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Why study history • Provides an understanding of the heritage behind Nursing as a Career • Highlights the contributions of eminent and inspirational nurses towards development of the nursing profession
DEFINATION • Nursing (as an art): Is the art of caring sick and well individual in their recovery and in the promotion and maintenance of health. It involves the creative application of knowledge in service of people. • Nursing (as a science): It is the body of abstract knowledge arrived through scientific research and logical analysis. • Nursing as a profession: • Profession : Calling in which its members profess to have acquired special knowledge by training or both so that they may guide, advise or save others in that special field.
Definitions of Nursing: An Historical Perspective • Virginia Henderson • “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) and that he would perform unaided if he had the necessary strength, will or knowledge. And to do this in such a way as to help him gain independence as rapidly as possible.” (Henderson, 1966, p. 21)
Ancient Indian and nursing ;(Nursing in early period) • Illness earlier was seen as “magic”, “sin”, “punishment”. • About 700 B.C the practice of medicine has passed in to the hand of Brahmins who were scholars and members priestly class. • Banaras become the centre of medical education (700 to 600 B.C)
During 700-600 B.C sushruta and charaka the famous physician where the leading authorities on the ancient India system known as “ AYURVEDA-THE SCIENCE OF LIFE.” • He was the man who described the technique of caesarean section, plastic surgery and cataract operation . • The first nursing school started in India in 250B.C during Charaka’ time.
Women • In period women provided nursing services at home as part of their ethical and humanitarian responsibilities. • Women have cured for infants children thus nursing could be said to have its root in ‘the homes’. • Women used her skills as a loving mother to care for a sick on a person to person basis.
KING ASHOKA (272-230 B.C.) • Public hospital with male nurses and some older women hospitals like universities of Taxila and nalanda (Bihar) • HIPPOCRATES IN THE 5TH CENTURY • Hippocrates known as a ‘father of medicine’. • Developed system of assessment, observation, record keeping . • Developed terms prognosis, diagnosis, and cure.
IN MIDDLE AGE ERA (500-1500A.D) • RELIGION: has also played significant role in development of nursing, most nurses were part of religious orders. • Several wealthy matrons of the roman empire converted Christianity during the 3rd and 4th centuries and used their wealth to provide houses of care and healing for the poor and sick and homeless.
EARLY CHRISTIAN ERA • Women began nursing as an expression of Christianity and devote their time outside the home to care for the poor and sick as an expression of ‘Christian love’ • It was during this period that a rich person like • FABIOLA: dedicated her life to nursing • She found deaconesses ( female servant ) an order of Christian women who served the sick and poor. PAULA: was friend of fabiola. she built a hospital for stranger ,traveler and ford sick. • She devoted herself for the services of the sick . • The knights of saint lazarus dedicated themselves to caring for people with: leprosy , syphilis, chronic skin condition.
THE DARK PERIOD OF NURSING: • Many religious order, women were expected to devote their time and energies to their own families and home, and raising children. • Women of low status who became “nurses”. These women worked off jail sentence through nursing duties. • Women had no training or preparation for the care of the sick. • Nursing ceased to be valued as an intellectual Endeavour it lost much of its economic support and social status. • So this period is referred to as the “DARK AGE OF NURSING.”
In ancient Egypt • Physicians practiced medicine in temples and were assisted by women helper. Though the record of nursing procedure are available. • There is no indication whether these helpers were nurses or any other persons.
Nursing in medieval period (AD1000-1450) • During RESAISSANCE to the 19th century (1450-1800A.D) there were despair wars, plague and indifference to the poor and sick. • This was a period of decline for nursing but the field of medicine was growing. • During 17th century st.Lincet de paul founded the sisters of charity and who cared the sick.
MODERN NURSING • Florence nightingale known as ‘mother of modern nursing’ • She was born in a prominent English family (1820-1910) • She believed she was ‘called by god to help others….to improve the wellbeing of mankind.’ • She was determined to become a nurse in spite of opposition from her family. • She visited KAISERWERTH in 1847, were she received 3 months training in nursing. In 1853 she studied in Paris with the sisters of charity. • She made round at night with a lamp, so she called as “lady with the lamp”. • She established 1st “nightingale training school” for nurses at st .Thomas hospital, London. • Nightingale was a nurse, philosopher, and statistician. • Today nightingale is considered the founder of modern nursing. • She never visited India, her accurate knowledge of the condition prevailing at the time were obtained from the ‘circular of enquiry’ which was sent to all military station in India.
Military nursing in india • Florence nightingale had a great influence over nursing in India especially in army. • In 1964 the east India company helped to start a hospital for soldiers at fort st. George, Madras. • March 25,1888 ten fully qualified , certificate nurses landed in Bombay • The Indian military nursing service was born during the first world war of 1939. • Military nursing service in India was formed in 1927 and it had 12 matron, 18 sisters and 25 staff nurses.
NURSING IN MODERN INDIA • 1871 The first school of nursing was started in government general hospital, madras. • 1897 Dr B.C.ROY did great work in raising the standards of nursing and that of male and female nurses. • There was many government, municipal, mission hospital started training of Indians as nurses. • The trained nurse association of India (TNAI) was established in 1908. • 1963, the School of Nursing in Trivandrum, instituted the first two years post certificate Bachelor Degree program.
Conclusion:- • History of development of nursing profession, how nursing was in ancient India and how the started various nursing training school. • Florence nightingale the lady of lamp. She was founded modern nursing. • In India developed military nursing and various civilize hospital.
Code of ethics (INC), code of professional conduct(INC), autonomy and accountability, assertiveness, legal considerations
INRODUCTION: • Health care delivery system has undergone notable changes during the last few decades including increased participation, shorter hospital stays and restructuring services to provide care in settings such as outpatient clinics short stay units, long term care and in home care. • For nurses, these changes have contributed to the development of new clinical environment and expanded practice. Nurses today frequently encounter difficult situations involving decisions about the best course of action. • Nurses are obligated to provide ethical and legal client care that demonstrates respect for others. Both fundamental principles of health care ethics and laws governing the scope of nursing guide nursing practice in all situations
Terminologies: Code: • A code may be defined as conventionalized set of rules or expectations devised for a specific purpose. Ethics: • Word ethics is derived from the Greek word “ethos” means customs, character or conduct. • - The branch of knowledge concerned with moral principles. • - Ethics is a also branch of philosophy that examines the difference between right and wrong. Conduct: the manner in which a person behaves. the directing or managing of something.
Code of ethics & professional conduct Introduction: • The code for professional conduct for nurses is critical for building professionalism & accountability. • While ethical consideration are vital in any area dealing with human being because they represent value, right & relationship. • Everybody knows nurse must have competence, responsibility & accountability with moral obligation. Purposes • To inform both nurse & the society of the minimum standard for professional conduct. • It provides regular bodies a basis for decision regarding standard of professional conduct. • The code of ethics helps to protect the rights of individuals, families & community & also the rights of nurses.
The use of code • Acknowledges (accept) the rightful place of individual in health care delivery system. • Contributes towards empowerment of to become responsible for their health & well-being. • Contributes to quality care. • Identifies obligations (morally or legally bound) in practice, research & relationships. • Informs the individuals, families, community & other professionals about expectations of a nurse.
CODE OF ETHICSAmerican Nurses Association • 1. The nurse provides services with respect for human dignity and the uniqueness of the client unrestricted by considerations of social or economic status, personal attributes, or the nature of health problems. • 2. The nurse safeguards the client’s right to privacy by judiciously protecting information of a confidential nature. • 3. The nurse acts to safeguard the client and the public when health care and safety are affected by the incompetent, unethical, or illegal practice of any person. • 4. The nurse assumes responsibility and accountability for individual nursing judgments and actions. • 5. The nurse maintains competence in nursing.
6. The nurse exercises informed judgment and uses individual competence and qualifications as criteria in seeking consultation, accepting responsibilities, and delegating nursing activities to others. • 7. The nurse participates in activities that contribute to the ongoing development of the profession’s body of knowledge. • 8. The nurse participates in the profession’s efforts to implement and improve standards of nursing. • 9. The nurse participates in the profession’s efforts to establish and maintain conditions of employment conducive to high-quality nursing care. • 10. The nurse participates in the profession’s effort to protect the public from misinformation and misrepresentation and to maintain the integrity of nursing. • 11. The nurse collaborates with members of the health professions and other citizens in promoting community and national efforts to meet the health needs of the public.
TRENDS IN NURSING • Basic nursing education in community, colleges and universities. • A growing variety of employment settings. • Growing emphasis on the aspects of nursing that characterize it as a profession. • Increasing political influence of nursing. • Nursing influences on health care policy and practice.
Current Trends in Nursing • Everyone in the healthcare field knows that the one constant in our profession is change! From changing legislation and regulations to changing technologies, each year we see new trends emerge. Nursing professionals are typically exposed to the most change as they are navigating the front lines of patient care.
New Nursing Specialties Experience Growth. There is never a shortage of new specialties for nurses to consider as they manage their career. Two, in particular, are on the leading edge for the future of nursing: • Genetics Nurse – Due to continuing advancements in the study of genetics, nurses with specialized training in genetics will be in great demand as sequencing technology becomes more prevalent. We are learning more about rare diseases and debilitating conditions through genome sequencing than any other current area of research. This transformational research will need support from a growing number of clinicians with a specialty in genetics. • Stem Cell Technology Nurse – An increasing amount of research is being conducted into the beneficial aspects of stem cell technology in the treatment of multiple diseases, including many cancers. Soon, nurses with specialized training in stem cell technology will be in great demand in care facilities as opposed to their current limitation to research facilities.
Robots to Assist, Not Replace. There has been discussion about utilizing robots to alleviate future nursing shortages, however, in the near term they will be used to supplement the nursing workforce, not replace them. There are research projects worldwide developing a variety of applications for the integration of robots into the healthcare setting. For example, in Japan, a robot has been developed as an assistant to lift up and move patients from beds to wheelchairs and reduce debilitating lifting injuries. Another robot developed in Belgium is an automated Triage Nurse, capable of taking a patient's vitals, updating medical records, and medical history. Another being developed at Duke University is designed to perform housekeeping tasks and take vital signs for patients with infectious diseases.
More Medical Device Technologies. Today’s nursing professionals are finding that they have to become more tech-savvy every year and 2017 is no different. There are some technologies that are now a reality. • GPS Tracking. How often have you found yourself wasting valuable time in the unit tracking down a needed piece of equipment? Now, tracking chips are being embedded into these devices and integrated with an “in-house” positioning system so they can be located instantly. The same concept is being used in elderly care situations, where residents have wearable technology that tracks them no matter where they are in the care facility. • Wireless Patient Monitoring. The constant retrieval of data is increasingly being performed by wireless devices. This technology has even migrated to the actual patient beds and mattress pads where weight, blood pressure, pulse rate, sleep patterns and more are constantly being transmitted. The collation and utilization of this data alert nurses to any number of changes to a patient’s status. • Intelligent Alarms. Are you often overwhelmed with the number of alarms that are activated during a chaotic shift? New technology using “intelligent” alarm notification has the ability to discern which alarms need immediate intervention and which others are less critical. The proliferation of patient monitoring technologies and data collection allow for this layered approach to alarm notifications and responses.
Code of Ethics for Nurses in India 1. The nurse respects the uniqueness of individual in provision of care. • Provides care for individuals without consideration of caste, creed (system of religious belief/faith), religion, culture, ethnicity (member of minority), gender, socio-economical & political status, personal attributes or any other grounds. • Individualizes the care considering the beliefs, value & culture sensitivities. • Appreciate the place of individual in the family & community & facilitates participation of significant others in the care. • Develops & promotes trustful relationship with individuals. • Recognizes uniqueness of response of individuals to interventions and adapts accordingly.
2. The nurse respects the rights of individual as partner in care and help in making informed choices • Appreciate individual right to make decision about their care & so gives adequate & accurate information for enabling them to make informed choices. • Respect the decision made by individuals regarding their care. • Protect public from misinformation & misinterpretations. • Advocates special provisions to protect vulnerable groups.
3)The nurse respects the individual’s right to privacy, maintains confidentiality, and share information judiciously • Respect the client’s right to privacy of their personal information. • Maintain confidentiality of privileged information except life threatening situation & discretion (freedom to decide) in sharing information. • Takes informed consent & maintain anonymity when information required for quality assurance/academic/legal reason. • Limit the access to all personal records written & computerized to authorized personal only.
4)Nurse maintains competence in order to render quality nursing care • Nsg. Care must be provided only by registered nurse. • Nurse strives to maintain quality nsg.care & uphold the standard of care. • Nurse values continuing education, initiates & utilizes all opportunities for self development. • Nurse values research as a mean of development of nsg. Profession
5) The nurse if obliged to practice within the framework of ethical, professional & legal boundaries. • Adheres to code of ethics & code of professional conduct for nurses in India developed by Indian Nursing Council. • Familiarizes with relevant laws and practices In accordance with the law of the state.
6) Nurse is obliged to work harmoniously with members of the health team • Appreciates the team efforts in rendering care. • Co-operates, co-ordinates & collaborates with members of the health team to meet the needs of people.
7) Nurse combines to reciprocate the trust invested in nursing Profession by society. • Demonstrates personal etiquettes in all dealings • Demonstrates professional attributes in all dealings.
1) Professional responsibility & accountability. • Appreciates sense of self worth & nurtures it. • Maintains standards of personal conducts reflecting credit upon the profession. • Carries out responsibilities within the framework of the professional boundaries. • She is accountable for maintaining INC standards, own decisions & actions. • Practices healthful behavior. • She is compassionate. • Responsible for improvement of current practices. • She provides adequate information to individuals.
2) Nursing practice • Treats all individuals with human dignity in providing holistic aspects of care. • Provides care with set standard of practice • Respects all individuals , promotes healthy practices & discourages harmful practices. • Presents realistic pictures truthfully in all situations. • Promotes participation of individuals & significant others in the care. • Ensures safe practice.
3) Communication & interpersonal relationship • Establishes & maintains effective interpersonal relationship with individual, families & communities. • Uphold dignity of team members & maintain interpersonal relationship with them. • Appreciate & nurtures professional role of team members. • Cooperates with other health professionals to meet the need of the individuals, families & communities.
4) Valuing human being • Prevent individuals from harmful unethical practices. • She must take decision in the interest of the individuals. • Encourage & supports individuals in their rights. • Respects & supports choices made by individuals.
5) management • Ensures appropriate allocation & utilization of available resources. • Participation & supervision & education of the students. • Communicate effectively following appropriate channels of communication. • Participation in performance appraisal. • Participation in evaluation of nursing services. • Work with individuals to identify their needs.
6) Professional advancement • Ensures the protection of human rights. • Contributes to the development of nursing practice. • Participates in determining & implementing quality care. • Takes responsibility for updating own knowledge & competencies. • Conducting & participating in research.
AUTONOMY • Autonomy = Autos (self) +Nomos (rule of law) • Means = self rule • It refers to the right to make one’s own decisions & choices. • Types of Autonomy • Two types are there: 1) inward autonomy: They have ability to make choice. 2) Outward autonomy: Their choices are not limited or imposed by others.
DIFFERENT VIEW OF AUTONOMY • ►POLITICS : • In the United States government, autonomy refers to one's own self-governance. • One former example of an autonomous jurisdiction into the United States government belong to the Philippine Islands; The Philippine Autonomy Act of 1916 provided the framework for the creation of an autonomous government providing the Filipino people (Filipinos) broader domestic autonomy, though it reserved certain privileges to the United States to protect its sovereign rights and interests. • ►PHILOSOPHY: • The word autonomy has several meanings in a philosophical context. • In ethics, autonomy refers to a person's capacity for self-determination in the context of moral choices. • Kant argued that autonomy is demonstrated by a person who decides on a course of action out of respect for moral duty. That is, an autonomous person acts morally solely for the sake of doing "good", independently of other incentives.
►RELIGION • In the society of the Orthodox Church, the term "autonomous" describes a type of church body. • A church that is autonomous has its highest-ranking bishop, such as an archbishop or metropolitan, appointed by the patriarch of the mother church from which it was granted its autonomy, but is self-governing in all other respects. • ►MEDICINE: • In a medical context, respect for a patient's autonomy is considered a fundamental ethical principle. • This belief is the central premise of the concept of informed consent and shared decision making. • In the 1940s, the phrase "informed consent" appeared but didn't become widely used until the 1970s. Initially, discussions about informed consent focused almost exclusively on research subjects, but eventually has come to apply to the conventional physician-patient relationship as well.
ACCOUNTABILITY It is often used synonymously with responsibility,, answerability, liability, and other terms.
