UNIT-3

History of Nursing
and Nursing as a
Profession
 HISTORY OF NURSING

 CHRISTIANITY
 MIDDLE AGES
 FIFTEENTH TO NINETEENTH CENTURY
 FLORENCE NIGHTINGALE
 TEWNTIETH CENTURY & TWENTY FIRST CENTURY
 CHRISTIANITY

 Entry of women in to Nursing

 Christians
taught that men and women are equal before god
and carry on his work in the behalf of all who in distress
 Middle Ages (1100-1200 AD)

 Charitable institutions were started to care for the aged, sick

and poor
 Nurses delivered custodial care and depended on physicians
or priests for direction.
 Nurse Midwifery Flourished.
 Fifteenth to Nineteenth century

 Expanded Hospitals and nursing orders

 Formation of group of public health or visiting nurses
 Sisters of Charity, Founded in 1633, cared for peoples in hospitals, asylums and
poor houses and these sisters became widely known as visiting nurses.
 In 1809 the Sisters of Charity was introduced in America by Mother Elizabeth
Senton, later their names was changed to Daughters of Charity.
 There was little formal nursing education, Nursing Knowledge and skills were
generally passed by experienced nurses.
Contribution of Florence Nightingale

 Florence Nightingale is known as “Lady with the Lamp”,

was a British nurse, social reformer and statistician.
 Known as the Founder of Modern Nursing.
 Her experience as a nurse during Crimean War were
foundational in her views about sanitation.
 She established St. Thomas Hospital and Nightingale
Training School for Nurses in 1860.
 Her efforts to reform health care greatly influenced the
quality of care in the 19th and 20th centuries.
 Contributions to Nursing

 Founder of Modern Nursing

 Leady with the Lamp
 1st Nursing Philosopher
 Nursing Educator
 Nursing Researcher
 Statistician
 English Reformer
 Improvement of Environment and Controlled Morbidity and Mortality
 Reform in Nursing Curriculum
 Contribution in Nursing Theory; Environmental Theory
 TEWNTIETH CENTURY & TWENTY FIRST
CENTURY

 Movement towards scientific research based, define knowledge and practices

 Where body of knowledge and practice is seen first time in the provision of health
care
 Philosophy of Nursing

Philosopher: “The one who has a thirst for every

sort of knowledge and who is curious to learn
and is never satisfied with it, termed as
‘philosopher’.”
- Plato
 Definition of Philosophy

 “A search for comprehensive view of nature an attempt at a

universal explanation of the nature of things” – Alfred
Weber.
 CLIENT

PHYLOSOPH
NURSE HEALTH
Y OF
NURSING

ENVIRONMENT
 Philosophy of Nursing

1.CLIENT –
 Recipient of nursing care.
 Unhealthy health status by physiological, psychological, &
socio-cultural systems.
 Modification through interaction.
 Individual, society & the environment influence on each other.
 Philosophy of Nursing

2. HEALTH-
State of maximum wellness/ functional.
Adapt to the internal and external stressors.
Able to make free choices.
 Philosophy of Nursing

3. ENVIRONMENT -
 Human, social, political, economic, geographic & physical factors.
 Mutually influence by each other through exchange of energy.
 All conditions and elements – internal and external surroundings.
 Philosophy of Nursing

4. Nurse –
 Works autonomously and collaboratively.
 Advocate and change agent.
 Supervises and co-ordinates.
 Compassion
 Honesty
 Respect
 Nursing as a Profession

A profession is defined as an occupation with ethical components,

that is devoted to the promotion of human and social welfare.

Or
A profession is a form of employment especially one that is
respected in society as honorable and is possible only for an
educated person and after training in some special branch of
knowledge.
 Criteria of a Profession:

 A profession must satisfy an indispensable social need and must be based on well
established and socially accepted scientific principals.
 It must demand adequate pre-professional and cultural training.
 It must demand the profession of a body of a specialized and systematized training
 It must give evidence of needed skills which public does not possess: that is skill
which are partly inherent partly acquired
 It must have developed a scientific technique which is the result of tested experience
 It must have sufficient self impelling power to retain its members throughout life. It
must not be used as a mere stepping stone to occupation.
 Objectives of Nursing Practice

1. Assess, identify, plan, implement and evaluate nursing care contributing to health.
2. Demonstrate competency - physical, biological and behavioral sciences.
3. Participate as members of health team in the promotive, preventive, curative and
restorative health care delivery system of the country

4. Demonstrate skills in communication and interpersonal relationship.

5. Demonstrate leadership qualities and decision-making abilities in various situations.

 Objectives of Nursing Practice

6. Demonstrate skills in teaching to individuals and groups in

community health settings.

7. Demonstrate managerial skills in community health settings.

8. Practice ethical values.
9. Participate in research activities and utilize research findings.
10. Recognize the need for continued learning.
 Characteristics of Nursing

 Nursing is caring

 Nursing involves close personal contact with the recipient of care.

 Nursing is concerned with services that take humans into account as psychological
and sociological organisms.

 Nursing is committed to promoting individual, family, community and national

goals in its best manner possible.
 Nursing Responsibilities

1. Caregiver - physical, psychological, developmental, cultural, & spiritual level.

2. Communicator - identify, clear, accurate.

3. Educator – restore or maintain health.

4. Client Advocate – protect client.

5. Counselor – recognize & cope with stressful problems.

6. Change agent – make modification.

7. Leader – accomplish a specific goal.

8. Manager – nursing care, requires knowledge.

9. Case Manager – measure & monitor outcomes.

10. Research Consumer – awareness, sensitive, participation & discriminating.

 Ethical Principles of Nursing as a Profession
 Principles of Autonomy  Justice [ Equal to all]

[Independent decision Making]  Non mall efficiency

 Accountability  Truth

 Utility
 Assertiveness
 Peaceful
 Fidelity [Promises]
 Confidentiality
 Duty
 Principal of respect of human
 Responsibility
dignity
 Code of Ethics/Conduct of Nurses in India
 The nurse respects the uniqueness of an individual in provision of care

 The nurse respects the right of individuals as a partners in care and helps in making informed

choices
 The nurse respects the individuals rights to privacy, maintain confidentiality and shares

information judiciously
 The nurse maintain competence in order to render quality nursing care.

 The nurse is obliged to practice within the framework of ethical, professional and legal

boundaries.
 The nurse is obliged to work harmoniously with members of health team

 The nurse commits to reciprocate the trust invested in nursing profession by the society.
 Legal Issues in Nursing

1. Liability: Professional nurses are always legally responsible or liable for their action. Ex:
Employers, Supervisors etc..

2. Informed Consent: Every person has the right to either consent or to refuse medical
treatment. Law states that a person has to give voluntary and informed consent to treatment.
The person have the right to withdraw the consent which is get notify to the concerned
authority. The law holds that if a reasonable person were aware that the situation was life
threatening , he or she would give consent for care.

3. Fraud: Fraud is deliberate deception for the purpose of personal gain and usually prosecuted
as crime situations ex; trying to obtain a better position by giving incorrect information to a
prospective employer.
 Legal Issues in Nursing

4. Medication Error: Errors result from drugs with similar names, look a like
medication containers, poor systems for communication in which handwriting
problems may contribute to lack of clarity.

5. Torts: Torts are civil wrongs committed by one person against another. The wrong
may be physical harm, psychological harm or harm to reputation, livelihood.

6. Assault: Assault is an intentional threat to bring about harmful or offensive contact.

No actual contact is necessary.
 Legal Issues in Nursing

 Battery: Battery is an un-consented or unlawful touching of a person . For battery to

occur, the touching must occur without consent

 False Imprisonment: The tort of false imprisonment occurs with unjustified

restraining of a person without a legal warrant. Ex; this occurs when nurses restrain a
client in a bounded area to keep the person away from freedom

 Invasion of Privacy: It is intrusion in the personal life of another, without just cause,
which can give the person whose privacy has been invaded a right to bring a law for
damages against the person or entity that intruded.
 Legal Issues in Nursing

 Negligence: it refers to the act of doing something or neglecting to do something that

other medical professions will do in similar situation. Ex: Breach of duty, Injury,
Performance failure etc.

 Mal practice: Medical Malpractice is defined as a wrongful act by a physician, nurse

or another medical professional in the administration of treatment to a patient under
his or her care.
 Legal Responsibility for Nurse

 Registration: Licensing is a mandatory procedure for practice of

nursing. Registration aims at protecting patients by providing qualified
nurses. The nurse is responsible to obtain registration in the respective
state nursing registration council.

 Legal Liability/Act of Negligence: License of a nurse can be suspended

or cancelled for any act of negligence or malpractice, following a
specified procedure.
 Legal Responsibility for Nurse

 Medico-Legal Case (MLC): A medico legal case is a patient who is

admitted to the hospital with some unnatural pathology and has to be
taken care of in concurrence with the police and court.

 Correct identity: A nurse/ midwife is responsible to make sure that all

the patients especially the new born are to be correctly identified and
labelled. A nurse who is working with various instruments/swabs at OT
have to check before closure it is returned.
 Legal Responsibility for Nurse

 Leave against Medical Advice (L.A.MA): Inform medical officer in

charge. Signature of both patients and witness to be taken as per
institutional policy.
 Patient’s Property: Inform patient on admission that hospital does not
take responsibility of his belonging. If patient is unconscious then a list
of items must be made, counter checked by two staff nurses and kept
under safe custody.
 Legal Responsibility for Nurse

 Dying Declaration: Doctor or Nurses should not involve themselves in

dying declaration, in case where police records the dying declaration.
Dying declaration is to be record by the magistrate. If condition of
patient becomes serious then medical officer recorded by the two nurses
as a witness.
 Wills: Doctor has to be present there, if patient wants to recode his will.
 Examination of rape case: Female attendant/female nurse must be
present during the examination
 Legal Responsibility for Nurse

 Artificial Human Insemination: Written consent should be obtained

from both donor and recipient. Donor and recipient must have the same
blood group. Donor and recipient identity should be kept confidential.
 Poison Case: Do not give either verbal or written opinion. Do not allow
to take photos unless special permission is granted by appropriate
authority.
Collect and preserve all excreta, vomits and aspirates seal them
. immediately and send to forensic laboratory at the earliest.
 Definition

 Value: It is a personal belief about worth that acts as a standard to guide one’s
behavior

 Value system: Is an organization of values in which each value is rank along

continuum of importance, a value system often operates as a personal code of
conduct
Values for professional nursing

 Provides foundation for nursing practice and guide the nurse’s

interaction with patients, colleagues and the public

 There are seven essential professional values which each

professional nurse should follow during their practice
 Professional Values
1. Aesthetics
2. Altruism
3. Autonomy
4. Human dignity
5. Integrity
6. Social justice
7. Truth
 Aesthetics

 It is qualities of objects, events and people that provide satisfaction

 Itcan be developed by appreciation, creativity , imagination and
sensitivity
 Aestheticsense of a nurse adapt the environment in such a way that
it becomes pleasant for the client
 Ithelps to create a pleasant work environment for self in a manner
that promotes a positive image of nursing.
 Altruism

 Selflessness, self-sacrifice and humanity

 Nurse’s concern for the welfare and wellbeing of the patients, other
nurses and other heath care providers. E.g.
 Demonstrate understanding of cultures, beliefs and perspective of
others
 Advocates for patients particularly the most vulnerable
 Takes risk on behalf of patients and colleagues
 Mentors other professionals
 Autonomy

 Independent decision making, self-government, self- rule and self

sufficiency
 It is the right to self-determination
 Nurse should respect patients right to make decisions about their health
care. E.g.
 Plans care in partnership with patient
 Honors the right of patients and families to make decisions about health
care
 Provides information so that patients can make informed choices
 Human dignity

 Respect for the inherent worth and uniqueness of individuals and

populations
 It is reflected in practice when a nurse values and respects all patients and
colleagues
 .E.g.
 Provides culturally competent and sensitive care
 Protects the patient's privacy
 Preserves the confidentiality of patients and health care providers
 Designs care with sensitivity to individual patient’s needs
 Integrity
 Honesty, truthfulness and reliability
 Acting in accordance with an appropriate code of ethics and accepted standards of
practice
 It is reflected when the nurse is honest and provides care based on an ethical
framework that is accepted within the profession. E.g.
 Provides honest information to patients and public
 Documents care accurately and honestly
 Demonstrates accountability for own actions
 Social justice

 Upholding morale, legal and humanistic principles

 It is reflected when the nurse works to assure equal
treatment under the law and equal access to quality health
care. E.g.
 Supports fairness and non-discrimination in the delivery of
care
 Promotes universal access to health care
 Truth

 Faithfulness to fact and reality

 It is achieved through accountability, authenticity , honesty, rationality.
E.g.
 Obtain sufficient data to make sound judgment before reporting
infractions of organizational policies
 Participates in professional efforts to protect the public from
misinformation about nursing
 Value clarification

 Is a process by which people come to understand their own values

and value system
 It is a process of discovery and allows the person to discover through
feelings and analysis of behavior what choices to make when
alternatives are presented and to identify whether or not their
choices are rationally made or are the result of previous conditioning
Steps in valuing process

 Three steps are involved in the valuing process

1. Choosing
2. Prizing
3. Acting
1. Choosing

 When one values something it is chooses freely

from alternatives after careful consideration of the
consequences of each alternative.
2. Prizing

 Involves pride and happiness

 Public affirmation
3. Acting

 Acts by combining into one’s behavior with

consistency and regularity on the value.
Trends in Nursing Profession

NON- UNIVERSITY PROGRAMMES

UNIVERSITY PROGRAMMES
 NONUNIVERSITY PROGRAMMES
 Training of Dais
 Auxillary Nurse Midwife
 Lady Health Visitor Course
 General Nursing and Midwifery Course (GNM)
 Post Basic / Post Certificate Short Term Courses and
Diploma programmes
 The goal was to train one Dai in each village and ultimate goal
was to train the entire practising dais in country.
 Duration of training was 30 days.
 No age limit was prescribed, training include theory and
practice, more emphasis on field practice.
 This training was done at subcentre and equipment
provided by UNICEF (United Nation International
Children Emergency Fund)
ANM curriculum intends to prepare skilled and
effective female health workers to achieve the goals
of national rural health mission which aims at
bringing about dramatic improvement in the health
system and health status of the
Training of LHV course continued post-independence.

 The syllabus prepared and prescribed by INC in 1951.

The entrance qualification was matriculation.

The duration was two and a half years which

subsequently reduced to 2 years
 1918 Diploma nursing program has been started in Lady

School of Nursing.
 477 centres

 The latest revision of syllabus by INC in 2004 has increased

the duration of the course from 3 year to 3.5 year.

 Age for the entrance shall be 17 to 35 years provided they meet the
minimum educational requirement

 Minimum education, all students should pass 12 classes or its

equivalent, preferably with science subjects

 Admission of students shall be once a year.

 Students should be medically fit

 The selection committee should comprises tutors, Nurse administrators

and educationalist or phycologist the principal of the school shall be the
chair person
Purpose :

 Provide quality care to patients with cardio thoracic disorders.

 Manage and supervise patient care with cardio thoracic

disorders.

 Teach nurses, allied health professionals, patients and communities

in areas related to cardio thoracic nursing.

 Conduct research in areas of cardio thoracic nursing.
The purpose of this course is to train the nurses to:
 Provide quality care to patients in OT.

 Manage and supervise patient care of patients in OT.

 Teach nurses, allied health professionals, patients and

communities in areas related to OT nursing.
 Conduct research in areas of OT nursing.
The purpose of this course is to train the nurses to:

 Provide quality care to patients with an acute or potential diagnosis of

cancer.

 Manage and supervise patient care in clinical and community settings.

 Teach nurses, allied health professionals, patients and communities in

areas related to oncology nursing.

 Conduct research in areas of oncology nursing.
The purpose of the course is to train nurses to
 Provide quality care to neonates

 Manage and supervise care of neonates at all the three levels of care.

 Teach nurses, allied health professionals , patients and communities in

areas related to neonatal nursing.

 Conduct research in areas of neonatal nursing.
 Provide quality care to individuals suffering from mental and emotional disorders.

 Manage and supervise care of mentally ill patients in clinical and community settings.

 Teach nurses, allied health professionals, patients and communities in areas

related to psychiatric nursing.

 Keep pace with the developments in other related discipline for effective management of

psychiatric nursing.

 Conduct research in areas of psychiatric nursing.

UNIVERSITY PROGRAMMES

1. Basic B.Sc Nursing

2. Post Basic B.Sc Nursing

3. Post Basic B.Sc Nursing By Distance Education Mode

4. Master Of Science In Nursing

5. Master Of Philosophy In Nursing

6. Philosophy Doctorate In Nursing

BASIC BSc NURSINg

 1946 in CMC Vellore and RAK college of nursing Delhi.

 Undergraduate nursing program is broad based education with in

the academic framework specifically directed to the development of
critical thinking skills, competencies and standards required for
practice of professional nursing and midwifery as envisaged in
national health policy 2002.
 BASIC BSc NURSINg

Duration: 4 years.

The revised syllabus incorporated new format of

syllabus evolved in order to facilitate teaches and
to have uniform standard of education in the
country.
 BASIC BSc NURSING - Eligibility
A candidate seeking admission should :
 Pass the 2 year of pre university exam or equivalent as recognized by
concerned university with science subject i.e. Physics, Biology, and Chemistry.
 Students of vocational courses
 Obtained at least 45% of total marks in science subjects in the qualifying
exam, if belong to SC/ST, should have obtained not less than 40% of total
marks in science subjects
 Completed 17 years of age at the time of admission or will
complete this age on or before 31 December of the year of
admission.
 Is medically fit
 Post basic BSc Nursing

 Undergraduate nursing program at post basic level is a broad based

education with the academic framework, which builds upon the skills
and competencies acquired at diploma level.
 Duration : 2 years

 The goal is the preparation of the trained nurse as a generalist who

accept responsibility for enhancing the effectiveness of nursing care
 Eligibility

 The candidate seeking admission must:

 Hold a certification in general nursing
 Be a registered nurse
 Have minimum of two years of experience

 Have passed pre university exam in the arts/ science commerce or equivalent which is
recognized the university
 Be medially fit
 Have a good personal and professional record
 Have working knowledge of English.
 POST BASIC BSc NURSING BY DISTANCE EDUCATION MODE

The programme was launched in July 1994 and is recognised by the Indian
Nursing Council (INC).
In-service nurses.
Revised syllabus of INC (2001).
Duration
◦Minimum Duration: 3 Years
◦Maximum Duration: 5 Years
 Eligibility

10+2 with three years Diploma in General Nursing and Midwifery

(GNM) with minimum 2 yr experience.
OR
10th class (Matriculation) or its equivalent with three years Diploma in
General Nursing and Midwifery (GNM) with minimum of 5 yr experience.
* For male nurses or nurses who have not done midwifery in the GNM
Programme should have a certificate in any of the nursing courses of 6-9
months duration prescribed by the Indian Nursing Council in lieu of
midwifery
 MSC. NURSING

• Post graduate program is essential to prepare nurses to improve the

quality of nursing education and practice in India

• It builds upon and extend competence acquired at the graduate levels,

Emphasize applications of relevant theories in to nursing practice,
education, administration and development of results skills.
 ELIGIBILITY CRITERIA

• A registered midwife of equivalent with any state Nursing registration

council.
• The minimum educational requirements shall be passing of BSc nursing
/ BSc Hons Nursing/Post Basic BSc Nursing with minimum of 55%
aggregate marks.
• Minimum 1 year of work experience prior or after Post Basic BSc
Nursing.
 MASTER OF PHILOSOPHY PROGRAM
IN NURSING
 RAK College of Nursing, Delhi, 1980’s - regular
and part time course.

 The academic council recommended to delink MPhil

from the PhD program.

 The MPhil program started on October 15, 1986.

 Full time – 1 Yr
 Part time - 2 Yr
The MPhil studies will be in two distinct
parts:
Part -I – consists of 3 courses – Research
methods in nursing, Major aspects of nursing
and Applied Disciplines
 Part – II a dissertation
 PHILOSOPHY DOCTORATE IN NURSING

 The doctor of philosophy is the university’s highest level supervised research

degree.

 The purpose is to have doctoral education to prepare nurse scholars who will
contribute both to the development and application of knowledge in nursing for
enhancing quality of nursing education, research, practice and dissemination of
nursing knowledge.

 National Consortium for Ph.D in Nursing has been constituted by Indian Nursing
Council to promote research activities, in various fields of Nursing in collaboration
 ELIGIBILITY

 The candidate must have MPhil or MSc (N) or a postgraduate

degree in nursing recognized by INC
 He or she passed minimum of 60%marks
 The final selection of candidate is made on the basis of all India
entrance test
 Those candidate who passes MPhil degree as well as published original
research article are given a weightage of 10 marks(5 marks for each)
 DURATION OF COURSE

 Full time candidate should complete research work and

submit the thesis of university within 5 year.
 For a part time candidate , the maximum period for
submit the thesis in 7 year.
Scope of Nursing Profession

Expanded Career Roles

 93
Expanded Career Roles

1. Independent Nurse Practitioner

2. Nurse Anesthetist
3. Clinical Nurse Specialist
4. Nurse Midwife
5. Nurse Researcher
6. Nurse Administrator
7. Nurse Educator
8. Nurse Entrepreneur