These notes are prepared for Pakistani nurses and is allowed to everyone for copying .some notes are taken from ICN web site for actual references.(author)DEFINITION OF NURSING: The ICN Definition of Nursing • Nursing encompasses autonomous and collaborative care of individuals of all ages, families,

groups and communities, sick or well and in all settings. Nursing includes the promotion of health, prevention of illness, and the care of ill, disabled and dying people. Advocacy, promotion of a safe environment, research, participation in shaping health policy and in patient and health systems management, and education are also key nursing roles.

• Nursing is a profession in which the nurse applies skills and attitudes in the provision of comfort and care for the health needs of people. It is a dynamic, therapeutic and educative process by which the practitioner provides preventive, curative promotive and rehabilitative health services to individuals, families and communities.

• According to MS. Florence Nightingale (1860).“The act of utilizing the environment of the patient to assist him in his / her recovery”.

• MS. Virginia Henderson defines nursing in functional terms (1970).“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 a peaceful death) that he would perform unaided if he/she had the recovery strength, will or knowledge and to do this in such a way as to help him gain independence as rapidly as possible”.

• According to ANA, (1980)“Nursing is the diagnosis and treatment of human responses to actual and potential health problem.

In the 20th century there are many theoretical definition of nursing developed. The following are common facts to that entire nursing is: -

• Caring for and caring about people.• Has evolved from an unstructured method of caring for the ill through a scientific process,

moves from the mystical beliefs to a high tech, high touch era.• Art and science, using scientific knowledge in a human manner, critical thinking skills with

caring behaviors.• Requires balance of promoting client’s, independence and dependence,• Focuses not on illness but rather on the client’s response to illness.• Promotes health and helps clients move to a higher level of wellness.• Assisting a client with a terminal illness to maintain comfort and dignity in the final Stage of

life.Roles and responsibilities of the nurse.The nurse professional role has a wide variety of components. Some of those are following:

1. HEALTH EDUCATOR : Provide health education and information to client and families formally and Informally about health and illness and the ways to cope with illness and its consequences.

2. COMMUNICATOR: Establishing and maintain effective communication skills with clients, families, and significant others.Use communication as a tool for interpersonal & trust worthy relationship in such a way that are most helpful & supportive to the client & familyObtain information’s needed to provide optimum health care (through interview)A nurse evaluates effectiveness of one’s own communication with clients, colleagues, and others.

3. CARE PROVIDER: Use the nursing process to formulate and maintain individualized nursing care plans by assessing, planning, implementing, and evaluating.

4. MANAGER:

Assess and sets nursing care priorities.Provides clients care (With guidance) utilizing resources and nursing personnel according to their nursing and educational perpetration and experience.Plan and provide in-service education to develop nursing personal to skills in giving nursing care.

5. ADVOCATE Working to support clients and families and speaking up on issues such as safety and access to services.

6. COUNSELOR Plays a therapeutic role in helping to cope with problems and to identify resources.

7. ROLE AS A PROFESSIONAL:• Is accountable for his or her nursing practice.• Practice within the professional’s ethical and legal standards.• Assure responsibilities for self-development.• Participates in research.• Work within the policies of the employing institution.• Work as a change agent.

8. ETHICAL AND LEGAL RESPONSIBILITIES OF NURSES. 9. As a nurse it is important to have an understanding of : 10. How laws affect on nursing practice.11. Your abilities to practice safe nursing care.12. Your legal boundaries/ standards within which you must function.13. Responsibility to protect clients from harm.

THE LAWThis defines the minimum ethical standards in a given area of practice. For example, deceptive advertising is illegal and violators of this law are liable to large fines, to arrest and / loss of good will. TYPE OF LAWS: Nursing practices subject to:-1. Statutory laws. (Nurse Practice Act)2. Regulatory laws. ( PNC pass Rules & Regulation and administrator laws)3. Common laws. ( Informed Consent, Clients Rights To Refuse treatment) 4. Criminal laws. (On Server Offense Imprisonment or Death)5. Civil laws. (Protect Individual)

STATUTORY LAWStatutory law is enacted by the legislative branch of Government. Nurses are examples of

statutory Law, which are designed to protect the public from in-competent practitioners.COMMON LAW

Each state has its own body of common law related to the delivery of health care within that state. These laws should be reviewed by health professional as a basic for accountability, quality and management within their professional practice. This law assets nurses to work within the boundaries of their role and to advocate for nursing practice when necessary.ADMINISTRATIVE LAW

Administrative law is made by administrative agencies. According to certain statuses, administrative agencies are granted authorities to enact rules and regulations that ill c.: out specific interaction to the statute.CLIENT, S RIGHTS

Clients are protected by law (invasion of privacy) against unauthorized release of personal clinical data, such as symptoms, diagnoses, and treatments. Nurses, as well as other health care personnel, may be held personally liable for invasion of privacy, should litigation arise from the unauthorized release of client data. Confidential information, however, may be released with the client’s consent. Information release is mandatory when ordered by a court or when state statutes require reporting child abuse, communicable diseases, or other incidents. Nurses have a legal and

ethical responsibility to become familiar with their employer’s policies and procedures regarding protection of clients’ information.

Medical records are the key written account of such client information as signs and symptoms, diagnosis, treatment, and responses to treatment. Not only do these records document care given to clients, but they also provide effective means of communication among health care personnel. These records contain important data for insurance and other expense claims and are used in court in the event of litigation.

Health professionals are becoming more aware of the implications of clients’ rights as society in general becomes more aware of every human being’s basic rights. Although there are still gaps in the legal process, many states are beginning to grapple with the status of laws applicable to clients who are hospitalized. It is essential that nurses be aware of the particular state’s laws and statutes affecting clients and themselves. Nurses as well as physicians are accountable for their actions, and the threat of civil and criminal prosecution is becoming more prevalent.The Client Bill of Rights:1. The client has the right to considerate and respectful care.2. The client has the right to obtain from his or her physician complete current information

concerning diagnosis, treatment, and prognosis in terms the client can be reasonably expected to understand.

3. The client has the right to receive from the physician information necessary to give informed consent prior to the start of any procedure or treatment. . . . Where medically significant alternatives for care or treatment exist, or when the client requests information concerning medical alternatives, the client has the right to such information to know the name of the person responsible for the procedures or treatment.

4. The client has the right to refuse treatment to the extent permitted by law and to be informed of the medical consequences of his or her action.

5. The client has the right to every consideration of privacy concerning his or her own medical care program.

6. The client has the right to expect that all communications and records pertaining to his or her care should be treated as confidential.

7. The client has the right to expect that within its capacity a hospital must make reasonable response to the request of a client for services.

8. The client has the right to obtain information as to any relationship of the hospital to other health care and educational institutions in so far as his or her care is concerned [ any professional relationships among individuals, by name, who are treating him or her.

9. The client has the right to be advised if the hospital proposes to engage in or perform human experimentation affecting his or her care or treatment. A patient has the right to refuse to participate.

10. The client has the right to expect reasonable continuity of care.11. The client has the right to examine and receive an explanation of his or her bill regard less of

source of payment.12. The client has the right to know what hospital rules and regulations apply to his or her con duct

as a client.NEGLIGENCE:

The doctrine of negligence rests on the duty of every person to exercise due care in his/her conduct toward others from which injury may result. To find liability there must be a duty of care on the part of the nurse and a causal relationship between damage or harm to the client as well as an act or an omission to act by the nurse.Gross negligence is the intentional failure to per form a duty in reckless disregard of the consequences affecting the client. It is viewed as a gross lack of care to such a level as to be considered willful and wanton.

Criminal negligence also consists of a duty on the part of the nurse and an act that is the proximate cause of the injury or death of a client. This type of negligence is usually defined by statute and as such is punishable as a crime. The act being punished would be a flagrant and reckless disregard of the safety of others and/or a willful disregard to the injury liable to follow so

as to convert the act into a crime when it results in personal injury or death. One is not “negligent” unless he/she fails to exercise the degree of reasonable care that would be exercised by a person of ordinary prudence under all the existing circumstances in view of probable danger of injury.Malpractice:

Malpractice is any professional misconduct that is an unreasonable lack of skill or fidelity in professional duties. In a more specific sense it means bad, wrong, or injurious treatment of a client resulting in injury, unnecessary suffering, or death to a client proceeding from ignorance, carelessness, lack of professional skill, disregard of established rules, protocols, principles or procedures, neglect, or a malicious or criminal intent. COMMON SOURCES OF NEGLIGENCE:You should be aware of the common negligent acts that have resulted in lawsuits against hospital and nurses: -1. Medication error that result in injury to clients.2. Intravenous therapy errors resulting in infiltration or phlebitis.3. Burns to clients caused by equipment, bathing, or spills of hot liquids and foods.4. Falls resulting in injury to clients.5. Failure to use aseptic techniques where required.6. Error in sponge, instrument, or needle counts in surgical cases.7. Failure to give a report, or giving an incomplete report, to an oncoming shift.8. Failure to adequately monitor a client condition.9. Failure to notify a physician of a significant change in a clients status.STANDARDS OF CARE:• Nursing standard of care are the legal guidelines for safe nursing practice.• The nursing practice acts of each state/country (PNC) define the scope of nursing practice &

expanding nursing roles in specific areas, set educational requirements for nurses.• Distinguish b/w nursing practice and medical practice. LICENSURE:• To practice nursing, the nurse must be licensed by the board/ council of nursing of the state/

country in which she /he practice.• Nursing license can be suspended or revoked by the board/council if nurses’ conduct violates

provision of the licensing statute.STUDENTS NURSES:Student nurses are responsible for all of their actions that cause harm to clients.If the client is injured as a direct result of her actions, the liability for the incorrect action may be shared by.• student• Instructor• Head Nurse• Staff Nurse • Hospital or Health care facility

BECAUSE Nursing teachers and head nurses are responsible for instructing observing their students and staff nurses work with them. As a student nurse they should never be assigned to perform tasks for which they are unprepared.PHYSICIAN PRESCRIPTION: • The physician is responsible for directing the medical treatment and nurses are responsible for

carrying out that medical treatment.• Therefore nurse must assess all physician prescriptions and if she determine them to be

erroneous or harmful , she should obtain further clarification from the physician if the physician confirm the prescription but she still believe that it is inappropriate inform the medical house officer or your Supervisor .

• If there is risk for client she should not carry out the physician orders.• If she carry out the questionable prescription she may be legally responsible for harm

suffered by the client.• Prescription should be in writing and dated and timed appropriately.

• Verbal or telephone prescriptions are not recommended because they have possibility of errors.• In case of emergency, it should be written and signed by the physician as soon as possible

usually within 24 hours. NURSING BODIES The International Council of Nurses

The International Council of Nurses is a federation of National Nurses’ Associations (NNAs), representing nurses in more than 128 countries. Founded in 1899, ICN is the world’s first and widest reaching international organisation for health professionals.  Operated by nurses for nurses, ICN works to ensure quality nursing care for all, sound health policies globally, the advancement of nursing knowledge, and the presence worldwide of a respected nursing profession and a competent and satisfied nursing workforce. ICN Goals and Values Three goals and five core values guide and motivate all ICN activities. The three goals are: •    To bring nursing together worldwide; •    to advance nurses and nursing worldwide; •    to influence health policy. The five core values are: •    Visionary Leadership•    Inclusiveness•    Flexibility•    Partnership•    Achievement.

The ICN Code of Ethics for Nurses, most recently revised in 2006, is a guide for action based on social values and needs. The Code has served as the standard for nurses worldwide since it was first adopted in 1953. The Code is regularly reviewed and revised in response to the realities of nursing and health care in a changing society.The Code makes it clear that inherent in nursing is respect for human rights, including the right to life, to dignity and to be treated with respect. The ICN Code of Ethics guides nurses in everyday choices and it supports their refusal to participate in activities that conflict with caring and healing.

ICN's Mission: To represent nursing worldwide, advancing the profession

and influencing health policy.The ICN Code for Nurses is the foundation for ethical nursing practice throughout the world. ICN standards, guidelines and policies for nursing practice, education, management, research and socio-economic welfare are accepted globally as the basis of nursing policy. ICN advances nursing, nurses and health through its policies, partnerships, advocacy, leadership development, networks, congresses, special projects, and by its work in the arenas of professional practice, regulation and socio-economic welfare. ICN is particularly active in:Professional Nursing Practice

International classification for nursing practice - ICNP® Advanced nursing practice Entrepreneurship HIV/AIDS, TB and malaria Women’s health Primary health care Family health Safe water

Nursing Regulation Regulation and Credentialing Code of ethics, standards and competencies Continuing education

Socio-economic Welfare for Nurses  Occupational health and safety

Human resources planning and policy Remuneration Career development International trade in professional services The ICN Definition of Nursing

Nursing encompasses autonomous and collaborative care of individuals of all ages, families, groups and communities, sick or well and in all settings. Nursing includes the promotion of health, prevention of illness, and the care of ill, disabled and dying people. Advocacy, promotion of a safe environment, research, participation in shaping health policy and in patient and health systems management, and education are also key nursing roles.

THE ICN CODE OF ETHICS FOR NURSESAn international code of ethics for nurses was first adopted by the International Council of Nurses (ICN) in 1953. It has been revised and reaffirmed at various times since, most recently with this review and revision completed in 2005.

PREAMBLENurses have four fundamental responsibilities: to promote health, to prevent illness, to restore health and to alleviate suffering. The need for nursing is universal.Inherent in nursing is respect for human rights, including cultural rights, the right to life and choice, to dignity and to be treated with respect. Nursing care is respectful of and unrestricted by considerations of age, colour, creed, culture, disability or illness, gender, sexual orientation, nationality, politics, race or social status. Nurses render health services to the individual, the family and the community and co-ordinate their services with those of related groups.THE ICN CODEThe ICN Code of Ethics for Nurses has four principal elements that outline the standards of ethical conduct.ELEMENTS OF THE CODE1. NURSES AND PEOPLE• The nurse’s primary professional responsibility is to people requiring nursing care.• In providing care, the nurse promotes an environment in which the human rights, values,

customs and spiritual beliefs of the individual, family and community are respected.• The nurse ensures that the individual receives sufficient information on which to base consent

for care and related treatment.• The nurse holds in confidence personal information and uses judgment in sharing this

information.• The nurse shares with society the responsibility for initiating and supporting action to meet the

health and social needs of the public, in particular those of vulnerable populations.• The nurse also shares responsibility to sustain and protect the natural environment from

depletion, pollution, degradation and destruction.2. NURSES AND PRACTICE• The nurse carries personal responsibility and accountability for nursing practice, and for

maintaining competence by continual learning.• The nurse maintains a standard of personal health such that the ability to provide care is not

compromised.• The nurse uses judgement regarding individual competence when accepting and delegating

responsibility. • The nurse at all times maintains standards of personal conduct which reflect well on the

profession and enhance public confidence.• The nurse, in providing care, ensures that use of technology and scientific advances are

compatible with the safety, dignity and rights of people.3. NURSES AND THE PROFESSION• The nurse assumes the major role in determining and implementing acceptable standards of

clinical nursing practice, management, research and education.• The nurse is active in developing a core of research-based professional knowledge.

• The nurse, acting through the professional organisation, participates in creating and maintaining safe, equitable social and economic working conditions in nursing.

4. NURSES AND CO-WORKERS• The nurse sustains a co-operative relationship with co-workers in nursing and other fields.• The nurse takes appropriate action to safeguard individuals, families and communities when

their health is endangered by a coworker or any other person.SUGGESTIONS FOR USE OF THE ICN CODE OF ETHICS FOR NURSES• The ICN Code of Ethics for Nurses is a guide for action based on social values and needs. It

will have meaning only as a living document if applied to the realities of nursing and health care in a changing society.

• To achieve its purpose the Code must be understood, internalized and used by nurses in all aspects of their work. It must be available to students and nurses throughout their study and work lives.

APPLYING THE ELEMENTS OF THE ICN CODE OF ETHICS FOR NURSESThe four elements of the ICN Code of Ethics for Nurses: nurses and people, nurses and practice, nurses and the profession, and nurses and co-workers, give a framework for the standards of conduct. The following chart will assist nurses to translate the standards into action. Nurses and nursing students can therefore:o Study the standards under each element of the Code.o Reflect on what each standard means to you. Think about how you can apply ethics in your

nursing domain: practice, education, research or management.o Discuss the Code with co-workers and others.o Use a specific example from experience to identify ethical dilemmas and standards of conduct

as outlined in the Code. Identify how you would resolve the dilemmas.o Work in groups to clarify ethical decision making and reach a consensus on standards of ethical

conduct.o Collaborate with your national nurses’ association, co-workers, and others in the continuous

application of ethical standards in nursing practice, education, management and research.

Element of the Code # 1: NURSES AND PEOPLE

Practitioners andManagers

Educators andResearchers

National Nurses’Associations

Provide care that respects human rights and is sensitive to the values, customs and beliefs of all people.

In curriculum include references to human rights, equity, justice, solidarity as the basis for access to care.

Develop position statements and guidelines that support human rights and ethical standards.

Provide continuing education in ethical issues.

Provide teaching and learning opportunities for ethical issues and decision making.

Lobby for involvement of nurses in ethics review committees.

Provide sufficient information to permit informed consent and the right to choose or refuse treatment.

Provide teaching/learning opportunities related to informed consent.

Provide guidelines, position statements and continuing education related to informed consent.

Use recording and information Management systems that ensure Confidentiality

Introduce into curriculum concepts of privacy and confidentiality.

Incorporate issues of confidentiality and privacy into a national code of ethics for nurses.

Develop and monitor environmental safety in the workplace.

Sensitize students to the importance of social action in current concerns.

Advocate for safe and healthy environment.

Element of the Code # 2: NURSES AND PRACTICE

Practitioners andManagers

Educators andResearchers

National Nurses’Associations

Establish standards of care and a work setting that promotes safety and quality care.

Provide teaching/learning opportunities that foster life long learning and competence for practice.

Provide access to continuingeducation, through journals, conferences, distance education, etc.

Establish systems for professional appraisal, continuing education and systematic renewal of licensure to practice.

Conduct and disseminate research that shows links between continual learning and competence to practice.

Lobby to ensure continuing education opportunities and quality care standards.

Monitor and promote the personal health of nursing staff in relation to their competence for practice.

Promote the importance of personal health and illustrate its relation to other values.

Promote healthy lifestyles for nursing professionals. Lobbyfor healthy work places and services for nurses.

Element of the Code # 3: NURSES AND THE PROFESSION

Practitioners andManagers

Educators andResearchers

National Nurses’Associations

Set standards for nursing practice, research, education and management.

Provide teaching/learning opportunities in setting standards for nursing practice, research, education and management.

Collaborate with others to set standards for nursing education, practice, research and management.

Foster workplace support of the conduct, dissemination and utilisation of research related to nursing and health.

Conduct, disseminate and utilize research to advance the nursing profession.

Develop position statements, guidelines and standards related to nursing research.

Promote participation in national nurses’ associations so as to create favourable socio-economic conditions for nurses.

Sensitise learners to the importance of professional nursing associations.

Lobby for fair social and economic working conditions in nursing. Develop position statements and guidelines in workplace issues.

Element of the Code #4: NURSES AND CO-WORKERSPractitioners and

ManagersEducators and

ResearchersNational Nurses’

AssociationsCreate awareness of specific and overlapping functions and the potential for interdisciplinary tensions.

Develop understanding of the roles of other workers.

Stimulate co-operation with other related disciplines.

Develop workplace systems that support common professional ethical values and behaviour.

Communicate nursing ethics to other professions.

Develop awareness of ethical issues of other professions.

Develop mechanisms to safeguard the individual, family or community when their care is endangered by health care personnel.

Instill in learners the need to safeguard the individual, family or community when care is endangered by health care

Provide guidelines, position statements and discussionfora related to safeguarding people when their care is endangered by health care

personnel. personnel.

DISSEMINATION OF THE ICN CODE OF ETHICS FOR NURSESTo be effective the ICN Code of Ethics for Nurses must be familiar to nurses. We encourage you to help with its dissemination to schools of nursing, practising nurses, the nursing press and other mass media. The Code should also be disseminated to other health professions, the general public, consumer and policy-making groups, human rights organisations and employers of nurses.

GLOSSARY OF TERMS USED IN THE ICN CODE OF ETHICS FOR NURSESCo-worker: Other nurses and other health and non-health related workers and professionals.Co-operative: A professional relationship based on collegial relationship and reciprocal actions, and behaviour that aim to achieve certain goals.Family: A social unit composed of members connected through blood, kinship, emotional or legal relationships.Nurse shares: A nurse, as a health professional and a citizen, with society initiates and supports appropriate action to meet the health and social needs of the public.Personal health: Mental, physical, social and spiritual wellbeing of the nurse.Personal: Information obtained during professional information contact that is private to an individual or family, and which, when disclosed, may violate the right to privacy, cause inconvenience, embarrassment, or harm to the individual or family.Related groups: Other nurses, health care workers or other professionals providing service to an individual, family or community and working toward desired goals.

PAKISTAN NURSING COUNCILWHAT IS THE PAKISTAN NURSING COUNCIL (PNC)?The PNC is an autonomous, regulatory body constituted under the Pakistan Nursing Council Act (1952, 1973), and empowered to register (license) Nurses, Midwives, Lady Health Visitors (LHVs) and Nursing Auxiliaries to practice in Pakistan PNC was established in 1948. WHAT ARE THE FUNCTIONS OF THE PNC? • PNC sets the curriculum for the education of nurses, Midwives, LHVs and Nursing Auxiliaries.• PNC inspects educational institutions for approval based on established standards• PNC provides registration (license) to practice • PNC maintains standards of education and practice • PNC works closely with the four Provincial Nursing Examination Boards (NEBs)• PNC plays an advisory role for the overall benefit of Nurses, Midwives, LHVs and Nursing

Auxiliaries in the country.• PNC maintains an advisory role for the Federal and Provincial Governments regarding nursing

education and nursing services.• PNC communicates policy decisions regarding nursing education and the welfare of nurses,

taken in council meetings, to Governments, Nursing Institutions, NEBs and Armed Forces Nursing Services for implementation.

• PNC prescribes penalties for fraudulent registration by intention or pretense, and removes persons from the Register for professional misconduct.

HOW IS THE PNC ORGANIZED? • The PNC consists of the President, Vice President, Registrar and Members. • The President has traditionally been, by election, the D. G. Health.• The Vice-President is Mrs. Faiz Alam Zeb, Principal College of Nursing Peshawar.• Mrs. Nighat Ijaz Durrani is the Registrar. WHO ARE THE COUNCIL MEMBERS? • The PNC consists of Ex-Officio, Regular and Co-opted Members and Observers. EX-OFFICIO MEMBERS: • Director General Health.• Provincial Secretaries of Health.• Nursing Advisor. • Director, Armed Forces Nursing Services.

• Four Chief Nurses of the Provinces. REGULAR MEMBERS: • Four Senior Nurses, one from each Province. • Four Nurse-cum-Midwives, one from each Province.• One Member from Pakistan Medical and Dental Council.• Three elected Members from the Pakistan Nurses’ Federation.• Two Members from the National Assembly. • Four Lady Members, one from each Provincial Assembly. • Four Health Visitors, one from each Province. • One experienced educationist nominated by the Federal Government Ministry of Education. Co-opted Member: • One Faculty from the School of Nursing, Faculty of Health Sciences, Aga Khan University. OBSERVERS:• Controllers from the Provincial Nursing Examination Boards• Two observers from each Province. WHEN ARE THE PNC MEETINGS? • The PNC meetings take place twice a year, usually in May and November. HOW IS THE PNC FINANCED? • The PNC is financed through registration fees from Nurses, Midwives, LHVs and Nursing

Auxiliaries, and affiliation fees from the PNC. The PNC also receives a grant-in-aid from the Federal Government.

WHERE IS THE PNC OFFICE? • The PNC office is in the National Institute of Health in Islamabad. • WHO WORKS IN THE PNC OFFICE? • The Registrar and clerical staff work in the PNC office, Saturdays to Thursdays, from 08:30 to

14-:30 hs. WHAT IS THE FUNCTION OF THE PNC MEETINGS?• All of the functions of the PNC listed earlier in this brochure are carried out through the PNC

office. WHAT ARE THE RECENT ACTIVITIES OF THE PNC? The PNC has been involved in the: • Revision of the Pakistan Nursing Council Act (1973)• Organization of the archives in the PNC Office. • Computerization of the PNC Registration System. • Formation of an academic Council to review new curricula. • Preparation of a new career structure for Nurses, Midwives, LHVs and Nursing Auxiliaries, and

its submission to the Federal Government. • Conduction of Regulation of Nursing Workshops in each Province.PAKISTAN NURSES FEDERAT ION: (PNF) • Is an independent non-governmental professional association of nursing in Pakistan. • The PNF was registered on July 6, 1972, by the Assistant Registrar, Joint Stock Companies,

Lahore Region, under Societies Act 1860, as successor to the Trained Nurses Association of Pakistan, which was founded and duly registered in 1949.

THE FUNCTIONS OF THE PNF ARE

o To work for the welfare and betterment of nurses, midwives and health visitors in Pakistan and AJK.

o To pursue and enter into negotiations with concerned Government regarding matters pertaining to the welfare of nurses.

o To advance high ethical and professional standards among nurses. o To bring professional knowledge and skills to the service and care of the sick. • To improve nursing practice through in-service education. • To publish a journal providing updated information in nursing.

• To endeavor to furnish legal aid to members, within the financial means of the PNF, when needed by them for the protection of their professional rights.

ORGANIZATION OF PNF • PNF consists of Branches in various cities and/or districts who report to their Provincial Nurses

Associations (PNA) in each Province and AJK. The PNAs, in turn, communicate directly with the national body, PNF.

THE FOLLOWING ARE PNF STANDING COMMITTEESBRANCH LEVEL (CITY/DISTRICT) • Nursing Education and Nursing Services • Public Health Nurses, Lady Health Visitors and Midwives. • Professional Programme • Membership • PNA level (provincial) PNA LEVEL (PROVINCIAL)• Nursing Education • Nursing Services • Public Health Nursing • Student Nurses PNF LEVEL (NATIONAL) • Same Standing Committees as at the PNA level.

1. The membership and functions of these various Standing Committees are detailed in the PNF Constitution and bylaws.

YOUR MEMBERSHIP FEES

Fees are received at the Branch level. The Branch retains 25% of this fee for local activities, and forward 75% to the respective Provincial Nurses Association (PNA). The PNA retains 25% for its programmes, and send 50% to the national body, the PNF.  

From the fees received by PNF, memberships in the International Council of Nurses (ICN and the Commonwealth Nurses Federation (CNF) are maintained. The remainders of fees are used by PNF for their national activities.  

Financial support for PNF comes entirely from membership fees. Therefore, to strengthen PNF, increase of membership and timely renewal of memberships is vital.

TO BECOME A MEMBER OF PNF,Contact your Branch or your PNA:o Mrs. Talat Shah, principal school of Nursing layari general hospital,KARACHI.

ETHICSEthics from the A Greek “ethicos” meaning “theory of living” is one of the major branches

of philosophy, which attempts to understand the nature of mortality; to distinguish that which is right from that which is wrong.

Ethics is the systemic study of what a person’s conduct and actions to himself or her self, other human beings ,the environment, or good and the bad of what a person’s life and relationship ought to be ,not necessary what they are.

Ethics is a science that deals with the principles of right and wrong, good and bad. it governs our relation ship with others. Ethics are based on personal beliefs and values that guide the decision-making process.

Ethics in plain words means studying and analyzing right from wrong; good from bad,ETHICAL DILEMMASEthical dilemmas can be defined as situations in which one must choose between two or more undesirable alternatives. Curtin (1982) maintains that for a problem to be an ethical dilemma, it must have three characteristics. First, the problem cannot be solved using only empirical data.

Second, the problem must be so perplexing that deciding hat facts and data need to be used in making the decision difficult; third, the results of the problem must defect more than the immediate situation.Remember that the way manager approach and solve ethical dilemmas is influenced by their values and basic believes about the rights, duties, and goals of all human beings. The self awareness fosters self-initiation, self correction, self-evaluation, and this self-evaluation should be based on one’s values and virtues — what terms virtue- ethics. This type of self awareness will be necessary to create nursing leadership needed to survive the future.PRINCIPALS OF ETHICAL REASONINGThe theorists have developed a group of moral principals that are used for ethical reasoning. The most fundamental universal principal is respect for people.AUTONOMY (self-determination):A form of personal liberty, autonomy also is called freedom of choice of accepting the responsibility for one’s choice. The legal right of self determination supports this moral principal. The use of progressive discipline recognizes the autonomy of the employee. The employee, in essence, has’ the, choice to meet organizational expectations or to be disciplined further.Shaw and Rer (2001) maintain that autonomy has become one of the most important ethical principal to be protected in health care decision making.BENEFICIENCE (doing good)The principal actions states that the actions one takes should be done in an effort to promote good. The concept of non-malificence, which is associates with beneficence, says that if one cannot do well, then one should at least do no harm.PATERNALISM:This principal is related to beneficence in that one person assume the authority to make a decision for another, because paternalism limits freedom of choice, most ethical theorists believe paternalism is justify only to prevent a per3on from coming to harm.UTILITY:This principal reflects a belief in utilitarianism — what is best for the common good outweighs what is best for the individual, Utility justifies the paternalism as a means of restricting individual freedom. Managers who use the principals of utility need to be careful not to become so focused on production that they become less humanistic.JUSTICE (treating people fairly):This principal states that equals should be treated equally and un should be treated according to their diff’ This principal is frequently applied when ‘ ar scarcities or competition for resources or benefits.TRUTH TELLING (veracity):This principal is used to explain how people feel about the need for truth telling or the acceptability of deception.FIDELITY (keeping promises):Breaking a promise is believed by many ethicists to be wrong regardless of the consequences. In other words, even if there were no far-reaching negative results of the broken promise, it is still wrong because it would render the making of any promise meaning less.CONFIDENTIALITY (respecting privileged information):The obligation to observe the privacy of another and to hold certain information in strict confidence is the basic ethical principal and is a foundation of both medical and nursing ethics.

FLORENCE NIGH1INGALE:Florence Nightingale, the heroine of the Crimean war, the reformer of the administration in

military hospitals and public hygiene, was the founder of modern professional nursing. She was the most important writer in the field of nursing and health. She was born on May 12, 1820, in Florence, Italy. She was a progressive leader of the feminist movement, whose intelligent mind was, far in advance of her time, and whose warm motherly heart enabled her to dedicate herself to her profession with the greatest devotion.

Every nurse must, therefore, know the life history of Florence Nightingale and take inspiration from her biography to work in the nursing profession in the most dedicated manner.

Florence Nightingale belonged to a renowned British Family. She was the second daughter of William Edward Nightingale and Frances Smith. Florence was educated more than an average English girl. Her father taught her Greek, Latin, German, Italian History, Philosophy and Mathematics She was also interested in Political Science and Languages. Through out her life, she read widely in many languages.

From childhood, Florence showed interest in nursing, She visited the sicker neighborhood and helped them. Florence who knew the humanitarian aspect of service in nursing spent a number of years studying the hospitals in England, Scotland, Ireland, France and Belgium before she went for training to the institute for Dacconnesses at Kaiserworth in Germany With reference to the value of professional training, She wrote “I should like to advise all young ladies to feel the call to come-to join this definite profession, train yourselves for it in the way, man trains for his work. Do not believe that you can not learn to understand it in any other way.

Crimean war broke out in 1854. At that time, England had only untrained men to look after soldiers. She offered her services to the Minister of War, Sir Sidney Herbert. With his help, she collected 38 nurses from different orders and went to help at Scutari. She worked in the Barracks Hospital. The hospital was dirty, crowded and poorly ventilated. There was no clothing or other hospital equipment. The quality of food was poor. 42% of patients used to die due to infections and poor sanitary conditions. As an excellent commander, Florence Nightingale accepted the responsibility of nursing the soldiers. For emergencies, she used her own money. Her nurses worked under strict discipline with doctors and improved the hygienic and dietary conditions of the soldiers. She employed soldiers’ wives to help the nurses. She visited the soldiers with a lighted lamp during night shifts, so she was known as the Lady with the Lamp.In 1855, she contacted Crimean fever. After her recovery in 1856, peace was declared and hospitals at Scutari were closed. She returned to England.

Born with a silver spoon in her mouth, Florence Nightingale was known to the wounded soldiers as the “Lady with the Lamp” at over the world. Her life was meant to alleviate pain and give relief to the suffering humanity when other young women of her age were absorbed in the gaiety of social life. She undertook the task of and developed it. Nurses all over the world rightly conemmerate her birthday as “International Nurses’ Day. The work of Florence Nightingale during the Crimean war was admirable. She reformed the army medical services. Her dedicated work in the profession brought about a revolution in the whole nursing system. She attracted the most intelligent and scrupulous women to join the profession.Florence Nightingale died on August 13th 1910. Her life is a guiding beacon to all the nurses. Let us have her everlasting spirit and selfless dedication in our nursing profession She improved the heath facilities of the soldiers with the help of Sir Sydney Herbert in England. In 1859 she wrote notes on nursing. The Nightingale school, at the St. Thomas Hospital, England, was started in June 1860. Nursing became a career for women. The nurses, graduates from the Nightingale school, went all over the world and started nursing schools. Graduates of this school became the early pioneers in nursing education.INTERNATIONAL HEALTH AGENCIESWorld health organization (WHO)o WHO is one of the specialized health agencies of the United Nation?o It is established in 1948 A.D. o It has present 187 members of state (nation)o Its head quarters are in Geneva and Switzerland.o WHO day celebrate every year on 7th April. o WHO has six regional offices which are?

• America • Africa• Europe• South East Asia• Western pacific • Eastern Mediterranean

Functions

• To established and maintain in effective collaboration with the United Nations, specialized agencies, governmental health administrations, and professional groups, and other organizations.

• To assist the governments in strengthening the health cervices.• Provide health services and facilities to special groups such as trust territories.• To stimulate and advance work to eradicate epidemic, endemic and other diseases• To promote maternal and child health services• To promote improve standards of teaching and health training.• To provide information, counsel and assistance in the field of health. • To promote international standards of food, biological, pharmaceutical productsActivities • Fellowships, training courses and seminar.• Advisory and operational cervices• Equipment supplies• Control of communicable diseases• Education and training education, professional educations• Co-ordination of medical research• Development of public health cervicesUNITED NATION OF INTERNATIONAL CHILDERN EMERGENCY FUND (UNICEF)• UNICEF is one of the specialized agencies of the United Nations.• It was established in 1946.• Its head quarters in New York.• At present 105 countries are its members.• In 1953 UNICEF had given permanent status in U.N.O• Financial budget of UNICEF depend on the voluntary contribution of the country.• Recently UNICEF encourages strategies for child health as GOBI + 3Fs, in which letter stand

for:G = growth chart to monitor child development from birth to 6 yearsO = oral rehydration B = breast feedingI = immunizationF = female literacyF= family planningF = food

FUNCTIONS• UNICEF provides services for following:• Maternal and Child health • Primary health care• Immunization• Rural water supply and sanitations• Child nutrition• Communicable control disease measure• Village level technology (low cost based technology)• Formal and non- formal educations (training program)• Social welfare services for children • Emergency relief and rehabilitation (immediate post disaster period)World food program (WFP)• WFP is specialized agency of UNO• The aim of WFP is not the food distribution as charity but its aim is as package of health

facility to reduce the high incidence of malnutrition among the children, pregnant mother and nursing mothers.

• One aim WFP is to encourage mothers and children to attend the facilities for the:1. Pre and postnatal care 2. Immunization3. Family planning

4. Oral rehydration therapy5. Nutritional educations

• In 1975 the government of Pakistan was requested to WFP authority for providing the package of the health facilities to reduce high incidence of malnutrition among the pre- school, children, pregnant and nursing mothers.

Function of WFPWFP provide services for:

• Immunizations• Family planning• Oral rehydration therapy • Nutritional educations

Line of authority WFP1. Project director of UNO2. Deputy project director of Pakistan (Islamabad)3. Secretary health of each province of Pakistan4. Director General Health5. Divisional director health6. DHO / MS7. ADHO/ AMS 8. WMO / LHV

FOOD AND AGRICULTURE ORGNIZATION (FAO)FAO is one of the specialized agencies of the United Nations formally formed in 1945 with the head quarter in Rome.Functions • To help nation raise their living standards• To improve nutrition level of people of all countries• To improve production and distributions of all food and agricultural products • To improve the condition of rural populationsRed Cross Red Cross is non- political, non- official international humanitarian voluntary originations devoted to services for mankind in peace and war. It was founded by Henry Dunant when traveling through North Italy in 1959 and saw thousand of wounded neglected and dying soldiers in the battle of Solferino.Red Cross provides humanitarian services to victims of wars, natural disasters, i.e. floods, earthquake, services to armed forces, first aid and home nursing, health education, maternal and child welfare services.

Pre-Partition Status of NursingEven through the history of Nursing in Pakistan existed long ago in ancient times. Its

immediate history can be traced from the British rule in India, prior to independence when Pakistan was part of India. During that time, admissions to nursing were exclusively reserved for Anglo-Indian and European girls and thus both Hindu and Muslims were prevented from enrolling in Nursing Programs.

A primary reason for this policy was prohibition by their own culture. The first Indian student was not admitted to the nursing training school until 1934, fifty years after the training program was started.. During the period from1943-46 a study was conducted to examine the reasons for lack of interest in nursing by the girls from educated families. The reason identified in the study was that families did not want to their daughters to enter the profession because of low pay scales, poor hygienic conditions, and absence of recreational and cultural conditions and lack of pensions.. In 1860, training for midwives was initiated by the Government of Indian Subcontinent, gradually British Nursing Sisters were posted to different Civil Hospitals and the first Nursing School in West Pakistan opened at Mayo Hospital, Lahore in 1884. Thus nursing has undergone many changes in every area through out its history.

These hospitals remained understaffed and the status of the profession continued to be low. However, in spite of the above conditions, those Indian or Muslims girls who refused entry by the matrons because they came from low socio-economic and purdah observing families and they believed these girls would not make good nurses.Military Nursing

In 1664, few hospitals were established with some attendants to care for wounded and ill soldiers, and for the first time in 1888, ten qualified certificated Nursing Sisters from London were hired by the British Government of India.The Nurses felt needed to train male nursing attendants to help them and to carry out recruited routine ward activities. In 1914, the nurses were recruited by the Queen Alexandra’s Military Nursing Services for India.

At first only few hospitals in Punjab Uttar Pradesh and Bihar joined, but very soon the number increased and hospitals in NWFP, Sindh and Bengal were included. Gradually co-ordination of training was extended through out North and South of India. In 1910, the first Nursing Journal of India was published.Post-partition Status of Nursing

In 1947, when Pakistan came into being and the Colonial rule ended, the majority of non-Muslim nurses migrated to India and the British Nurses left for England. This left behind a handful nurses.

The small number of nurses was responsible for taking care of huge number of refugees, among those who were wounded in riots in their cities and in attacks on their cravens. Large number of those who were ill had variety of other maladies with them. Most were suffering from varying degrees of both physical and psychological shocks.

It was not possible to fill vacuum created by abrupt and profound changes in the system with the associated loss of personnel in a day or even in a year to compensate for the shortage of experienced and able personnel. During that time of crises the political and administrative leaders in Pakistan appealed to the women of West Pakistan to come out to serve their great hour of need and help the Pakistan required urgent care and healing of wounds as well as emotionally sympathies to cope with the critical situation.

In this endeavor, the influential leader was Miss. Fatima Jinnah, sister of Founder of Pakistan. The second leader was Begum Raana Liaquat Ali Khan, wife of the Prime Minister. The other person influence was Lt. Col. S. M. K. Mallick, who was the Inspector General of the Civil Hospital Punjab.

There was good response to the call and hundreds of women left their homes and colleges and moved into hospitals and refugee camps to render elementary nursing care and they worked day and night under the supervision of qualified nurses.There was no School of Nursing left in operation in Pakistan. As immediate measures the Government initiated Nurses to those schools, which had operated before the partition. The three main training schools were:The Lady Reading Hospital, Peshawar.The Civil Hospital, Karachi.The Mayo Hospital, Lahore.

In 1948, the first new School of Nursing established following the partition was Sir Ganga Ram Hospital, Lahore. The first Nursing Tutor of this school was Mrs. C. M. Darrah, the first Nursing Superintendent was Mrs. Mumtaz Painda Khan and the first Medical Superintendent of this School was Mr. Shujaat Ali. In 1952, the first class of seven girls completed their three years of General Nursing.

In 1948, another School of Nursing was initiated at Karachi “Jinnah Hospital”. The development was followed by the commencement of other schools of nursing at:• Bahawalpur• Hyderabad• Multan

After the establishment of number of Schools of Nursing to provide basic education, the nursing profession as well as the Government become aware of the acute shortage of trained Tutors to educate students. To resolve the problems in the early 1950, consideration was given to the

establishment of an institution within Pakistan, which could offer a program of advanced study in the areas of administration and technology.

After partition in what now constitutes Pakistan there operated: •Punjab Nursing Council.• Sindh Nursing Council.• NWFP Nursing Council and Midwifery Board.• Bengal Nursing Council at Calcutta.

In 1948, constitution the General Nursing Council. The fore runner of Pakistan Nursing Council.Director General Health, Government of Pakistan was named as the chairman of this Council.Council had33 members including eminent doctors, educationists, nurses, midwives and lady health visitors. The Trained Nurses Association of Pakistan was also represented by taking one of its members in the Council. In 1948 reorganization of the Punjab Nursing Council Mrs. Taiffany May was the first Registrar of the Punjab Nursing Council.In 1952, PNC Act 1952 was passed by Constituent Assembly provided a uniform system for nurses, midwives and health visitors.In 1954, a post of Chief Nursing Superintendent was created in the Directorate of Health.In 1955, a College of Nursing was proposed as a health and sanitation project in collaboration with an agency of the Government of USA.

In 1959, the Pakistan Nursing Council was approached for evaluation and recognition of program. After few visits and observations, the Pakistan Nursing Council gave approval in 1963 to College of Nursing. Courses and Diplomas were thus granted formal recognition.In new curriculum, two separate courses over the two years period were prepared. They are:

•Diploma in Ward Administration (DWP) — One year course.•Diploma in Teaching Administration (DTA) — One year course.

In 1966, total 134 graduates had completed training and were teaching in various School of Nursing in Pakistan Miss. Wazir Begum mounted the administrative leader and first Principal of the College of Nursing in Pakistan . Armed Forces Nursing Services, the senior name in the nurses of Pakistan army is Nusrat Jahan Saleem. She was the first Director of Nurses in General Headquarters, Rawalpindi.Pakistan Nursing Council received affiliation fee at prescribed rates from every training institution seeking recognition. Grant in Aid from GovernmentPNC Own fees e.g., Registration fee, Affiliation fee.