Lecture 3: The Development of Nursing as a Profession PDF

THE DEVELOPMENT OF NURSING AS A PROFESSION  Definition of Nursing Defining nursing can be difficult. A major factor that has made it difficult to define nursing is that it is taught as encompassing both theoretical and practical aspects. Early Definitions of Nursing: A nur...

THE DEVELOPMENT OF NURSING AS A PROFESSION  Definition of Nursing Defining nursing can be difficult. A major factor that has made it difficult to define nursing is that it is taught as encompassing both theoretical and practical aspects. Early Definitions of Nursing: A nurse is a person who nourishes, fosters, and protects A person who is prepared to care for the sick, injured, and aged  3 Definition of nursing Many would expect that any definition of nursing must indicate that it is both an art and a science. Art: composed of skills that require expertise and proficiency for their competent education. Science: requires systematized knowledge derived from observation, critical thinking, study, and research.  Definitions of Nursing Theorists Florence Nightingale: “The goal of nursing is to put the patient in the best condition for nature to act upon him, primarily by altering the environment” 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 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”.  Definitions of Nursing Theorists Ida Orlando Pelletier: “Nursing’s unique and independent role concerns itself with an individual’s need for help in an immediate situation for the purpose of avoiding, relieving, diminishing, or curing that individual’s sense of helplessness”. Jean Watson: “The essence and central unifying focus for nursing practice is caring, a transpersonal value. Focuses on the spiritual subjective aspects of both nurse and patient and the “caring moment” relating to the time when nurse and patient first come  Definitions of Nursing Theorists Dorothy Orem: “Nursing is concerned with the individual’s need for self-care action, which is the practice of activities that individuals initiate and perform on their own behalf in maintaining health and well-being”. Sister Callista Roy: “The goal of nursing is the promotion of adaptive responses (those things that positively influence health) that are affected by the person’s ability to respond to stimuli. Nursing involves manipulating stimuli to promote adaptive responses”.  Nursing as Defined by Organizations ANA: “Nursing is the diagnosis and treatment of human responses to actual or potential health problems” (ANA, 1980). National Council of State Boards of Nursing (NCSBN): “The ‘Practice of Nursing’ means assisting individuals or groups to maintain or attain optimal health, implementing a strategy of care to accomplish defined goals, and evaluating responses to care and treatment” (NCSBN, 1994). What is a Profession? When nurses were first developing their identity separately from that of physicians, there was no thought about their being part of a profession. Over the years, as the scope of practice has expanded and the responsibilities have increased, nurses have increasingly begun to consider what they do as professional activities. What is a Profession? - In common usage, terms such as position, job, occupation, and profession often are used interchangeably and incorrectly. The following definitions will clarify what is meant by these terms:  Position: A group of tasks assigned to one individual.  Job: A group of positions that are similar in nature and level of skill that can be carried out by one or more individuals.  Occupation: A group of jobs that are similar in type of work and that are usually found throughout an industry or work environment.  Profession: A type of occupation that meets certain criteria that raise it to a level above that of an occupation  Characteristics of A Profession Of the many researchers and theorists who have attempted to identify the traits that define a profession, Abraham Flexner, Elizabeth Bixler, and Eliza Pavalko are most widely accepted as the leaders in the field.  Characteristics of A Profession 1. Body of knowledge that describes phenomena. A primary criticism leveled at nursing is that it has no body of specialized knowledge that belongs exclusively to nursing. Critics state that nursing borrows from biologic sciences, social sciences, and medical science, and then combines the various skills and concepts and calls it “nursing.” Nursing leaders and theorists disagree whether nursing is a unique profession or one borrowed from other disciplines. This mixture and synthesis of some areas with application to another may be one of nursing’s distinctive qualities.  Characteristics of A Profession Nursing researchers also are working to develop an organized body of knowledge that is unique to nursing. Nursing theorists are challenging one another to identify and describe the general principles that govern nursing practice. Nursing leaders are developing a language of nursing, As a result of these efforts, nursing is emerging as a profession with an established body of knowledge.  Characteristics of A Profession 2. Use of the Scientific Method to Enlarge the Body of Knowledge. Critical to any profession is its ability to grow and change as the world changes. Equally important is the method by which those changes occur. Changes cannot take place in a haphazard, random, or hit-or-miss fashion; they must be well thought out. Data must be systematically gathered and carefully analyzed, the problems must be correctly identified, alternative solutions must be sought, the best approach selected and implemented, and the results thoroughly evaluated. This is thought of as the scientific method.  This has been applied to nursing practice through the nursing process and through critical thinking. Accreditation criteria established for nursing programs by the national accrediting agencies require that libraries have up-to-date references and periodicals available to students either in print or through electronic reference resources. Nursing knowledge also increases because of nursing research and nursing practice. The number of nurses involved in nursing research is increasing. Journals focusing on clinical practice and the profession as a whole increasingly include news briefs or full articles reporting results of recent research affecting the practice of nursing.  Characteristics of A Profession 3.Education Within Institutions of Higher Education. Previously, students were assigned to experienced practitioners who taught the skills with which they were familiar. Once those skills were acquired, the student moved into the world of employment. Over time, the settings in which nurses are educated have changed. Today, most nursing programs preparing RNs are located in institutions of higher education or collegiate settings (at either community colleges or senior colleges or universities).  Characteristics of A Profession 4. Control of Professional Policy, Professional Activity, and Autonomy. Most critics reviewing professions against professional standards emphasize the ability of any group to develop its own professional policy and to function autonomously. Some would suggest that this is an area in which nursing always has been weak, although current health care reform may assist the profession in achieving the full autonomy it has been seeking.  Characteristics of A Profession Historically, the nurse worked under the direction of the patient’s physician, often in a hospital setting. Only in the last 50 years has nursing made significant inroads in defining the unique role of the nurse in “care” as opposed to “cure” of the patient. Nurses are responsible for planning and implementing the nursing care patients receive, and nurses are also accountable for the care provided. Nursing committees establish policies and protocols. Nursing diagnosis, once challenged as an inappropriate responsibility for nurses, has become a standard of good nursing care.  Characteristics of A Profession 5. A Code of Ethics A critical standard established for professions is that there exists a code of ethics. The general standard for the professional behavior of nurses in the United States is the ANA Code for Nurses. This document was developed by the ANA and periodically is revised to address current issues in practice.  Characteristics of A Profession Similarly, the International Council of Nurses ICN , housed in Geneva, Switzerland, has developed a code for nurses that also addresses many of the issues outlined in the ANA code. The international code sets the standards for ethical practice by nurses throughout the world.  Characteristics of A Profession 6.Nursing as a Lifetime Commitment Most individuals who have been nurses continue to identify themselves as nurses long after they retire. Today, there is a greater likelihood that individuals who enter the profession of nursing at one educational level will continue to advance in practice and education by pursuing additional degrees (and experience). Defined as loyalty, the desire to stay in a profession, and a sense of responsibility toward the profession's particular problems and challenges. Commitment to nursing implies commitment to provide an optimal patient care and promote the nursing profession, and to continue in lifelong learning.  Characteristics of A Profession 7. Service to the Public Many theorists list altruism, service to the public, and dedication among criteria for professions. Some suggest that altruism, or the desire to provide for the good of society, must be the worker’s motivating force.  Distinguishing Nursing From Medicine The primary differences between nursing and medicine are the purpose and goal of each profession, and the education needed to fulfill each role. Historically, medicine has been perceived as a profession for men and nursing as a profession for women. Medicine is concerned with the diagnosis and treatment (and cure, when possible) of disease. Nursing is concerned with caring for the person in a variety of health related situations  Distinguishing Nursing From Medicine The role of the nurse in client care also involves teaching about health and the prevention of illness, and caring for the ill individual. It also may encompass case management. Nursing takes place in the community and the home, in hospice centers, ambulatory care environments, schools and day care centers, and rehabilitation facilities. In all environments, nurses play a key role in promoting higher standards of health.  Defining A Language for Nursing The development of a special language for nursing began as an effort to develop a language that would describe the clinical judgments made by nurses that are not in medical language systems. Defining a language for nursing involves the development of classification systems that communicate information and guide data collection about nursing activities.  25 Rational for the development of a classification for nurses 1. Permits recognition and communication with others by giving a name to the things nurses do. 2. Provides a uniform legal record of care. 3. Supports clinical decision making. 4. Lays the groundwork for nursing research. 5. Capture the cost of nursing services for billing and accounting purposes. 6. Generates a structured retrieval data base for quality assurance.  Major Classification for Nursing Care Title Description North AmericaNursing A clinical judgment about an individual, family, or community Diagnosis Association response to actual or potential health problems. (NANDA) Nursing Intervention A comprehensive standardized language, describing treatments Classification (NIC) that nurses perform in all settings and in all specialties. Nursing Outcomes A variable concept that represents a patient or family caregiver state, behavior, or perception that is measurable along a continuum Classification (NOC) and responsive to nursing interventions. The Omaha System A system of client problems, interventions, and client outcomes, referred to as the Problem Classification Scheme, the Intervention Scheme, and the Problem Rating Scale for Outcomes.