4. 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
5. 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
6. 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
7. 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)
8. 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.
9. 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.
10. 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
11. 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.
12. 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)
13. 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
15. 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
16. 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
17. 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.
18. 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.
19. 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
20. 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
21. 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.
22. 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.
23. STANDARDS OF PROFESSIONAL
NURSING PRACTICE
American Nurses
Association (ANA) 2010
1. ANA Standards of
Care
2. ANA Standards of
Professional
Performance
24. 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.
25. 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.
26. 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.
27. 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.
30. 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)
31. 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
33. 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
34. Inquisitive
A professional nurse is
always curious to
investigate.
35. 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
36. 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
37. 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
38. Honesty and Integrity
Attitude
Truthful
IS EVERYTHING!
Does not gossip
Sets the tone
Upholds patient
Should be positive
confidentiality and
privacy
39. Appearance
First impressions are
important
Can instill confidence or
mistrust
Represents your pride in
yourself and your
profession
43. 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.
44. 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.
45. 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.
46. 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.
47. 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
48. 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
49. 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
50. 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
51. 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
52. 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.
53. 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.
54. 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.
55. 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