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

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.

3. 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

4. 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.

5. 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.

6. 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.

7. 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)

8. 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)

9. 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)

10. 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)

11. 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)

12. 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.

13. 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.

14. 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.

15. 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.

16. 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

17. 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.

18. 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”

19. 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)

20. 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).

21. 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).

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

23. 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,

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

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

26. 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

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

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

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

30. 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

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

32. 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

33. 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

34. 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.

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

36. 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

37. 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

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

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

40. 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

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

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

43. 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

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

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

46. 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

47. 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

48. 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

49. 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

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

51. 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),