' reasonably independent and self: -governing in decision making and practice. It has been difficult for nurses to attain the degree of freedom enjoyed by other professionals. Until recent times, physicians, hospital administrators and others directed nurses in the health care delivery system because they could not understand why nurses require autonomy. Thank goodness for increased clinical competence and better education 52 NSC219 MODULE 1 preparation. Nurses are increasingly taking independent roles in nurse run clinics, collaborative practice, and advanced nursing practice. In Nigeria nursing autonomy remains a thorny issue. The tradition of the physician holding tightly to the reins of con

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