01.nursing Foundation

.
FOUNDATION OF MODERN NURSING
By:-Anwar Tahir (BSc, MSc in AHN)
1 foundation of Nursing I 12/15/2023

Learning Objectives
At the end of this session, students will be able to:
 Definition of Nursing
 The history of Nursing in Ethiopia
 Describe the importance of theory to the nursing profession.
 Define terms related to theory.
 Describe the major ethical principles

Break 2 minute
What is nursing ?
Why you are interested in Nursing?
What you will going to add in nursing profession ?

Definition of Nursing
 Nursing is the art and science of assisting individuals in learning
to care for themselves whenever possible and caring of them when

they are unable to meet their own needs.
 “It is the diagnosis and treatment of human responses to actual or
potential health problems” (ANA 1980).

 It is assisting the individual, sick or well in the performance of
those activities contributing to health or its recovery (to peaceful

death) (Virginia Henderson 1960).

Definition of Nursing…cont’d
It is a dynamic, therapeutic and educational process that serves
to meet the health needs of the society, including its most
vulnerable members.
Nursing is a humanistic science dedicated to compassionate

concern with maintaining and promoting health, preventing
illness and caring for and rehabilitating the sick and disabled.
foundation of Nursing I 12/15/2023

5
History and Development of Nursing
 Moral action is the historical basis for the creation, evolution and
practice of nursing.
The early record of ancient civilization offers little
information about those who care for the sick.
During this time beliefs, about the cause of disease were embedded
in superstition and magic and thus treatment often involved
magical cures.
Ancient Egyptians developed community planning and strict

hygienic rules to control communicable diseases.
History and Development of Nursing
The ancient Greeks gods were believed to have special healing power.
In 460 BC Hippocrates born and credited with being the Father of medicine.
He proved that illness had natural cause and not to be of a religious or

magical cause.
Hippocrates first proposed such concepts as physical assessment, medical

Ethics, patient – centered care and observation and reporting.
Although medicine as a science was developed there was little evidence of

establishing a foundation for nursing.

The development of modern Nursing
In the latter half of eighteenth century

Florence nightingale the founder of modern
nursing changed the form and direction of
nursing;
And succeeded in establishing it as a respected

profession.
She was born to wealthy and intellectual

family in 1820.

Modern Nursing…cont’d
Nightingale believed she was "called” by God to help others and
to improve the wellbeing of mankind.
She saw nursing as a separate profession from the church, yet she
began her career as the result of the spiritual experience.
Nightingale was the first to mention Holism (treating the whole

patient) in nursing and the first who stated that a unique body of
knowledge is required to practice professional nursing.

Modern Nursing…cont’d
She also founded the first training
school for nurses
The school served as a model for
other training schools.
Its graduates traveled to other
counties to manage hospitals and
nursing training programs.

History of Nursing Ethiopia
In ancient Ethiopia illness was considered to be punishment from
sins or magic.
Most tribes had a medicine man or women called "Hakims" or

wegesha" who performed rituals, using various plants and herbs
to heal the sick.
The religious people were also providing care for the sick or
injured.
In late 19th century foreign nurses were practicing in the health

care delivery system of Ethiopia.
History of Nursing Ethiopia…cont’d
In 1908, Emperor Menelik II established the 1st Governmental public health
services.
In 1909, the first hospital Menelik II was built in Ethiopia.
Later on Imperial Hailesilassie established different Hospitals in different regions

including Addis Ababa.
The first clinic was established near Messwa.
The Dejasmatch Balcha Hospital was established in 1948 under the agreement
with Soviet Red Cross.
The Princes Tsehai memorial Hospital was opened in 1951, to now known as
Army Hospital.
Ethiopian Nurses
Princess Tsehai was the first graduated national nurse from Ormand street
hospital in London.
In 1948 the Ethiopian Red cross nursing school established by his Imperial
majesty in the private Hospital Bet-Saida which later changed to Halesilassie I
Hospital.
Then during the Derg regime, this hospital is changed its name to Yekatit 12
hospital,which still exists.
In 1950, the school of nursing was established at Empress Zewditu memorial

hospital for male and female nurses.
In March 1953, the first eight nurses from Ethiopian Red Cross of nursing and
nine from Empress Zewditu memorial hospital were graduated.
Cont’d
In 1951, two school of Nursing was established:
- one at the princess Tsehai memorial only for
female nurses.
- and the other one was in Nekemt at the
Teferie Mekonnen Hospital.
In 1959 the post basic training started at princess Tsehai memorial hospital for
midwifery nursing and four nurses graduated in 1960.
In 1954 the Gonder Health College and training center opened and gave training
to community nurses.
In 1958, fifteen (15) community nurses graduated from this center.

Nursing as a profession
 Nursing is a profession rather than an occupation.
An occupation is identified in terms of the market place,i.e.,
established monetary rewards for equivalent competencies.
A profession is explained in terms of specialized expertise,
i.e., a skill level formally recognized after long, intensive,
academic training.
A profession is a calling that requires special knowledge and
skilled preparation.

Nursing as a profession…cont’d
Profession differs from occupation by:-

 Professionalism requires prolonged specialized training
acquiring a body of knowledge pertinent to the role to be
performed.
 An orientation of the individual toward service, either to
community or organization.

Why nursing is considered as a profession?
 The services provided are vital to humanity and the wellbeing

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.

Why Nursing as a profession…cont’d
 There is a special body of knowledge that is continually
enlarged through research.
In the past, nursing was based on principles borrowed from the
physical and social sciences and other disciplines. Today there

is a unique body of knowledge to nursing

 The services involve intellectual activities. Individual
responsibilities (accountability) are a strong feature.
Nursing has developed and refined its own unique
approach to practice. e.g.. use of nursing process to solve
health problems.
 Practitioners are educated in institution of higher
learning. There are basic nursing program, baccalaureate
program, masters and Doctoral program in nursing
 Practitioners are relatively independent and control their

own policies and activities (Autonomy).
 Practitioners are motivated by service (altruism = service
to others) 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.

 There is a Code of Ethics to guide the decisions and

conduct of practitioners. ICN has established CNE through
which standards of practice are established, promoted and
refined.
There is an organization (Association) that encourages
and supports high standards of practice.eg. ENA, ANA

Comparison between Profession and occupation
Occupation Profession
1 Training may occur on job Education takes place in College and

university
2 Length of training varies Education is definite and prolonged
3 Value, beliefs and Ethics are not Prominent Value beliefs, and Ethics are integral
features of preparation part of preparation
4 Works are supervised Works are autonomous
5 Commitment & personal identification vary Commitment & personal

identification are strong
622 People often changes

foundation of Nursing Ijobs People unlikely to change 12/15/2023
jobs
Philosophies of nursing
Philosophy-the study of the truths and principles of being,
knowledge, or conduct.
It is a set of beliefs and attitudes that direct the behavior of

individuals to the achievement of a goal.
Nursing philosophies are broad and address general ideas about

nursing.

Philosophies of nursing…cont’d
They are expressions of values in nursing that are used as bases for
thinking and acting.
Most philosophies of nursing are built on a foundation of beliefs

about people, environment, health, and nursing.
Because of their breadth nursing philosophies contribute to the

discipline by forming a foundation for theory development.

Over review of nursing theory
A theory is a set of systematically interrelated concepts or
hypothesis that seeks to explain and predict phenomena.
A set of concepts and prepositions that provide an orderly way to

view a phenomena
Nursing theory- a conceptualization of some aspect of reality

invented or discovered that pertains to nursing.

Reasons for the interest in theory:
1. Development of theory adds knowledge to the discipline. i.e. a
means of establishing nursing as a profession.
2. The enrichment of theory by itself is an important goal of nursing,
as an intellectual discipline, to follow.
3. Theory helps practicing nurses categorize and understand what is
going on in nursing practice.

Definition of terms related to theory
Concepts- a term or label that describes a phenomenon or group of
phenomenon.
A meta paradigm- the global concepts that identify the phenomena of

the central interest to a discipline.
The global propositions that describes the concepts.
The global propositions that state the relations between and among the
concepts.

Definition of terms…cont’d
The central concepts of the discipline of nursing are:-
1. Human being/person
2. Environment
3. Health
4. Nursing

Definition of terms…cont’d
Conceptual model-a set of concepts or statements that integrate the
concepts in to a meaningful configuration. => it provides an over all
view or orientation to focus our thoughts
Assumptions-truth that represents the value and beliefs of the theory and
conceptual framework.
A Proposition-a statement about a concept or a statement of the relation
between two or more concepts=> is capable of being tested, believed or
denied

Relationship of theory to practice and research
Any activity in nursing should be based on evidence based
practice.
Evidence Based Practice includes best research evidence, clinical

expertise and patient value.
Why is EBP very important?

 Error free practice
 Quality practice
 Effectiveness and efficiency or good competence

Relationship of theory to practice and research…cont’d
Professional nursing practice is also grounded in a theoretical

foundation.
Conceptual models attempt to explain the nursing paradigm, or

overall scheme to the context of the practice of nursing.
Some of the commonly used theories in nursing are the

following:-

Theories used in nursing
1. General systems theory: explain the breaking of whole things
into parts & the working together of these parts into systems
A system- a set of interacting elements.
All the elements serve the common purpose of contributing to the

overall goal of the system.
The whole system is always greater than the sum of its part.

General systems theory…cont’d
The system theory helps nurses to view the individual client, the
family as well as the community holistically.
Human being > physical + psychology + social.
An open system allows energy, matter and information to move

freely between systems and boundaries.
It maintains balance through feedback.

General systems theory…cont’d
Input - Nursing personnel, Clients, equipments,
- Knowledge, belief, value, etc.
Transformation process- nursing management by nursing

personnel, application of nursing theories, critical thinking, etc.
Output- resolution of nursing problem of the client, client

improvement, etc.

2. Orem's self care nursing Theory
It is based on the concept self care.
It encompass three related theories.
1. Self care theory: postulates that self care & the self care dependents are learned
behaviors that individuals initiate & perform on their own behalf to maintain life,
health & Well being
2. Self care deficit theory: asserts that people benefit from nursing b.c they have health
related limitations in providing self care
3. Nursing system theory: postulates that nursing systems form when nurses prescribe,
design, & provide nursing that regulates the individual’s self care capabilities and
meets therapeutic self care requirements.

Orem's self care nursing Theory…cont’d
Nursing becomes necessary if the client is unable to achieve self
care. i.e. if the client has self care deficit.
Nursing becomes partly compensatory where both nurse and client

work to achieve self –care.
The role of nurse becomes facilitator, educator where the client can
perform self care activities but, does not do so without assistance.

.
3. Johnson Behavioral Systems Model
Nursing care is directed toward caring for the whole patient to

facilitate effective and efficient behaviors necessary to prevent
illness.
E.g. facilitating to develop habit of
physical exercise to prevent DM.

 Nursing is separate from medicine.
 Nursing's role is complementary to the medical role.

.
4.Roy adaptation Theory
The goal of nursing is promoting adaptation to the environment to

contribute to a person’s health, quality of life and dying with
dignity.
5.Rogers Model of the science of Unitary Man
The nurse's goal is to promote holistic health and environment

interaction in order to maximize client health potential.

Legal aspects of nursing

What is “ethics”?
 Ethics: “the rules of conduct recognized in respect to a particular
class of human actions or a particular group, culture”

 It is a formal reasoning process used to determine right conduct.
 Professionally and publicly stated.
 It is the inquiry of principles and values
 Bioethics : as applied to life.
 Nursing ethics: refers to ethical issues involved in nursing practice

Values
 Values are the beliefs of people about what is right and wrong and
what is most important in life, which control their behavior.
 Each person has a set of personal values.
 The origin of a person’s value can be traced to culture, society,
institutions and personality.
 Acquiring values is a gradual process, usually occur at unconscious
level.
 A person’s real values are shown by consistent patterns of behavior.
 foundation of Nursing I 12/15/2023

41
Give examples personal values and societal values
Professional values
 They are often a reflection & expansion of personal values.
 They are acquired during socialization into nursing:
 Watson outlined four important values of nursing experiences
1. Strong commitment to service
2. Belief in the dignity & worth of each person
3. Comitment to education
4. Autonomy

Morals
 Usually it refers to personal standards of right and wrong
 Sometimes the first clues to the moral nature of a situation is
an aroused conscience or an awareness of feeling.
 The tendency to respond to the situation with words such as
ought, should, right, wrong, good, and bad is another indicator.

Common Ethical theories
there are four ethical theories:

1.Deontology
2.Teleology
3.Intuitionism
4. The ethic of caring
1. Deontology (Duty or rule-Based theory)
The rightness or wrongness of an action depends on the
nature of the act rather than its consequences.
System of ethical decision making that is based on moral
rules and unchanging principles.
Based on the ethical absoluteness of principles regardless
of the consequence of the decisions
Ethical theories…
This theory holds that you are acting rightly when you
act according to duties and rights.
Responsibility arises from these moral facts of life.
 The theory denotes that duties and rights are the
correct measuring rods for evaluating action.. E.g.
informed consent, respect of patient, tell the truth..

2. Teleology (utilitarian or end based theory)
Consequences of an action important in judging
whether that action is right or wrong.
Utilitarian hold that no action in itself is good or bad,
the only factors that make actions good or bad are the
outcomes, or end results that are derived from them (the
end justifies the means).
The greatest good for the greatest number

3. Intuitions
The notion that people inherently know what is right or
wrong( is not a matter of rational thought or learning).
E.g. nurse inherently knew it is wrong to strike a client.
4. The ethic of caring (case based theory)
Unlike the preceding theories which are based on the
concept of fairness (justice) an ethical caring is based on
relationships.
It stresses courage, generosity, commitment, and
responsibility.
 Caring is a force for protecting and enhancing client
dignity.

The Application of Ethical Theories
Essential structure for nurses as a means of resolving
particular ethical dilemmas.
Ethical theories do not provide cook book solutions for
ethical dilemmas, but a framework for decision making
to apply in a particular situation.
Most health professionals like nurses attempt to make
ethical decisions through combining the two theories.

Ethical Principles
1. Autonomy
 Autonomy/Self determination/- Respecting the choices and wishes
of persons who have the capacity to decide and protecting those
who lack this capacity.
 It conflicts with the paternalistic attitude of many health
professionals.
 Autonomy is the promotion of independent choice, self
determination and freedom of action.
Generally
• The autonomous person is respected
• The autonomous person must be able to determine personal goals.

2. Beneficence
Beneficence is doing or promoting good.
This principle is the basis for all health care providers.
 e.g administer pain medication, perform a dressing to
promote wound healing.
It lays the groundwork for the trust that society places in
the nursing profession and the trust that individuals place
in particular nurses or health care agencies.
The principle of beneficence has three components:
Promote good
Prevent harm
Remove evil or harm

3. Non maleficence
 It means to avoid doing harm. When working with
clients, health care workers must not cause injury or
suffering to clients.
It is to avoid causing deliberate harm, risk of harm and
harm that occurs during the performance of beneficial
acts.
E.g. Experimental research that have negative
consequences on the client.
Non maleficence also means avoiding harm as a
consequence of good.
 In that cases the harm must be weighed against the
expected benefit.

4. Justice
 Justice is fair, equitable and appropriate treatment.
 It is the basis for the obligation to treat all clients in an
equal and fair way. Just decision is based on client need
and fair distribution resources.
 It would be unjust to make such decision based on how
much he or she likes each client.
5. Veracity
 Veracity means telling the truth, which is essential to the
integrity of the client-provider relationship
 Health care providers obliged to be honest with clients
 The right to self-determination becomes meaningless if
the client does not receive accurate, unbiased, and
understandable information
6. Fidelity
Fidelity means being faithful to one's commitments and
promises.
E.g-providing safe care and maintaining competence in
nursing practice.
Fidelity means not only keeping commitment but also
keeping or maintaining our obligation.

7. Confidentiality
 To keep information obtained in the course of their work private.
 Confidentiality is non-disclosure of private or secret information
with which one is entrusted.

 Confidentiality comes from Latin fide: trust.
 confide as to “show trust by imparting secrets”; “tell in assurance
of secrecy”; “entrust; commit to the charge, knowledge or good

faith of another”; while confidential or in confidence is “a secret
or private matter not to be divulged to others”

Case study
Can Nurses Violate Confidentiality?
Think About the two given scenarios and discuss
about it
1. If a relative contracted HIV from a source who
the nurse knew was infected, and had reason to
believe would infect others, but neglected to warn.
What do you do?
2. If Mr Abebe is HIV infected and the health
provider violated his right to confidentiality. What
do you think about the act?

Ethical Dilemma
 Ethical dilemmas is a situation arising when
equally compelling ethical reasons both for
and against a particular course of action are
recognized in which the appropriate choice
in the situation is unclear and a decision
must be made.
Ethical Dilemma…cont’d
 Situation that requires an individual to make a choice between two
equally unfavorable alternatives.

 Conflict between one individual’s rights and those of another, or
between one individuals obligation and the rights of another,

usually form the basis of the dilemma.
 E.g. Obligation to keep confidentiality and keep the public from
hazards.

The ethical decision-making process
 Provides a method for nurses/physicians to answer key questions
about ethical dilemmas

 Organize their thinking in a more logical and sequential manner.
 Collect ,analyze and interpret data
 State the dilemma
 Consider choices of action
 Analyze advantage and disadvantage of each choice
 Make decision

Quadrant method of analysis

Ethical problems in Nursing
Some of the most common ethical issues faced by nurses
today includes:
Confidentiality
use of restraints,
 trust,
refusing care, and
end-of-life concerns

General Legal Concepts
Law can be defined as “those rules made by humans
which regulate social conduct in a formally prescribed

and legally binding manner” (Benzweig 1990, p. 3).
Hall (1990, p.35) states that laws prohibit extremes of
behavior so that individuals can live without fear for

their person or their property.

Functions of Law in Nursing
 It provides a framework for establishing which nursing actions in
the care of clients are legal.

 It differentiates the nurse’s responsibilities
 It helps establish the boundaries of independent nursing action.
 It assists in maintaining a standard of nursing practice by making
nurses accountable under the law.

Sources of law
Three primary sources of law are:
Constitution
Legislation
Common law

Sources of law con’t.
Constitution
 Constitution is the supreme law of the country.
 Constitutions create a legal rights and responsibilities and are the
foundation for a system of justice.
 Constitution has due process and equal protection clauses.
Legislation
 That enacted by any legislative body are called statutory laws.
Common Law
 The body of principles that evolves from court decisions is referred to as
common law.
 Common law is continually being adapted and expanded.

Types of Laws:
 Laws govern the relationship of private individuals with government and with
each other.
 There are two types of law: Public Law and Private Law.
 Public Law: refers to the body of law that deals with relationship between
individuals and the government and governmental agencies.

 An important segment of public law is criminal law, which deals with actions
against the safety and welfare of the public. E.gs. Homicide, manslaughter, and
theft.

Types of Law con’t.
 Private law or Civil Law: It is the body of law that deals with relationships
between private individuals.
 It is categorized as Contract law and Tort law.
 Contract Law: involves the enforcement of agreements among private
individuals or the payment of compensation for failure to fulfill the agreements.
 Tort law: defines and enforces the duties and rights among private individuals
that are not based on contractual agreements.
 Some examples of torts applicable to nurses are: negligence and malpractice,
invasion of privacy, and assault and battery.

Legal Liability in Nursing.
Negligence and Malpractice
 Liability: is the quality or state of being legally responsible to
account for one’s obligations and actions and to make financial

restitution for wrongful acts.
 Negligence: is “failure to behave in a reasonably and prudent
manner, whether as a layperson or a professional and whether

engaged in the simplest or most complex type of activity”
(Bernzweig 1990, p. 21)

Legal Liability in Nursing cont’d.
Malpractice
 Refers “to the negligent acts of persons engaged in
professions or occupations in which highly technical

or professional skills are employed”
 Also known as professional negligence, as only
professional can be sued for malpractice;

Informed consent
 It is an agreement by a client to accept a course of treatment or
a procedure after complete information, including the risks of

treatment and facts relating to it, has been provided by the
physician.
 Often, the nurse’s responsibility is to witness the giving of
informed consent.
 To give consent the person must be competent and an adult.

Legal liability in nursing cont’d.
Assault and Battery
 Assault is a stated intent to touch a person in an offensive, Insulting, or
physically intimidating manner.

 Battery is the touching of another person without the person’s consent.
 The legal issues arising from assault and battery are usually based on
whether the client consented to the touching that occurred.

 Because assault and battery both deal with acts of touching, the client’s
cultural values, beliefs, and practices must be respected by the nurse.

Privacy and Confidentiality
 Nurses are accountable for respecting the client’s right to privacy.
 Nurses must obtain the client’s permission before disclosing any
information regarding the client, going through the client’s

personal belongings, performing procedures, and photographing
the client.
 An essential component of nursing practice is protecting the
client’s confidentiality and privacy.

Legal Liability in Nursing…Cont’d
Defamation
 It occurs when information is communicated to a third party that
causes damage to someone else’s reputation either in writing (libel)
or verbally (slander).
 The most common examples of this tort are
 giving out inaccurate or inappropriate information from the medical
record;
 discussing clients, families, or visitors in public areas; or
foundation of Nursing I
 speaking
72 negatively about coworkers (Zerwekh & Claborn, 1997).
12/15/2023
Legal Liability in Nursing Cont’d.
Controlled substances
The improper use of controlled substances may lead to
criminal penalties in the United States and Canada under laws

governing the distribution and use of controlled substances
(narcotics, depressants, stimulants, and hallucinogens).

Safety
 The promotion of physical safety is one of the most important
responsibilities of the nurse. There are four areas regarding client

safety in which nurses are at legal risk:
(1) failure to monitor client status,
(2) medication errors,
(3) falls, and
(4) use of restraints.

The End
Thank you!!!

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FOUNDATION OF MODERN NURSING

By:-Anwar Tahir (BSc, MSc in AHN)

1 foundation of Nursing I 12/15/2023

 The history of Nursing in Ethiopia

 Describe the importance of theory to the nursing profession.

 Define terms related to theory.

 Describe the major ethical principles

2 foundation of Nursing I 12/15/2023

Why you are interested in Nursing?

What you will going to add in nursing profession ?

3 foundation of Nursing I 12/15/2023

to care for themselves whenever possible and caring of them when

potential health problems” (ANA 1980).

those activities contributing to health or its recovery (to peaceful

4 foundation of Nursing I 12/15/2023

Nursing is a humanistic science dedicated to compassionate

foundation of Nursing I 12/15/2023

The early record of ancient civilization offers little

information about those who care for the sick.

Ancient Egyptians developed community planning and strict

He proved that illness had natural cause and not to be of a religious or

Hippocrates first proposed such concepts as physical assessment, medical

Although medicine as a science was developed there was little evidence of

7 foundation of Nursing I 12/15/2023

In the latter half of eighteenth century

And succeeded in establishing it as a respected

She was born to wealthy and intellectual

8 foundation of Nursing I 12/15/2023

Nightingale was the first to mention Holism (treating the whole

9 foundation of Nursing I 12/15/2023

school for nurses

The school served as a model for

other training schools.

Its graduates traveled to other

counties to manage hospitals and

nursing training programs.

Most tribes had a medicine man or women called "Hakims" or

In late 19th century foreign nurses were practicing in the health

In 1909, the first hospital Menelik II was built in Ethiopia.

Later on Imperial Hailesilassie established different Hospitals in different regions

The first clinic was established near Messwa.

In 1950, the school of nursing was established at Empress Zewditu memorial

In 1951, two school of Nursing was established:

- one at the princess Tsehai memorial only for

- and the other one was in Nekemt at the

Teferie Mekonnen Hospital.

In 1958, fifteen (15) community nurses graduated from this center.

14 foundation of Nursing I 12/15/2023

15 foundation of Nursing I 12/15/2023

Profession differs from occupation by:-

16 foundation of Nursing I 12/15/2023

 The services provided are vital to humanity and the wellbeing

17 foundation of Nursing I 12/15/2023

physical and social sciences and other disciplines. Today there

18 foundation of Nursing I 12/15/2023

 Practitioners are relatively independent and control their

20 foundation of Nursing I 12/15/2023