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It deals with II Unit of B.Sc. Nursing I Year prepared according to INC Syllabus


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Mrs. P. Vadivukkarasi Ramanadin, Professor, Dept. Of OBG (N), Shri Vinoba Bhave College of Nursing, Shri Vinoba Bhave Civil Hospital, Silvassa, DNH. Nursing as a profession II UNIT

II UNIT - 16 Hrs:

II UNIT - 16 Hrs   NURSING AS A PROFESSION   Nursing as a profession • Definition and Characteristics of a profession • Nursing: - o Definition , Concepts, Philosophy , objectives o Characteristics, nature and scope of nursing practice o Functions of nurse o Qualities of a nurse o Categories of nursing personnel o Nursing as a profession o History of Nursing in India • Values : Definition, Types, Values Clarification and values in professional Nursing: Caring and Advocacy • Ethics : o Definition and Ethical Principles o Code of ethics and professional conduct for nurses     20/08/2014 2 Shri Vinoba Bhave College of Nursing, Silvassa

Basic termoniologies:

Basic termoniologies Philosophy: The study of the fundamental nature of knowledge, reality, and existence, especially when considered as an academic discipline. Profession:  A n occupation  requiring  special  training in the liberal arts or sciences,  esp one of the three learned professions, law,  theology, or medicine. Should follow the legal principles & ongoing research must be there. Concept: A  general idea derived or inferred from  specific instances or  occurrences. 20/08/2014 3 Shri Vinoba Bhave College of Nursing, Silvassa

Cont . . . :

Cont . . . Aim:   To direct (a weapon) toward an intended target. Or To direct toward or intend for a particular goal or group Objectives: Something worked toward or striven for; a  goal. Charecteristics / Nature: T he fundamental qualities of a person or thing; identity  or essential character Scope:   The range of one's perceptions, thoughts, or  actions. Or Breadth or opportunity to function. 20/08/2014 4 Shri Vinoba Bhave College of Nursing, Silvassa

Cont . . .:

Cont . . . Values: A  principle, standard, or quality considered worthwhile or desirable Ethics:   A set of principles of right conduct. Or A theory or a system of moral values Advocacy: The  act of pleading or arguing in favor of something such as a cause, idea, or policy; active support. 20/08/2014 5 Shri Vinoba Bhave College of Nursing, Silvassa


DEFINING A PROFESSION Profession: A type of occupation that meets certain criteria that raise it to a level above that of an occupation or An occupation that requires extensive education, special knowledge, skill, and preparation. Professional: a person who belongs to and practices a profession. 20/08/2014 Shri Vinoba Bhave College of Nursing, Silvassa 6


Professionalism: demonstration of high level of personal, ethical and high level of skill characteristics of a member of a profession. Or Refers to professional character, spirit, or methods. It is a set of attributes, a way of life that implies responsibility and commitment. Professionalization: is the process of becoming professional. Or it i s the process of becoming professional, that is, of acquiring characteristics considered to be professional.

Criteria of a Profession:

Criteria of a Profession Specialized education. Body of knowledge. Ongoing research. Code of ethics. Autonomy: is a state of independent and self directed with out any control from out side. Service orientation Professional organization.

Characteristics of a Profession:

Characteristics of a Profession I. Professions are occupationally related social institutions established and maintained as a means of providing essential services to the individual and the society. 2. Each profession is concerned with an identified area of need or function (for example, maintenance of physical and emotional health, preservation of rights and freedom, enhancing the opportunity to learn). 20/08/2014 Shri Vinoba Bhave College of Nursing, Silvassa 9


3. The profession collectively, and the professional individually, possesses a body of knowledge and a repertoire (range) of behaviors and skills (professional culture) needed in the practice of the profession; such knowledge, behavior, and skills normally are not possessed by the nonprofessional. 20/08/2014 Shri Vinoba Bhave College of Nursing, Silvassa 10


4.Members of the profession are involved in decision making in the service of the client. These decisions are made in accordance with the most valid knowledge available, against a background of principles and theories, and within the context of possible impact on other related conditions or decisions. 5. The profession is based on one or more undergirding disciplines from which it builds its own applied knowledge and skills. 20/08/2014 Shri Vinoba Bhave College of Nursing, Silvassa 11


6. The profession is organized into one or more professional associations, which, within broad limits of social accountability, are granted autonomy in control of the actual work of the profession and the conditions that surround it (admissions, educational standards, examination and licensing, career line, ethical and performance standards, professional discipline). 7. The profession has agreed-upon performance standards for admission to the profession and for continuance within it. 20/08/2014 Shri Vinoba Bhave College of Nursing, Silvassa 12


8. Preparation for and induction into the profession is provided through a protracted preparation program , usually in a professional school on a college or university campus. 9. There is a high level of public trust and confidence in the profession and in individual practitioners, based upon the profession's demonstrated capacity to provide service markedly beyond that which would otherwise be available. 20/08/2014 Shri Vinoba Bhave College of Nursing, Silvassa 13


10. Individual practitioners are characterized by a strong service motivation and lifetime commitment to competence. 11. Authority to practice in any individual case derives from the client or the employing organization; accountability for the competence of professional practice within the particular case is to the profession itself. 12. There is relative freedom from direct on-the-job supervision and from direct public evaluation of the individual practitioner. The professional accepts responsibility in the name of his or her profession and is accountable through his or her profession to the society. 20/08/2014 Shri Vinoba Bhave College of Nursing, Silvassa 14

Six Characteristics of a Profession (Wickenden):

Six Characteristics of a Profession (Wickenden) Renders a specialized service based upon advanced specialized knowledge and skill, and dealing with its problems primarily on an intellectual plane rather then on a physical or a manual labor plane. 20/08/2014 Shri Vinoba Bhave College of Nursing, Silvassa 15


Involves a confidential relationship between a practitioner and a client or a employer . Is charged with a substantial degree of public obligation by virtue (feature) of its profession of specialized knowledge. Enjoys a common heritage of knowledge, skill, and status to the cumulative store of which professional men are bound to contribute through their individual and collective efforts. Performs its services to a substantial degree in the general public interest , receiving its compensation through limited fees rather than through direct profit from the improvement in goods, services, or knowledge, which it accomplishes. Is bound by a distinctive ethical code in its relationships with clients, colleagues, and the public. 20/08/2014 Shri Vinoba Bhave College of Nursing, Silvassa 16

Types of Nursing Educational Programs:

Types of Nursing Educational Programs Diploma programs (DGNM) Under Graduate Program (B.Sc.(N) & P.B.B.Sc.(N)) Post graduate Programme (M.Sc.(N)), M.Phil (N) Doctoral Programs (Ph.D(N)) Certificate Programme ()


INTRODUCTION The nursing profession has evolved greatly over time, moving from dependence upon total medical direction providing basic care into an independent practice modality with its own nursing theory practice, nursing models, and distinct nursing interventions . 20/08/2014 18 Shri Vinoba Bhave College of Nursing, Silvassa


MEANING Nurse originated from Latin word “Nurtix” which means “to nourish” The nurse is a person who nourishes, fosters, protects and who is prepared to take care of sick, injured and aged people 20/08/2014 19 Shri Vinoba Bhave College of Nursing, Silvassa

Definition :

Definition Nursing is an art & science . It may be defined as service to the individual which helps him or her to obtain or maintain a healthy state of mind or body and the relief of pain & discomfort Hemmer & Henderson Nursing is a unique function of the nurse, i.e to assist the individual, sick or well, in the performance of those activities contributing to health or recovery (or to peaceful death) that he / she would perform unaided if he / she had the necessary strength, will or knowledge and to do so in such a way as to help him / her to gain independence as rapidly as possible - Virginia Henderson 20/08/2014 20 Shri Vinoba Bhave College of Nursing, Silvassa

Cont . . .:

Cont . . . Nursing as the protection, promotion and optimization of health and abilities; prevention of illness & injury; alleviation of suffering through the diagnosis & treatment of human response; and advocacy in the care of individuals, families, communities and populations ANA, 2010 Nursing encompasses autonomous & collaborative care of individuals of all ages, families, groups & communities, sick or well & in all setting s. Nursing includes the promotion of health, prevention of illness & the care of ill, disabled & dying people. Advocacy, promotion of safe environment, research, participation in shaping health policy in patient & health systems management & education are also key nursing roles. - ICN, 2010 20/08/2014 21 Shri Vinoba Bhave College of Nursing, Silvassa

Cont . . .:

Cont . . . Historical perspectives and key concepts of Nursing • Nightingale (1860): To facilitate “the body’s reparative processes” by manipulating client’s environment • Peplau 1952: Nursing is; therapeutic interpersonal process. • Henderson 1955: The needs often called Henderson’s 14 basic needs • Abdellah 1960: The nursing theory developed by Faye Abdellah et al (1960) emphasizes delivering nursing care for the whole person to meet the physical, emotional, intellectual, social, and spiritual needs of the client and family. 21 basic needs 20/08/2014 22 Shri Vinoba Bhave College of Nursing, Silvassa

Cont . .. :

Cont . .. Orlando 1962: To Ida Orlando (1960), the client is an individual; with a need; that, when met, diminishes distress, increases adequacy, or enhances well-being. • Johnson’s Theory 1968: Dorothy Johnson’s theory of nursing 1968 focuses on how the client adapts to illness and how actual or potential stress can affect the ability to adapt. The goal of nursing to reduce stress so that; the client can move more easily through recovery. 20/08/2014 23 Shri Vinoba Bhave College of Nursing, Silvassa

Cont . . . :

Cont . . . Rogers 1970: to maintain and promote health, prevent illness and care for and rehabilitate ill and disabled client through “humanistic science of nursing” Orem1971: This is self-care deficit theory. Nursing care becomes ne cessary when client is unable to fulfil biological, psychological, developmental, or social needs. King 1971: To use communication to help client re-establish positive adaptation to environment. Goal attainment. 20/08/2014 24 Shri Vinoba Bhave College of Nursing, Silvassa

Cont . .. :

Cont . .. Neuman 1972: Stress reduction is goal of system model of nursing practice. Roy 1979: This adaptation model is based on the physiological, psychological, sociological and dependence-independence adaptive modes. Watson’s Theory 1979: Watson’s philosophy of caring 1979 attempts to define the outcome of nursing activity in regard to the; humanistic aspects of life. 20/08/2014 25 Shri Vinoba Bhave College of Nursing, Silvassa


CONCEPTS Nursing is caring . Nursing is an art . Nursing is a science. Nursing is client centered . Nursing is holistic . Nursing is adaptive. Nursing is concerned with health promotion , health maintenance , and health restoration . Nursing is a helping profession . 20/08/2014 26 Shri Vinoba Bhave College of Nursing, Silvassa


PHILOSOPHY 20/08/2014 27 Shri Vinoba Bhave College of Nursing, Silvassa


PHILOSOPHY Indian Nursing Council believes that, Health is a state of well-being that enables a person to lead a psychologically, socially and economically productive life. Health is a right of all the people. Individuals, f amilies and c ommunities have a responsibility towards maintaining their health . Nursing contributes to the health services in vital and significant way in the health care delivery system . It recognizes national health goals and is committed t o participate in the implementation of National Health policies and programs . It aims at identifying health needs of the people, planning and providing quality care in collaboration with other health professionals and c ommunity groups. 20/08/2014 28 Shri Vinoba Bhave College of Nursing, Silvassa

Cont . .. :

Cont . .. Scope of nursing practice encompasses provision of promotive, preventive, curative and rehabilitative aspects of care to people across their life span in wide variety of health care settings. Practice of Nursing is based upon application of basic concepts and principles derived from the physical, biological, behavioral sciences, medicine and nursing. Nursing is based on values of caring , and aims to help individuals to attain independence in self-care . It necessitates development of compassion and understanding of human b ehavior among its p ractitioners to provide care with respect and dignity and protect the rights of individuals and groups. 20/08/2014 29 Shri Vinoba Bhave College of Nursing, Silvassa


AIM 20/08/2014 30 Shri Vinoba Bhave College of Nursing, Silvassa


Provide care Promote Health Prevent illness Rehabilitate client Make Clientindependent 20/08/2014 31 Shri Vinoba Bhave College of Nursing, Silvassa


CHARECTERISTICS OF NURSING  Knowledge Personal Qualities Caring, Compassionate and Respectful Safe Competent Care Behaviour Communication Being Accessible Teamwork 20/08/2014 32 Shri Vinoba Bhave College of Nursing, Silvassa

Cont . .. :

Cont . .. 1. Empathy   2. Detail Oriented   3. Communication 4. Intuition 5. Physical Endurance 6. Emotional Stability 7. Critical Thinking 8. Coordinator of Services 9. Patience 10. Dedication 20/08/2014 33 Shri Vinoba Bhave College of Nursing, Silvassa

Characteristic /Pneumonic / Quality of a Nurse :

Characteristic /Pneumonic / Quality of a Nurse N - Noble U - Understanding R - Responsible S - Sincere E - Empathetic 20/08/2014 34 Shri Vinoba Bhave College of Nursing, Silvassa


Qualities of a nurse A strong sense of responsibility A highest standards of integrity. Well education, Ability to integrate the art and the science of working with people 20/08/2014 35 Shri Vinoba Bhave College of Nursing, Silvassa

Qualities of a Nurse:

Qualities of a Nurse A nurse must be Self Confident Humble Honest Loyal Cooperative Good listener Keen observer Good administrator Good supervisor Impartial Capable to manage critical situation Critical thinking person Volunteer Responsible Accountable Competent Advocate Counselor Communicator

Scope of Nursing:

Scope of Nursing


Nurses provide care for three types of clients: individuals, families, and communities. Nursing practice involves four areas: Promoting health and wellness Preventing illness Restoring health and Care of the dying . 20/08/2014 38 Shri Vinoba Bhave College of Nursing, Silvassa

I. Promoting Health and Wellness :

I. Promoting Health and Wellness Wellness is a state of well-being. It means engaging in attitudes and behavior that enhance the quality of life and maximize personal potential. 20/08/2014 39 Shri Vinoba Bhave College of Nursing, Silvassa


Nurses promote wellness in clients who are both healthy and ill . This may involve individual and community activities to enhance healthy lifestyles, such as improving nutrition and physical fitness, preventing drug and alcohol misuse, restricting smoking, and preventing accidents and injury in the home and workplace & r educe over weight. 20/08/2014 40 Shri Vinoba Bhave College of Nursing, Silvassa

II. Preventing Illness:

II. Preventing Illness The goal of illness preventing programs is to maintain optimal health by preventing disease. Nursing activities that prevent illness include immunizations, prenatal and infant care, and prevention of sexually transmitted disease. 20/08/2014 41 Shri Vinoba Bhave College of Nursing, Silvassa

III. Restoring Health :

III. Restoring Health Focuses on the ill client and it extends from early detection of disease through helping the client during the recovery period . 20/08/2014 42 Shri Vinoba Bhave College of Nursing, Silvassa

Eg of Nursing Activities Include the following:

Eg of Nursing Activities Include the following Providing direct care to the ill person, such as administering medications, baths, and specific procedures and treatments. Performing diagnostic and assessment procedures, such as measuring blood pressure and examining feces for occult blood. Consulting with other health care professionals about client problems. Teaching clients about recovery activities, such as exercises that will accelerate recovery after a stroke. Rehabilitating clients to their optimal functional level following physical or mental illness, injury, or chemical addiction. 20/08/2014 43 Shri Vinoba Bhave College of Nursing, Silvassa


IV. Care of the Dying This area of nursing practice involves comforting and caring for people of all ages who are dying. it includes helping clients live as comfortably as possible until death and helping support person cope with death. 20/08/2014 44 Shri Vinoba Bhave College of Nursing, Silvassa

Categories of nursing personnel :

Categories of nursing personnel HOSPITAL: Staff Nurse Senior Staff Nurse Nursing Superintendent Grade II Nursing Superintendent Grade I Nursing Institutions: Sister Tutor (School of Nursing) Clinical Instructor (College of Nursing) Lecturer Assistant Professor Associate Professor Professor Vice – Principal Principal Joint Director of Nursing/ Depty. Director of Nursing / Assistant Director of Nursing Director of Nursing 20/08/2014 Shri Vinoba Bhave College of Nursing, Silvassa 45

Categories of nursing personnel :

Categories of nursing personnel Bedside Nurse Public Health Nurse / Community H ealth Nurse Industrial / Occupational Health nurse Military Nurse Private Duty Nurse Independent Nurse Practitioner Clinical Specialist Nurse Midwife Nurse anesthetist Nurse educator Nurse researcher Nurse administrator Nurse entrepreneur


Roles and Functions of the Nurse 20/08/2014 47 Shri Vinoba Bhave College of Nursing, Silvassa


Function of the nurse Caring for individuals, sick or well Assess the responses to health status. Assist individuals in the performance of activities contributing to health or recovery. Share with other health team the planning, implementation and evaluation to ensure the adequacy of the health system for promoting health, preventing illness, and caring for ill and disabled 20/08/2014 48 Shri Vinoba Bhave College of Nursing, Silvassa

The professional roles of the nurse:

The professional roles of the nurse Teacher and trainer for student in nursing sciences both theoretically and practically A researcher as well as assisting in research Expert and consultant in nursing for national and international issues 20/08/2014 49 Shri Vinoba Bhave College of Nursing, Silvassa


Caregiver encompasses the physical, psychosocial, developmental, cultural, and spiritual levels. The nursing process provides nurses with a framework for providing care. A nurse may provide care directly or delegate it to other caregivers. 20/08/2014 50 Shri Vinoba Bhave College of Nursing, Silvassa


Communicator Communication is integral to all nursing roles. Nurses communicate with the client, support persons, other health professionals, and people in the community. 20/08/2014 51 Shri Vinoba Bhave College of Nursing, Silvassa

Teacher :

Teacher As a teacher , the nurse helps clients learn about their health and the health care procedures they need to perform to restore or maintain their health. 20/08/2014 52 Shri Vinoba Bhave College of Nursing, Silvassa

Client advocate :

Client advocate A client advocate acts to protect the client. In this role the nurse may represent the client's needs and wishes to other health professionals, such as relaying the client's wishes for information to the physician. They also assist clients in exercising their rights and help them speak up for themselves. 20/08/2014 53 Shri Vinoba Bhave College of Nursing, Silvassa

Counselor :

Counselor Counseling is the process of helping a client to recognize and cope with stressful psychological or social problems, to develop improved interpersonal relationships, and to promote personal growth. It involves providing emotional, intellectual, and psychological support. 20/08/2014 54 Shri Vinoba Bhave College of Nursing, Silvassa

Change agent:

Change agent The nurse acts as a change agent when assisting others, that is, clients, to make modifications in their own behavior. Nurses also often act to make changes in a system, such as clinical care, if it is not helping a client return to health. Nurses are continually dealing with change in the health care system. 20/08/2014 55 Shri Vinoba Bhave College of Nursing, Silvassa


Leader A leader influences others to work together to accomplish a specific goal. The leader role can be employed at different levels: individual client, family, groups of clients, colleagues, or the community. 20/08/2014 56 Shri Vinoba Bhave College of Nursing, Silvassa

Manager :

Manager The nurse manages the nursing care of individuals, families, and communities. The nurse manager also delegates nursing activities to other nurses, and supervises and evaluates their performance. 20/08/2014 57 Shri Vinoba Bhave College of Nursing, Silvassa


Managing requires knowledge about organizational structure and dynamics, authority and accountability, leadership, delegation and supervision and evaluation. 20/08/2014 58 Shri Vinoba Bhave College of Nursing, Silvassa

Case manager :

Case manager Nurse case managers work with the multidisciplinary health care team to measure the effectiveness of the case management plan and to monitor outcomes. Each agency or unit specifies the role of the nurse case manager . 20/08/2014 59 Shri Vinoba Bhave College of Nursing, Silvassa

Research consumer:

Research consumer Nurses often use research to improve client care. In a clinical area, nurses need to: Be aware of the process and language of research. Be sensitive to rights of human subjects. Identification of significant researchable problems. Be a discriminating consumer of research findings. 20/08/2014 60 Shri Vinoba Bhave College of Nursing, Silvassa

Extended & Expanded career roles:

Extended & Expanded career roles Such as those of nurse practitioner, clinical nurse specialist, nurse midwife, nurse educator, nurse researcher, and nurse anesthetist, all of which allow greater independence and autonomy. 20/08/2014 61 Shri Vinoba Bhave College of Nursing, Silvassa

Cont .. . . :

Cont .. . . Nurse Practitioner (Adult Nurse Practitioner, Family Nurse Practitioner, School Nurse Practitioner, Pediatric Nurse Practitioner, Gerontology Nurse Practitioner) Clinical Nurse specialist (Gerontology, oncology) Nurse anesthetist Nurse Midwife Nurse Researcher Nurse administrator Nurse educator Nurse entrepreneur (Health related business) 20/08/2014 62 Shri Vinoba Bhave College of Nursing, Silvassa


HISTORY OF NURSING 20/08/2014 Shri Vinoba Bhave College of Nursing, Silvassa 63


History of nursing Nursing is one of the youngest profession but one of the oldest arts. It evolved from the familial roles of nurturing and care taking . 20/08/2014 64 Shri Vinoba Bhave College of Nursing, Silvassa


Nursing in Ancient Time The nurse usually was the mother who cared for her family during sickness by providing physical care and herbal treatment. This nurturing and caring role of nurse has continued to include assisting women during childbirth, suckling healthy newborns, and ministering to the ill, aged and helpless within households and surrounding communities. Its hallmark was caring more than curing 20/08/2014 65 Shri Vinoba Bhave College of Nursing, Silvassa


Nursing in Christian Time During the Middle Ages in Europe, people attributed illness to punishment for sin or caused by evil spirit. Religious groups assumed many of the roles of nursing. Nuns and priests combined their efforts to save souls with commitment to care for the sick. But their number was not enough. Consequently, some convents engaged lay people to assist with physical care of the sick people. Nursing attendants were ignorant, uncouth, and apathetic to the need to their charge. 20/08/2014 66 Shri Vinoba Bhave College of Nursing, Silvassa


Nursing in Christian Time cont. Infection, pressure sores and malnutrition were a testimony to their neglect In the early Christian period, nursing began to have a formal and more clearly defined role. Led by the belief that love and caring for ‘others were important, women called deaconesses made the first organized visits to sick people and members of male religious orders gave nursing care The Greeks began to establish centers and Hospitals for the enormous number of pilgrims needing healthcare, and nursing became a respected vocation. 20/08/2014 67 Shri Vinoba Bhave College of Nursing, Silvassa

The influence of Hippocrates:

The influence of Hippocrates Hippocrates, born in 460 BC on the Greek island He is the Father of Medicine He helped to lay the groundwork for nursing and medicine He proposed the concept of physical assessment. 20/08/2014 68 Shri Vinoba Bhave College of Nursing, Silvassa


He emphasized the importance of caring for the whole person (holistic healthcare) Physician repeat the Hippocrates oath when graduating. Hippocrates healthcare education and training become standard as scientific knowledge increased 20/08/2014 69 Shri Vinoba Bhave College of Nursing, Silvassa

The Roman Matrons:

The Roman Matrons The first recorded history of nursing began with biblical women who cared for the sick and injured. The first nursing educator is a Roman woman who converted her house into a monastery 20/08/2014 70 Shri Vinoba Bhave College of Nursing, Silvassa

Monastic and military nursing orders:

Monastic and military nursing orders Beginning in the first century, several monastic orders were established to care for the sick. Sometimes, the monastery itself became the refuge for sick and cared by religious men and women During the crusades, - female in northern Europe were nearly eliminated from giving nursing care 20/08/2014 71 Shri Vinoba Bhave College of Nursing, Silvassa

Monastic and military nursing orders cont.:

Monastic and military nursing orders cont. Male military conducted most nursing care because they were required to defend the hospital as well as to care for the sick 20/08/2014 72 Shri Vinoba Bhave College of Nursing, Silvassa

The Reformation:

The Reformation In the 1500s, during the European religious movement, many monasteries closed and the work of woman in religious orders nearly ended. 1800s, “ The dark ages of nursing” the few women who cared for the sick were prisoners or prostitutes. Nursing was considered menial of all tasks. 20/08/2014 73 Shri Vinoba Bhave College of Nursing, Silvassa


By the late 1800s, many school for trained nurses existed throughout Europe. The status of nursing began to improve and many women including religious once again became involved in nursing care. 20/08/2014 74 Shri Vinoba Bhave College of Nursing, Silvassa

Florence Nightingale:

Florence Nightingale Was born in 1820 to wealthy English parents. She entered the deaconess school of nursing and her family were strongly apposed to her becoming a nurse and then graduated in 1853 20/08/2014 75 Shri Vinoba Bhave College of Nursing, Silvassa

Florence Nightingale cont.:

Florence Nightingale cont. She was working as a manager for nursing home in London. During the Crimean war, 1854, Nightingale entered the battlefield with 38 other nurses and cared for sick and injured 20/08/2014 76 Shri Vinoba Bhave College of Nursing, Silvassa

Florence Nightingale cont.:

Florence Nightingale cont. She insisted on establishing sanitary conditions and providing quality nursing care day and night carrying oil lamps which reduced the mortality rate. 20/08/2014 77 Shri Vinoba Bhave College of Nursing, Silvassa

Nightingale definition of nursing.:

Nightingale definition of nursing. In 1859 Nightingale said that nature alone cures, medicine and surgery assist nature to remove the obstruction. Nursing put the patient in the best condition for nature to act upon him. 20/08/2014 78 Shri Vinoba Bhave College of Nursing, Silvassa

Florence Nightingale school:

Florence Nightingale school She opened the first nursing school out side hospitals in 1860. The nursing course was one year in length and included both classroom and clinical experiences in London. The school emphasized learning rather than service. Some principles of this school are still taught today. 20/08/2014 79 Shri Vinoba Bhave College of Nursing, Silvassa

Nightingale principles of nursing:

Nightingale principles of nursing Cleanliness is vital to recovery The sick person has individual needs Nursing is an art and science Nurses should spend their time caring for others not cleaning Prevention is better than cure The nurse must work as a member of a team 20/08/2014 80 Shri Vinoba Bhave College of Nursing, Silvassa

Nightingale principles of nursing cont.:

Nightingale principles of nursing cont. Self-discipline and self-evaluation are important The nurse should be healthy in mind and body Teaching is part of nursing Nursing is a specialty A nurse should continue learning throughout her career 20/08/2014 81 Shri Vinoba Bhave College of Nursing, Silvassa

Nursing in the United States:

Nursing in the United States Nursing started as familial role. Throughout the 19 th and 20 th centuries, historical and nursing developments interacted to build the foundation of modern nursing practice The establishment and growth of a system of nursing education is the most important development that has shaped today’s nursing 20/08/2014 82 Shri Vinoba Bhave College of Nursing, Silvassa

Nursing in Islamic Time:

Nursing in Islamic Time Nursing found since (El-Rasol period); women caring soldiers in war by permission from El Rasol and give care for wound also used method of administration in regulation and coordination the work. 20/08/2014 83 Shri Vinoba Bhave College of Nursing, Silvassa




A value is a personal belief about the worth of a given idea, attitude, custom, or object that sets standards that influence behavior. Values are enduring beliefs or attitudes about the worth of a person, object, idea, or action.

Value Formation:

Value Formation Development of values begins in childhood, shaped by experiences within the family unit. Variations in childrearing result in variations in values and behaviors as children grow. The fundamental urge to love and nurture children takes on different expressions within each of the wide variety of cultures in our world. Schools, governments, religious traditions, and other social institutions play a role in the formation of values, reinforcing or sometimes challenging family values. Over time an individual acquires values by choosing some that the community holds strongly and perhaps discarding or transforming others.

Belief :

Belief Beliefs and attitudes are related, but not identical, to values. People have many different beliefs and attitudes, but only a small number of values. Beliefs (or opinions) are interpretations or conclusions that people accept as true. They are based more on faith than fact. Beliefs do not necessarily involve values. Forexample , the statement “If I study hard I will get a good grade” expresses a belief that does not involve a value. By contrast, the statement “Good grades are really important to me. I must study hard to obtain good grades” involves both a value and a belief.


Attitudes Attitudes are mental positions or feelings toward a person, object, or idea (e.g., acceptance, compassion, openness). Typically, an attitude lasts over time, whereas a belief may last only briefly. Attitudes are often judged as bad or good, positive or negative, whereas beliefs are judged as correct or incorrect. Attitudes have thinking and behavioral aspects.

Types :

Types Personal Values Although people derive values from society and their individual subgroups, they internalize some or all of these values as personal values. People need societal values to feel accepted, and they need personal values to have a sense of individuality. 2. Professional Values Nurses’ professional values are acquired during socialization into nursing from codes of ethics, nursing experiences, teachers, and peers. The American Association of Colleges of Nursing (AACN, 2008) identified five values essential for the professional nurse: altruism, autonomy, human dignity, integrity, and social justice (Table 5–1).

Values Transmission:

Values Transmission Values are learned through observation and experience. As a result, they are heavily influenced by a person’s sociocultural environment—that is, by societal traditions; by cultural, ethnic, and religious groups; and by family and peer groups.

Values Clarification:

Values Clarification Values clarification is a process by which people identify, examine, and develop their own individual values. A principle of values clarification is that no one set of values is right for everyone.

Essential Nursing Values:

Essential Nursing Values Altruism is a concern for the welfare and well-being of others. In professional practice, altruism is reflected by the nurse’s concern for the welfare of patients, other nurses, and other health care providers. Autonomy is the right to self-determination. Professional practice reflects autonomy when the nurse respects patients’ rights to make decisions about their health care. Human dignity is respect for the inherent worth and uniqueness of individuals and populations. In professional practice, human dignity is reflected when the nurse values and respects all patients and colleagues. Integrity is acting in accordance with an appropriate code of ethics and accepted standards of practice. Integrity is reflected in professional practice when the nurse is honest and provides care based on an ethical framework that is accepted within the profession. Social justice is acting in accordance with fair treatment regardless of economic status, race, ethnicity, age,citizenship, disability, or sexual orientation.

Values Clarification:

Values Clarification Choosing (cognitive) Beliefs are chosen ■ Freely, without outside pressure ■ From among alternatives ■ After reflecting and considering consequences Example: A person learns about energy resources, production, and consumption; the greenhouse effect; and other environmental issues, including ways to minimize use of and to recycle limited resources. Prizing (affective) Chosen beliefs are prized and cherished Example: The person is proud of the belief that he or she has an obligation to participate in some way in reducing environmental waste. Acting (behavioral) Chosen beliefs are ■ Affirmed to others ■ Incorporated into one’s behavior ■ Repeated consistently in one’s life Example: The person participates in the city recycling program for household waste, uses public transportation rather than driving a personal car when possible, helps organize recycling in the workplace, and is active in legislative and political activities related to environmental issues.


ETHICS 20/08/2014 Shri Vinoba Bhave College of Nursing, Silvassa 94


ETHICS IN NURSING 8/16/2012 Mata Sahib Kaur College of Nursing, Mohali, Punjab 95 Meaning of ethics Ethics are norms for conduct that distinguish between or acceptable and unacceptable behavior. Another way of defining 'ethics' focuses on the disciplines that study standards of conduct, such as philosophy, theology, law, psychology, or sociology.

Definition :

Definition Ethics is the study of conduct and character. It is concerned with determining what is good or valuable for individuals, for groups of individuals, and for society at large.

Cont . . .:

Cont . . . 8/16/2012 Mata Sahib Kaur College of Nursing, Mohali, Punjab 97 There are three primary ethical principles in human subjects research. They are Autonomy – respect for human dignity Beneficence – above all do no harm Justice - equality in distribution Fidelity - act honestly; keep promises Nonmaleficence - Avoid causing harm


Autonomy 8/16/2012 Mata Sahib Kaur College of Nursing, Mohali, Punjab 98 Right to self determination –voluntary decision Right to full disclosure – nature of the study, risk and benefit Right to refuse participation


Beneficence 8/16/2012 Mata Sahib Kaur College of Nursing, Mohali, Punjab 99 Freedom from harm Freedom from exploitation Benefits of research Risk/benefit ratio


Justice 8/16/2012 Mata Sahib Kaur College of Nursing, Mohali, Punjab 100 Right to fair treatment Fair and non-discriminatory selection of subjects. Non-prejudiced treatment of individuals declining to participate. Honoring all agreements Subjects access to researcher at any point to clarify doubts Subjects access to appropriate professional assistance in case of damage. Debriefing Respectful and courteous treatment

Cont ….:

Cont …. 8/16/2012 Mata Sahib Kaur College of Nursing, Mohali, Punjab 101 Respect for privacy Not more intrusive than it ought to be. Subjects privacy is maintained Confidentiality maintained Obtain identifying details only if necessary Assign ID no. to each subject Maintain identifying details in a locked file Restrict access to identifying data Destroy identifying data as quickly as possible. Report research finding in aggregate

Cont. . . :

Cont. . . 8/16/2012 Mata Sahib Kaur College of Nursing, Mohali, Punjab 102 Informed consent Subject status Study purpose Type of data collected Nature of commitment – duration etc. Sponsorship Subject selection Procedure Potential risk and cost Potential benefit Confidentiality pledge Voluntary consent Right to withdraw & withhold information Alternatives available Contact information


Nonmaleficence Maleficence refers to harm or hurt; thus nonmaleficence is the avoidance of harm or hurt. In health care, ethical practice involves not only the will to do good, but the equal commitment to do no harm. The health care professional tries to balance the risks and benefits of care while striving at the same time to do the least harm possible


Fidelity Fidelity refers to the agreement to keep promises. As a nurse you keep promises by following through on your actions and interventions. If you assess a patient for pain and offer a plan to manage the pain, the standard of fidelity encourages you to monitor the patient’s response to the plan. Professional behavior includes revision of the plan as necessary to try to keep the promise to reduce pain. Fidelity also refers to the unwillingness to abandon patients even when care becomes controversial or complex.


CODE OF ETHICS Code - “A code may be defined as conventionalized set of rules or expectations devised for a specific purpose . ” Ethics: Word ethics is derived from the word “ Ethos ”. It is a Greek word and meaning of this word is customs, character or conduct . Ethics is the branch of philosophy that examines the difference between right and wrong “ A specific set of professional behaviors and values the professional interpreter must know and must abide by, including confidentiality, accuracy, privacy & integrity.” An  ethical code is adopted by an organization in an attempt to assist those in the organization called upon to make a decision (usually most, if not all) understand the difference between right and wrong and to apply this understanding to their decision.


A code of ethics is a set of guiding principles that all members of a profession accept. It is a collective statement about the group’s expectations and standards of behavior. Codes serve as guidelines to assist professional groups when questions arise about correct practice or behavior.

Basic principles of code of ethics:

Basic principles of code of ethics Responsibility: ( R esponsibility refers to a willingness to respect one’s professional obligations and follow through on promises. ) Accountability ( Accountability refers to the ability to answer for one’s actions.) Advocacy : ( Advocacy refers to the support of a particular cause. As a nurse she / he should advocate for the health, safety, and rights of patients, including their right to privacy.) Confidentiality : (Maintaining secret)


INC CODE OF ETHICS FOR NURSES IN INDIA The nurse respects the uniqueness of individual in provision of care: 1.1 Provides care for individuals without consideration of caste, creed, religion, culture, ethnicity, gender, socio-economic and political status, personal attributes, or any other grounds 1.2 Individualizes the care considering the care considering the beliefs, values and cultural sensitivities . 1.3 Appreciates the place of the individual in family and community and facilitates participation of significant others in the care . 1.4 Develops and promotes trustful relationship with individu al(s ). 1.5 Recognizes uniqueness of response of individuals to interventions and adapts accordingly .

Cont . . .:

Cont . . . 2 ) The nurse respects the rights of individuals as partner in care and helps in making informed choices 2.1 Appreciates individual’s right to make decisions about their care and therefore gives adequate and accurate information for enabling them to make informed choices . 2.2 Respects the decisions made by individual (s) regarding their care . 2.3 Protects public from misinformation and misinterpretations . 2.4 Advocate s special provisions to protect vulnerable individuals/groups .

Cont . . .:

Cont . . . 3 ) The nurse respects individual’s right to privacy, maintains confidentiality, and shares information judiciously 3.1 Respects the individual’s right to privacy of their personal information. 3.2 Maintains confidentia lity of privileged information except in life threatening situations and uses discretion in sharing information.

Cont . . .:

Cont . . . 4) Nurse maintains competence in order to render Quality Nursing Care 4.1 Nursing care must be provided only by registered nurse 4.2 Nurse strives to maintain quality nursing care and upholds the standards of care . 4.3 Nurse values continuing education , initiates and utilizes all opportunities for 4.4 Nurse values research as a means of development of nursing profession and participates in nursing research adhering to ethical principles . 5 ) The nurse is obliged to practice within the framework of ethical, professional and legal boundaries 5.1 Adheres to code of ethics and code of professional conduct for nurses in India developed by Indian Nursing council. 5.2 F amiliarizes with relevant laws and practices in accordance with the law of the state .

Cont . . . :

Cont . . . 6) Nurse is obliged to work harmoniously with the members of the health team. 6.1 Appreciates the team efforts in rendering care. 6.2 Cooperates, coordinates and collaborates with the members of the health team to meet the needs of the people. 7 ) Nurse commits to reciprocate the trust invested in nursing profession by society 7.1 Demonstrates personal etiquettes in all dealings. 7.2 Demonstrates professional attributes in all dealings.


INC CODE OF PROFESSIONAL CONDUCT FOR NURSES IN INDIA Professional Responsibility and accountability 1.1 Appreciates sense of self-worth and nurtures it . 1.2 Maintains standards of personal conduct reflecting credit upon the profession . 1.3 Carries out responsibilities within the framework of the professional boundaries . 1.4 Is accountable for maintaining practice standards set by Indian Nursing Council 1.5 Is accountable for o wn decisions and actions 1.6 Is compassionate 1.7 Is responsible for continuous improvement of current practices 1.8 Provides adequate information to individuals that allows them informed choices 1.9 Practices healthful behavior

Cont . . . :

Cont . . . 2. Nursing Practice 2.1 Provides care in accordance with set standards of practice 2.2 Treats all individuals and families with human dignity in providing physical, psychological, emotional, social and spiritual aspects of care 2.3 Respects individual and families in the context of traditional and cultural practices and discouraging harmful practices 2.4 Presents realistic picture truthfully in all situations for facilitating autonomous decision-making by individuals and families 2.5 Promotes participation of individuals and significant others in the care 2.6 Ensures safe practice 2.7 Consults, coordinates, collaborates and follows up appropriately when individuals’ care needs exceed the nurse’s competence .

Cont . . .:

Cont . . . 3. Communication and Interpersonal Relationships 3.1 Establishes and maintains effective interpersonal relationship with individuals, families and communities 3.2 Upholds the dignity of team members and maintains effective interpersonal relationship with them 3.3 Appreciates and nurtures professional role of team members 3.4 Cooperates with other health professionals to meet the needs of the individuals, families and communities 4 . Valuing Human Being 4.1 Takes appropriate action to protect individuals from harmful unethical practice 4.2 Consider relevant facts while taking conscience decisions in the best interest of individuals 4.3 Encourage and support individuals in their right to speak for themselves on issues affecting their health and welfare 4.4 Respects and supports choices made by individuals

Cont . . .:

Cont . . . 5. Management 5.1 Ensures appropriate allocation and utilization of available resources 5.2 Participates in supervision and education of students and other formal care providers 5.3 Uses judgment in relation to individual competence while accepting and delegating responsibility 5.4 Facilitates conducive work culture in order to achieve institutional objectives 5.5 Communicates effectively following appropriate channels of communication 5.6 Participates in performance appraisal 5.7 Participates in evaluation of nursing services 5.8 Participates in policy decisions, following the principle of equity and accessibility of services 5.9 Works with individuals to identify their needs and sensitizes policy makers and funding agencies for resource allocation

Cont . . .:

Cont . . . 6. Professional Advancement 6.1 Ensures the protection of the human rights while pursuing the advancement of knowledge 6.2 Contributes to the development 6.3 Participates in determining and implementing quality care 6.4 Takes responsibility for updating own knowledge and competencies 6.5 Contributes to the core of professional knowledge by conducting and participating in research

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