Fundamental of Nursing, Nursing as a Profession

Prepared by :
Monika Devi
M.Sc. Nursing
Unit: 2
Nursing as a profession
Monika NR M.Sc.Nursing
1

INTRODUCTION
 The word nurse comes from Latin word nutritious which
means to nourish to protect , to educate, to support and to
supply. Nurse not only provides care to the sick and injured
patient, but also helps in the prevention of disease and their
cure.
 The nurse serve as a teacher, helps to educate public in regard
to health measures, she care for the mind as well as body
Monika NR
M.Sc. Nursing
2

DEFINITION OF A PROFESSION:
 The services offered by a profession are
based on specialized knowledge and skills
that have been developed in scientific and
learned manner.
3

Cont..
A profession is an occupation that require
extensive training and has ongoing
research, training is given in higher level
institution
4

CHARACTERISTICS OF PROFESSION
 It utilizes in its practice of well defined and well organized body
of special knowledge which is on the intellectual level of higher
learning.
 It constantly enlarges the body of knowledge.
 It applies its body of knowledge in practical services which are
vital to human and social welfare.
 It attracts individuals of intellectual and personal qualities.
5

Cont…
 It utilizes in its practice of well defined and well organized
body of special knowledge which is on the intellectual level of
higher learning.
 It constantly enlarges the body of knowledge.
 It applies its body of knowledge in practical services which
are vital to human and social welfare.
 It attracts individuals of intellectual and personal qualities.
6

Cont..
 It provide a specific services
 It process a code of ethics
 It demand truth and loyalty it demand continuous in services
training of its member.
 Member in professional autonomy in decision making and
practice.
7

NURSING
DEFINITION
 The unique function of the nurse is to assist the individual,
sick or well in the performance of those activities
contributing to health or recovery that he would perform
unaided if he had the necessary strength, well or knowledge
and do this in such a way as to help him gain independence
as rapidly as possible. Virginia Henderson (1960)
8

Cont…
 “Nursing is a helping profession & as such provides services
which contribute to the health & well-being of people”.
(ANA-American Nurses Association).
 The act of utilizing the environment of the patient to assist
him in his recovery. Florence nightingale (1860)
9

Cont…
The term nurse may be elaborated as follow:
 Noble
 Useful &understanding
 Responsible & resourceful
 Sympathetic
 Efficient
10

CONCEPTS OF NURSING
 There are mainly 4 concepts of nursing related to person,
environment, health, nursing.
 The connections between these 4 concepts are explained in
following statement in Donaldson and Crowley: “Nursing
studies the wholesome or health of humans, recognizing that
humans are in continuous interaction with their
environment.”
11

PHILOSOPHY:
 A philosophy of nursing includes beliefs and values with
regard to man in general and specifically man as the
learner, teacher, nurse, client and the beliefs about health ,
illness, society, nursing, learning etc.
 According to Christian philosophy : Nursing is a profession
of charity. it covers:
12

Cont…
1. Spiritual: religion should serve as the primary integrating
factor for the development of the curriculum in a school of
nursing. The principle of religion and morality are
unchanging.
2. Moral : Though understanding of moral principle,
governing man’s conduct and action leading the nurse’s to
study ‘ethics’ . Nurse has to develop right conscience.
13

Cont…
3. Intellectual: to provide a systematic development and
training of the intellect, so that it may be enlightened.
Disciplined & disposed to function. For the fulfillment of
nursing function , nursing education should give training
in:
 Memory
 Direction of imagination
 Strengthening & expansion of capacity for association.
 Cultivation and training of the intellect.
14

Cont…
 Imparts knowledge
 Development of communication skills to express their
thoughts.
15

Cont..
4. Emotional needs: nurse must be able to function as a mature,
self-dependent and responsible individual and must be able to
relate well to other people.
5. Physical: to promote the harmonious development, physical
needs also have to be met in order to preserve her body and the
essential of her health.
16

Cont…
 Social: Nurse is a social being , who must pass her life in
society in relation to which she has hold privileges and
obligation. Nursing is liked with social culture, in which
nursing activities are carried out.
 ex.: while working/staying in India, she should know the
culture, social privileges of the Indian society.
17

OBJECTIVES OF NURSING
 To prepare nurses who will give expert bedside nursing care
in the hospital and home.
 To provide integration of health and social aspect’s theory
and practice in generalized public health nursing
 To provide an adequate, sound scientific foundation to
understand the functioning of body and mind in health and
disease
18

Cont...
 To prepare nurses who will be able to work co operatively
with team members.
 To provide opportunities through curricular and extra
curricular activities for full development of personality of
each individual student
19

Cont..
 To ensure opportunities for initiative and resourcefulness,
sense of responsibility for oneself.
 To provide services to the individual, family, community
that promote health, prevent illness, restore health and
facilitate coping.
20

NURSING PRACTICE:
 Nursing is a dynamic and Supportative profession guided by
its code of ethics and it rooted in caring, a concept evident
throughout its four field of activity:
1. Practices
2. Education
3. Administration
4. Research
21

CHARACTERISTICS OF NURSING
 Nursing is caring
 Nursing involve close personal contact with the recipient of
care
 Nursing is concerned with services that take human into
account as physiological, psychological and sociological
organisms.
 Nursing committed to promoting individual, families.
22

Cont..
 community, and national health goals in its best manner
possible.
 Nursing committed personalized services for all persons
without regard to color, creed, and social or economic status.
Nursing is an art, science of a profession. It is a call to serve
the people who are in need of care.
 It is educative, it can be preventive, or therapeutic.
23

Cont…
 It is a science: Science is the body of knowledge based on a
no. of facts to establish certain laws & principles. Nursing is a
science because any nursing intervention done for the patient
is based on knowledge of scientific principles. Nursing is an
applied science.
 Nursing is adapted to the individual needs of patient. Each
individual is considered as a unique person.
24

NATURE OF NURSING
25

NATURE OF NURSING
 Nursing has been called the oldest of arts and the youngest
of professions. The word nurse evolved from the Latin
word nutritious, which means nourishing. The word
nourish means to supply that which is necessary to life.
 Nursing is defined by various authors at various times.
 Nursing, besides being a honourable profession, is one of
the oldest arts and an essential modern occupation.
26

Conti..
 Handerson says “nursing is primarily assisting the
individuals (sick or well) in the performances of those
activities, contributing to health or its recovery (or to a
peaceful death) that he would perform unaided, if he had the
necessary strength, will or knowledge.
 The unique contribution of nursing is to help the individual
to be independent as soon as possible.
27

Cont…
 Nursing has its own body of knowledge scientifically based and
humanitarianism that promises expanded benefits to people and society.
It assists the individual or family to achieve their potential for self-
direction for health.
 Nursing is not only an applied science, it is also an art, which provides
skillful care for the sick in appropriate relationship with the patient,
family, physician and with others who have related responsibilities.
28

Cont…
 It is concerned equally with the prevention of illness and
the conservation of health. Skillful nursing care embraces
the whole person, body, mind and soul, his physical,
mental, social and spiritual well-being (holistic approach).
 In its broadest sense, nursing covers not only the care of
the sick, the aged, the helpless and the handicapped, but
also cares for the promotion of health and prevention of
illness.
29

 The arts of nursing had its birth in the earliest home where
a mother cared for the well being of the rest members of
the family. It is this mother care that through the ages
developed into a skilled art and a well-organized science.
30

SCOPE OF NURSING
PRACTICE
31

SCOPE OF NURSING PRACTICE
 The term “scope of practice” is used to define the
actions, procedures, etc. that are permitted by law for a
specific profession. It is restricted to what the law
permits based on specific experience and educational
qualifications.
 There was a time when professional nurses had very
little choice of service because nursing was centered in
the hospital and bedside nursing. Career opportunities
are more varied now for a numbers of reasons.
32

The list of opportunities available
are given under:
1. Staff Nurse
2. Ward sister or Nursing Supervisor
3. Department supervisor/Assistant Nursing Superintendent
4. Deputy nursing superintendent
5. Nursing Superintendent
6. Director of Nursing
7. Community Health Nurse
8. Teaching in nursing
9. Industrial nurse
10. Military Nurse
11. Nursing service administrative positions.
33

 1. Staff Nurse provides direct patient care to one patient
or a group of patients. Assists ward management and
supervision. She is directly responsible to the ward
supervisor.
 2. Ward sister or Nursing Supervisor, She is
responsible to the nursing superintendent for the nursing
care management of a ward or unit. Takes full charge of
the ward. Assigns work to nursing and non-nursing
personnel working in the ward. Responsible for safety and
comfort of patients in the ward. Provides teaching
sessions if it is a teaching hospital.
34

 3. Department supervisor/Assistant Nursing
Superintendent. She is responsible to the nursing
superintendent and deputy nursing superintendent for
the nursing care and management of more than one ward
or unit. Example – Surgical department. Out-patient
department.
 4. Deputy nursing superintendent. She is
responsible to the nursing superintendent and assists in
the nursing administration of the hospital.
35

 5. Nursing Superintendent She is responsible to the
medical superintendent for safe and efficient
management of hospital nursing services.
 6. Director of Nursing She is responsible for both
nursing service and nursing educations within a teaching
hospital.
 7. Community Health Nurse (CHN) services
rendered mainly focusing Reproductive Child Health
programme.
36

 8.Teaching in nursing. The functions and responsibilities of
the teacher in nursing are planning, teaching and supervising
the learning experiences for the students. Positions in nursing
education are clinical instructor, tutor, senior tutor, lecturer,
and associate professor, Reader in nursing and Professor in
nursing.
37

 9. Industrial nurse Industrial nurses are providing
first aid, care during illness, health educations about
industrial hazards and prevention of accidents.
 10. Military Nurse. Military Nursing service became a
part of the Indian Army by which means nurses became
commissioned officers who are given rank from
lieutenant to major general.
38

 11.Nursing service abroad Attractive salaries and
promising professional opportunities, which causes a major
increase for nursing service in abroad.
 12.Nursing service administrative positions. At the state
level the Deputy Director of Nursing at the state health
directorate. The highest administrative position on a national
level is the Nursing Advisor to the Govt. of India.
39

FUNCTION OF
NURSES
40

FUNCTION OF NURSES:
1. Care giver
2. Clinical and ethical decision maker.
3. Protector
4. Advocate.
5. Case manager
6. Rehabilitation
7. Comforter
8. Communication
9. Teacher
41

Care giver:
 As care giver nurse help s client to regain health through
healing process.
 Nurse addresses the holistic health care needs of client.
 She helps the client and families to set goals and meet
those goals.
 She preserves dignity of client
 She accepts client as person nor merely as mechanical
being.
42

Clinical and ethical decision maker:
 Nurse uses critical thinking skill throughout the
nursing process to provide effective care.
 Nurse makes decision in collaboration with the client
and family.
 She also collaborate and consults with other health
professionals.
43

Protector
 She provides a safe conductive environment to the
client.
 She takes step to prevent injury to client.
 She protects the client from every possible adverse
effect of treatment.
 She asks about any allergy to medicine or food.
 She provides immunization against disease.
44

Advocate:
 She protects client human and legal rights and
provides assistance in asserting those rights if the need
arise.
 She advocates the client by keeping in mind the client’s
religion and culture.
 Nurse defends the client right in general way by
speaking out against policies that might endanger their
well-being.
45

Manager:
 As a manager, nurse co-ordinate the activities of other
members of health care team.
 She manage the nursing care of not only one client but
also of families and in communities.
 She delegates the nursing activities.
46

Communicator:
 Effective communication is an essential element of all
professional including nursing.
 Nursing involves communication with client and families,
other nurses, health care professional, resources person
and the community.
 As a communicator, nurse provides information to other
health team members about the planned and unplanned
nursing care.
 She convey information verbally as well as through
documentation.
 Nurse communicate verbally at change shift.
47

Comforter:
 The role of comforter is a traditional and historical one
in nursing and has continued to be important as nurses
have assumed new roles.
 She motivates clients to reach therapeutic goals.
 She promotes comfort to client by staying near the
patient.
48

leader
 Nursing leadership is defined as a mutual process of
interpersonal influenza through which nurse helps
client in making decision for establishing and achieving
the goals to improve the client well being. As a leader,
she influences the client to make decision regarding
health.
49

Counselor:
 Nurse helps the client to recognize and cope with
stressful, psychological or social problem.
 She assist the client for developing good interpersonal
relationship.
 Nurse counsels primary healthy individual with normal
adjustment difficulties.
 Nurse help the persons to develop new attitude felling
and behavior.
50

Rehabilitator:
 Rehabilitation process by which individuals return to
maximal levels of functioning after illness, accident or
other events.
 Nurse helps the clients to adapt as fully as possible who
experiences physical or emotional impairment that
change their events.
51

Teacher /Educator:
 Teaching refer to the activities by which the teacher
helps the learner to learn. As a teacher
 She determines that the client fully understood.
 She also evaluates client’s progress in learning.
 She gives health education on diet, about prevention
measures of disease.
52

Researcher:
 Nurse investigates problems in order to improve
nursing care and expand the scope of nursing practices.
She does many qualitative and quantitative researches.
Based upon these finding, they practice nursing care in
hospital as well as clinical setting.
 For example: investigating various ways to resoles
client’s pain.
53

ROLES OF NURSES
54

ROLES OF NURSES
1. Nurse educator
2. Clinical nurse specialist
3. Nurse practitioners
4. Certified nurse-midwife
5. Nurse anesthetist
6. Nurse administrators
7. Nurse researcher
55

ROLES OF NURSES
 Nurse educator works in schools of nursing, staff
development departments. They provide the
educational programme for student’s nurses and
nurses, teach clients about the self-care and home
care.
56

 Clinical nurse specialist specializes in managing
specific diseases and they function as clinicians,
educators, managers, consultants and researchers.
 Nurse practitioners are certified to provide health
care to clients in out-patient or community settings.
57

 Certified nurse-midwife are certified by the
American College of Nurse-Midwives to provide
independent care for women during normal pregnancy,
labour and delivery.
 Nurse anesthetist, having advance training in
anesthesiology, provides surgical anesthesia to the client
under the supervision of an anesthesiologist during
minor surgery with baccalaureate degrees or master’s
degree.
58

 Nurse administrators manage client care within the
healthcare agencies in a middle level or upper level
management position.
 Nurse researcher with Doctoral degree investigate
nursing problem to improve care and to define and expand
the scope of nursing practice.
59

QUALITIES OF NURSE
60

QUALITIES OF NURSE
61
 Self confident
 Humble and honest
 Loyal
 Co-operative
 Good listener
 Keen observer
 Good administration
Good supervisor
Impartial
Capable
Good workmanship
Responsible
Competent
Judge
Advocate

QUALITIES OF NURSE
Nurse should have the following qualities:
 Self confident: a professional nurse have self confidence.
Because of this , she is able to take decisions, and provides
holistic care.
 Humble and honest: With this quality, nurse develops
rapport and gain trust of the client. An honest nurse gives
explanation regarding treatment .
62

 Loyal: Nurse accept the client as he is. She recognizes
the client as a person and understands empathetically
his feelings.
 Co-operative: As an individual , nurse plays many
role in hospital. She works cooperatively with health
team members as with family members.
63

 Good listener: this is the best quality of nurse, by which
she understands client’s view. By active listening, she
identifies clients need and provides care accordingly.
 Keen observer: while dealing with client a nurse observer
keenly his verbal as well as non verbal command/behavior.
64

 Good administration: because of this quality, a
professional nurse executes and evolutes the junior nursing
staff.
 Good supervisor: A professional nurse works as
supervisor to the junior nursing staff as well other
employees while performing their duties.
65

 Impartial: professional nurse treats each client without any
prejudice/ personal interest. She provides care fairly to every
client.
 Capable: a nurse is competent enough and has a capability
to give care effectively.
 Good workmanship: A professional nurse fulfils her
duties and responsibilities very well by coordinating with
other members of health care team.
66

 Responsible: a professional nurse is liable to her course of
action. She has a duty of care according to the laws. She is
accountable for initiating any nursing care.
 Competent: competent nurse is able to provide holistic
nursing care to clients admitted with different health
problems.
67

 Judge: Registered nurse has ability to identify the problem
before they occur. For ex. Nurse can judge that a bed ridden
client is prone to develop pressure ulcer. So due to this
judging ability, she can prevent the occurrences of such
complications.
 Advocate: A Nurse supports and speaks in favor of client
and provide information to client and family for making
informed decisions.
68

CATEGORIES OF NURSING
PERSONNEL:
In hospital
 Staff nurse
 Senior staff nurse
 Head nurse
 Deputy Nursing superintendent
 Nursing superintendent grade-II
 Nursing superintendent grade-I
 Nursing officer
69

In college
 Clinical instructor
 Nursing tutor school of nursing
 Assistant professor, college of
nursing
 Associate professor, college of
nursing
 Vice principal
70

In community:
 District public health nurse- family
welfare bureau
 District MCH officer
 Joint director of nursing
 Additional director of nursing
 Deputy director of nursing
 Assistant director of nursing
71

NURSING AS A
PROFESSION
72

NURSING AS A PROFESSION
 Professions are those occupation based on specialized
intellectual study and training the purpose of which is
supply skilled services with ethical components to
other, for a definite fee or salary.
 Profession is a type of occupation that meet certain
that raise it to a level above that of an occupation .
73

 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 individual, families, communities, and population.
74

Criteria’s of a profession.
Genevieve and Roy Bixler first
wrote about the status of nursing as a
profession in 1945. These criteria
include the following
75

Occupation are principle area of work
classified according to various feature
such as preparation, skills and
knowledge require; the nature of work
itself, supervision, motivation.
76

1. The services provided are vital to humanity and
the welfare of the society. Nursing is the service that
is essential to the wellbeing of the people and to the
society. Nursing promotes, maintains and restores the
health of individuals, groups and communities. Assisting
others to attain the highest level of wellness is the goal of
nursing. Caring, meaning nurturing and helping others
are the basic components of professional nursing.
77

2.The services involve intellectual activities.
Individual responsibilities (accountability) are a
strong feature. Nursing has developed and refined its
own unique approach to practice. Nursing process is a
cognitive activity that requires both critical and creative
thinking and serves as the basis of providing nursing
care. Individual accountability in nursing has become the
hallmark of practice.
78

 Accountability is ‘ is being answerable to some one for
something one has done’ Through legal opinion and court
cases, society has demonstrated that nurses are
individually responsible for their actions as well as for
those of personnel under their supervision.
79

Conti..
3. Practitioners are educated in institution of higher
learning. There are basic nursing program, baccalaureate
program, masters and Doctoral program in nursing.
4.Well-defined body of specific and unique knowledge
that undergoes continual growth through research
80

5. Practitioners are relatively independent and control
their own policies and activities. (Autonomy). Autonomy or
control over one’s practice is another controversial area for
nursing. Although many nursing actions are independent, most
nurses are employed in hospitals where authority resides in one’s
position.
6. Practitioners are motivated by service (altruism) and
considered their work an important component of their
lives. Nurses are dedicated to the ideal of service to others, which
is known as altruism
81

7. There is a Code of Ethics to guide the decisions
and conduct of practitioners. The International Council
of Nurses (ICN) has established Code of Nursing Ethics
through which standards of practice are established,
promoted and refined.
82

8. There is an organization (Association) that
encourages and supports high standards of
practice. Nursing has a number of professional
associations that were formed to promote the
improvement of the profession. Foremost among these,
is the TNAI (The Trained Nurses Association of India).
The purposes of TNAI are to foster high standards of
nursing practice, promote professional and educational
advancement of nurses and promote the welfare of the
nurses.
83

HISTORY OF NURSING IN
INDIA
84

HISTORY OF NURSING IN INDIA
 History of nursing in India goes back through
centuries to about 1500BC. Susrutha, the father of
surgery lived during 1400BC. In charaka samhita
the writing of charaka, the importance of bathing to
purify the body is mentioned; King Asoka improved
medical care in India. Hippocrates, the father of
medicine was born about 460BC.hippocratic oath is
used in medical colleges today.
85

Military nursing:
 With coming of the British, army institutions were
developed. In 1764 the east India company helped to
start a hospital for soldiers at forest. George, madras.
Later a civilian hospital was built and the medical staff,
appointed by the east India Company, served in both
hospitals. In 1797 a lying in hospital was built and in
1854 the government sanctioned a training school for
midwives.
86

 In 1861, through the efforts of Miss Nightingale, reform
in military hospital led to reform the civilian hospital.
Efforts were made to provide health services for the
people of India.
87

Civilian hospitals:
 Nursing in the military hospital was poor quality. In 1871
a training programme for nursing was started at
government general hospital, madras. Nurse were
brought from England to be in charges and the first six
students were those who had previously received their
diploma in midwifery. Later this plan was reversed.
General training was taken first followed by a course of
midwifery.
88

 Provision for the nursing care of patient in these early
hospitals was very limited. In the JJ group, nursing
was done by medical students. In 1891, Bai Kashibai
Ganpat, was the first Indian nurse to come for
training was at first for two years but become three
years afterwards. In 1893 the north India united
board of examiners for mission hospital was formed.
After the second world war several nursing school
were established.
89

 In Bombay, the first school of nursing was stated at JJ
hospital in 1886.
 In 1926 the first nurse’s registration act was passed in
Madras. Gradually nursing councils were established in
all states.
90

MISSION HOSPITAL
 Mission hospital were first to begin the training of
Indian nurses. Religion prevented Hindu and Muslim
girls from joining nursing. Only Christian girls could be
trained at first. But for many years even they felt that
nursing was an inferior profession.
91

Cont..
 In the beginning there was no informality of courses or
educational requirement. About 1907- 1910 the north
India united board of examination for mission hospital
was organized and set rules for admission for training
and conduct of public examination.
92

DUFFERIN FUND
 Until the late 19th century there were no women doctor and
therefore women were denied of care except in mission
hospital. This fact was brought to the attention of Queen
Victoria. At this time lady dufferin was coming to India with
her husband who was on government service. Queen
Victoria instructed lady dufferin about need for medical care
for women and children in India and asked her to take a
special interest in this problem. Lady Dufferin wrote her
friend and influential people to get financial aid.
93

 Thus in 1885, Lady Dufferin was responsible for
starting the ‘national association for supplying medical
aid to women of India’ this is commonly called the
dufferin fund and continues to provide medical
education for women, to train nurses and midwives for
hospital and private work, and to improve medical
facilities for women.
94

MODERN NURSING
 Progress in science and medicine during past three
centuries increased interest for better nursing services
and training.
Florence nightingale: the era of modern nursing
commences with the work of Florence nightingale in
the Crimean war (1854-1856). She was born on 12 may
1820. She was the second daughter of wealthy English
parents. She felt that god had call her to fulfill
‘mission of mercury’.
95

 She thought of nursing or education work. She
observed the life of poor and tried to relive the sick.
Nursing appeared to her as the field in which she could
do the best.
96

 She studied sanitary reforms and did consider the
nursing done in Kaiser’s war to be of a very high
standard but she gained idea from efficient method of
administration. When she was 33 year old of age, she
brought change which showed her exceptional ability
as an organizer and as an administration.
97

Principles which she established in her
school as St. Thomas hospital
 Nurses should have practice training in hospital set-up.
 Nurses should live in a home to form their moral character
and discipline.
 Nursing education must be directed by a nurse.
 Education is necessary for a nurse because she must know the
reason why she is to teach others.
 Theory and practical must be correlated.
 The school should be economical independent.
98

NURSING EDUCATION
 Nursing education in India began with very brief period
of training. The Nursing Council Act was passed in 1948
and a council of nurses was formed to ensure the quality
of nursing education in India. The Indian Nursing
Council (INC) is an autonomous body that acts as a
regulatory body for nurses and nursing education. There
are several levels of nursing education India.
99

 With efforts of the professor S. Radhakrishnan (the
chairman of university education commission), nursing
education in the country was integrated into the system of
higher education in all the state with graduate,
postgraduate college coming up.
 Association such as the international council of nurse,
TNAI, Indian nursing council and state level registration
council promote and support the nursing profession.
 State wise councils started developing from 1935 onward.
100

There are seven level of nursing education
in India today. They are
courses Years (time period)
Auxiliary nursing and midwifery (ANM) 2 years
General nursing and midwifery(GNM) 3 years
Basic bachelor of nursing (B.Sc. nursing) 4 years
Post basis bachelor of nursing (P.B.B.SC) 2years
Master of nursing (M.Sc. nursing) 2 years
Master of philosophy in nursing ( M.Phil) 1 years
Doctorate in philosophy in nursing (Ph.D) :3 year
101

VALUES IN NURSING
102

VALUES IN NURSING
Introduction:
 Nurses, as one of the health service providers and members in
health system, are responsible for giving care to the clients and
patients based on ethical issue. Nursing is carring profession. The
values of nursing arise from a concern with human flourishing.
The caring professional nurse integrates these values in clinical
practice.
 Values are the starting points for morality and ethics. These three
concept value, ethics, moral can be seen to interact to each other.
103

Definition :
 Values are the standards for decision making that endure
over a significant period of time in one’s life. (According
to hall et al.)
 Values have four parts: thinking, choosing, feeling and
behaving. (According king )
104

MAJOR CATEGORIES
1. Operative values
2. Terminal values
3. Moral values
105

1. Operative values: these are those value that are indicates
by a specific behavior, which may be a response or a
performance.
2.Terminal values: these are those values that are regarded as
good in themselves, they Transcend immediate needs and
shape long term goals.
3.Moral values: these values involve correct behavior such as
having some of right and wrong outness.
106

TYPES OF VALUE
1. Professional values
2. Personal values
3. Ethical values
107

 Professional, Personal, Ethical values essential to nurses
include ……
Human dignity and respect:
 Respect to individual including the persons, their
families, and the society is an important nursing ethical
value. Dignity respect is define as the consideration of
human innate values, respecting beliefs and preservation
of privacy during clinical procedures, communication
with patient.
108

Equity and justices:
 Justice is a refers to equality of distribution. Social justices
focus on equal access to health services and the right of being
fairly treated and cared free of economic, social, and culture
status.
109

Altruism:
 Altruism is a common nursing value .altruism is defined as
focusing on clients as a human and struggling to preserve
their health and well being. Nurse should have spirit of
selflessness and helpless toward other.
110

 Autonomy and decision making.
 Independency in decision making is a nursing ethical value.
It is right of independence decision making, right to accept
or reject suggested treatment, intervention or care.
111

Goodness or rightness:
 Individual should promote goodness over badness, cause no
harm or badness, and prevent badness or harm
Integrity:
 It is a quality that encompasses honestly, trustfulness, and
indicative of a person who displays morality and good character.
112

Responsibility and intelligence:
 Having responsibly on client is a ethical value. It is
feeling of being responsibility for the duties toward
patients, and respecting the patient right for decision
making.
113

Human relationship:
 Human relationship has been indicated as a nursing ethical
value with traits of mutual respect, trust, and reliance which
are accompanied by patient confidentiality and privacy.
 It can verbal and non verbal and defined through having
honestly in word and practices, sympathy and mutual
understanding, courtesy, and friendliness.
114

Individual and professional competency:
 Individual and professional competency as a nursing
ethical value has been defines as a struggle to make
nursing as a profession, feeling the need to grow and
develop.
 Personal and professional competency results in
acquiring up-to date knowledge and promotion of clinical
skill and practical abilities.
115

Sympathy:
 Sympathy has been indicated as a nursing ethical value with
trait of understanding patients and their family’s need and
giving care based on making a faire communication.
Trust:
 Trust is a nursing ethical value and is defined trait of honestly
in words and practices. Nurses should gain patients their
families and society’s trust through understanding patient’s
situation.
116

VALUE CLARIFICATION
 Value clarification is a method of self discovery by
which people identify their personal value and their
value ranking. This process does not evaluate the value
as such, but rather helps people identify their own
values.
117

 Phases and steps in value clarification
1.Choosing one’s belief & behavior
 Choosing freely.
 Choosing among alternatives.
 Choosing after consideration of consequences.
2.Prizing one’s belief & behavior
 Prizing & cherishing.
 Affirming
3.Acting on one’s beliefs
 Acting upon choices
 Repeating.
118

PROFESSIONAL VALUE IN NURSING
 Professional nursing values can be traced in the
history and tradition of nursing. Beginning with
nightingale pledge in 1893, through to current
American nurse associations (ANAs) code for nurses,
nurse have recommended to define standards of
practices. These standard are base on universal moral
principle or value, the central one being respect for
people or human dignity.
119

 The other statement advanced by American association
of colleges of nursing(AACN) in essentials of college &
university education for professional nursing identifies
seven core value for nurses that is altruism, equality,
aesthetics, freedom, human dignity, justice and truth.
 Although ANA & AACN both have statements on
importance of value how nursing students do develop
these value? Is big question.
120

ETHICS
121

INTRODUCTION
 Ethics is the systematic study of what a person’s
conduct should be with regard to self, other humans
and environment.
 Ethics have always been an integral part of nursing.
Throughout nursing, one can code of ethics, statement
of moral principle practiced and discussion of moral
and ethical issues. Caring for and comforting the sick
and protecting the sufferings are human activities of
nursing. These human activities directing affect the
moral, customs and beliefs of humankind.
122

 Nursing ethics provide the standard for professional
behavior and is the study of principle of right and
wrong conduct for nurses, nursing ethics state the
duties and obligation of nursing to their clients, other
health professionals, the profession and community.
Ethics promote the philosophical and theological study
of morality, mental judgment and moral problems.
123

Definition
 Ethics refers to the moral code for nursing and is based on
obligation to services and respect for the human life.
“Melanie and Evelyn”
 Ethics are the rules or principle that governs right conduct
and are designed to protect the rights of human begins.
“Sister Nancy”
124

ETHICAL PRINCIPLES
 Ethical principles actually control professionalism
nursing practice much more than to the ethical
theories. Principle are the moral norms that nursing,
as a profession, both demands and strive to
implement to every day clinical practice. Ethical
principle that the nurses should consider when
making decision are follows
125

1. Respect for person
2. Respect for Autonomy
3. Respect for Freedom
4. Respect for Beneficence
5. Respect for Non-malfeasance
6. Respect for Veracity
7. Respect for Justice
8. Respect for Right
9. Respect for Fidelity
10. confidentiality
126

1. RESPECT FOR PERSON
 This principle not only applied to clinical situation, but it
applies to all life situation it direct individual to treat
themselves and other with a respect inherent to main
humans. The respect to person’s a need to be simplified as
not affect nursing practice.
127

2.AUTONOMY
 Autonomy means that individual are able to act for
themselves to the level of their capacity. It is the right of
individual, governing their action according to their owe
purpose and reason. it is called freedom of choices or
accepting responsibility for one’s choice.
Monika NR
M.Sc.Nursing
128

3.FREEDOM
 Nurses a group believes that patient should be
observed freedom to choice within the nation’s health
care system. This principle should be observed by staff
nurses when planning patient care, by nurse’s manager
when leading subordinates
129

4.BENEFICENCE
 The beneficence principles states that the actions
one takes should promote good. It requires the
balancing the harm and benefits. Benefits promote
the clients welfare and health whereas harms or
risk detract from the client’s health and welfare. In
other words, providing benefit that enhance the
other welfare. Whereas balancing the benefits and
harms of intervention made on the other half.
130

5.NON-MALFEASANCE
 The principle of non-malfeasance state that one should
do not harm. The nurse should interpret the term harm
to mean emotional and social as well as physical injury.
Harm is threading, defeating or setting back one
persons interest through invasive action by another.
131

6.VERACITY
 Veracity concern truth talking and incorporates the
concept that individual should always tell the truth. It
requires professional care giver to with accurate, reality
based information about their health status and care or
treatment prospective.
132

7.JUSTICE
 Justice concerns the issue that persons should be
treated equally and fairly. This principle of justice
require treating other fairly and giving persons their
due.
 Medical care system provides care on the basis of
medical care need rather than ability to pay, social
status, race, gender.
133

8.RIGHT
 Right is an entitlement (the fact of having a right to
something)to behave in a certain way under
circumstances, such as nurses entitlement to freely
express personal belief and preferences by voting in
a political election.
 Right is also used to mean agreement with justice,
law and morality. So right may be mental right or
legal rights to respective profession.
134

9.FIDELITY
 Fidelity is keeping one’s promises or commitment the
principles of fidelity hold that the a person should
faithfully his duties and obligations.
 Nurses have an obligation to follow through care.
135

10.CONFIDENTIALITY
 Confidentiality is the duty to respect privileged
information. The principle of confidentiality
provide that care givers should respect a patient
need for privacy and by personal information about
him or her only to improve care.
 Nurses should practice confidentiality to decrease
patient vulnerability and share form widespread
knowledge of personal information divulged during
care.
136

CODE OF ETHICS
 A code of ethics is a set of ethical principles that are
accepted by all members of a profession.
 Ethics are the distinction between right and wrong based
on body of knowledge not just based on opinions.
 Fundamental responsibility of the nurse is fourfold: to
promote health, to prevent disease, to restore
health, to alleviate suffering.
137

Purposes of code of ethics in nursing
 Standard for behavior of nurse and provide general
guideline for nursing action in ethical dilemma.
 The code helps to distinguish between right and wrong
at a given time especially when alternative appear just
as satisfactory.
 The code enable a correct decision and a uniform
decision with in the groups.
 Helps to protect right of individual, families, community
and also the right of the nurses
138

I.C.N CODE OF ETHICS FOR NURSES
(1953) revised in 2005
Elements of code of ethics
1.Nurses and people
2.Nurses and practice
3.Nurses and society
4. Nurses and coworkers
5.Nurses and the profession
139

1.NURSES AND PEOPLE
 The nurses primary responsibility is the those people who
require nursing care.
 The nurses provides care, promotes an environment in
which the value customs and spiritual belief of the individual
are respected.
 The nurses hold confidence, personal information and uses
judgment in sharing their information.
 The nurse ensure that the individual receive sufficient
information on which to base consent for care and related
treatment.
140

2.NURSES AND PRACTICE
 The nurse carries personal responsibility for nursing
practice and for maintaining competence by continuous
learning.
 The nurse maintains the higher standards of nursing care
possible within the reality of a specific situation.
 The nurses assess judgment in relation to individual
competence when accepting and delegating responsibilities.
 The nurses when acting in a professional capacity should at
all times maintain standard of personal conduct which
reflects credit upon the profession.
141

3.NURSES AND SOCIETY
 The nurse shares with other citizen with other the
responsibility for initiating and supporting actions to
meet the health and social needs of the public.
142

4.NURSES AND COWORKERS
 the nurses sustains a cooperative relationship with
coworkers in nursing and other fields.
 The nurses takes appropriate actions to safeguard the
individual when his care is endangered by coworkers or any
other person.
143

5.NURSES AND THE PROFESSION
 The nurses play the major role in determining and
implementing desirable standard practice and nursing
education.
 The nurse is a active in developing a core of research based
professional knowledge
 The nurses is acting through the professional organization,
participates in creating and maintaining safe, equitable, social
and economic working in nursing.
 The nurses is active in developing in a care professional
knowledge.
144

Code of ethics :Indian nursing
council
1. The nurse respects the uniqueness of individual in
provision of care nurse.
2. The nurse respect the right of individual as partner in
care and help in making informed choice.
3. The nurse respect individual rights to privacy,
maintain confidentiality and share information
judiciously.
4. Nurse maintain competence in order to render quality
nursing care.
145

Conti..
5. The nurse is obliged to practice within the
framework of ethical professional and legal
boundaries.
6. Nurse obliged to work harmoniously with
member of health team nurse
7. Nurse commits to reciprocate the trust invested in
nursing profession by society nurse.
146

PROFESSIONAL CONDUCT FOR NURSE
1. PROFESSIONAL RESPONSIBILITY AND
ACCOUNTABILITY
2. NURSING PRACTICE
3. COMMUNICATION AND INTERPERSONAL
RELATIONSHIPS
4. VALUING HUMAN BEING
5. MANAGEMENT
6. PROFESSIONAL ADVANCEMENT
147

1.PROFESSIONAL RESPONSIBILITY AND
ACCOUNTABILITY
 To maintain professional responsibility accountability, the
nurse
 Appreciate a sense of worth and nurtures.
 Maintains standards of personal conduct, reflecting credit
upon the profession.
 Carriers out responsibilities within the framework of the
professional boundaries is accountable for maintaining
practice standards set by the Indian nursing council.
148

 Is accountable for his/her own decisions and action.
 Is compassionate.
 Is responsible for the continue improvement of current
practice.
 Provided adequate information to individual these allows
them to make informed choices.
 Practices healthful behavior.
149

2.NURSING PRACTICE
 In the course of practice of nursing. The nurses
 Provide care in accordance with set standards of practice.
 Respects individuals and families in the context of traditional and
cultural practicing, promoting healthy practices and discouraging
harmful practiced.
 Treats all individual and families with human dignity in providing
the physical, psychological, emotional social and spiritual and
aspects of care.
150

 Present realistic practices truthful in all situation
for facilitating autonomous decisions making by
individual and families
 Promote participate and individual and significant
others in the care.
 Ensures safe practices.
 Consults, co-ordinate, callboards and follow up
approximately when an individual care needs
exceed the his or her competence.
151

3. COMMUNICATION AND INTERPERSONAL
RELATIONSHIPS
 This plays a key role in the interaction of the nurse with
his or her clients. To effect optimal interaction the nurse
 Establish and maintain effective interpersonal
relationship with individuals families and communities.
 Uphold the dignity of term members and maintains
effective interpersonal relationship with them.
152

 Appreciate and nurtures the professional role of team
members.
 Co-operates with other health professionals to meet the
need of individuals, families and communities.
153

4.VALUING HUMAN BEING
The nurse values human life. He or she
 Takes appropriate action to protect individual form harmful
unethical practices.
 Consider relevant fact while taking cons…...decisions in the best
interest of individuals.
 Encourages and supports individual in their right to speak for
themselves on issues affecting health and welfare.
 Respect and supports choices made by individuals.
154

5.MANAGEMENT
 Proper management of resources and unfortunate is
essential for improving the over all efficiency of the nurse.
Hence the nurses.
 Ensures appropriate in supervision and education of
students and other formal providers.
 Uses the judgment in relation to individual competences
which accepting and delegating responsibility.
155

 Facilitate conducive work culture in order to achieve
institutional objective.
 Communicates effectively following appropriate channels
of communication.
 Participates in performance appraisal.
 Participates in evaluation of nursing services.
 Participate in policy decision, following the participates of
equity and accessibility of services.
156

6.PROFESSIONAL ADVANCEMENT
 Ensures the protection of human right, while pursuing
the advancement of knowledge.
 Participate in determine and implementing quality.
 Take responsibility for updating one’s own knowledge
and competencies. Contribute to the core of professional
knowledge and conducting and participating in research.
157

Thank you
158

Fundamental of Nursing, Nursing as a Profession

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