perspectives of nursing

NURSING
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.
-American Nurses Association

 Nursing includes the promotion of

health, prevention of illness, and the care
of ill, disabled and dying people.
Advocacy, promotion of a safe
environment, research, participation in
shaping health policy and in patient and
health systems management, and
education are also key nursing roles.
- International Council of Nurses

 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.
-Virginia Avenel Henderson

PROFESSION
 Profession is a classic piece of educational literature

that provided the impetus for the much needed reform
of medical education.
–Abraham Flexner (1910)
 Professionalism involves the application of knowledge
and skills, high standards of practice, leadership, self
regulation, professional commitment, social values
and self directed activity.
- Muller (1998)

Richard H Hall identified 5
indicators of individuals’
attributes towards
professionalism (1968):
 Use of a professional
organization as a primary
point of reference.
 Belief in the value of public
service.
 Belief in self regulation.
 Commitment to a
profession that goes
beyond economic
incentives.
 A sense of autonomy in
practice.

Characteristics of a Profession
 A profession requires an extended education of its






members, as well as a basic liberal foundation.
A profession has a theoretical body of knowledge
leading to defined skills, abilities and norms.
A profession provides a specific service.
Members of a profession have autonomy in decision
making and practice.
The practice as a whole has a code of ethics.

Criteria of Nursing Profession
1.
2.

3.
4.
5.
6.
7.

Specialized Education
Body of Knowledge
Service Orientation
Ongoing Research
Code of Ethics
Autonomy
Professional
Organizations

Two terms related to Profession
 Professionalism: It refers to the professional

character, spirit or methods. It is a set of attributes, a
way of life that implies responsibility and
commitment.
 Professionalization: It is the process of becoming

professional, that of acquiring characteristics
considered being professional.

Nursing: Occupation vs Profession
 Occupation is defined as

“What occupies or engages one’s time; business;
employment”
- Webster (1996)
 Profession is defined as
“A calling, vocation or form of employment that
provides a needed service to society, possesses
expertise, autonomy, long academic
preparation, commitment, & responsibility”
-Huber(2000)

Professional Preparation
Five core competencies:
 Provide patient-centered care
 Work in interdisciplinary teams
 Employ EBP
 Apply quality improvement principles
 Utilize informatics

-IOM Summit in 2003

Professional Commitment
 Professional

Commitment to their
profession is strong.
They deliver much of
their personal identity
from their work and
consider it as an integral
part of their life.

Characteristics of Profession vs.
Occupation
Profession

Occupation

College/university preparation

On the job, trade school, community
college preparation

Usually 4 or more years

Shorter preparation time

Values, beliefs, ethics always present
(code of ethics)

Values, beliefs, ethics not always
present

Commitment & personal ID always
present (mentoring)

Commitment & personal ID not
always present

Independent, autonomous

Supervised by others

Work stable, rarely change profession

Often change jobs

Individual accountability

Accountability usually rests with
employer

Nursing Pathway to
Professionalism
Nursing pathway to professionalism has not been
smooth. For decades an ongoing subject for discussion
in nursing circles has been the following question “is
nursing a profession”.
 Bixler’s Criteria
 Kelly’s Criteria
 Miller’s Wheel of Professionalism in Nursing

Bixler’s Criteria
 A profession utilizes in its practice a well defined
and well organized body of specialized

knowledge which is on the intellectual level of
higher learning.
 A profession constantly enlarges the body of
knowledge, its uses and improves its
techniques of education and service by the use
of scientific method.
 A profession entrusts the education of its
practitioners to institutions of higher
education.

Bixler’s Criteria…….
 A profession functions autonomously in the formulation

of professional policies and in the control of professional
activity there by.
 A profession applies its body of knowledge in practical
services which are vital to human and social welfare.
 A profession attracts individuals of intellectual
personal qualities who exalt service above personal
gain and who recognize their chosen occupation as a life
work.
 A profession strives to compensate its practitioners
providing freedom of action, opportunity for
continuous professional growth and economic
security.

Kelly’s Criteria
 Services provided vital to humanity/society
 There is a Specialized knowledge that continuously enlarged







with research
The services involve Intellectual activities, accountability:
individual responsibility is a great feeling.
Education in higher learning institution
Autonomy - Practitioners are independent, control own policies
and activities
Altruism - Practitioners are motivated by service and consider
their work as an important part of their lives
There is a Code of ethics to guide decisions and conduct
There is an organization (association) that encourages and
supports high standards of practice

Miller’s Wheel of Professionalism
in Nursing
 Center represents the

essential foundation of
nursing education
 Eight spokes
 Competence and Continuing








Education
Adherence to the code of
ethics
Participation in professional
organization
Community Service
Publication and
Communication
Theory and research
development and utilization
Self-regulation and autonomy

Professional Nursing Practice
 Nurse Practice Acts
 It regulates the licensure and practice of nursing.
 The nurse practice act of each state defines the practice
of nursing within that area.
 The board of nursing in each states sets requirements
for licensure.

Professional Nursing Practice…..
 Standards of Practice
 As nursing became an independent profession, it began
to develop its own standards of practice.
 It serves as a guideline for providing and evaluating
nursing care and serves as criteria in legal questions of
whether adequate care was given.

STANDARDS OF PROFESSIONAL
NURSING PRACTICE
American Nurses
Association (ANA) 2010
1. ANA Standards of
Care
2. ANA Standards of
Professional
Performance

ANA Standards of Care
 Standard I: Assessment

The registered nurse collects comprehensive data pertinent
to the healthcare consumer’s health or the situation.
 Standard II: Diagnosis
The registered nurse analyzes the assessment data to
determine the diagnoses or issues.
 Standard III: Outcome Identification
The registered nurse identifies expected outcomes for a plan
individualized to the healthcare consumer or the situation.

 Standard IV: Planning

The registered nurse develops a plan of care that prescribes
strategies and interventions to attain expected outcomes.
 Standard V: Implementation
The nurse implements the interventions identified in the
plan.
Standard 5A - Coordination of Care
Standard 5B - Health Teaching and Health Promotion
Standard 5C - Consultation (Graduate Prepared Specialty
or Advanced Practice Nurse)
Standard 5D - Prescriptive Authority and Treatment
(Advanced Practice Nurse)
 Standard VI: Evaluation
The registered nurse evaluates progress toward attainment of
outcomes.

ANA Standards of Professional
Performance
 Standard VII: Ethics

The registered nurse practices ethically.
 Standard VIII: Education
The registered nurse attains knowledge and competence that
reflects current nursing practice.
 Standard IX: Evidence-Based Practice and Research
The registered nurse integrates evidence and research findings into
practice.
 Standard X : Quality of Practice
The registered nurse contributes to quality nursing practice.
 Standard XI: Communication
The registered nurse communicates effectively in a variety of
formats in all areas of practice.

 Standard XII: Leadership

The registered nurse demonstrates leadership in the
professional practice setting and the profession.
 Standard XIII: Collaboration
The registered nurse collaborates with the healthcare
consumer, family and others in the conduct of nursing
practice.
 Standard XIV: Professional Practice Evaluation
The registered nurse evaluates her or his own nursing
practice in relation to professional practice standards and
guidelines, relevant statutes, rules and regulations.
 Standard XV: Resource Utilization
The registered nurse utilizes appropriate resources to plan
and provide nursing services that are safe, effective and
financially responsible.
 Standard XVI: Environmental Health
The registered nurse practices in an environmentally safe and
healthy manner.

Professional Responsibilities and
Roles of Nurses
 Care Giver

 Advocate
 Educator
 Communicator
 Manager

 Decision Maker
 Client Counselor
 Research Consumer
 Change Agent
 Leader

 Co-coordinator

Expanded roles of Nurse
 Clinician
Provide direct care, educate client & restore health

 Advanced Practice Nurses (APN)


Independent functioning nurse with masters’ degree in nursing



Advanced education in pharmacology and physical assessment
Certification and expertise in a specialized area of practice.








Clinical Nurse Specialist (CNS)
Nurse Practitioner
Certified Nurse Midwife (CNM)
Certified Registered Nurse Anesthetist (CRNA)

 Nurse Educator
 Works in schools of nursing, staff development of health
care agencies and client education departments.
 Nurse Administrator
 manages client care and the delivery of specific nursing
services within a health care agency.
 begins her position such as the charge nurse or assistant
nurse manager.
 Nurse Research

Qualities of Professional Nurse
 Truthfulness, loyalty & honesty

 Empathy

 Love for the fellowmen

 Humor

 Caring

 Kindness

 Commitment

 Morality

 Compassion, generosity

 Courage

 Acceptance, assertiveness

 Accountability

 Punctuality

 Authenticity

 Fairness

 Alertness

 Self esteem and tolerance

 Intelligence

 Appreciation

 Efficiency

 Creativity

 Self discipline

 Imagination

 Openness

 Confidence

 Independent

Attributes of Professionalism in
Nursing
 Knowledgeable

How do we stay
knowledgeable?
 Involved in nursing

organizations
 Reading journals
 Continuing our
education
 Continually seeking out
new information

 Inquisitive
 A professional nurse is

always curious to
investigate.

 Autonomy
 working independently
 exercising decision-

making
 having the ability to
carry out the
appropriate course of
action
 having the capacity as a
nurse to determine
her/his own course of
action

 Innovator and Visionary
 Innovation: Bring in

new methods, ideas, etc.
 Visionary: The act or
faculty of seeing, sight;
imaginative insight;
ability to plan or form
policy in a far-sighted
way

 Accountability and

Dependability
 Admit mistakes and

learns from them
 Timeliness
 Keeps their word

 Advocacy
 Respectful of others
 Understands the needs

of the patient
 Recognizes that the
family members of the
patient are also their
responsibility

 Collegiality and

Collaboration
 Willingness to help

others
 Teamwork

 Honesty and Integrity

 Attitude

 Truthful

 IS EVERYTHING!

 Does not gossip

 Sets the tone

 Upholds patient

 Should be positive

confidentiality and
privacy

 Appearance
 First impressions are

important
 Can instill confidence or
mistrust
 Represents your pride in
yourself and your
profession

Professional
Registered
Nurse
Education

In-service
Education

EDUCATION
AL
PREPARATI
Post
ON graduation
Continuing
Education

Education

Graduate
Education

Educational Preparations of
Nursing Profession
 Professional Registered Nurse Education
 Diploma in Nursing
 Associate Degree in Nursing
 Graduate Education
•
Basic BSc Nursing
•
Post Basic Nursing:

Postgraduate Program
• Masters’ Education
• Doctoral Preparation
Continuing Education
In-service Education

Factors Influencing Contemporary
Nursing Practice
 Economics
 Greater financial support provided through public

and private health insurance programs has
increased the demand for nursing care.
 Increased cost of health care
 Current health care industry is shifting its
emphasis from inpatient to outpatient care

 Consumer Demands
 People are better educated and have more knowledge about
health and illness.
 The publics’ concept about health and nursing also changed
 Consumer has become an active participant in making
decisions about health care.

 Family Structure
 More people are living away from the extended family
and the nuclear family.
 Many single men and women rear children and in many
two parent families both parents work.
 Adolescent mothers also need specialized nursing
services, both while they are pregnant and after their
babies are born.
 Science and Technology
 Nurses will need to expand their knowledge base and
technical skills as they adapt to meet the new needs of
client.

 Collective Bargaining
 More nurses are using collective bargaining to deal with
their concerns.
 The ANA participates in collective bargaining on behalf
of nurses through its economic and general welfare
programs.
 Nursing Associations
 Provides leadership that affects many areas of nursing.
 Accreditation of nursing programs is given by
associations which are regulatory bodies.

 Information and Telecommunications
 Nurses may need to interpret internet sources of
information for clients and their families.
 Nurses has to help client to access high quality, valid
websites; interpret information and then help to
evaluate the information.
 Legislation
 Legislation about nursing practice and health matters
affect both the public and nursing.
 E.g. Patient Self Determination Act (PSDA)
 Demography
 From demographic data, needs of the population for
nursing service can be assessed.

 Nursing Shortage
1. Aging nurses workforce





Number of nurses under 30 decreasing
Number of nurses age 40-49 increasing with 40% older than
50 by 2010
New graduates entering workforce at an older age and will
have fewer years to work.

2. Aging of nursing faculty


As nursing faculty retire, nursing program may have fewer
faculty to educate further nurses.

3. Reduced entry of younger population into nursing

4. Aging population


Increased health needs

5. Increased demands for nurses



Increased need for specialized nurses
Shorter hospital stay resulting in transfer of clients to long
term care and community setting creating increased demand
for nurses in the community.

6. Workplace issues








Inadequate staffing
Heavy workload
Overtime work
Lack of sufficient support staff
Inadequate wages
Difficult recruiting and retaining nurses

Impacts of nursing shortage on healthcare:
 Increased nurses’ patient workloads
 Increased risk for error, thereby compromising patient





safety
Increased risk of spreading infection to patients and
staffs
Increased risk for occupational injury
Increase in nursing turnover, thereby leading to greater
costs for the employer and the health care system
Increase in nurses' perception of unsafe working
conditions, contributing to increased shortage and
hindering local or national recruitment efforts

Professional Nursing
Organizations
 International Council of Nursing
 American Nurses Association
 National League for Nursing
 American Association of Colleges of Nursing

 National Student Nurses Association
 Specialty Organizations
 The Indian Nursing Council

 Trained Nurses Association Of India
 The Student Nurses Association

TRENDS AND ISSUES IN CURRENT
AND FUTURE NURSING
 Influence of today’s health care settings
 Expansion of Employment opportunities

 Nursing’s public perception
 Nursing impact on Politics and Health policy

Trends in India
 Changes in society





Intensive efforts of government to meet the health needs of
people.
Gradual improved literacy level of the people with the
growing awareness of health needs.
Advanced scientific technology
The changing role of women and the continuing growth of
population.

 Changes in other professions
 Growing specialization in medical field is resulting in a trend
towards increased specialization in nursing.
 The development of new diagnostic procedure and
equipments make specialization even more necessary.
 Patients’ Bill of Rights
 The nurses are also accountable for patients care and have
legal responsibilities for the patient.

 Developments in other discipline
 Nursing is moving towards more specific

nursing functions
 Leadership within the profession
 Leadership within the profession also influences the

trends in nursing.
 Nursing is moving towards professionalism due to the
untiring efforts of nurses who have been dedicated to
achieve the aim

 Working and studying in abroad
 Shortage of nurses in other countries, higher salary paid
in abroad is the main causes for the working of Indian
nurses in abroad.

 Greater specialization in nursing education and practice
 Greater specialization in nursing education and practice is a
trend related to that in the medical profession and the
growing amount of scientific knowledge available.
 Working conditions
 Working conditions for nurses are also changing.
 There is a gradual change towards shorter and more
convenient hours of duty, better accommodations and higher
salaries.
 Trends in other countries
 Trends in other country also influence the trends in the
nursing profession in India.
 The rapid development of the degree25 programme has
promoted the same emphasis and development here for
professional nursing.

BIBLIOGRAPHY
 Patricia Potter, Anne Griffin Perry. Fundamentals of Nursing. 6th









ed. New Delhi: Elsevier Publications;2006
Carol Tylor, Carol Lillis,Priscilla Lumon. Fundamentals of
Nursing. 5th ed. New Delhi: wolter kluwer health;2006
Andry Berkman,Shirlee Synder, Barbara Kozier, Glenora Erb.
Kozier’s & Erb’s Fundamentals of Nursing. 5th ed. New Delhi:
pearson education;2008
Kay Kittrel, Chilty, Beth perry Black. Professional Nursing
Concepts and Challenges. 6th ed. USA: saunders publication;2013
Susan B Hassmiller. The National Perspective on Future Nursing:
where we are going. Vol 72. www.ncmedicaljournal.com/cvpcontent/uploads/2011/07/72418-web.pdf
http:/enwikipedia/wiki/nursing
www.aft.org/pdfs/healthcare/staffing/halt-report.pdf
Pires DE. Rev Bras Enferm. 2013 Sep;66(spe):39-44.
PMID:24092308

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