CONCEPTS OF NURSING

- Nursing as a Profession
- Nursing as an Art
 Profession
-a calling requiring specialized knowledge and often long and intensive
academic preparation

NURSING AS A PROFESSION
-An education that requires extensive education
- A calling that requires special knowledge, skills and preparation

WHO IS THE CENTER OF OUR PRACTICE?

- To act professionally, you administer quality patient-centered care in a safe, prudent,
and knowledgeable manner.
- It serves all of society and not the specific interest of the group
- You are responsible and accountable to yourself, your patients, and your peers.

“ making a difference in your patient’s lives is fulfilling”

 Nursing as an Art
- An art is the expression or application of human creative skills producing
works to be appreciated primarily for their beauty or emotional power.

- As a professional nurse you will learn to deliver care artfully with

compassion, caring, and respect for each patient’s dignity and personhood.
UNDERSTANDING OF THE ART OF NURSING SHAPES YOUR
PRACTICE
- As nurses, we help patient to adapt to change their health by
applying the art of nursing.

- Unlike scientific explanations, the art of nursing does not

require a scientific explanation but deals with how experiences
feel and what they mean (Robinson, 2014)

- The values and principles of related to the art of nursing allows us to be

inspirational and compassionate while focusing on quality level of care.
  The theory related to the sciences of nursing is the examination of
law, theories, and the concept of nursing.
“In order for me to practice safe nursing, I have to be knowledgeable of the
science of nursing and actively include it in my nursing practice.
My practice will be based on data that has been gathered and proven thru
scientific trials from research that was developed from disease related
situations. “
 The 6 C’s of Caring

- Caring is a universal phenomenon influencing the ways in which people think, feel and
behave in relation to one another.
- Caring means that people, events, projects, and things matter to people
( Benner and Wrubel, 1989; Benner et al., 2010)

- The 6 C’s of nursing stand for the professional commitment to always deliver excellent
care

- Each value is equal, not one is more important than the other
They focus on putting the person being cared for at the heart of the care they are given.
Definition of Nursing
- History of Nursing
- Carper’s Four Patterns of Knowing
  Florence Nightingale defined nursing nearly 150 years ago as;
“ The act of utilizing the environment of the patient to assist him in his
recovery”
“ the nurse must use her brain, heart and hands to create healing environments
to care for the patient's body, mind and spirit”

Virginia Henderson was one of the first modern nurses to define

nursing as;
“ 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, and to do this in such a way
as to help him gain independence as rapidly as possible”
 In the latter half of the 20th century, a number of nurse theorist developed
their own theoretical definitions of nursing. Certain themes are common to many
of these definitions.

 Nursing is caring
 Nursing is an art
 Nursing is a science
 Nursing is client centered
 Nursing is holistic
 Nursing is adaptive
 Nursing is concerned with health promotion, health maintenance
and health restoration.
 Nursing is a helping profession
 Historical Perspectives
Nursing has undergone dramatic change in response to societal needs and influences.

 Women’s Roles
 Traditional female roles of wife, mother, daughter, and sister
have always included the care and nurturing of other family
members.

 Generally, the care provided was related to physical

maintenance and comfort. Thus, the traditional nursing role
has always entailed humanistic caring, nurturing, comforting,
and supporting.
 Religion
 It was the Christian value of “love thy neighbors as thyself” and Christ’s
parable of the Good Samaritan that had a significant impact on the
development of Western nursing.
 The wealthy matrons of the Roman Empire, such as Fabiola, converted
to Christianity and used their wealth to provide houses of care and
healing for the poor, the sick, and the homeless. (3rd & 4th century)
 The Crusades saw the formation of several orders of knights, including
the Knights of Saint John of Jerusalem (also known as the Knights
Hospitalers), the Teutonic Knights and the Knights of Saint Lazarus.
- Provided nursing care to their sick and injured comrades
- Built hospitals, the organization and management of which set a
standard for the administration of hospitals throughout Europe
 War

 During the Crimean War (1854-1856) , Nightingale and her nurses

transformed the military hospitals by setting up sanitation practices, such
as handwashing and washing clothes regularly.
 During the American Civil War (1861-1865) Harriet Tubman and
Sojourner Truth provided care and safety to slaves fleeing to the North in
the Underground Railroad.
 Progress in health care occurred during the World War I . There were
advancements in the use of anesthetic agents, infection control, blood
typing, and prosthetics.
 World War II casualties created an acute shortage of caregivers, and the
Cadet Nurse Corps was established.
 Scope of Nursing
1. Promoting Health and Wellness
Wellness is a process that engages in activities and behaviors that
enhance quality life and maximize personal potential (Anspaugh, Hamrick, &
Rosata, 2003, p. 490). Nurses promote wellness in clients who are both healthy
and ill. This may involve individual and community activities to enhance
healthy lifestyle.
2. Preventing Illness
The goal of illness prevention program is to maintain optimal health
by preventing disease. These includes immunizations, prenatal and infant
care, and prevention of sexually transmitted disease
 3. Restoring Health
Restoring health focuses on the ill client and it extends to early
detection of disease through helping the client during the recovery period.
Activities include:
a.Providing direct care to the ill person
b. Performing diagnostic and assessment procedures
c. Consulting with other health care professionals about client
problems.
d. Teaching clients about recovery activities
e. Rehabilitating clients to their optimal functional level.
 4. Caring for the Dying

This area of nursing practice involves comforting and caring for

people of all ages who are dying. It includes helping clients live as
comfortably as possible until death and helping support persons cope
with death. Nurses carrying out these activities work in homes,
hospitals, and extended care facilities.
 Cont. in Definitions of Nursing

NURSE
o Latin word “to nourish” or “to cherish”
o One who cares for the sick, the injured, and the
physically, mentally, and emotionally disabled
o One who advise and instruct individuals, families,
groups, and communities in the prevention, treatment
of illness and diseases and in the promotion of health.
 NURSE

oAn essential member of a health team who cares

for individuals, families, and communities in disease
and illness prevention and in the promotion of health
and health equipment.
  PATIENT

o Comes from a Latin word, “to suffer” or “to Bear”

o An individual who is in state of physical, mental, and
emotional imbalance
o An individual who seeks for nursing assistance, medical
assistance, or for surgery due to illness or a disease
o Is an individual who is waiting or undergoing medical or
surgical care. One who is physically or mentally disabled.
 Roles and Functions of the Nurse
 Caregiver

• This role has traditionally included those activities that assist the
client physically and psychologically while preserving the client’s
dignity.
Communicator
• Nurses communicate with the client, support persons, other
health professionals, and people in the community.
• In the role of communicator, nurses identify client problems
and then communicate these verbally or in writing to other
members of the health team.
  The quality of a nurse’s communication is an important factor in
nursing care.
• The nurse must be able to communicate clearly and accurately in
order for a client’s health care needs to be met.
Teacher
• As a teacher, the nurse helps clients learn about their health and
the health care procedures they need to perform to restore or
maintain their health.
• The nurses assesses the client’s learning needs and readiness to
learn, sets specific learning goals in conjunction with the client,
enacts teaching strategies, and measures learning.
  Nurses also teach unlicensed assistive personnel to whom they
delegate care and they share their expertise with other nurses and
health professional.
 Client Advocate
• A client advocate acts to protect the client.
• In this role, the nurse may represent the client’s needs and
wishes to other health professionals, such as relaying the client’s
wishes for information to the physician.
• They also assist the clients in exercising their rights and help
them speak up for themselves.
  Counselor

• Counseling is the process of helping a client to recognize and

cope with stressful psychologic or social problems, to develop
improved interpersonal relationships, and to promote personal
growth.
• It involves providing emotional, intellectual, and psychologic
support.
• The nurse counsels primarily healthy individuals with normal
adjustment difficulties and focuses on helping the person
develop new attitudes, feelings, and behaviors by encouraging
the client to look at the alternative behaviors, recognize the
choices, and develop self-control.
  Change Agent

• The nurse acts as a change agent when assisting clients to make

modifications in their own behavior.
• Nurses also often act to make changes in a system, such as
clinical care, if it is not helping a client return to health.
Leader

• A leader influences others to work together to accomplish a specific goal.

• Effective leadership is a learned process requiring an understanding of

the needs and goals that motivate people, the knowledge to apply the
leadership skills, and the interpersonal skills to influence others.
 Manager
• The nurse manages the nursing care of individuals, families, and
communities.
• The nurse manager also delegates nursing activities to ancillary
workers and other nurses, and supervises and evaluates their
performance.
• Managing requires knowledge about organizational structure
and dynamics, authority and accountability, leadership, change
theory, advocacy, delegation, and supervision and evaluation.
  Case Manager
• Nurse case manager work with multidisciplinary health care team
to measure the effectiveness of the case management plan and to
monitor outcomes.
• In some institutions, the case manager works with primary or
staff nurses to oversee the care of a specific caseload.
• In other agencies, the case manager is the primary nurse or
provides some level of direct care to the client and family.
• Regardless of the setting, case managers help ensure that care is
oriented to the client, while controlling costs.
  Research Consumer

• In a clinical area, nurses need to;

a.Have some awareness of the process and language of research
b.Be sensitive to issues related to protecting the rights of human
subjects
c. Participate in the identification of significant researchable
problems, and
d.Be a discriminating consumer of research findings.
 Selected Expanded Career Roles for Nurses

1. Nurse Practitioner – usually deal with nonemergency acute or chronic illness and
provide primary ambulatory care. A nurse who has completed either as certificate
program or a master’s degree in a specialty and is also certified by the appropriate
specialty organization. She is skilled at making nursing assessments, performing P.
E., counseling, teaching and treating minor and self- limiting illnes

2. Clinical Nurse Specialist – a nurse who has an advanced degree

or expertise and is considered to be an expert in a specialized area
of practice.
3. Nurse Anesthetist – a nurse who has completed advanced education in
an accredited program in anesthesiology, performs preoperative visits and
assessments, and administer general anesthetics for surgery under the
supervision of a physician.
4. Nurse Midwife – an RN who completed a program in midwifery, gives
prenatal and postnatal care and manages deliveries in normal pregnancies.
5. Nurse Researcher – investigates nursing problems to improve nursing
care and to refine and expand nursing knowledge.

6. Nurse Administrators – manages client care, including the delivery of

nursing service.
7. Nurse Educator – responsible for classroom and often clinical teaching.
8. Nurse Entrepreneur – manages health related business.
 CARPER’S 4 PATTERNS OF KNOWING IN NURSING

 represented the complex phenomenon of knowing that nurses use when

caring for patients
 represents personal conviction that there is a need to examine the kinds of
knowing that provides discipline
 Increase awareness of the complexity and diversity of knowledge to
nurses
1. Empirics
2. Esthetics
3. Ethical Knowing
4. Personal Knowing
 1. EMPIRICS

 Based on research and systematically organized

 factual, objective, and verified by outcome measures
 how we came to understand the science of nursing
and discipline used in the nursing practice
 “ the science of nursing”
 2. ESTHETICS

 “Art of nursing”
 Creative and imaginative use of nursing knowledge in
nursing practice
 Encompassess non-verbal expressions, therapeutic actions,
unconditional presence and empathy
 3. ETHICAL KNOWING
 Important to the discipline and practice of nursing
 Ethics in nursing is the moral component providing
guidance for choices
 Guides and direct nurses in doing what’s right, doing,
what’s ask of them and what a prudent nurse should do
 “ moral component of nursing”
 4. PERSONAL KNOWING
 Striving to know oneself and to actualize the authentic
relationship between the nurse and others that you are
caring for
 Sees patient as a heading toward attainment of potential
rather than viewing the individual as an object
 “ the self and other in nursing”
 Knowing self is vital in choosing a nursing theory to guide
day to day actions in nursing
 5. EMANCIPATORY (added by Chin and Kramer)

 capacity for man to be aware of the society, culture and

political situation of society and to critically reflect on
these issues
 “ praxis of nursing”

Reference: Parker, M., Smith, M. (2010). Nursing theories and

nursing practice (3rded.). Philadelphia, PA:
F.A. Davis Company
Socialization in Nursing
Fundamentals in Nursing Practice Lecture
socialization
 Defined simply as the process by which people
a. Learn to become members of the groups and
society and
b. Learn the social rules defining relationships
into which they will enter.
 Involves learning to behave, feel, and see the
world in a manner similar to other persons
occupying the same role as oneself (Hardy &
Conway, 1988, p.261)
 Benner's level of proficiency
 Describes five levels of proficiency in nursing based on the Dreyfus
general model of skill acquisition.
 The five stages, which have implications for teaching and learning are;
1. Novice
2. Advanced beginner
3. Competent
4. Proficient
5. Expert
Stage I: Novice
 No experience (e.g., nursing
students).
 Performance is limited, inflexible,
and governed by context-free rules
and regulations rather than
experience.
  Demonstrates marginally acceptable
performance.
Stage II: advanced
 Recognizes the meaningful "aspects"
beginner
of a real situation.
 Had some level of experience with the
situation, this experience may only be
observational in nature but the nurse
is able to identify meaningful aspects
of nursing care
Stage III: competent  Has 2 to 3 years of experience.
 Demonstrates organizational and
planning abilities.
 Differentiates important factors from
less important aspects of care
 Coordinates multiple complex care
demands.
Stage IV: proficient  Has 3 to 5 years of experience.
 Perceives situation as a whole rather
than in terms of parts, as in Stage II.
 Uses maxims as guides for what to
consider in a situation.
 Has holistic understanding of the client,
which improves decision making.
 Focuses on long-term goals.
  Diverse experience
Stage V: Expert  Performance is fluid, flexible, and
highly proficient; no longer requires
rules, guidelines, or maxims to connect
an understanding of the situation to
appropriate action.
 Demonstrates highly skilled intuitive
and analytic ability in new situations.
 Is inclined to take a certain action
because "it felt right".