Nursing as profession

Profession

 Is an occupation or calling requiring advanced training and experience in some specific or

specialized body of knowledge which provide service to society in that special field. (Webster)

Profession

 Is a calling that requires special knowledge, skill and preparation.

 An occupation that requires an advanced knowledge and skills and that it grows out of society’s
needs for special services.

Characteristics of A Profession

Specialized education

 Standard in a collegial setting

Body of knowledge on which performance is based

 Intellectual characteristics
 Nursing theory development

Ability to deliver unique service to other ethics

 Value of worth and dignity to others

 Social policy statement and code for nurses

7 critical attributes of profession

1. Specialized education
2. Code of ethics
3. Research orientation
4. Autonomy
5. Body of knowledge
6. Service orientation
7. Professional Organization

Criteria of Profession

Abraham Flexner (1916)

 Intellectual (opposite of physical)

 Based on body of knowledge, that can be learned
 Practical rather than theoretical
 Can be taught through a process of professional education
 Has a string internal organization of members
 Has practitioner
Nursing

 Is a disciplined involved in the delivery of health care to society

 Is a helping profession
 Is a service-oriented to maintain health and well-being of people
 Is an art and science

Nursing

 Is the protection, promotion, and optimization of health and abilities, prevention of illness and
injury, alleviation of suffering through the diagnosis and treatment of human response, and
advocacy in the care of individuals, families, communities, and populations. (American Nurses
Association)
 In 1980, the (ANA) changed the definition of nursing to this “Nursing is the diagnosis and
treatment of human responses to actual or potential health problems”
 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)
 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. (Virginia Avenel
Henderson)

Characteristics of Nursing:

 Nursing is caring.
 Nursing involves close personal contact with the recipient of care.
 Nursing is concerned with services that take humans into account as physiological,
psychological, and sociological organisms.
 Nursing is committed to:
o Promoting individual, family, community, and national health goals in its best manner
possible.
o Personalized services for all persons without regard to color. Creed, social or economic
status.
o Involvement in ethical, legal and political issues in the delivery of health care.

Nursing as a Profession

 Accountability
o Personal accountability
o Public accountability
 Nurses, as professionals, are responsible for their actions
 The goal is to:
o Maintain high standard of care
o Protect the patient from harm
 licensures
Dimensions of Nursing Practice

1. the personal dimension: the nursing assessment based upon theories of human development
and communication.
 It is inclusive of the person’s self-concept, body image, self-awareness, and self-esteem.
 Assessment also involves meanings of sexuality; spirituality, and philosophical values particular
to each person.
 Clients as persons, families, and/or communities are viewed as open systems that interact and
interface with the environment.
2. The social dimension focuses on the person in the family and environment
 Includes the cultural, moral, and political realms.
 Assessments within this dimension identify roles and patterns of behavior that impact on health
maintenance and related behaviors.
3. The physical dimension: include
 The cardiovascular,
 Gastrointestinal
 Genitourinary/reproductive,
 Integumentary,
 Musculoskeletal,
 Neurologic, and
 Respiratory systems.
 The genetic patterns

Qualifications and Abilities of a Professional Nurse

A. Professional Preparation

the professional nurse must

1. Have license to practice nursing in the country

2. Have a bachelor of Science degree in Nursing
3. Be physically and mentally fit

Personal Qualities and Professional Proficiencies

 Interest and willingness to work and learn with individuals/groups in a variety of settings
 A warn personality and concern for people
 Resourcefulness and creativity as well as a well-balanced emotional condition
 Capacity and ability to work cooperatively with others
 Initiative to improve self and service
 Competence in performing work through the use of nursing process
 Skill in decision-making, communicating, and relating with others and being research oriented
 Active participation in issues confronting nurses and nursing
Nursing: Occupation vs Profession

 Occupation is defined as “what occupies or engages one’s time; business; employment”

(Webster 1996)
 Profession is defined as “A calling, vocation or from of employment that provides a needed
service to society, possesses expertise, autonomy, long academic preparation, commitment, &
responsibility”

Criteria of nursing profession

1. Specialized education
2. Body of knowledge
3. Service orientation
4. Ongoing research
5. Code of ethics
6. Autonomy
7. Professional Organization

How did nursing start

Ancient Civilization

Nursing is noted to be as old as time

It basically started from instinct

 Human nature
 Nurturing,
 Caring
 Nursing

Egyptians

Health and healing beliefs of ancient civilization

Superstition of black magic

Injuries from war and other tragic events.

Biblical records

Jesus healing the wounded and the infected

Good Samaritan law

Christian organization and orders “crusades”

Knights of St. john of Jerusalem

 Aka knights of hospitalities

 Descendants are the knights of templars
 The first nursing orders – monastic order of St. Augustine
Sisters Charity

Established by St. Vincent de Paul in France

6th century

Founding of religious orders

3 attributes of nursing

1. Self-denial
2. Devotion to hard work and duty
3. With spiritual calling

Main guiding principles

1. “love thy neighbor as thy self”

2. Parable of the good Samaritan.
a. Beneficence (doing good to others)

2 types of beneficence

1. Ordinary – doing good to others

2. Ideal - entails sacrifice

Christian organization and orders

Order of deaconesses

 Founded in kaiserwerth, Germany

 Recognized the role of women in taking care of the sick
 Initiated the establishment of training school of nurses
 Founders of the training school: Pastor Theodore Fliedner & Frederika Fliedner(wife)
 Pounders of order
o Kaiserwerth institute for deaconesses

A lady named…

Florence nightingale

 An English lady from a wealthy family during the Victorian era

 During the Crimean War known to be “lady of the lamp” a nursing theorists’ writer and
satisfaction

Prior to nightingale

Is the dark age for nursing because…

Nursing is considered as

 A very low job of social hierarchy

 A job the uneducated and poor
  A desperate occupation

Who are the nurses

 Women of lowest social standing

 Wayward women of low status, instead of going to prison
 Morastic women
 Poor unmarried woman

Florence nightingale

Changed the image of nursing

Dubbed as the “Lady with the Lamp”

 Founded many schools of nursing with theoretical and practical basis in the care of the sick
 First to stress on aseptic precaution while caring for the patient
 Her favorite dictum “Do the patient no harm”
 Notes in nursing what is and what it is not

School of nursing

 1860 Nightingale laid the foundation of the professional nursing when 1 st school of nursing was
established

Environmental theory

Maintaining a safe and clean environment to promote well-being

Transformation of nursing into a profession

Nightingale nurses

 Linda Richards, the first American trained nurse (1870) became a great nursing pioneer in USA
and Japan
 Some nurses became the matrons at several leading hospitals (St. Mary’s Westiminister
Hospital, Royal Victoria Hospital, Sydney Hospital)

Nightingale describes nursing as:

Science

Nursing is a body of scientific knowledge using empirics

Art

Nursing has its own way proper way of doing things and applying knowledge.

Milestones in nursing

Training and education

  Development and establishment of nursing schools all over the world.

Regulating agency/body

 Existence of regulating body for nurses that sets that the conduct of nurses and regulates safe
nursing practice. Example code of ethics

A professional organization

 Development of nursing organizations from local to international levels

Continuing education

 Continuing professional education and training for nurses for competency (trainings, Masters
degree in Nursing, Doctorate in Nursing)

Community involvement

 Nursing has extended roles and has various participation in the community service and industry.

Development of nursing knowledge

 Development of nursing theory and applied into nursing practice

Involvement in research and geared research outputs results towards evidenced-based practice

Through the years… nursing has gone a long way

Because of her, Florence nightingale, Founder of modern nursing

A Nurse…

N – Nobility, Knowledge

U – usefulness, Understanding

R – Righteousness, Responsibility

S – Simplicity, Sympathy

E – Efficiency, Equanimity

Nursing pathway to professionalism

Nursing pathway to professionalism has not been smooth. For decades an ongoing subject for
discussion in nursing circles has been the following question “is nursing a profession”

 Bixler’s Criteria
 Kelly’ Criteria
 Miller’s Wheel of Professionalism in Nursing

The nursing profession began with a genuine desire to serve and care for others, combined with a
sense of compassion and commitment. Nurses are special people.

Bixler’s Criteria
  A profession utilizes in its practice a well-defined and well-organized body of specialized
knowledge which is on the intellectual level of higher learning.
 A profession constantly enlarges the body of knowledge, its uses and improves its techniques
of education and service by the use of scientific method.
 A profession entrusts the education of its practitioners to institutions of higher education.
 A profession functions autonomously in the formulation of professional policies and in the
control of professional activity there by.
 A profession applies its body of knowledge in practical services which are vital to human and
social welfare.
 A profession attracts individuals of intellectual personal qualities who exalt service above
personal gain and who recognize their chosen occupation as a life work.
 A profession strives to compensate its practitioners providing freedom of action, opportunity
for continuous professional growth and economic security.

Kelly’s criteria

 Services provided vital to humanity/society.

 There is a specialized knowledge that continuously enlarged with research
 The services involve Intellectual activities, accountability: individual responsibility is a great
feeling
 Education in higher learning institutions.
 Autonomy – practitioners are independent, control own policies and activities.
 Altruism – practitioners are motivated by service and consider their work as an important part
of their lives.
 There is a Code of ethics to guide decisions and conduct
 There is an organization (association) that encourages and supports high standards of practice.

Miller’s wheel of professionalism in nursing

 Center represents the essential foundation of nursing education

 Eight spokes
o Competence and continuing education
o Adherence to the code of ethics
o Participation in professional organization
o Community service
o Publication and communication
o Theory and research development and utilization
o Self-regulation and autonomy

Professional nursing practice

 Nurse practice acts

o It regulates the licensure and practice of nursing.
o The nurse practice act of each state defines the practice of nursing within that area.
o The board of nursing in each States sets requirements for licensure.
 Standards of practice
 o As nursing became and independent profession, it began to develop its own standards
of practice.
o It serves as a guideline for providing and evaluating nursing care and serves as criteria in
legal question of whether adequate care was given.

The American nurses’ association (ANA)

 Develops the general nursing scope and standards that apply to all nurses
 Specialty organizations align with those broad parameters by developing and revising their own
specific scope and standards of practice. Standards of professional practice include a description
of the standard followed by multiple competency statements that serve as evidence based
 The standards of professional practice are divided into two categories, standards of practice and
standards of professional performance
 The standards of practice align with the nursing process and define what NPD (nursing
professional) practitioners do (Wilson, 2012)
 The standards of professional performance describe how NPD practitioners comply with the
standards of practice, apply the nursing practice, apply the nursing process, and attend other
practice concerns and issues.
 The standards of practice (standards 1-6) align with the steps of the nursing process and, as
mentioned earlier define what NPD practitioners do in their practice.
 The standards of professional performance (standards 7-16) relate to how the NPD practitioner
complies with the standards of practice, performs the nursing process, and manages other
nursing practice issues and concerns (ANA, 2010)

ANA standards of care

 Standard I: assessment
o The registered nurse collects comprehensive data pertinent to the healthcare
consumer’s health or the situation.
 Standard II: diagnosis
o The registered nurse analyzes the data to determine the diagnoses or issues
 Standard III: outcome identification
o The registered nurse identifies expected outcomes for a plan individualized to the
healthcare consumer or the situation.
 Standard IV: planning
o The RN develops a plan of care that prescribes strategies and interventions to attain
expected outcomes.
 Standard V: implementation
o The nurse implements the interventions identified in the plan.
o 5A – coordination of care
o 5B – health teaching and health promotion
o 5C – consultation (graduate prepared specialty or advanced practice nurse)
o 5D – prescribe authority and treatment (advanced practice nurse)
 Standard VI: evaluation
 o The RN evaluates progress toward attainment of outcomes

ANA standards of professional performance

 Standard VII: ethics

o The RN practices ethically.
 Standard VIII: education
o The RN attains knowledge and competence that reflects current nursing practice.
 Standard IX: evidence-based practice and research
o The RN integrates evidence and research finding into practice.
 Standard X: quality of practice
o The RN contributes to quality of nursing practice.
 Standard XI: communication
o The RN communicates effectively in a variety of formats in all areas of practice.
 Standard XII: leadership
o The RN demonstrates leadership in the professional practice setting and the profession
 Standard XIII: collaboration
o The RN collaborates with the healthcare consumer, family, and others in the conduct of
nursing practice.
 Standard XIV: professional practice evaluation
o The RN evaluates her or his own nursing practice in relation to professional practice
standards and guidelines, relevant statutes, rules and regulations.
 Standard XV: resource utilization
o The RN utilizes appropriate resources to plan and provide nursing services that are safe
effective and financially responsible.
 Standard XVI: environmental health
o The RN practices in an environmentally safe and healthy manner.

Attributes of professionalism in nursing

 Knowledgeable
 How do we stay knowledgeable?
o Involved in nursing organizations
o Reading journals
o Continuing our education
o Continually seeking out new information
 Inquisitive
o A professional nurse is always curios to investigate
 Autonomy
o Working independently
o Exercise decision-making
o Having the ability to carry out the appropriate course of action
o Having the capacity as a nurse to determine her/his own course of action
 Innovator and visionary
o Innovation: bring in new methods, ideas, etc.
 o Visionary: the act or faculty of seeing, sight; imaginative insight; ability to plan or form
policy in a far-sighted way
 Accountability and dependability
o Admit mistakes and learns from them
o Timelines
o Keeps their word
 Advocacy
o Respectful of others
o Understands the needs of patients
o Recognizes that the family members of the patient are also their responsibility
 Collegiality and collaboration
o Willingness to help others
o Teamwork
 Honesty and integrity
o Truthful
o Does not gossip
o Upholds patient confidentiality and privacy
 Attitude
o IS EVERYTHING!
o Sets the tone
o Should be positive
 Appearance
o First impressions are important
o Can instill confidence or mistrust
o Represents your pride in yourself and your profession

Educational preparation

 Graduate education
 Professional registered nurse education
 In-service education
 Continuing education

Body of knowledge

 The body of knowledge that serves as the rationale for nursing practice has patterns, forms, and
structure that serves as horizons of expectations and exemplify characteristic ways of thinking
about phenomena
 Involves critical attention to the question of what it means to know and what kinds of
knowledge are held to be of most value in the discipline of nursing

Why develop patterns of knowing

 The aim of carper's theory was to:

o Formally express nursing knowledge
o Provide a professional and discipline identity
 o Convey to others what nursing contributes to healthcare
o Create expert and effective nursing practice

Knowing and knowledge

 Knowing refers to the way of perceiving and understanding self and the world
 Knowledge refers to knowing that is expressed in a form that can be shared and communication
to others

Patterns of knowing

1. Empirics, the science of nursing

2. Esthetics, the art of nursing
3. The common of a personal knowledge in nursing; and
4. Ethics, the component of moral knowledge of nursing

Empirics: the science of nursing

 Based on the assumption that what is known is accessible through the physical senses: seeing,
touching, and hearing
o Reality exists and truths about it can be understood
 A pattern of knowing that draws on traditional ideas of science
o Expressed in oractice as scientific competence
 Competent action grounded in scientific knowledge including theories and formal description
o Involves conscious problem solving and logical reasoning

Empirical knowing

 Positive science
o Knowledge is systematically organized into general laws and theories
 Source of this knowledge
o Research
o Theory

Aesthetic knowing: the art of nursing

 Expressed through:
o Actions, bearing, conduct, attitudes, narrative, and interaction
o Knowing what to do without conscious deliberation
 Involves:
o Deep appreciation of the meaning of a situation
o Moves beyong the surface of a situation
o Often shared without conscious exhange of words
o Transformatives art/acts
o Brings together all the elements of a nursing care situation to create an meaningful
whole
Personal knowing:

 Concerned with becoming self-aware

o Self-awareness that grows over time through interaction with others
 Used when nurses engage in the therapeutic use of self in practice
o Scientific competence, moral/ethical practise, insight and experience of personal
knowing
 Personal reflection
o Informed by the response of others
 Openness to experience

Ethics:

 Guides and directs how nurses conducts their practice

 Requires
o Experiential knowledge of social values
o Ethical reasoning
 Focus is on:
o Matters if obligation, what ought to be done
o Right, wrong and responsibility
o Ethical codes of nursing
o Confronting and resolving conflicting values, norms, interests or principles

Sources of ethical knowing

 Nursing's ethical codes and professional standards

 An understanding of different philosophical positions
o Consequentialism
o Deontology
o Duty
o Social justice