Exploring the Growth of Nursing as a Profession Lecture 1+2

Introduction There is no particular date or time period when nursing came into being. While nursing as we know it today may go back less than 150 years, the early origins of nursing, like those of medicine, are intertwined with the ancient civilizations and cultures of the world.

Historical Perspective of Nursing Nursing has carried forward three heritages from the past that some believe impeded the development of nursing as a profession. Folk image Religious image Servant image of the nurse created by the Protestant-capitalist ethic from the 16th to 19th century

The Folk image Primary responsibilities focused on nourishing and nurturing children, caring for the elderly, and caring for aging family members. Skills were learned through trial and error and passed from one generation to another. This image presents the nurse as a “caring” person who uses common sense to help the sick individual.

The Religious image Groups were organized in conjunction with the establishment of churches in the Christian Church era with their primary concern focused on care for the sick, the poor, orphans, widows, the aged, slaves, and prisoners. The first hospitals were also developed at this time, being located close to monasteries. Nurses in this setting were expected to devote their lives to caring and to exhibit selfless commitment based upon their religious faith.

The Servant image The Reformation, which began in Germany in 1517, brought with it a change in the role of women, limiting it to the confines of the home. Duties were those of bearing children and caring for the home. Hospital care was relegated to uncommon women, a group consisting of prisoners, prostitutes, and drunks who had no status in society and were treated as servants who did distasteful tasks. This began what may be called the “Dark Ages” of nursing . This image may have greatly influenced the development of nursing as a profession as many capable and desirable persons were unwilling to enter nursing.

Nursing in Islam and Caring: an Islamic Perspective “In the Name of Allah (God), Most Gracious, Most Merciful’ (‘Bismi Llah ir Rahman ir Rahim’) The opening words of the Qur’an (Holy Book of Islam) are frequently used as an invocation at the commencement of any word or action for many Muslims in health and sickness. Central to Islamic teachings are the connections between knowledge, health, holism, the environment and the 'Oneness of Allah', the unity of God in all spheres of life, death and the hereafter. Islamic teachings and practice have enabled the production of a holistic framework in meeting the physical, spiritual, psycho-social and environmental needs of individuals and communities (Rassool, 2000)

Caring is an attribute of Islam, a religion of peace, 'from all individuals not only towards human beings but also towards the fauna, flora and nonliving things'. (Salleh, 1994a) The principles and practices of caring and moral discipline, from an Islamic perspective, are based on the Divine revelation that is permanent. (Rassool, 2000)

In the Islamic context, was the Prophet's Mosque in Medina. The notion of formal caring in nursing, in the West, can be dated back to Florence Nightingale In the Islamic context, was the Prophet's Mosque in Medina. (Rassool, 2000)

The concept of caring is embedded in the theological framework of Islam. Prophet Muhammad (PBUH) and Prophet Eesa (Jesus, PBUH), show how Allah expects human beings to act by caring for the weak, the suffering and the outcasts of society. Caring in Islam means the will to be responsible, sensitive, concerned with the motivation and commitment to act in the right order to achieve perfection. (Rassool, 2000)

In Islam, caring is expressed at three different levels: Intention thought action. Underlying the intention and verbal expression of caring is the understanding of what, when, who to care for and why (Salleh 1994a). (Rassool, 2000)

The beginning of Change During the 17th century, social reform began in Europe. Several nursing groups were organized. These groups gave money, time, and service to the sick and the poor, visiting them in their homes and ministering to their needs.

Florence Nightingale Influence During this time, one woman dramatically changed the form and direction of nursing and succeeded in establishing it as a respected field. Born May 12, 1820, the second daughter of a wealthy family, she was named after the city in which she was born—Florence, Italy. Because of her family’s high social and economic standing, she was cultured, well traveled, and educated.

The basic principles on which Miss Nightingale established her school included the following: Nurses would be trained in teaching hospitals associated with medical schools and organized for that purpose. Nurses would be selected carefully. The school matron would have final authority over the curriculum, living arrangements, and all other aspects of the school. The curriculum would include both theoretic material and practical experience. Teachers would be paid for their instruction. Records would be kept on the students, who would be required to attend lectures, take quizzes, write papers, and keep diaries.

Florence Nightingale In many other ways, Florence Nightingale advanced nursing as a profession. She believed that nurses should spend their time caring for patients, not cleaning; that nurses must continue learning throughout their lifetime and not become “stagnant;” that nurses should be intelligent and use that intelligence to improve conditions for the patient.

The military influences Examples: The American Revolution The Civil War World War I World War II The Korean and Vietnam Conflicts The Middle East Conflict

Definition of nursing When attempting to define nursing, we often stumble over theoretical concepts and the practical, hands-on application of nursing and how to combine the distinct and unique aspects of both. Despite the challenges, serious efforts were put into defining nursing in the late 1970s and early 1980s.

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. In this sense, “nurse” is used as a noun and is derived from the Latin nutrix, which means “nursing mother.” Dictionary definitions of nurse include such descriptions as “suckles or nourishes,” “to take care of a child or children,” Florence Nightingale, in her Notes on Nursing: What It Is and What It Is Not, described the nurse’s role as one that would “put the patient in the best condition for nature to act upon him”

Definitions of Nursing In 1958, Virginia Henderson, a nurse educator, author, and researcher, was asked by the nursing service committee of the International Council of Nurses (ICN) to describe her concept of basic nursing. Hers is still one of the most widely accepted definitions of nursing: The unique function of the nurse is to assist the individual, sick or well, in the performance of those activities contributing to health or its recovery (or to peaceful death) that he would perform unaided if he had the necessary strength, will or knowledge. (Henderson, 1966, p. 15)

Definitions of Nursing The American Nurses Association (ANA) first defined nursing in its Social Policy Statement published in 1980. Nursing is the protection, promotion, and optimization of health and abilities, prevention of illness and injury, alleviation of suffering through the diagnosis and treatment of human response, and advocacy in the care of individuals, families, communities, and populations (ANA, 2010).

Definitions of Nursing The National Council of State Boards of Nursing has as one of its major responsibilities, the management of licensure of nurses throughout the United States. Through the Model Nurse Practice Act, the NCSBN states, The Practice of Nursing means assisting clients to attain or maintain optimal health, implementing a strategy of care to accomplish defined goals within the context of a client-centered health care plan, and evaluating responses to nursing care and treatment (NCSBN, Article II, Section 1, 2006).

Defining Nursing for the Future As the profession grows and responsibilities change, undoubtedly we will continue to refine the definition of nursing.

Nursing as a Profession Extended education Theoretical body of knowledge Provides a specific service Autonomy in decision making and practice Code of ethics Control of Professional Policy,

ANA Standards of Professional Performance Quality of practice Professional Practice Evaluation Education Collegiality Ethics Collaboration Research Resource Utilization Leadership

Nursing Today Registered Nurse Licensed Practical Nurse Nurse Practitioner Clinical Nurse Specialist Nurse Midwife

Current Trends & Issues in Healthcare Nursing Shortage Patient Satisfaction Managed Care Transcultural Nursing National Patient Safety Initiatives Evidence-Based Practice Information Age Genetics Globalization of Health Aging Population Legal & Ethical Issues Terrorism/Disaster Nursing

1. Nursing Shortage National problem which is growing Critical shortage in specialty areas Average age of nurse is 45 Resurgence of enticements for recruitment

Reasons for Shortage Work environment Recruitment Retention Aging workforce Aging Baby Shortage of nursing faculty

2. Patient Satisfaction Good customer service Patient Rights Treat patients like family Healthcare is a business

Managed Care Goal is to keep length of stay (LOS) down Patients are discharged sooner Patient acuity higher Health Care Plans Case manager work closely with physicians and insurance companies

3. Transcultural nursing Nursing has become a melting pot Nurses are challenged to be more culturally aware Cultural sensitivity

4. Joint Commission National Patient Safety Goals Improve the accuracy of patient identification Improve the effectiveness of communication among caregivers Improve the safety of using medications Reduce the risk of health care-associated infections Accurately and completely reconcile medications Reduce the risk of patient harm from falls. Encourage patients’ active involvement in their own care as a patient safety strategy. The organization identifies safety risks inherent in its population

4. Evidence Based Practice Goal is to achieve cost-effective, high quality patient care based on scientific inquiry Nurses need to understand research process involved Nursing care should not be based on opinions, past practices, but on the results of scientific research Practice guidelines Nursing research

5. Information Age Consumers today are more computer savvy regarding healthcare. More information on internet. Consumers could possibly be more informed than health care worker.

6. Genetics Many major developments in the field of genetic research Stem Cell Legal & Ethical issues

7. Globalization of Health Healthcare has become a global issue People are mobile, diseases can travel Nurses need to have an understanding of the issues pertaining to global health

8. Legal Limits of Nursing Sources of Law Statutory law: Nurse Practice Acts Regulatory law/Administrative law Common law Criminal law Civil law: negligence & malpractice

Civil & Common Law Issues in Nursing Practice Intentional Tort Unintentional Tort Negligence Malpractice Consent Informed Consent Malpractice Insurance Abandonment & Assignment Issues

9. Aging Population Population is aging Growing concerns regarding the unique needs of the elderly Gerontological nursing

10.Terrorism/Bioterrorism/Disaster Nursing The 9-11 terrorist attacks have heightened attention to the growing threats of terrorism Nurses need to be aware to the health consequences of terrorism and use of biological agents

Nursing Education Diploma ADN BSN Master’s Doctorate Continuing education In-service education

Nursing Roles Autonomy & Accountability Caregiver Client Advocate Educator Manager/Clinical Decision Maker Communicator Collaborator Career Development

Autonomy & Accountability Autonomy is the essential element of professional nursing Person is reasonably independent and self-governing in decision making & practice Increased autonomy=Increased responsibility Accountability- nurse is responsible professionally & legally for type & quality of care provided

Clinical Decision Maker- Nursing Roles Utilizes critical thinking skills and the nursing process Nursing Process: Assessment, Diagnosis, Planning, Implementation, Evaluation

Client Advocate - Nursing Roles Nurse protects the clients human and legal rights Providing information to assist in decision making Patient Bill of Rights

Rehabilitator Role - Nursing Roles Assist client to return to optimal level of functioning Nurse helps client to adapt physically and emotionally to changes in lifestyle, body image

Comforter Role - - Nursing Roles Caring for client as a human being Care is directed to whole person, not just a body part Demonstration of care and concern

Communicator Role - Nursing Roles Role is central to all other roles Involves communication with client, family, healthcare team members, resource people, and the community Without clear, concise communication it will be difficult to give effective care

Teacher/Educator Role - Nursing Roles Explains concepts and facts about health, demonstrates procedures, reinforces learning, determines understanding, and evaluates progress of learning Unplanned or informal education Planned or formal education

Healthcare Team Members Nurses Physicians Physician Assistant Therapists and Technicians Pharmacist Nutritionist/Dietitian Case Manager/Social Worker Nursing Assistant Unit Secretary

References NURSING in TODAY’S WORLD Trends, Issues, and Management by Janice Rider Ellis, Celia Love Hartley. Rassool, G.H. (2000). The crescent and Islam: healing, nursing and the spiritual dimension. Some considerations towards an understanding of the Islamic perspectives on caring. Journal of Advanced Nursing, 3(6), 1476-1484.