UNIVERSITY OF MEDICAL SCIENCES, ONDO Department of Nursing Science

Foundation of Nursing I NSC 211

Unit I - Introduction to Professional Nursing

Unit I - Introduction to Professional Nursing

Akin-Otiko, B. O.

MPH, PhD. (RN, RM, RNE, FWACN)

December, 2017

Unit Content:

• Definition of Nursing

• The Professional Nurse

• Consumers of Nursing Services

• History of Nursing

• Trends in Nursing - Nursing: Past, Present and Future

• Etiquettes in Nursing

• Characteristics of a Polyvalent Nurse

• The Roles of the Nurse

Unit Objectives:

At the end of this unit, the students should be able to:

• Define nursing

• Describe nursing as a profession

• Identify a professional nurse

• Describe consumers of nursing services and their expectations

• Summarize the history of nursing in general and Nigeria in particular

• Discuss changes in nursing education, administration, practice and research from Florence Nightingale era to date

• Discuss etiquettes in nursing

• Describe the roles of the nurse

Definition of Nursing

The nurse is a person who has completed a program of basic, generalized nursing education and is authorized by the appropriate regulatory authority to practice nursing in his/her country. Basic nursing education is a formally recognized program of study providing a broad and sound foundation in the behavioral, life, and nursing sciences for the general practice of nursing, for a leadership role, and for post-basic education for specialty or advanced nursing practice. The nurse is prepared and authorized (1) to engage in the general scope of nursing practice, including the promotion of health, prevention of illness, and care of physically ill, mentally ill, and disabled people of all ages and in all health care and other community settings; (2) to carry out health care teaching; (3) to participate fully as a member of the health care team; (4) to supervise and train nursing and health care auxiliaries; and (5) to be involved in research. (International Council of Nurses, 1987a)

A nurse is a person who has received authorized education, acquired specialized knowledge, skills and attitudes, and is registered and licensed with the Nursing and Midwifery Council to provide promotive, preventive, supportive and restorative care to individuals, families and communities, independently, and in collaboration with other members of the health team. The Nurse must provide care in such a manner as to enhance the integrity of the profession, safeguard the health of the individual client/patient and protect the interest of the society. (Nursing & Midwifery Council of Nigeria, 2017)

Definitions of Nursing

Nursing has been defined over time in terms of the environment and functions of nursing, consumers of the services provided by nurses, abilities of the practitioners, and the scope of practice.

Examples:

– Florence Nightingale

–Virginia Henderson

– Faye Glenn Abdellah

–World Health Organization

– International Council of Nurses

Florence Nightingale

The act of utilizing the environment of the patient to assist him in recovery - Florence Nightingale 1969 (Berman, Snyder, & Frandsen, 2016:39)

“What nursing has to do… is to put the patient in the best condition for nature to act upon him” – Florence Nightingale 1859 (Gonzalo, 2011a)

Virginia Henderson

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 - Virginia Henderson, 1966 (Berman, et al., 2016:39)

Virginia Henderson (Contd.)

• “I believe that the function the nurse performs is primarily an independent one – that of acting for the patient when he lacks knowledge , physical strength, or the will to act for himself as he would ordinarily act in health, or in carrying out prescribed therapy. This function is seen as complex and creative, as offering unlimited opportunity for the application of the physical, biological, and social sciences and the development of skills based on them.” - Virginia Henderson, 1960 (Gonzalo, 2011b)

Faye Glenn Abdellah

"Nursing is based on an art and science that mould the attitudes, intellectual competencies, and technical skills of the individual nurse into the desire and ability to help people, sick or well, cope with their health needs." - Abdellah, F. G. (-----, 2011)

World Health Organization

Nursing encompasses autonomous and collaborative care of individuals of all ages, families, groups and communities, sick or well and in all settings. It includes the promotion of health, the prevention of illness, and the care of ill, disabled and dying people

(World Health Organization, -----)

International Council of Nurses – Definition of Nursing (long version) Nursing, as an integral part of the health care system, encompasses the promotion of health, prevention of illness, and care of physically ill, mentally ill, and disabled people of all ages, in all health care and other community settings. Within this broad spectrum of health care, the phenomena of particular concern to nurses are individual, family, and group "responses to actual or potential health problems" (ANA, 1980, P.9). These human responses range broadly from health restoring reactions to an individual episode of illness to the development of policy in promoting the long-term health of a population.

International Council of Nurses –

Definition of Nursing (long version) contd.

The unique function of nurses in caring for individuals, sick or well, is

to assess their responses to their health status and to assist them in

the performance of those activities contributing to health or

recovery or to dignified death that they would perform unaided if

they had the necessary strength, will, or knowledge and to do this in

such a way as to help them gain full of partial independence as

rapidly as possible (Henderson, 1977, p.4). Within the total health

care environment, nurses share with other health professionals and

those in other sectors of public service the functions of planning,

implementation, and evaluation to ensure the adequacy of the health

system for promoting health, preventing illness, and caring for ill and

disabled people. (International Council of Nurses, 1987b)

International Council of Nurses –

Definition of Nursing 2 (short version)

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. (International Council of Nurses, 2002)

Nursing is a profession based on a unique body of knowledge and skills that empowers the nurse to support individuals, families, and communities through with their health goals, towards attaining and / or maintaining optimal level of functioning (OLOF), or having a peaceful end of life experience

- Akin-Otiko, B. O.

References

-----. (2011, ). Faye Glenn Abdellah's Theory Twenty-One Nursing Problems Retrieved 2nd November, 2017, from http://currentnursing.com/nursing_theory/abdellah.html

Berman, A., Snyder, S. J., & Frandsen, G. (2016). Kozier & Erb's Fundamentals of Nursing - Concepts, Process, and Practice. Boston: Pearson.

Gonzalo, A. (2011a). Florence Nightingale - Nursing: Notes on Nursing. Theoretical Foundations of Nursing Retrieved 2nd November, 2017, from http://nursingtheories.weebly.com/florence-nightingale.html

Gonzalo, A. (2011b). Virginia Henderson - The Principles and Practice of Nursing. Theoretical Foundations of Nursing Retrieved 2nd November, 2017, from http://nursingtheories.weebly.com/virginia-henderson.html

International Council of Nurses. (1987a). Definition of a Nurse Retrieved 9th November, 2017, from http://www.icn.ch/who-we-are/icn-definition-of-nursing/

International Council of Nurses. (1987b). Definition of Nursing (long version) Retrieved 9th November, 2017, from http://www.icn.ch/who-we-are/icn-definition-of-nursing/

International Council of Nurses. (2002). Definition of Nursing 2 (short version) Retrieved 9th November, 2017, from http://www.icn.ch/who-we-are/icn-definition-of-nursing/

Nursing & Midwifery Council of Nigeria. (2017). Code of Professional Conduct Retrieved 12th September, 2017, from http://www.nmcn.gov.ng/codec.html

Ojo, A. A. (2010). The Challenges of Best Practices and Standards in Nursing in Nigeria Inaugural Lecture Series - 4th. Benin: Igbinedion University Press Ltd. World Health Organization. (-----). Definition of Nursing Retrieved 9th November, 2017,

from http://www.who.int/topics/nursing/en/

The Professional Nurse

The Professional Nurse

• It is important to discuss this issue to enable students appreciate the great honour, demands and expectations associated with the nursing profession.

• Outside Nigeria, we have the practical nurses and the professional nurses; however, in Nigeria, we only have the professional nurses’ cadre in the scheme of service.

What is a profession?

A profession is an occupation (vocation) requiring rigorous educational training that endows the practitioners with the unique knowledge, skills and attitudes to render specific services to the public for a reward

The Industrial Arbitration Panel awards that:

• “Nursing is a profession sui generis subject to no directions or control whatsoever by any profession so ever except in so far as it forms parts of an organic whole” (Ndatsu, 1999:255)

Attributes of a profession include:

• Unique body of knowledge

• Educational engagement - Essential period of educational preparation encompassing theory and practice towards enabling members to acquire the required knowledge, attitude, and skills for professional practice

• Continuing professional development

• Responsibility – obligation to provide specialized service to the public

• Accountability – Practitioners are individually liable and answerable for their actions

• Code of ethics guide behaviour of practitioners towards the general public, colleagues and the profession

Attributes of a profession (contd.):

• Autonomy – Regulated by members

• Respect for rights and dignity of clients or consumers of their services

• Guarantees confidentiality in all professional-client relationship

• Non-exploitative remuneration

• There is public confidence in the profession and its members

• Practitioners may practice independently or within an establishment

• Provides opportunities for career development and upward mobility of practitioners

Who is a professional?

A Professional is a person who, on fulfilment of all the educational requirements, and possession of the required competencies to practice, is duly licensed by the regulatory agency of the profession to render services to deserving members of the public, in accordance with the extant professional code of ethics and regulations.

The Professional Nurse

Refer to NMCN’s definition of a nurse

• A nurse is a person who has received authorized education, acquired specialized knowledge, skills and attitudes, and is registered and licensed with the Nursing and Midwifery Council to provide promotive, preventive, supportive and restorative care to individuals, families and communities, independently, and in collaboration with other members of the health team. The Nurse must provide care in such a manner as to enhance the integrity of the profession, safeguard the health of the individual client/patient and protect the interest of the society. (Nursing & Midwifery Council of Nigeria, 2017)

• Safety and dignity of the consumers of nursing services is core

The Professional Nurse

Education

• Three years professional training leading to the award of the General Nursing certificate and professional title “RN” on registering with the appropriate regulatory agency

• Four to five years Bachelor of Nursing degree and earns a BNSc degree and professional title “RN” on registering with the appropriate regulatory agency

Registration and Licensing

• RN and specialty

• Registered and licensed to practice

• Practice in …..

• Specializes

The Professional Nurse

Regulation

• Protects nursing

• Protects the public

• Approves nursing education

• Describes competences

• Disciplines through rules and regulations

• Prescribes code of ethics to guide behaviour

Responsibilities

• Aware of professional ethics and etiquettes

• Complies with every aspect of the professional code of ethic in her practice of the profession

• Accountable for own actions, owns up to mistakes and corrects them where possible

Hazards

• Like every other profession, nursing has its hazards.

• Hazards of the profession may vary, depending on where the professional works and the nature of services provided.

• Usually, there are five possible areas of occupational hazards and theses apply to nursing too.

oBiological

oChemical

oMechanical

oPsychological

oSocial

Reference

Ndatsu, P. N. (1999). Practising Nursing and Midwifery in Nigeria (Ordinances and Laws) 1930-1992. Lagos: Nursing and Midwifery Council of Nigeria.

Consumers of Nursing Services / Care

Consumers of nursing services / care

• A consumer is an individual, a group of people, or a community that uses a service or commodity (Berman, Snyder, & Frandsen, 2016:39).

• Consumers of healthcare services, including nursing services, are usually referred to as patients.

• Patient is an English noun from a Latin word patiens meaning “one who suffers”, and it suggests a state of dependency on the health professionals.

• Progressively over the years, nursing functions have changed in terms of the people who receive nursing care, the type of care provided, and the settings within which care is provided (Barber, Stokes, & Billings, 1977; Berman, et al., 2016); hence, the preference of some nurses for the term client.

Consumers of nursing services / care (contd.)

• Client is derived from the word cliēns which means “to lean”, and refers to someone benefitting from the advice and/or services of a professional. Its Latin root (cliēns) connotes alliance and interdependence (Smeltzer, Bare, Hinkle, & Cheever, 2010).

• In nursing practice today, both patient and client are used interchangeably.

• Consumers’ of nursing services have moved from passive participation in their care to being actively involved because today, they are more knowledgeable about health issues, their rights to quality care, and how to seek redress when things go wrong.

• Nurses work with their patients to identify their health challenges and solve them (Smeltzer, et al., 2010).

Consumers of nursing services / care (contd.)

• Consumers of nursing care are the focus of nursing services – promotive, preventive, restorative and rehabilitative.

• The consumers are central to all that nurses do.

• These consumers could be individuals, families, or communities.

• Consumers request for nursing services for one or more areas of needs - physical, social, psychological, spiritual, etc; and the needs vary from one consumer to the other.

• Even when they have the same medical or nursing diagnoses or problem descriptions, no two consumers are the same in character and in responses to their needs.

• Therefore, nursing services are individualized (client-centred).

References

• Barber, J. M., Stokes, L. G., & Billings, D. M. (1977). Adult and Child Care (2nd ed.). Saint Louis: The C. V. Mosby Company.

• Berman, A., Snyder, S. J., & Frandsen, G. (2016). Kozier & Erb's Fundamentals of Nursing - Concepts, Process, and Practice. Boston: Pearson.

• Smeltzer, S. C., Bare, B. G., Hinkle, J. L., & Cheever, K. H. (2010). Brunner & Suddarth's Textbook of Medical-Surgical Nursing (12th ed.). Philadelphia: Lippincott Williams & Wilkins.

History of Nursing

Pre Florence Nightingale Era

• The practice of nursing is as old as human existence being the foremost caring profession. (Nursing & Midwifery Council of Nigeria, 2017).

• Before Florence Nightingale, women and religion were significant in shaping the practice of nursing (Berman, Snyder, & Frandsen, 2016).

• Nursing started in the homes with the primary functions being to provide physical and psychological support to unwell members of the community (Berman, et al., 2016).

• These functions were rendered by women caring for their family members or assisting neighbours (Ojo, 2010).

• Christian teachings on responsibility for the wellbeing of others as contained in Luke 10:25-37; Mark 12:31; and Matthew 25:31-46 etc., motivated people and organizations to provide facilities and support, to cater for the needy.

• Fabiola, a rich and noble woman in the Roman Empire, founded an infirmary and gave all her wealth, time and labour to care for the poor and the sick.

Fabiola

• Similarly, men in the religious orders (knights) committed themselves to taking care of people with diverse disease conditions (Berman, et al., 2016).

• The deaconesses, who were earlier prevented, made fresh appearance 1836 when Theodor Fliedner re-established the group, and in addition opened a mini hospital and established a training school in Kaiserswerth, Germany where Florence Nightingale was trained (Berman, et al., 2016).

• Theodor Fliedner (1800 - 1864) - German Lutheran minister and founder of Lutheran deaconess training.

Theodor Fliedner (1800 - 1864)

Florence Nightingale Era

Assignment

• Write briefly on Florence Nightingale

• Length - 1 page A4 sized paper

• Font - Times New Roman; size 12

• Spacing - double line spacing

• Indicate name and matriculation number on the paper

• Save document with surname and first name

• Submit to bakinotiko@unimed.edu.ng

Florence Nightingale (1820-1910)

Florence Nightingale (1820-1910)

Background

• Born 15th May 1820 at Florence and named after the city

• From rich and educated background

• A Christian - Motivated by her Christian virtues

• Reportedly perceived God called her to help and enhance the wellbeing of others

• Well educated - knew Greek and Latin traditional languages, and contemporary French, German, and Italian languages. Studied history, grammar, philosophy and mathematics

• She was determined to become a nurse in spite of opposition from her family and the restrictive societal code for affluent young English women

Nursing Education

• 1847 – 3 months nursing training in Kaiserswerth Germany

• 1853 – in Paris with the Sisters of Charity

• Career

• England - superintendent of a charity hospital for all governesses

• Crimean War (1854-1856)

o Statistician – Records showed her intervention reduced mortality among the soldiers

o Lady with the Lamp – rounds at night to care for injured soldiers

Contributions to nursing

• Nightingale School for Nurses, England (opened 1860) - £4,500 honourarium from English public for great work during the Crimean War

• Model

• Graduates managed hospitals and established nursing education programmes in other countries

• Researcher

• Individualized care

• Public Health and Health Promotion nursing functions

• Mother of modern nursing (scientific nursing)

• Wrote books e.g. Notes on Nursing: What it is and what it is not; Notes on Hospitals – in 1859 and raised £59,000 which she used to further the course of the profession

• Several quotes

Honours

Nightingale Pledge taken by new nurses during their induction ceremony

International Nurses’ Day annually in May

Exit - Died 13th August 1910 at age 90

The Lady With The Lamp

• During the Crimean War (1854-1856), there was a grave need to cater for the wellbeing of the soldiers (Berman, et al., 2016)

• Florence Nightingale (1820-1910) and 38 other nurses (Ojo, 2010) rose to the challenge, and cared for the sick and injured men.

• Her combination of Christian ideals, strict discipline and a sense of mission paved way for what is known today as the nursing profession (Nursing & Midwifery Council of Nigeria, 2017).

• Her doggedness, commitment to service day and night earned her the title Lady with the Lamp (Ojo, 2010).

• Modern scientific nursing has its roots in Florence Nightingale’s approach to nursing (Nursing & Midwifery Council of Nigeria, 2017).

• Nightingale and her nurses transformed the military hospitals by setting up sanitation practices, such as hand washing and washing clothing regularly. Nightingale is credited with performing miracles; the mortality rate in the Barrack Hospital Turkey, for example was reduced from 42% to 2 % in 6 months … (Berman, et al., 2016:29)

• Nurses have also served during other wars under terrible conditions, providing care and succor to the wounded and affected as volunteers; and their memories are revered in those countries For example:

• During the American Civil war (1861-1865)

• Several nurses emerged who were notable for their contributions to a country torn by internal strife.

• Harriet Tubman and Sojourner Truth provided care and safety to slaves fleeing to the North on the Underground Railroad.

• Mother Bickerdyke and Clara Barton searched the battlefields and gave care to injured and dying soldiers. (Berman, et al., 2016:29)

Harriet Tubman

Sojourner Truth

During the Vietnam War

• Approximately 11,000 American military women stationed in Vietnam were nurses.

• Most of them volunteered to go to Vietnam right after they graduated from nursing school, making them the youngest group of medical personnel ever to serve in wartime …

• Near the Vietnam Veterans Memorial (“The Wall”) stands the Vietnam Women’s Memorial (Berman, et al., 2016:30)

Post Florence Nightingale Era

• Establishment of training schools for nurses

• Training activities organized and regulated.

• Movement for the recognition and registration of nurses began in 1882 (Ojo, 2010).

• International Council of Nurses (ICN) was established in 1899 making nursing the first in the health industry to form an international organization (Nursing & Midwifery Council of Nigeria, 2017).

• Royal British Nurses Council was established in 1893 and the British College of Nurses in 1926.

• Others include the Royal College of Nursing (1916) and the General Nursing Council for England and Wales (1919) (Nursing & Midwifery Council of Nigeria, 2017)

Linda Richards (1841-1930)

• America’s first trained nurse

• 1873 - Graduated - New England Hospital for Women and Children

• Introduced nurse’s notes and doctor’s orders

• Initiated the use of uniforms by nurses

• Pioneered work in psychiatric and industrial nursing (Berman, et al., 2016:32)

Linda Richards (1841-1930)

Mary Eliza Mahoney (1845-1926)

• Born 7th May, 1945

• First African American professional nurse

• 1879 - Graduated - New England Hospital for Women and Children

• Women and civil rights activist; worked consistently for:

oacceptance of African Americans in nursing (integration)

opromotion of equal opportunities for patients and health workers

opromoted better working condition

Mary Eliza Mahoney (1845-1926)

Mary Eliza Mahoney (1845-1926) contd.

• Membership

oNurses Associated Alumnae of the United States and Canada (now American Nurses Association)

oNational Association of Colored Graduate Nurses

• Mary Mahoney award – given biennially by American Nurses Association for significant contributions in interracial relationships. (Berman, et al., 2016:33)

• Inducted into:

oNursing Hall of Fame (1976)

oWomen’s Hall of Fame (1993)

• Died 4th January 1926 at age 80

History of Nursing in Nigeria

• The history of nursing in Nigeria is intertwined with the general history of the profession worldwide and with the history of the country (Nursing & Midwifery Council of Nigeria, 2017).

• Christians believe God can heal the ailing spirit, soul and body of man through Jesus Christ the Great Physician.

• Therefore, in the early 19th century, when the Christian missionaries came to Nigeria, they combined their evangelism work with provision of health care services (Nursing & Midwifery Council of Nigeria, 2017).

• Nursing came to Nigeria with the British colonial masters.

• Like Florence Nightingale, nurses provided care for the wounded soldiers.

• The colonial masters established the first nursing home in Jericho, Ibadan.

• This initial government provision was complemented by missionaries and their wives setting up mission homes, dispensaries, etc. and started training of nurses through on-the-job skills acquisition.

• To keep abreast the trends in nursing globally and to ensure quality nursing care for the civil servants and their families, the colonial government introduced formal nursing education (Nursing & Midwifery Council of Nigeria, 2017).

• Regional governments trained their nurses based on set regional standards for the training of nurses.

• The General Nursing Council for England and Wales granted special consideration to graduates of some schools of nursing like the one in the University College Hospital, Ibadan, to be registered as SRN in the United Kingdom.

• Currently there are accredited schools of nursing, midwifery, and post basic nursing programmes in the country in addition to faculty /departments of nursing in universities offering first and higher degree programmes in nursing. (Ndatsu, 1999)

Regulation –

• The ordinance regulating the training and practice of Midwifery was established in 1930 and that for nursing in 1947 both went through series of amendment over the years before the eventual merger.

• The popular decree 89 of 1979 established the Nursing and Midwifery Council of Nigeria (NMCN) (Nursing & Midwifery Council of Nigeria, 2017).

Association –

• In 1938, Nigeria Union of Nurses (NUN), the first organization of nurses in Nigeria was formed and registered in 1943.

• On 8th of December 1977 a single umbrella body of all nurses and midwives in the country, the National Association of Nigeria Nurses and Midwives (NANNM), was formed

• It provides a unified voice for all nurses and midwives on issues of interest to the professions.

• Two female nurses – Comrade E. Hannatu Omole and Mrs. Julie Omigbo emerged as the pioneer president and deputy president of the Association respectively in 1978, (NANNM, -----).

Nigerian nurses in history

• Many Nigerian nurses have made significant contribution to the growth of the profession in Nigeria and beyond the shores of the country.

• Some have lost their lives in the course of service.

• Presented below are only four from the past and the contemporary world.

Grace Tinuke Oyelude –

First Miss Nigeria (1957) later trained as a nurse

Chief Kofoworola Abeni Pratt (Hon. FRCN) - 1910-1992

• Discouraged from training as a nurse, trained as a teacher.

• Married an Englishman, moved to England in 1946 and trained as a nurse in Nightingale School at St Thomas’ Hospital, London and qualified as SRN in 1950

• Active in West African Students’ Union

• First black nurse to work in Britain’s National Health Service

• First black Chief Nursing Officer of Nigeria, Federal Ministry of Health

Kofoworola Abeni Pratt (1910-1992)

Chief Kofoworola Abeni Pratt (Hon. FRCN) - 1910-1992 (Contd.)

• Commissioner of Health, Lagos in the 1970s

• 1973 – recipient of Florence Nightingale Medal awarded by the International Committee of the Red Cross

• 1979 – Honourary Fellow of the Royal College of Nursing (Hon. FRCN)

• Died 18th June 1992

Miss Justina Obioma Ejelonu

• First day at work (in a private hospital) came in contact with the late Patrick Sawyer

• 14th August, 2014 - died of Ebola

Mrs. Abolanle Adesuyi

• Assistant Chief Nursing Officer at Federal Medical Centre, Abeokuta

• Died of Lassa Fever on Sunday 18th December 2016

References

• Berman, A., Snyder, S. J., & Frandsen, G. (2016). Kozier & Erb's Fundamentals of Nursing - Concepts, Process, and Practice. Boston: Pearson.

• NANNM. (-----). National Association of Nigeria Nurses and Midwives (NANNM) Retrieved 6th January, 2017, from http://nannm.com.ng/

• Ndatsu, P. N. (1999). Practising Nursing and Midwifery in Nigeria (Ordinances and Laws) 1930-1992. Lagos: Nursing and Midwifery Council of Nigeria.

• Nursing & Midwifery Council of Nigeria. (2017). Origin of Nursing in Nigeria Retrieved 12th September, 2017, from http://www.nmcn.gov.ng/history.html

• Ojo, A. A. (2010). The Challenges of Best Practices and Standards in Nursing in NigeriaInaugural Lecture Series - 4th. Benin: Igbinedion University Press Ltd.

Trends in Nursing –

Nursing: Past, Present and Future

• At inception, nursing was not organized in terms of education and practice and the practitioners had no significant social status.

• However, as a live profession, nursing is dynamic.

• It continuously responds to the changing needs of the society, and to the needs of its members for development and fulfilment.

• Over time, it has developed its own language, rituals, culture, arts and science for quality client care.

• The developmental process has been challenging amidst misconceptions about its roles and placement in the health system

• Three key areas of development for professional recognition are: legality, scope of practice, and nursing education (NANNM, -----).

• With the significant contributions of Florence Nightingale through her service, publications, research, etc., nursing began a progressive professional development and has taken its place in the committee of professions generally, and in the health sector in particular.

• In Nigeria, before 1981, nursing was seen as a calling. However, with the Industrial Arbitration Panel (IAP) award of 1981, nursing was declared a profession sui generis.

Philosophical underpinnings

Asceticism –

• Beginning,

• Strong pre-Nightingale till 1910-1920

• Self-denial - based in Christianity and willingness to sacrifice own life, safety, comfort for the wellbeing of others with rewards in the hereafter.

• Early nurses gave up wealth, family and comfort and nursing was seen as a calling.

• Nurses worked for seven days with only one afternoon off.

• Although devotion to duty was emphasized by Nightingale, absolute self-denial was not given prominence by her.(Bevis, 1989).

Romanticism –

• Prominent 1920s, 30s and 40s

• Lady with the Lamp – romance for an alma mater, patients, personal glory, pride in devotion, doing the best for client, doctor’s pride in performance etc. were romantic impressions that motivated nursing actions.

• Educational and practice models conformed with the medical and hospital-based models conforming to what the physicians and hospital administrators wanted for nursing.

Romanticism (contd)

• Lack of autonomy, assertiveness, or independence closely tied to societal value for women as supporting men to succeed.

• Since the remnants of romanticism are still there today it expresses itself in nurses wanting to be junior doctors or taking on doctors’ responsibilities without rationale for doing so.(Bevis, 1989).

Pragmatism –

• Post World War II till 1960s

• No longer time for romantic activities as reality dawned on nurses with gross shortage of nurses.

• There was the need to approach emerging situations pragmatically.

• This gave rise to non-professional cadres to support nurses while nurses undertook supervisory and teaching roles, the support staff mostly took care of the patients supervised by nurses.

• There was reconsideration of patients’ needs and need for hospitalization etc.

• We still have issues with people taking on nursing duties.(Bevis, 1989)

Humanistic existentialism –

• Began in 1960s

• Focus shifted from the physician to the client

• Care settings outside the hospital received attention.

• Nursing now focused on the whole person, family and community. Man is more than the sum of his parts (Aristotle – The whole is greater than the sum of its parts)

• Medical model was no longer appropriate for organizing nursing concerns and education.(Bevis, 1989).

• Today, nurses have developed tools for providing evidence based services and care to clients in holistic manner. One of such is the Nursing Process.

Past Present Future

Practice Undefined,

unskilled practitioners

Focus on the sick and injured

Acute care settings

During Nightingale

era (1880) – in

addition to patient

care, washed linen,

cooked and served

meals, cleaned the unit etc.

Highly organized

Standardized

Evidence based best practices

Universal

Promotive, preventive, supportive, restorative

Independent, inter-

dependent and dependent

roles – direct client care,

patient advocate,

counselor, health educator, researcher, etc.

Advanced practice / specialty areas

Keep improving

On-going work

on Nursing

diagnosis,

outcomes,

intervention etc.

Past Present Future

Education No specific entry

requirement initially

Initially informal

Apprenticeship

model – “what is

this? It is a gallipot”

Later organized,

short hospital

based, no

qualification awarded

Formal

Highly organized

Tertiary

University based

Specific educational

qualification acquired -

Certificate, Diploma,

Associate degree, first to

third degrees and post-doctoral

Specific entry requirements

comparable with any other in the health sector

NMCN organized qualifying

examinations adjudged best

professional examination in the country

Unlimited

Highly specialized

Only

university based

Past Present Future

Administration Highly

influenced by

philosophical

and socio-

cultural

orientation at

the time –

religion,

gender rights,

nature of

government,

times e.g. wars etc.

Well organized

Directorates /

departments of nursing

with sub-divisions in

government and institutions

Involved in high level

policy formulation on

health and health related issues

Minister of State,

Commissioner for Health, etc. in Nigeria

Former Surgeon General

of USA - Sylvia Trent-Adams

Improved inter-

country support

and

collaboration on-going

Past Present Future

Regulation None before In-country

Registration

and licensing

Code of

Ethics and

Discipline

Education

and practice

International

organizations

Continue to

improve in

strategies to

protect the

public and

members

Past Present Future

Research Florence

Nightingale era

A number of

theorists in

the 19th century

Hallmark of modern nursing

Evidence based practices and reforms

Covers every aspect of nursing

Numerous nursing journals

for disseminating original research work

Part of nursing education at all levels

Increasingly experimental

Work in research institutes

Professors in research institutes

More clinical research

Growing field of

nursing informatics

Past Present Future

Association Initially none

Self-denial and

sacrifice

emphasized

Later struggle

against

discrimination

Some

participated in

human rights

activism –

blacks, women,

and colonial rule

in West Africa

National and

international

nurses

associations

Member of

National

labour /

trade union

groups e.g.

in Nigeria,

NANNM,

JOHESU,

NLC

Promoted by

ICN and

guidelines

provided for

implementation

in-country

Past Present Future

Image Poor

Sometimes negative

e.g. Charles Dickens’ book Martin Chuzzlewit (1896) character Sairy Gamp

19th Century –

Nightingale’s influence during Crimean War

o Guardian Angel

o Angel of Mercy

(respectable, noble, compassionate, moral, religious, dedicated, self-sacrificing)

Influence of socio-political and cultural discrimination against women

o Doctor’s handmaiden

Nurses’ bravery during World War II and fight against poliomyelitis

o Heroine

Others over time include sex object, surrogate mother, tyrannical mother

(Berman, Snyder, & Frandsen, 2016:31-32)

Nurses still have

image issues and

working assiduously to improve it.

NMCN and

NANNM working

with people in the

creative industry

especially Nollywood

Workshops

Education

Addressing quackery

Disciplinary actions

against erring

members of the profession

Need to be intensified

Assignment: Visit the Nursing & Midwifery Council of Nigeria website and read profusely about the organization www.nmcn.gov.ng References Berman, A., Snyder, S. J., & Frandsen, G. (2016). Kozier & Erb's Fundamentals

of Nursing - Concepts, Process, and Practice. Boston: Pearson. NANNM. (-----). National Association of Nigeria Nurses and Midwives

(NANNM) Retrieved 6th January, 2017, from http://nannm.com.ng/ Ndatsu, P. N. (1999). Practising Nursing and Midwifery in Nigeria (Ordinances

and Laws) 1930-1992. Lagos: Nursing and Midwifery Council of Nigeria. Nursing & Midwifery Council of Nigeria. (2017). Origin of Nursing in Nigeria

Retrieved 12th September, 2017, from http://www.nmcn.gov.ng/history.html Ojo, A. A. (2010). The Challenges of Best Practices and Standards in Nursing in

NigeriaInaugural Lecture Series - 4th. Benin: Igbinedion University Press Ltd.

Etiquettes in Nursing

Etiquettes in Nursing

• Nursing is a highly interactive profession. Professional nurses conduct themselves professionally and not haphazardly.

• Etiquettes in nursing refer to the set of rules guiding the acceptable behaviour of professional nurses at work and in the society.

• No matter the socio-cultural background of nurses, these rules apply.

• Nurses are expected to imbibe the nurses’ culture and continue to improve on it as they advance in the profession.

• It is the responsibility of every nurse to comport herself properly.

• Good manners are quite rewarding as they produce and sustain good relationships, respect, and successful nursing career.

• Inappropriate behaviours attract appropriate sanctions.

General Etiquettes

• Be polite to everybody, every time, and everywhere

• Always address people by their titles, and by their first names only when permitted to do so - avoid nicknames or pet names in formal relationships

• Greet patients, patients’ relatives, senior colleagues, other members of the health team appropriately in culturally and professionally acceptable ways

• Be the first to introduce yourself confidently

• Make a handshake (as tolerable by religion and socio-culturally) – standing, smiling and with eye contact

• Introduce other people and / or colleagues to strangers (start with the person to whom another is being introduced, then the person being introduced, sharing a little information about both - first about the last then the former)

• Verbally express appreciation of kind deeds from others by saying "Thank you"

• Maintain confidentiality and keep other people’s secret

• Keep appointments promptly and be punctual to work

• Comport yourself calmly and confidently

• Keep your promise – be of utmost integrity

Interpersonal communication

• Be kind and respectful in the way you talk

• Listen attentively and maintain eye contact with the person you are talking with

• Use language best understood by the other person

• Do not cover your mouth or exhibit unacceptable gestures while talking to others

• Do not interrupt others while talking without taking permission

• Respond promptly and appropriately to questions you are asked

• Recognize the importance of silence and talk only when necessary

• Let your body language be polite, decent and express what you mean, not sending wrong signals. Some body language tips by Pagana (2010) are:

o Stand tall with your shoulders back and your chin up; avoid slouching

oKeep your hands out of your pockets

oDon't put your hands on your hips or cross them over your chest

oUse a sincere smile to denote warmth and friendliness

o Look at the eyes of the person you're talking with to show your interest

oDon't wring your hands or make a fist

oMove with confidence and purpose

oDon't drag or shuffle your feet

• Avoid the following in conversation: • the "okay" sign --- thumbs up

• the "V" for victory sign, especially with the palm facing inward

• pointing or snapping your fingers

• waving your hand with your arm raised (Pagana, 2010)

• Avoid controversial topics

• Do not discuss or burden your patients and / or their relatives with your personal challenges

• Comply with regulations on the use of phone in PEP area and in skills laboratory

• Use personal and official phones civilly

• Ensure written correspondence (personal or official) is polite, simple and concise

• Avoid abuse of abbreviations and short forms in written correspondences

Relationship with senior colleagues • Address colleagues by their correct designation – social,

career, etc. titles

• Stand up in recognition of colleagues / people of higher ranks as they come in to you

• Comply with instructions from senior colleagues without quarrelling

• Open the door for senior colleagues and allow them to enter or exit before you

• Take excuse if you have to go past a senior colleague

• Assist senior colleagues with their heavy load if going along the same way

• Do not interrupt others while working without taking excuse

• Imbibe only practices that comply with established standards of practice

Appearance

• Be neat in your appearance always

• Dress decently and properly

• Do not wear tight or short dresses

• Comply with the following rules regarding the use of uniform

• Be in the proper uniform when on duty in professional experience placement (PEP) areas or in the skills laboratory

• Change your uniform and shoes everyday

• Always have your identification tag on

• Cover your hair with operating room (OR) cap where required and pull up long hair above your shoulders (not touching your uniform and away from your face)

• Shave beards clean

• Do not ever use any form of jewellery that may obstruct your work while on duty – remove piercings, bracelets, wrist watches, dangling earrings, necklaces and rings (except unadorned wedding rings). Breast watches with sweep second hands are allowed

• Keep natural nails trimmed and clean, without nail polish or acrylic fingernails

• Be of best behaviour when wearing your uniform outside the service areas

• Note that students who are not in prescribed uniforms or not neat in appearance may be denied access to the PEP area or skills laboratory

In the classroom

• Be punctual

• Appear in approved clothes / dresses (See UNIMED Students’ Information Handbook (2016) pages 57 & 58

• Participate actively in the teaching-learning sessions as required

• Stand up to answer questions in the classroom unless otherwise directed

• Complete and submit assignments on schedule

Reference

• Pagana, K. D. (2010). New Nurse Notes: 7 tips to improve your professional etiquette Retrieved 2nd November, 2017, from http://www.nursingcenter.com/journalarticle?Article_ID=983314

Characteristics of Polyvalent Nurse

Characteristics of a Polyvalent Nurse

• Poly – Many

• Valence – Power

• Polyvalent – Having Ability Or Capacity To Effectively Execute Many Tasks

• A Polyvalent Nurse Therefore, Is A Professional Nurse Who Can Provide Quality Care Across All Health Care Delivery Settings (University Of Medical Sciences, 2017:2).

• The BNSc Programme Produces Polyvalent Nurses With Competencies Of A Registered Nurse (Rn), Registered Midwife (Rm), And Registered Public Health Nurse (RPHN).

• Unlike nurse specialists who may be restricted to their field of specialization in practice, polyvalent nurses help to bridge the human resources for health (HRH) gap in the country by providing quality nursing care to individuals, families and communities in a variety of settings.

• Nursing is physically, psychologically and socially demanding.

• To function effectively, the polyvalent nurse must possess specific characteristics or attributes; some of which are listed below.

• Empathy – compassion and care based on understanding of patient’s experiences; sometimes described as putting oneself in the shoes of the patient

• Effective communication skills – listening, verbal, non-verbal, writing, advocacy, counseling

• Critical thinking ability / problem solving skills – gathering and analyzing information, correct judgment, making right decision

• Resilience – adapts to changing circumstances in the environment, multi-tasking under stress without making mistakes or breaking down and exhibiting untoward behaviours, adapts to odd hours / days of working

• Carefulness – carelessness can be costly / fatal; observant, pays due attention even in emergency situations and despite shortage of personnel, burnout from heavy workload etc.

• Stability – stressful profession with regular traumatic experiences in lives of patients and relatives; inner and physical strength essential to not make them personal, to cope with unpleasant happenings and to learn from the circumstances

• Physical Health – physically strong enough to withstand the long hours of standing, walking, working, lifting and performing stressful procedures; Nigeria – most procedures still manually executed compared with mechanized procedures in advanced countries

• Rapid and appropriate response – always prepared for unexpected incidences and responds confidently, promptly, calmly and appropriately

• Managerial skills / Leadership skills – planning, organizing, coordinating for patient’s care; influencing other team members to play their part towards achieving set goals;

• Interpersonal skills – binding force in the health care system, works effectively in a team (inter and intra professional harmony / collaboration for excellent service delivery)

• Respect for people and organization rules – values people and accords them due regard, complies with standards of operation in the institution

• Patience – ability to wait and not react in face of provocation

Reference

• University of Medical Sciences. (2017). Bachelor of Nursing Science (BNSc) Degree Programme Curriculum. Ondo, Nigeria: University of Medical Sciences, .

The Roles of the Nurse

The Roles of the Nurse

• The roles of the professional nurse are numerous, varying from specialty to specialty and from one setting of practice to another.

• Nurses have four fundamental responsibilities: to promote health, to prevent illness, to restore health and to alleviate suffering (International Council of Nurses, 2012:2).

• In performing her roles, the professional nurse

o promotes the best interest of her patient

o adheres to the code of ethics guiding her services

o accepts responsibility for her actions, whether taken independently or as part of a group of care givers.

• The major tool of quality nursing care is the Nursing Process

• It allows nurses to assess the patient, diagnose the problem, plan a line of nursing intervention, implement the plan, and evaluate the effectiveness of the intervention.

The general roles of nurses include the following:

1. Communicator –

• The nurse and the patient are initially strangers.

• The nurse needs to establish rapport and secure the confidence of the patient to be able get the required / helpful information and to continue to work together.

2. Caregiver –

• The nurse takes care of the patient’s bio-psycho-social needs completely, partially, or by counselling; depending on the patient’s condition and ability to participate in his own care.

3. Patient Advocate –

• Promotes the interest of the patient, ensuring that his rights are protected as enshrined in the patients’ bill of rights and provided for by the constitution and institutional policy.

• She assists the patient to express his concerns about his care and be heard by other caregivers.

4. Health Educator –

• Provides patients with adequate information about health matters, and their health in particular

• Does this in such a way to enable patients gain sufficient knowledge to assist them to assume responsibility for their health.

5. Counselor –

• Supports the patient through with her concerns and conflicts by providing information on all available options on issues.

6. Case Manager –

• She is the primary nurse

• Takes care of all the health needs of the particular patient from need assessment to evaluation.

7. Nurse Manager –

• The nurse manager plans, organizes, and coordinates activities performed by all collaborating in the care of patients in the unit.

• Particularly, she supervises the nurses and ensures safety of lives and properties in the unit.

• She mentors the other nurses and provides opportunities for feedback to enhance quality nursing care in the unit.

8. Researcher –

• Nurses engage in research activities and utilize research findings appropriately for evidence based practice and to improve quality of care.

9. Change Agent –

• Through her lifestyle in the society and at work, the professional nurse models acceptable character and standard of practice for others to emulate.

Nursing specialties

Specialized roles of nurses are related to their clinical specialties. Some nursing specialties are:

• Geriatric Nursing

• Radiology / Radiotherapy Nursing

• Ophthalmic Nursing

• Orthopedic Nursing

• Dermatology Nursing

• Genetic Nursing

• Otorhinolaryngology Nursing

• Anaesthetic Nursing

• Perioperative Nursing

• Paediatric Nursing

• Intensive Care Nursing (Critical Care Nursing)

• Burns and Plastic Nursing

• Renal Nursing (Nephrology Nursing)

• Mental Health Psychiatric Nursing

• Midwifery

• Accident and Emergency Nursing (Trauma Nursing)

• Occupational Health Nursing

• Cardio-thoracic Nursing

Competencies of graduates of the BNSc programme at UNIMED

• Knowledge

• Attitude

• Skills

Read:

Bachelor of Nursing Science (BNSc) Degree Programme Curriculum. (University of Medical Sciences, 2017 pp 4 & 5)

References:

• International Council of Nurses. (2012). The ICN Code of Ethics for Nurses revised 2012. Geneva: ICN.

• University of Medical Sciences. (2017). Bachelor of Nursing Science (BNSc) Degree Programme Curriculum. Ondo, Nigeria: University of Medical Sciences, .