6. Pedagogical aspects of Nurse in job with different Age categories

1. Nurse as health care provider

Nurses are on the front lines of the health care delivery team. They independently assess and monitor patients, and taking a holistic approach, determine what patients need to attain and preserve their health. Nurses then provide care and, if needed, alert other health care professionals to assist. Thus, nurses coordinate care delivery by physicians, nurse practitioners, social workers, physical therapists and others. Nurses assess whether care is successful. If not, they create a different plan of action.

Nursing: Nursing is the therapeutic relationship that enables the client to attain, maintain or regain optimal function by promoting the client’s health through assessing, providing care for and treating the client’s health conditions. This is achieved by supportive, preventive, therapeutic, palliative and rehabilitative means. The relationship with an individual client may be a direct practice role or it may be indirect, by means of management, education or research roles.

• One of the most important roles of the nurse is to be a patient advocate--to protect the interests of patients when the patients themselves cannot because of illness or inadequate health knowledge.

• Nurses are patient educators, responsible for explaining procedures and treatments. For instance, nurses teach patients and their families how to eat in a healthier way, take medicines, change wound dressings, and use health care equipment.

• Nurses empower patients, guiding them toward healthy behaviors and support them in time of need. When patients are able, nurses encourage and teach them how to care for themselves. Nurses provide physical care only when patients cannot do so for themselves.

• As patients near the end of their lives, nurses provide dignity in death by advocating for sufficient pain medication and the opportunity to die at home to allow them to spend meaningful time with family members in their final days.

• Hospital nurses are responsible for discharge planning, deciding together with other health professionals when patients can go home, and helping patients adapt to their conditions and work toward full recovery.

• Nurses, especially those working in community settings, work to prevent illness through education and community programs designed to decrease transmittable illnesses, violence, obesity and tobacco use, and provide maternal-child education--to prevent some of the leading health problems of our time.

Skills, knowledge, and abilities required and used by Registered Nurses and Nurse Practitioners include:

· Speaking - Talking to others to effectively convey information.

· Service Orientation - Actively looking for ways to help people.

· Social Perceptiveness - Being aware of others' reactions and understanding why they react the way they do.

· Reading Comprehension - Understanding written sentences and paragraphs in work related documents.

· Oral Comprehension - The ability to listen to and understand information and ideas presented through spoken words and sentences.

· Judgment and Decision Making - Weighing the relative costs and benefits of a potential action.

· Medicine and Dentistry - Knowledge of the information and techniques needed to diagnose and treat injuries, diseases, and deformities. This includes symptoms, treatment alternatives, drug properties and interactions, and preventive health care measures.

• · Biology - Knowledge of plant and animal living tissue, cells, organisms, and entities, including their functions, interdependencies, and interactions with each other and the environment.

• · Customer and Personal Service - Knowledge of principles and processes for providing customer and personal services including needs assessment techniques, quality service standards, alternative delivery systems, and customer satisfaction evaluation techniques.

• · Chemistry - Knowledge of the composition, structure, and properties of substances and of the chemical processes and transformations that they undergo. This includes uses of chemicals and their interactions, danger signs, production techniques, and disposal methods.

• · Problem Sensitivity - The ability to tell when something is wrong or is likely to go wrong. It does not involve solving the problem, only recognizing there is a problem.

• · Critical Thinking - Using logic and analysis to identify the strengths and weaknesses of different approaches.

Flexibility.Modularity.Economic efficiency.The new role of teacher.Specialized quality control of education.Use of specialized technology and training

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are the main characteristics of distance teaching

Nurses generally fall into several main groups, depending

on where they work: in hospitals, in private practice, in

private homes, etc.

Medical ethics is primarily a field of applied ethics, the study of moral values and judgments as they apply to medicine. As a scholarly discipline, medical ethics encompasses its practical application in clinical settings as well as work on its history, philosophy, theology, and sociology.

Medical ethics tends to be understood narrowly as an applied professional ethics, whereas bioethics appears to have worked more expansive concerns, touching upon the philosophy of science and the critique of biotechnology. Still, the two fields often overlap and the distinction is more a matter of style than professional consensus. Medical ethics shares many principles with other branches of healthcare ethics, such as nursing ethics.

There are various ethical guidelines. The Declaration of Helsinki is regarded as one of the most authoritative.

By the 18th and 19th centuries, medical ethics emerged as a more self-conscious discourse. For instance, authors such as the British Doctor Thomas Percival (1740-1804) of Manchester wrote about "medical jurisprudence" and reportedly coined the phrase "medical ethics." Percival's guidelines related to physician consultations have been criticized as being excessively protective of the home physician's reputation. Jeffrey Berlant is one such critic who considers Percival's codes of physician consultations as being an early example of the anti-competitive, "guild"-like nature of the physician community. In 1847, the American Medical Association adopted its first code of ethics, with this being based in large part upon Percival's work. While the secularized field borrowed largely from Catholic medical ethics, in the 20th century a distinctively liberal Protestant approach was articulated by thinkers such as Joseph Fletcher. In the 1960s and 1970s, building upon liberal theory and procedural justice, much of the discourse of medical ethics went through a dramatic shift and largely reconfigured itself into bioethics.

Since the 1970s, the growing influence of ethics in contemporary medicine can be seen in the increasing use of Institutional Review Boards to evaluate experiments on human subjects, the establishment of hospital ethics committees, the expansion of the role of clinician ethicists, and the integration of ethics into many medical school curricula.

Importance of communication

Many so-called "ethical conflicts" in medical ethics are traceable back to a lack of communication. Communication breakdowns between patients and their healthcare team, between family members, or between members of the medical community, can all lead to disagreements and strong feelings. These breakdowns should be remedied, and many apparently insurmountable "ethics" problems can be solved with open lines of communication.

Nursing ethics is a branch of applied ethics that concerns itself with activities in the field of nursing. Nursing ethics shares many principles with medical ethics, such as beneficence, non-maleficence and respect for autonomy. It can be distinguished by its emphasis on relationships, maintaining dignity and collaborative care.Development of subject

The nature of nursing means that nursing ethics tends to examine the ethics of caring rather than 'curing' by exploring the relationship between the nurse and the person in care. Early attempts to define ethics in nursing focused more on the virtues that would make a good nurse, rather than looking at what conduct is necessary to respect the human rights of the person in the nurse's care. However, in the modern era, the ethics of nursing has shifted more towards the nurse's obligation to respect these rights and this is reflected in a number of professional codes for nurses. For example, the importance of respecting human rights in nursing is made explicit in the latest code from the International Council of Nurses.

Distinctive nature

Although much of nursing ethics can often appear similar to medical ethics, there are some factors that differentiate it. The focus of nursing ethics is on developing a caring relationship and this produces some differences. For example, a well established principle of traditional medical ethics is beneficence. Whereas, traditional medical ethics allows this to be expressed through paternalism, this approach would not be compatible with nursing ethics. This is because nursing theory seeks a collaborative relationship with the person in care. Themes that emphasizes respect for the autonomy and maintaining the dignity of the patient by promoting choice and control over their environment are commonly seen. This is in contrast to paternalistic practice where the health professional chooses what is in the best interests of the person from a perspective of wishing to cure them.

The distinction can be examined from a different angle. Despite the move toward more deontological themes by some, there continues to be an interest in virtue ethics in nursing ethics and some support for an ethic of care. This is considered by its advocates to focus more on relationships than principles and therefore to reflect the caring relationship in nursing more accurately than other ethical views.

Nursing seeks to defend the dignity of those in their care. In terms of mainstream ethical theory, this may be interpreted as having a respect for autonomy. People are then enabled to make decisions about their own treatment. Amongst other things this grounds the practice of informed consent that should be respected by the nurse. Although much of the debate lies in the discussion of cases where people are unable to make choices about their own treatment due to being incapacitated or having a mental illness that affects their judgement. A way to maintain autonomy is for the person to write an advance directive, outlining how they wish to be treated in the event of them not being able to make an informed choice, thus avoiding unwarranted paternalism.

Another theme is confidentiality and this is an important principle in many nursing ethical codes. This is where information about the person is only shared with others after permission of the person, unless it is felt that the information must be shared to comply with a higher duty such as preserving life.

Also related to information giving is the debate relating to truth telling in interactions with the person in care. There is a balance between people having the information required to make an autonomous decision and, on the other hand, not being unnecessarily distressed by the truth. Generally the balance is in favour of truth telling due to respect for autonomy, but sometimes people will ask not to be told, or may lack the capacity to understand the implications.

By observing the principles above, the nurse can act in a way that maintains the dignity of the individual in their care. Although this key outcome in nursing practice is sometimes challenged by resource, policy or environmental constraints in the practice area.

Code of Ethics for Nurses

When nurses make professional judgments, their decisions are based on a reflection of consequences and on universal moral principles. A respect for individuals as unique persons is the most fundamental of these principles. Other principles deriving from this core principle are: doing good, avoiding harm, telling the truth, keeping promises, treating persons fairly, respecting privileged data, and self-determination.

A code of ethics states the primary goals and values of the profession. It indicates a profession's acceptance of the trust and responsibility with which it has been empowered by society. A code of ethics serves to inform both nurses and society of the profession's expectations and requirements in ethical matters. An ethical code provides a framework within which nurses can make ethical decisions and fulfill their responsibilities to the public, to other members of the health team, and to the profession.

The following Code of Ethics for Nurses was developed by the American Nurses Association (ANA). It is meant to serve as a guide throughout a nurse's professional practice.

ANA Code Of Ethics For Nurses*

1. The nurse, in all professional relationships, practices with compassion and respect for the inherent dignity, worth and uniqueness of every individual, unrestricted by considerations of social or economic status, personal attributes, or the nature of health problems.2. The nurse's primary commitment is to the patient, whether an individual, family, group, or community.3. The nurse promotes, advocates for, and strives to protect the health, safety, and rights of the patient.4. The nurse is responsible and accountable for individual nursing practice and determines the appropriate delegation of tasks consistent with the nurse's obligation to provide optimum patient care.5. The nurse owes the same duties to self as to others, including the responsibility to preserve integrity and safety, to maintain competence, and to continue personal and professional growth.6. The nurse participates in establishing, maintaining, and improving healthcare environments and conditions of employment conducive to the provision of quality health care and consistent with the values of the profession through individual and collective action.7. The nurse participates in the advancement of the profession through contributions to practice, education, administration, and knowledge development.8. The nurse collaborates with other health professionals and the public in promoting community, national, and international efforts to meet health needs.9. The profession of nursing, as represented by associations and their members, is responsible for articulating nursing values, for maintaining the integrity of the profession and its practice, and for shaping social policy.