CHARACTERISTICS OF PROFESSION

Although nursing has been called a profession for many years, an assessment of
characteristics of a profession indicates that it should more accurately be considered as
emerging profession‖. Characteristics of a profession have been defined as:
1. Authority to control its own work.
2. Exclusive body of specialized knowledge.
3. Extensive period of formal training.
4. Specialized competence.
5. Control over work performance.
6. Service to society.
7. Self-regulation.
8. Credentialing system to certify competence.
9. Legal reinforcement of professional standards.
10. Ethical practice.
11. Creation of a collegial subculture.
12. Intrinsic rewards.
13. Public acceptance.
Apart from this the characteristics of a profession can be categorized as following:
Intellectual: This character is reflecting commitment to serve society.
This category has three components:
a) Body of knowledge: professional practice is based on body of knowledge derived from
experience (leading to expertise) and research (leading to theoretical foundation for
knowledge).This knowledge base contributes to judgment and rationale for modifying
actions according to specific situation. However, the education has often emphasized proven
methods for responding to particular kinds of situations e.g. clients may be discharged
without self care teaching because the doctor did not write an order.
b) Specialized education: Nursing transmits knowledge through specialized education.
However, there are five levels of basic education for registered nurses, all of which prepare
for one licensure examination. Three of five levels (diploma, associate degree and
baccalaureate degree) accept high school graduation where as other two (master‘s degree
and doctoral degree) accept college with liberal arts majors.
c) Critical and Creative Thinking: A logical and critical thinking process is one essential
component of professional practice. The nursing process is a problem solving approach.It
includes:
 Collect and organize information derived from multiple sources.
 Decide what is needed, based on that information.
 Select and implement one approach from among many possible approaches.
 Evaluate the results of the process.

1
Personal:
This category emphasizes on autonomy. Autonomy means the practitioners have control
over their own functions in a work setting. Autonomy involves independence, a willingness
to take risks and responsibility and accountability for one‘s own actions as well as self-
determination and self-regulation. The autonomous practitioners are also obligated to
collaborate with others for the benefit of the patient.
Interpersonal: Nursing is a significant therapeutic interpersonal process. It functions
cooperatively with other human processes that make health possible for individuals in the
communities. The nurse collaborates with the patient, significant others and health care
providers in the formulation of overall goals and plan of care and in the decisions related to
care and delivery of services.

CRITERIA OF PROFESSION

Bixler and Bixler Criteria for Profession:

Genevieve and Roy Bixler who were against the status of ‗Nursing as a Profession
1945,appraised nursing according to their original seven criteria as follows:-
1. A profession utilizes in its practice a well defined and well organized body of knowledge,
which is on the intellectual level of the higher training.
2. A profession constantly enlarges the body of knowledge its uses and improves its
techniques of education and service by the use of the scientific method.
3. A profession entrusts the education of its practitioners to institutions of higher education.
4. A profession applies its body of knowledge in practical service, which is vital to human
beings and social welfare.
5. A profession functions autonomously in the formulation of professional policy and in
control of professional activities there by.
6. A profession attracts individuals of intellectual and personal qualities who exalt service
above personal gain and who can recognize their chosen profession as life long.
7. A profession strives to compensate its practitioners by providing freedom of action,
opportunity for continuous professional growth and economic security.
After examining all the criteria of profession and other related concepts and aspects
―world health organization‖ has already recognized ‗Nursing as a Profession‘.

2
 PRESPECTIVE OF NURSING PROFESSION:

At National Level: During the Post Independence period there has been enormous change
and development in the field of medicine, medical technology, health care and nursing.Some
vital recommendations to the Bohre Committee relevant to nursing profession are given
below:
1. Stipends to the nursing students: In order to prevent economic barriers in the way of
suitable persons entering the nursing profession, the committee suggested the provision of
Rs.60 per month for pupil nurses.
2.Nurses, Midwives and Dais: The committee suggested that by 1971, the number of trained
nurses available in country should be raised to 7, 40,000. As essential step towards the
achievement of this objective was the removal of the existing unsatisfactory conditions of
training and service. The committee made proposals to improve thesituations.
3. Training of Nurses and Midwives: In view of the extreme shortage of nursing personnel
the committee recommended that the first group of 100 training centres, eachtaking 50
pupils, should be started two years before the Health Organization began to be established,
that another set of 100 training centres should be created during the first two years of the
schemes and that a third group of the same number of training centres should be
established before the third year of the second puperium.
4. Male Nurses: Male nurses should be trained and employed in large numbers in the Male
wards and Male Out Patient Departments of Public hospitals, thus releasing women workers
for other work.
5.Public Health Nurses: The committee also made specific proposals with regard to the
training of Public Health Nurses. These should be fully qualified nurses with training in
midwifery as well.
6.Midwives: The number of midwives actually available for midwifery duties in the country
was probably 5000.The committee laid down certain fundamental requirements which
should be met before an institution could be organized as a training centre for Midwives.
7.Dais: The continued employment of women as dais was inevitable. The committee
advocated the training of dais as an in trim measure until an adequate number of midwives
would become available.
8.Nursing Staff: The report recommended to produce another category of Nursing Health
Personnel called Auxiliary Personnel. Auxiliary Nurse Midwife training was started to meet
the health needs of the country. Establishment of Indian Nursing Council: As a result of
Bohre Committee recommendations, Indian Nursing Council was established in 1947 to
regulate the standards of Nursing Education. Nursing Council made three important
decisions:
a) There should be only two standards of training of General Nursing and Midwifery:
i. The full course of General nursing to be for three years followed by a minimum of

3
nine months of midwifery.
ii. A course of Auxiliary Nurse Midwife for two years.
b) The minimum entrance requirement of General Nursing Course to be Matriculation
and for Auxiliary Nurse Midwife to be 7th or 8th standard of education.
c) The Auxiliary Nurse Midwife Course to replace various courses like Junior Grade
Nursing Certificate and courses other than for nurses

4
 ROLE OF REGULATORY BODIES AND
PROFESSIONAL ORGANISATION
ORGANIZATION:
According to L. White, "Organization is the arrangement of personnel for
facilitating the accomplishment of some agreed purpose though allocation
of functions and responsibilities."
PROFESSIONAL ORGANISATION:
Professional organization provides a mean through which your own
professional development can be channelled with authority because of their
representative character. It provides you an opportunity to express your
viewpoints, develop your leadership qualities and abilities and keep you
well informed of professional trends and news.
All qualified nurses must parti cipate in their professional state and
national organizations to keep themselves informed of new developments
and for upgrading the profession.
Some of the organization discussed below are recognized at national and
international level and have a great rol e in uplifting the nursing
profession.
INDIAN NURSING COUNCIL – INC:
The Indian Nursing Council is a statutory body constituted under the
Indian Nursing Council Act, 1947. It was established in 1949. The council
is responsible for regulation and Maintenanc e of a uniform standard of
training for nurses, Midwives, Auxiliary Nurses Midwives and Health
visitors.
Indian Nursing Council Act, 1947:
Indian Nursing Council Act, 1947, provides for constitution and
composition of the Council consisting of the followin g: -
1. One nurse enrolled in a state register elected by each State Council;

5
2. Two members elected from among themselves by the heads of
institutions recognized by the Council for the purpose of this clause in
which training is given: -
a. For obtaining a University degree in Nursing; or
b. In respect of a post-certificate course in teaching of nursing and in nursing
administration;
3. One member elected from among themselves by the heads of
institutions in which health visitors are trained;
4. One member elected by the Medical Council of India.
5. One member elected by the Central Council of the Indian Medical
Association.
6. One member elected by the Council of the Trained Nurses Association
of India.
7. One midwife or auxiliary nurse -midwife enrolled in a State Register,
elected by each of the State Councils in the four groups of State
mentioned below, each group of States being taken in rotation in the
following order namely:-
a. Kerala, Madhya Pradesh, Uttar Pradesh and Haryana.
b. Andhra Pradesh, Bihar, Maharashtra and Rajasthan.
c. Karnataka, Punjab and West Bengal.
d. Assam, Gujarat, Tamil Nadu and Orissa ;
8. The Director General of Health Services, ex -officio;
9. The Chief Principal Matron, Medical Directorate, Army Headquarters.
10.The Chief Nursing Superintendent, Office of the Director Gene ral of
Health Services.
11.The Director of Maternity and Child Welfare, Indian Red Cross
Society.
12.The Chief Administrative Medical Officer (by whatever name called)
of each State other than a Union Territory.
13.Four members nominated by the Central Government, of whom at least
two shall be nurses, midwives or health visitors enrolled in a State

6
register and one shall be an experienced educationalist.

AMENDMENTS IN I.N.C. ACT 1947:

The Act was amended in November 1957 to provide for the following
things:
1. Foreign Qualification:
a) A citizen of India holding a qualification which entitles him or her to
be registered with any registering body may, by the approval of the
council, be enrolled in any state register.
b) A person not is citizen of India, who is employed as a Nurse, Midwife,
ANM, Teacher or Administrator in any hospital or institution in any state,
by the approval of President of Council, is enrolled temporarily in state
register. In such cases foreign qualifications are recognized temporarily
for a period of 5 years. If one continues to practice in India, an extension
of recognition should be sort from INC.
2. Indian Nurses Register:
a) The council shall cause to be maintained in the prescribed manner a
Register of Nurses, midwives, ANM & Health visitors to be kno wn as the
Indian Nurses Register, which shall contain the names of all persons who
are for the time being enrolled on any state register.
b) Such register shall be deemed to be a public document within the
meaning of the Indian Evidence Act, 1872.
ORGANISATION CHART:
Committees:
1. Executive Committee: of the Council to deliberate on the issues
related to maintenance of standards of nursing programs
2. The Nursing Education Committee: The committee is constituted to
deliberate on the issues concerned mainly with nursing education and
policy matters concerning the nursing education.
3. Equivalence Committee: to deliberate on the issues of recognition of
foreign qualifications this is essential for the purpose of registration of

7
the Indian Nursing Council Act, 1947, as amended.
4. Finance Committee: This is another important Sub-Committee of the
Council which decides upon the matters pertaining to finance of the
5. Council in terms of budget, expenditure, implementation of Central
Govt. orders with respect to service conditions etc.
Functions:
 To establish and monitor a uniform standard of nursing education for
nurses, midwives, auxiliary nurse Midwives and health visitors by doing
inspections of the institutions.
 To recognize the qualifications for the purpose of re registration and
employment in India and abroad.
 To give approval for registration of Indian and Foreign nurses
possessing foreign qualification.
 To proscribe the syllabus and regulation for nursing programmed.
 Power to withdraw the recognition of qualification standards, that an institution
recognized by a state council for the training of nurses, midwives, auxiliary nurse
midwives or health visitors does not satisfy the requirements of council.
 To advise the state Nursing Councils, examination board, state government and
central government in various important items regarding nursing education in
country.
GUIDELINES FOR ESTABLISHMENT OF NEW NURSING
SCHOOL/COLLEGE IN INDIA APPROVED BY INC:
1. Any organization under the central Government, State Government,
Local body or a Private or Public Trust, Mission, Voluntarily registered
under society Registration Act wishes to open a school of nursing should
obtain the no objection /Essentiality certificate from the state
Government.
2. The Indian Nursing Council on rece ipt of the proposal from the
institution to start nursing programmed will undertake the first inspection
to assess suitability with regard to Physical Infrastructure, clinical
facility and teaching faculty in order to give permission to start the
programmers.
3. After the receipt of the permission to start the Nursing programmers

8
from INC, the institution shall obtain that approval from the State Nursing
Council and examination Board.

4. Institution will admit the students only after taking approval of state
nursing council and examination board.
5. The INC will conduct inspection every year till the first batch
completes the programmers. Permission will be given year by year till the
first batch completes.
TYPE OF INSPECTION:
1. First Inspection:
The first inspection is conducted on receipt of the proposal received from
the institute to start any Nursing programmed prescribed by INC.
2. Re-Inspection:
Re-inspections are conducted for those institutions, which are found
unsuitable by INC. The institution and the government are informed about
the deficiencies and advised to improve upon them. Once the institution
takes necessary steps to rectify the deficiencies, institution should submit
the compliance report with documentary proof of the deficiencies pointed
out and re-inspection fees. On receipt of the compliance report and fees
from the institution, it will be considered for re -inspection.
3. Periodic Inspection:
INC conducts periodical ( aft er 3 years) inspection of the institution once
the institution is found suitable by INC to monitor the nursing education
standards and adherence of norm prescribed by INC. Institutions are
required to pay annual affiliation fee every year. However, if the
institution does not comply to the norms prescribed by INC for te aching,
clinical and physical facility, the institution will be declared unsuitable.
PROGRAMMES UNDER I.N.C:
1. ANM
2. GNM
3. Post Basic B.Sc. Nursing

9
4. B.Sc. Nursing
5. M.Sc. Nursing
6. M. Phil
7. Doctorate in Nursing
RESOLUTIONS:
I. Maximum period for students to complete revised ANM and GNM course is 3 and 6 years
respectively.
II. INC resolved that maximum age for teaching faculty is 70 years subject to the condition
that he/she should be physically and mentally fit.
III. Admission to married candidate for the entire nursing programmed allowed subject to
the conditions that they should produce medical fitness certificate.
IV. Relaxation of norms to establish M.Sc. (N) programmed: As per INC norm, only those
institutions can start M.Sc. programmed where at least one batch of students has qualified
B.Sc. (N) programmed. INC resolved apart from these institutions the super specialty
hospitals can also open the M.Sc. (N) programmed. Even though the institutions are not
having B.SC. (N) Programmed.
V. Relaxation of student patient ratio for clinical practice: 1:3 student patient ratios instead
of 1:5 student patient ratios.
VI. Relaxation of teaching faculty qualification to start a B.SC. (N) programmed. At least 2
M.SC. (N) qualified teaching faculty to be available to start BSC (N) programmed for next 4
years in order to combat acute shortage of nursing and teachers till the position of M.SC. (N)
qualified teaching faculty improves.
VII. To maintain quality of post graduate in nursing, INC resolved not to have M.SC. (N)
programmed through distance education.
VIII. Institution should have its own building within 2 years of establishments.
IX. Maximum No. of 60 seats can be sanctioned to those institutions which are having less
than 500 bedded hospital. And 100 seats can be sanctioned to those having 500 bedded
hospitals.
REGISTRATION OF ADDITIONAL QUALIFICATION:
INITIATIVES BY I.N.C.
1. Teaching material for Quality Assurance Model(QAM) prepared :QAM in nursing is the set
of elements that are related to each other and comprise of planning for quality,
development of objectives setting and actively communicating standards, developing
indicators, setting thresholds, collecting data to monitor compliance with set standards for
nursing practice and applying solutions to improve care INC has developed a Quality
assurance programmed for nurses in India. The project was implemented in 2 hospitals in
New Delhi and PGI, Chandigarh for 3 months duration. The impact of QAM model adopted in

10
Chandigarh can be seen in the paper cutting which was published in Tribune on April 19th,
2004

2. Princes Srinagarindra award:

Mrs. Sulochana Krishnan, Ex- Principal of RAK College of nursing was awarded Princes
Srinagarindra, Thailand, award which is an international award to individual(s) registered
nurse(s) in honor of princess Srinagarindra, her royal highness and in recognition of her
exemplary contribution towards progress and advancement in the filed of nursing and social
services Mrs. Sulochana Krishnan name was proposed by INC from India.
3. Development of Curriculum for HIV/AIDS and training for nurses:Indian Nursing Council in
collaboration with NACO and Clinton foundation is developing a curriculum for training of
nurses in HIV/AIDS areas. It will be a 6 day training programmed. The pilot study was
conducted in Mumbai and Hyderabad.
4. National Consortium for Ph.D. in Nursing constituted 6 study centers recognized under
National consortium for Ph. D in nursing:MOU has been signed between INC, WHO and
RGUHS National consortium for Ph.D. in Nursing has been constituted by Indian Nursing
Council (INC) in collaboration with Rajiv Gandhi University of Health Sciences and W.H.O,
under the Faculty of Nursing to promote doctoral education in various fields of Nursing.
Applications for enrolment in PhD in nursing were invited from eligible candidates by
advertising in the national leading dailies from all over the country by the RGUHS. 125
appeared for the entrance test conducted on 07th January 2007.
5. MOU (Memorandum of Understanding:) signed between INC and Sir Edward Dunlop
Hospitals Ltd for advancing standards of nursing education and practices in India to meet
challenges currently faced by Nursing.Memorandum of Understanding (MOU) is entered at
New Delhi on 11th April 2006 between Indian Nursing Council and Sir Edward Dunlop
Hospitals (I) Ltd. for developing the strategic framework for advance standards and
investment plan for advancing standards of nursing education and practices in India with the
following objectives.
1. Provide training
2. Graduate, Post-graduate, and Ph. D courses.
3. Organizing Research Activities.
4. To help fill gaps in India and internationally benchmarked standards of nursing education
and practice, including credentialing etc., so that Indian nurses can directly be accepted to
meet inter national standards.
5. Train the faculty so as to provide high quality teaching staff to training institutes in the
country.
6. Steps taken up to enter into MRA under the Comprehensive Economic Cooperation
Agreement (CECA) between India and Singapore : This was signed in June 2005 and has
come into force from 1st August 2005. In that, it has been agreed that India and Singapore

11
would enter into mutual recognition agreements (MRAs) in Medical, dental and nursing
services in the healthcare sector
7. All State Registrars were invited to attend the two days meeting :The objective was to
ensure the uniformity and to maintain the quality of
nursing education in the country. It was also aimed to understand the problem/issues of
each state nursing council and evolve consensus between INC and SNRC.
8. The Indian Nursing Council (INC): initiated the live register in the state of Tamil Nadu. The
primary objective of the project is to conduct nurses census i.e., to collect the data regarding
number of working nurses as defined by INC. INC decided to conduct the pilot study in the
Sivaganga District of Tamil Nadu. 266 were found trained registered nurses out of 841
nurses.

STATE NURSING COUNCILS:

Registration in state nursing council is very necessary for every nurse. It is necessary to be
registered in order to function officially as a professional nurse. Registration councils are
functioning in all the states of India and they are affiliated to I.N.C. A register of names of
professional nurses is maintained by each state nurses Registration Council. These names are
also put into the Indian Nurses Register maintained by the Indian Nursing Council. Nurses,
midwives, auxiliary nurse midwives and health visitors are registered. All degree holding
nurses also have to get the registration in state council. The present functions of the State
Nurses Registration Council are:
1. Recognize officially and inspect schools of nursing in their states.
2. Conduct examinations.
3. Prescribe rules of conduct, take disciplinary actions, etc.
4. Maintain registers of Graduate nurses, nurses holding degrees in nursing, midwives
revised auxiliary nurse midwives or multi-purpose workers and health visitors. The State
Nursing Council is an independent body. Though the State Nursing Council functions
independently; it has to obtain approval from state government for all the By-Laws passed
by it and decisions taken. The State Nursing Councils are administratively headed by the
Registrar who usually is a nurse. There is deputy registrar who also is a nurse. There is a staff
consisting Accountant and other staff as clerks and peons to help him in his day to day work
and functions. The President and Vice-President are elected by members from amongs
themselves. The elections procedures for all the categories a re laid down by statutory
provisions in By-Laws of the Councils. Some of the members on the council are still
nominated by the Government whereas majority is elected by following the electoral
procedures.
FUNCTIONS OF THE REGISTRAR OF THE STATE NURSING
COUNCIL:
1. To draw a programmed for examinations of various types of educational programmed at
all centers at the same time.

12
2. To prepare a time schedule for written and practical examinations, to prepare Roll number
sheets of students and send them to various examination centers.
3. After examiners have drawn the question papers, to get them printed under strict
confidential atmosphere and keep up the secrecy regarding them.
4. To prepare examination results and communicate the results to concerned institutions.
5. To prepare the diploma certificates and registration certificates of nurses who have been
qualified for both.
6. To arrange for inspections to ascertain that the institutions are carrying out the
educational programmed as per syllabus, conditions and rules and regulations laid down by
State Council.
TRAINED NURSES ASSOCATION OF INDIA (TNAI):
The T.N.A.I. is the national professional association of nurses. The
association had its beginning in the association of nursing superintendents
which was founded in 1905 at Lucknow. The organization composed of 9
European Nurses holding administrative post in hospital.
They saw the need to develop nursing as a profession and also do provide
a forum where professional nurses meet and plan to achieve these ends.
The first president was Miss Allen Martian.
First Secretary: Miss Burn.
Objectives:
a. Uphold the dignity and honor of nursing profession.
b. Promote a sense of spirit de-corps among all the nurses.
c. Enabling member to take counsel together on matters rel ating to their
profession.
The association of nursing superintendents therefore sought the help and
co –operation of nurses throughout the country.
A decision was made in 1908 to establish a trained nurses association at
the annual conference at Bombay and accordingly association was
inaugurated in 1909.
These two organizations operated under the same leadership until 1910,
when TNA elected its own officers. In 1922, the two organizations were
brought together as the ―Trained Nurses Association of India. The aims of

13
TNAI are similar to those of original organization. These aims centre on
the needs of the individual and the problems of the nursing profession as a
whole.
These aims include the following:
1. To standardize, upgrade, develop nursing education and to elevate
nursing education.
Development of various colleges of nursing in the different states of India
is a result of this function of the national organization of nursing that is,
the TNAI. Thus the TNAI has contributed greatly to meet this aim.
2. To improve the living and working conditions of the nurses and also
develop the educational conditions available for nursing. To improve the
economic standards of the nurses in India.
The state government in every state has been directed by TNAI to appoint
a nurse as the nursing director.
3. To provide registration for qualified nurses and to provide reciprocity
of registration within different state in the country and within different
countries. The TNAI has established the following organization.
The association has established the following organizations:
a. Health visitor league (1922)
b. Midwives and auxiliary nurses: Midwives Association (1925)
c. Student Nurses Association (1929-30)
Membership:
The membership consists of:
 Full Members: Fully qualified Registered Nurses
 Associate Members: Health visitors, midwives and A.N.Ms.
 Affiliate Members: Student nurses and members of the affiliated
organizations e.g. Christian nurses‘ league.
Membership of TNAI is obtained by application and submission of copy
of one‘s state registration certificate. One can apply for a life
membership.
BENEFIT FROM T.N.A.I. MEMBERSHIP:

14
1. Various professional issues like representation to central pay
commission.
2. Holding National level conferences, scientific and business sessions.
3. Low cost publications for members and students.
4. Continuing education programmed for updating knowledge on various
topics at regular interval.
5. Socio-economic welfare programmed for destitute members.
6. Research studies conducted regularly for the benefit of the members.
7. At home with patron of TNAI member at Rashstarlpati Bhawan every
year on nurses day celebrations.
8. Scholarship for TNAI member and students nurses.
9. Annual grant to state branches to hold activities.
10.One fourth railway concession for TNAI members.
11.The guest room facilities at the headquarters and also in some states.
PUBLICATION:
o Hand Book of T.N.A.I. , published in1913
o Nursing Journal of India published monthly.
WHO Day, International Nursing Day and International Women‘s Day and
other related activities are celebrated with the initiative of T.N.A.I. in all
states of country.
STUDENTS NURSES ASSOCIATIONS (S.N.A.):
The student nurses associations were established in 1929 which is a
nationwide organization. In 1954, SNA celebrated the silver jubilee and
number of unit was 117. Now SNA have more than 506 units. S .N.A.
having separate biennial conference. There is a full time secretary for
SNA at national level.
OBJECTIVES OF S.N.A:
1. To help student to uphold the dignity and ideals of the profession for
which they are qualifying.
2. To promote a corporate spirit among student for the common good.
3. To furnish nurses in training with advice in their case of study leading

15
to professional qualification.
4. To encourage leadership ability and help students to gain a wide
knowledge of the nursing profession in all its different branches and
aspects.
5. To help the student to increase their social contacts and general
knowledge in order to assists them to take their place in the world when
they have furnished their training.
6. To increase professional, social and recreational developments and
arranging meetings, games and sports.
7. To provide a special section in the “Nursing Journal of India” for the
benefit of students.
8. To encourage student to compete for prizes in the student nursing
exhibition and to attend national and regional conferences.
The whole organization of SNA is similar to that of TNAI. Local units
are established in the institution. The Diary of various events is kept by
SNA Secretary. The diary for all the students are presented at the time of
national conferences, the diaries from all the units are presented. Later
on, the SNA unit moves to the national level as the TNAI.
MANAGEMENT OF S.N.A:
The governing body of the association shall be the council of TNAI which
will receive the recommendations of the General Committee of the SNA
for consideration.
The General Committee of SNA shall consist of:-
1. President of TNAI or one of the Vice -President if President wishes to
delegate this responsibility.
2. Vice Presidents of SNA State Branches, Honey. Treasurer of TNAI,
National SNA Advisor who must be a full member of TNAI, State
3. Branch SNA Advisors, Secretaries of SNA State Branches, Secretary
General of TNAI.
The General Committee shall meet once in a year a time of TNAI council
meeting.

16
SNA General Body:
At National Level Comprises
i) Members of SNA General Committee
ii) 3 representative from each unit i.e. SNA Vice President, SNA
Secretary and SNA Advisor
iii) All SNA delegates attending the conference
SNA General Body at State Level:
It consists of
i) State SNA Executive Committee Members (State Branch President,
Vice President, Advisor, Secretary, Treasurer and Programme
Chairperson).
ii) SNA Unit representative (Vice President, Secretary, SNA Advisor)
SNA Units
Each SNA Unit should elect its own members of Executive Committee in
its GBM (General Body Meeting) and these members are SNA Unit
Advisor, Vice President, Secretary, and Programmed Chairperson. The
SNA General Body Meetings should be held at regular intervals the
agenda for these meetings will be according to the needs of unit members
and objectives of SNA. SNA unit advisor is responsible to see that as soon
as a nurse has graduated, she is given an SNA to TNAI form for
membership in TNAI. This form must be signed by the Nursin g Head of
the Institution and sent to Secretary General of TNAI.
Membership:
The student nurse can obtain membership of student nurses Association
during their training period and SNA membership can be transferred to
TNAI membership.
The membership fee in SNA is quite less, which is easily met by the
nursing student.
They can take membership in TNAI after completion of basic education by
obtaining a certificate from the institution in which they have studied
within 6 month after completion of studies.

17
ACTIVITIES OF S.N.A:
A wide variety of activities are encouraged for S.N.A. Keeping in view
the objectives of association and to strengthen curricular and co -
curricular components as follows.
A. Organisation of meetings & conferenes:
At the TNAI conference two representatives of SNA from each state are
invited as observer and these students representative are vice -president
and secretary of the state branches. They are invited to attend business
meetings as observer.
Three to four days conference is held for SNA members biennially.
Member discuss and find solution for various problem faced by the
students. These conferences are held biennially at state level. At the units
usually the meeting is held monthly or bi- monthly.
B. Maintenance of diary:
This is a biennial record book drawn up for the use of unit secretaries.
The diaries are assessed annually by the state, SNA advisers and two best
diaries are sent by state to the national SNA advisor for biennial
evaluation and awards.
These diaries are assessed for pro fessional, educational, extra- curricular,
social, cultural and recreational aspects.
C. Exhibition:
Exhibition is very useful and very popular activity of the association. All
categories of students are eligible to participate either individually or in
groups. They can prepare models, charts & posters on the subjects taught
in their course of studies. Now, their activity is competed at the state
88
level and one best entry under each category and section is entertained at
national level.
D. Public speaking and writing:
Public Speaking and writing are encouraged to increase self confidence
and help them gain skill in communication through debates, panel

18
discussions, seminar on the theme of conference. Students are also
encouraged to write for nursing general of India on professional topic.
E. Project undertaking:
At the time of celebration of international nurses day students are given
project work on health related topics. Regular project work is also given
by institution to students.
F. Propagation of nursing profession:
Other professional and general public should be invited to celebration of
professional and non professional activities such as nurse‘s week, WHO
day. The other activities such as variety entertainment programme, game,
sports etc. are organi zed by nurses to acquaint general public with nursing
profession.
G. Fund raising:
To meet the expenses at head quarter and SNA state level unit, it is
necessary to raise the fund through voluntary donations.
H. Socio cultural and recreation activities:
To channelize your student energy, fine arts activities such as drama,
dance, music and painting are arranged and competitions are also held at
state and national level. Sports and games competitions are also held.
Other activities:
These can be in the form of quiz on general knowledge and professional
topics, article writing, poetry writing, smile competitions etc. Hobbies
such as sewing, stitching, knitting etc. should also be arranged.
INTERNATIONAL PROFESSIONAL ORGANISATIONS:
INTERNATIONAL COUNCIL OF NURSES (ICN):
MISSION:
To represent nursing worldwide, advancing the profession and influencing
Health policy.
Introduction:
The ICN is federation of national nurses association (NNAs), representing
nurses in more than 128 countries. Founded in 1899, ICN is the world‘s

19
first and widest reach international organization for health professionals.
Operated by nurse for nurses, ICN works to ensure quality nursing care
for all, sound health policies globally, the advancement of nursing
knowledge and the presence world wide of a respected nursing profession
and a competent and satisfied nursing workforce.
I.C.N. Goals:
1. To influence nursing, health and social policies, professional and socio
economics standards worldwide.
89
2. To assist national nurses associations (NNAs) to improve the standard
of nursing and the competence of nurses.
3. To promote the development of strong national nurses associations.
4. To represent nurses and nursing internationally.
5. To establish, receive and manage funds and trust which contribute to
the advancement of nursing and of ICN.
In shorts 3 main goals:
- To bring nursing together worldwide.
- To advance nurses and nursing worldwide.
- To influence health policy.
Core values:
1. Visionary leadership.
2. Inclusiveness.
3. Flexibility.
4. Partnership.
5. Achievement.
The ICN code for nurses is the foundation for ethical nursing practices
throughout the world.
ICN standard, guidelines and policies for nursing practices, education,
management, are globally accepted as per basis of nurse‘s policy.
ICN advances nursing, nurses and health through its policies, partnership,
advocacy and leadership development, ICN is particularly active in:

20
Professional nursing practice:
- Advanced nursing practice.
- HIV/AIDS, TB and malaria .
- Women‘s health.
- Primary health care.
- Family health.
- Safe Water.
Nursing regulations:
- Code of ethics, standards and competencies.
- Continuing Education.
Socio economic welfare for nurses:
- Occupational health and safety.
- Human resources planning and policies.
- Carrier development.
- International trade in professional services.
Governance of icn:
Meetings:
ICN meets every 4 years. The quadrennial meetings are called as
"Congresses" and when they are in session, the organization is called as
the International Congress of Nurses.
90
The ICN board of directors numbers15 and is comprised of the president,
three vice president and 11 members elected on the basis of ICN voting
area.
Function:
1. To provide policy directions to fulfill the objectives of ICN
2. To establish categories of members hip and determine their rights and
obligations.
3. To act upon recommendations of the board of directors relating to
admission and readmission of member associations into ICN.
4. To receive and consider information from the board regarding ICN

21
activities.
5. To receive nominees for the board and to elect the board.
6. To act upon proposed amendments to ICN constitution.
7. To act upon recommendation of the board of directors for the amount of
NNA‘s dues.
8. To act through mail or any written communication on ICN business th at
requires immediate attention.
Publication: International Nursing Review
American Nurses Association (A.N.A.)
Establish: 1911
Purpose: To improve quality of nursing care
Activities:
- Establish standards for nursing care
- Develop educational standard
- Promote nursing research
- Establish a professional code of ethics.
- Oversee a credentialing system.
- Influence Registration affecting health care.
- Protect the economic and general welfare of registered nurses.
- Assist with professional development of nurses by pro viding continuing
education programmed.
Membership:
Federation of state nurses association
- Individual registered nurses can participate in ANA by joining their
respective state nurses association.
Publication:
 American general of nursing.
 American Nurses.
Conclusion:
It is to conclude that the knowledge of all above discussed organization is
must for every nursing personnel. So that by utilizing this knowledge we

22
can update our knowledge and can advance the nursing practices, taking
this profession to the higher standards.

COLLECTIVE BARGAINING:
Definition
Collective bargaining is a mode of fixing the terms of employment by means of bargaining
between an organized body of employees or an employer or an association of employees
usually acing through duly authorized agents. It is fundamentally a method
of joint regulation as it necessarily involves both the parties directly. The essence ofcollective
bargaining is a bargaining between interested parties and the readiness of both the parties to
regulate industrial relation. Collective bargaining aims a reaching some settlement. Collective
bargaining has been defined in encyclopaedia of social science as
a process of discussion and negotiations between two parties, one or both of whom is agroup
of persons acting in concert. More specifically it is the procedure by which an employer and a
group of employees agree upon a condition of work.
Characteristics of collective bargaining.
Collective bargaining has been characterized as a form of industrial democracy and industrial
government. The management and the union representatives sit down at the bargaining
table where they deliberately, persuade, try to influence, argue and reach an agreement
which they regard in the form of contract. Generally speaking the union and the management
must learn to live with one another whether they like it or not. They must accommodate each
other under the labor law of the land. Once bargaining relationship have been commenced
both sides must be honestly seek an agreement.
Prerequisites of collective bargaining
i) Freedom of associations and independence of unions.
ii) Stability of organizations of workers and employers.
iii) Favorable political climate the Government should not only be sympathetic but
also encourage collective bargaining and agreements.
iv) Mutual trust and respect and also willingness on the part of the parties
concerned tosettle all matters by collective bargaining or negotiations
v) Bargaining power of each party depends on the (a) strength of its organization
(b)knowledge and skill of negotiation of its representatives (c) trade recession,
or boom andshortages and (d) surplus of labour, particularly in regard to semi-
skilled and unskilledworkers.
vi) There should be absence of any external pressure either on the employer or on
theworker to come to the king of agreement desired by the authority exerting
the pressure.vii) There should be an existence of a progressive and strong
management conscious ofits responsibility and its obligation to the industry,
the employee, the consumers and thecountry.
viii) There should be delegation of authority to local managements where there
areseveral units of a company. Delegation of authority is very essential for collective
bargaining as for successful management in general. the man at the bargaining
tablemust have wide powers to negotiate the contract and the people at the other side

23
of thetable must aware of it.The collective bargaining in India has not made that of
much headway as in some othercountries because of the following factors,1) Absence
of enlightened management .a few managements or employers are stillallergic to
trade unions.2) Weakness of trade unions due to their multiplicity, intra and inter
union rivalries, poorfinancial conditions, lack of leadership.3) Easy availability of
govt.interventions for conciliation and compulsory adjucation ofdisputes.4) Surplus
manpower

5) Restricted rights of workers and employers tostrike and lock out.6) Different
political affiliation of union and consequent political rivalry make difficultto
settle the disputes amicably by mutual negotiations7) Lack of mutual trust,
respect and sprit of give and take8) Unfavorable political and economic climate
since the government through want to encourage collective bargaining is not
prepared to allow endless trails of strength for fear of planned economy of the
country long disrupted.
Nature of collective bargaining.
Collective bargaining has existed in united state since the early 1800s.however,
it didn‘t
develop to its resent form until recently. In the early days the general practice
was that either employer or unions, depending upon their relative economic
strengths, would notify the other party of wage rates and other conditions of
employment which is indented to put into effects. there as very little
negotiations and discussion between the parties. if one party refused to accept
the terms imposed by the other, then either a strike or lockout as ensured. The
bargaining is collective in the sense that the chosen representative of
employees in carrying out negotiations and dealing with management. The
process may also be considered collective in the cases of the corporation where
paid professional manager represents the interest of the stock holders and the
board of directors in the bargaining with the union leaders. On the employer
side it is also collective on those common situations where companies have
joined together as an employer association for the purpose of bargaining with a
union.
Subject matter of collective bargaining:
1) Union recognition and scope of bargaining unit.
2) Management‘s rights.
3) Union security.
4) Strikes and lock outs.
5) Union activities and responsibilities
6) Wages
7) Working hours and conditions
8) Discipline, suspension and discharge
9) Grievance handling and arbitration.
10) Health and safety
11) Insurance and benefit programs
Objective and scope of collective bargaining:

24
The objective of collective bargaining is a labor-management agreement.
collective bargaining is generally referred to as a contract. In early days,
agreements were merely list of wages to be paid to the various occupational
groups covered. Today, there are tremendous variations in labor management
agreements. The negotiations of wages are a very complicated matter.
Different arguments are put forward .the criteria put forward by unions used in
wage negotiations are,
i) Changes in the cost of living
ii) Wage uniformity
iii) Changes in productivity
iv) The ability of employer to pay. Several of the criteria used by the unions in
seeking wage increases are also used by managements in resisting such
demands. It is often argued by managements that increases in productivity are
not the result of greater labor effects but stem of improve products and
production price
ss. If these s gains are sustained, managements‘ feels that sizable part of the
earnings need to be ploughed back into new equipments. Managements in
most cases is willing to concede that workers should have a share in gains
resulting from productivity .but the issue is the proportion that should go to
workers of a particular company. It is frequently claimed by management that
if higher wages are granted that increase cost will lead to drop in employment.
While union press for wage uniformity, management greatly objects to this
criterion serve as a code defining the rights and obligations of ach party in their
employment relations with one another.
Factors of success of collective bargaining
Lester and sister outline factors which determine the success of collective
bargaining. They have been grouped into
i) Economic environment factors
ii) Psychological factors and structure of power relation
iii) Nature and characters of the product market
iv) Nature of labor market
v) Capital requirement and cost conditions
vi) Types of industrial relationship.
Nurse manager role in collective bargaining:
Nurse Manager should evaluate their management skills and take continuing
education course to improve them. Motivational techniques are particularly
important for nurse administrator to possess because they work through
others. They must listen carefully to staff concerns about represent staff
associations wishes to top management .nurse administrators need to know
about labor relations. The director of nursing should not serve as the chief
negotiator during collective bargaining because it would put the director in an
advisory role. The agency legal representative is usually the negotiator. During
negotiations, the director of nursing

defines what is best for the nursing care of patients. Once the contract has been
negotiated, nurse managers must learn the terms of the contract and have

25
copies of the contract available to them. problems should be solved through
problem solving techniques as they arise.
Steps In Collective Bargaining

Assemble a group of nurses who support collective bargaining.

Arrange a meeting with a representative of the state nurses‘ association.
Assess the feasibility of an organizing campaign.

Conduct necessary research to develop a plan of action.

Establish an organizing committee and subcommittees.
Begin the process of obtaining union authorization cards.
Schedule an informal meeting for nurses eligible for the collective bargaining
unit.
Keep the lines of communication open with nurses.
Seek voluntary recognition from the employer.
Move toward formal organization of the unit.
Seek certification by the National Labor Relations Board as the exclusive
bargaining agent of the unit.
Initiate contract negotiations
Nurse Manager’s Role In Collective Bargaining
Unions may increase the cost for the hospital and limit the authority of its
managers.
Know the law, and make sure rights of the nurses as well as management are
clearly understood.
Act clearly within the law, no matter what the organization delegates to you as
manager.
Find out the reasons the nurses want collective action.
Discuss and deal with the nurses and the problems directly and effectively.
Distribute lists of disadvantages of unionization, such as paying dues.
Distribute examples of unions that did not help with patient care issues.
Nurse’s / Employees Role In Collective Bargaining
Know your legal rights and the rights of the manager.
Act clearly within the law at all times.
If a manager acts unlawfully, e.g., by firing an employee for organizing, report
the employer‘s actions to the National Labor Relations Board.
Keep all nurses informed through regular meetings held close to the hospital
Set meeting times conveniently around shift changes and assist with child care
during meetings.

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 Extended and Expanded Role Of Nursing:
Extended Role of Nurses
Extended role of a nurse is the responsibility assumed by a nurse beyond the traditional
role i.e; outside the practice. It is the scope of nursing services outside the hospital.
Expanded Role of Nurses
An expanded role of nursing is one in which a nurse assumes expanded or increased
responsibilities in a practice area and in most cases practice with greater autonomy.
Roles and Functions Of Nurse:
i) Care Giver.
ii) Manager.
iii) Advocate.
iv) Counsellor.
v) Educator.
vi) Consultant.
vii) Researcher.
viii) Collaborator.
ix) School Health Nurse.
x) Occupational Health Nurse.
xi) Parish Nurse.
xii) Public Health Nurse.
xiii) Private Health Nurse.
xiv) Home Care Nurse.
xv) Hospice Nurse.
xvi) Rehabilitation Nurse.
xvii) Office Nurse.

27
xviii) Nurse Epidemiologist.
xix) Military Nurse.
xx) Aerospace Nurse.
xxi) Telenursing.
xxii) Disaster Nursing.
xxiii) Forensic Nurse.
xxiv) Prison Nurse.
xxv) Peace Corps Nurse.
1) Care Giver:
Care giving role is a primary role of the nurse. The provision of care to clients combines
both the arts & science of nursing which helps clients regain health through healing
process. Healing is more than just curing a specific disease, although treatment skills that
promote physical health are important to caregivers. the nurse adders the holistic health
care needs of the client , including measures to restore emotional, spiritual & social well
being. The caregiver helps the client & families set goals & meet those goals with a
minimal cost of time & energy.
II) Manager:
As a manager, the nurse coordinates the activities of other members of the health care
team, such as nutrionists & physical therapists, when managing care for a group of
clients. Nurses must also manage their own time & resources of the practice setting when
providing care to several clients. As a clinical decision maker, the nurse uses critical
thinking skills throughout the nursing process to provide effective care. Before giving
care, the nurse should plan the action by deciding the best approach for each client. The
684
nurse makes these decisions alone or in collaborates and consults with each other health
care professionals.
III) Protector and Advocate:
As protector, the nurse helps to maintain a safe environment for the client and takes steps
to prevent injury and protect client from possible adverse effects of diagnostic or
treatment measures. Conforming that a client does not have an allergy to a medication
and providing immunization.

28
As advocate, nurse protects the client human and legal rights and provides assistance in
asserting those rights if the need arises. The task of an advocate is to be a supporter and
source of information for the patient and the patients significant others.
Eg: Nurse may provide additional information for a client who is trying to decide whether
or not to accept a treatment or the nurse may assist with communication with in the
family.
IV) Counsellor:
In the role of a counselor, nurse help to explore feelings and attitudes about wellness &
illness with patients and their families. It involves providing emotional, intellectual and
psychological support. In contrast to a psychotherapist, the nurse counsels primarily
healthy individuals with normal adjustment difficulties. The nurse encourages the client
to look at alternative behaviors, recognize the choices and develop a sense of control,
Counseling can be provided on a one – to – one basis or in groups. Counseling requires
therapeutic communication skills. She should be a skilled leader able to analyses a
situation, synthesize information & experiences & evaluate the progress & productivity
of the individual or group. The nurse must also be willing to model & teach desired
behaviors, to be sincere when dealing with people.
V) Educator:
As an educator, the nurse explains to client‘s concepts and factors about health,
demonstrates procedures such as self – care activities, determines that the client fully
understands reinforces learning or client behavior and evaluates the client‘s progress in
learning. The teaching process has four components - assessing, planning, implementing
& evaluating – which can be viewed as parallel to nursing process.
In assessment phase, the nurse determines the clients learning needs and readiness to
learn. During planning, the nurse sets specific learning goals & teaching strategies.
During implementation, the nurse enacts teaching strategies and during evaluation
measures learning.
Some client teaching can be un planned & informal. Eg: Nurse responds to a question
about a health issues in casual conversation. Other teaching activities may be planned &
formal. Eg: Self administration of insulin injection. The nurse uses h methods that match
client capabilities & needs & incorporates other resources, such as the family.

29
VI) Communicator:
The role of communicator is central to all nursing roles and activities. Nursing involves
communication with clients, families, other nurses and health care professionals, resource
persons and the community. Without any clear communication, it is impossible to give
care effectively, make decision with clients and families, and protect clients from threats
to well being, coordinate and manage client care, assist the client in rehabilitation, offer
685
comfort or teach. Quality of communication is a critical factor in meeting the needs of
individuals, families and communities.
Communication facilitates all nursing actions. The nurse communicates to other health
care personnel‘s the nursing interventions planned and implemented for each client and
should document them on client record. This type pf communication needs to be concise,
cleared and relevant
VII) Rehabilitator:
Rehabilitation is the process by which individuals return to maximum levels of
functioning after illness, accidents or other disability events. Usually, client experience
physical or emotional impairment that change their lives, and the nurse helps them to
adapt as fully as possible by using her knowledge and skills of many concepts when she
learned. Rehabilitation activities range from teaching client to walk with crutches to
helping clients to cope with life style changes of an associated with chronic illness.
VIII) Collaborator:
Many professions make up the team involved in the care of each client. Besides nurse,
there also can be physical therapists, occupational therapists, medical social workers,
home health aids, recreational therapists, volunteers and nutritionist. Nurse collaborates
with other team members when providing care to a client. Quality care is given when
nurse and team members work together in planning for the patient‘s care management. A
nurse can be a good collaborator when she is knowledgeable, a good planner when
providing patient care, and a good communicator of each patient‘s assessment and need
to work well with patients, families and health care members.
IX) School Heath Nurse:
School nursing is a specialized practice of professional nursing that facilitates the well

30
being, academic success and life long achievements of students. School heath services
have the goal of supporting educational success by enhancing health. Effective school
health services are comprehensive programmes that integrate health promotion principles
through out school‘s curriculum. A school nurse develops programmes that foster
children‘s growth, positive life skills for successful coping and acquisition of knowledge
and skills for self care and thereby reinforce positive health attitudes.
Functions:
 Direct caregiver: the school nurse is expected to give immediate nursing care to the
ill or injured child or the school staff members
 Case finder: The school health nurse identifies as early as possible children at risk for
physical, behavioral, social or academic problems.
 Case Manager: Helps to coordinate the health care for children, with complex health
problems
 Consultant: Provides professional information about proposed changes in school
environment and their impact on the health of the children
 Counselor: The school health nurse must be trust worthy person to whom children
can go if they are in trouble or they need some one to talk to.
 Researcher: The nurse makes sure that the nursing care is based on evidence based
practice.
 Health Educator: The nurse provides health education regarding proper nutrition or
safety information, personal hygiene to children and also to their parents.
686
X) Occupational Health Services:
Occupational and environmental health nursing is the specialty practice that provides for
and delivers health and safety programmes and services to workers, worker populations
and community groups. The practice focuses on promotion and restoration of health,
prevention of illness and injury and protection from work related and environmental
hazards.
Functions:
 Direct Nursing Care: This care encompasses primary, secondary and tertiary
prevention with nursing intervention from assessment to rehabilitation

31
Eg: Physical assessment, screening, emergency care etc.
 Case Management: Occupational health nurse acts as gate keepers for health services,
rehabilitation, return – to – work and recommending treatment plans that ensure quality
and efficacy while controlling costs and monitor care outcomes.
 Counseling and Crisis Intervention: Besides counseling workers about work related
illness and injuries occupational nurse counsels for issues such as substance abuse and
emotional or family problems and work place stressors?
 Health Promotion: Occupational health teach skills and develop health education
programmes specially on smoking cessation, exercise, nutrition, weight control, stress
management, control of chronic illnesses etc
 Legal And Regulatory Compliance: Occupational health nurse provides knowledge
regarding various occupational legislation and she works with employers on compliance
with regulations and laws affecting the work place
 Worker and Work Place Hazard Detection: Occupational health nurse monitors the
health status of worker populations by conducting research on the effects on work place
exposures, gathering health and hazard data and using the data to prevent the injuries and
illnesses.
According to a study, occupational research is seen as more complex issue in India,
which includes child labor, poor industrial legislation and vast informal sector and
balance between modern industrial exposures and health risk of traditional sectors.
XI) Parish Nurse:
Parish nurse is the most commonly used term for the professional advanced nurse
practice role that gather in churches, cathedrals, temples, or mosques and acknowledge
common faith traditions. Parish nurse in church has been referred to as congregational
health minister, an emergency church nurse, a faith community nurse or a health
minister‘s nurse. Parish nurse respond to health and wellness needs within the context of
populations of faith communities and are partners with the church in fulfilling the
mission of health ministry.
Functions:
 Provider of spiritual care: Spiritual care is the core of the parish nurse practice and
central to the healing process

32
 Health Counselor: Health counselor explains clarifies and interprets for the client the
language of health care. She discusses health risk appraisals, plan for healthier life styles,
provides support and guidance related to numerous acute and chronic, actual and
potential health problems and performs spiritual assessment.
687
 Health Advocate: As an advocate, parish nurse guides persons successfully for
problem solving and care options.
 Health Educator: As an educator, serves to gain knowledge in order to make best
choices for maintaining health, lowering health risks, preventing illness and managing
diseases already present.
 Facilitator of Support Groups: Facilitating the support necessary for those
encountering loss or other changes is an important part of whole person health journey.
Equipping congregations with the tools of support i.e.; coaching and facilitation, assures
sustainability.
 Trainer of Volunteers: Many volunteers need additional preparation in order to be
effective. The parish nurses facilitate varied trainings necessary for a variety of
ministries.
 Liaison to community resources and referral agent: Knowing community and
services available within the community and establishing relationships is an important
aspect of parish nurse.
XII) Public Health Nurse:
Public Health Nurse (PHN) is a registered nurse with special training in community
health. The PHN works special training in a specific geographic area & help the client &
the family with health concerns and parenting and lifestyle issues. PHN should be
knowledgeable about the resources in her immunity.
Function:
 Health Advocate: As an advocate, public health nurse collects monitors & analyse
data & discuss with the client which services & analyses data & discuss with the client
which services are needed. She also promotes healthy behavior, safe, water, air &
sanitation. The client can be either an individual, a family, a community or a population
 Care Manger: Public health nurses use the nursing process of assessing, planning,

33
implementing & evaluating outcomes to meet client‘s needs at the least cost.
 Referral Resource: The nurse educates clients to unable them to use the resources and
to learn self-care. Nurses refer to other services in the area, & the other services refer to
public health. Nurse for care & follow-up
 Health Educator: As an educator, the public health nurse identifies community needs
& develops & implements educational activities aimed at changing behavior.
 Direct Primary Caregivers: Public health nurse provides primary care is determined
by community assessment & is usually in response to an identified gap that the private
sector is unable to respond to, coupled with an assessment of the impact of the gap in
services on the health of the population. The direct care services are available in the
community for at risk-populations by working with the community to develop programs
that will meet the needs of that population
eg: Free or low cost immunization for target groups.
 Communicable Disease Control: Public health nursing skills are necessary for
education, prevention, surveillance, & outbreak investigations of communicable disease
in community.
 Disaster Preparedness: Nurse provides education that will prepare communities to
cope with disaster, professional triage of for local shelters, conducting communicable
disease surveillance, working with environmental health specialists to ensure safe food
688
and water for disaster victims and emergency workers and serving on the local
emergency planning comity.
XIII) Private Duty Nurse:
Private duty nurse is a registered nurse or a licesenced practical nurse that provide
nursing services to patients at home or any other setting in accordance with physician
orders. Patients may receive continues nursing services beyond the scope of care
available from certified home health care agencies (CHHAS). Patients may need only
intermittent nursing services which are normally provided with CHHAS which are
unavailable at the time the patients needs them.
XIV) Home Care Nurse:
Home care nurse is a nurse who provides periodic care to patients with in their home

34
environment as ordered by the physician. It includes health maintence, education, illness
prevention, diagnosis and treatment of disease. Palliation and rehabilitation. It is
component of a continuum of comprehensive health care where by health services are
provided to individuals and families in their home to promote, maintain or restore health,
or to maximize the level of independence while minimizing the effects of disability and
illness. Home care can be restorative care or acute care depending upon the client
condition.
Home care nurse acts as referral agent for clients who are discharged from acute care
settings such as hospitals or mental health facilities for continued care & follow up. In
community have care nurse, conducts home visits where nurse can view clients in
perspective and thus can understand them better, capitalize on their resources and tailor
health services to meet their needs.
XV) Hospice Nurse:
Hospice nurse is one who provides a family centered care and allows clients to live and
remain at homes with comfort, independence and dignity, while alleviating the strains
caused by terminal phase. The nurse provides care and support for the client and family
during the terminal phase or at the time of death. Hospice care can be given in patients
have, a hospital, nursing home or private hospice facility.
Functions:
 Pain & symptoms control: The nurse helps the patient to achieve comfort and allows
remaining in the control in life by managing to ensure that the patient is free of pain and
symptoms as much as possible.
 Spiritual Care: Spiritual care is individualized to meet patients and their families
need and to include helping the patient to look at what death means to them
 Home Care and impatient Care: The nurse stay involved in treatment of the patient
and with the family, resuming in – home care when appropriate.
 Family Conferences: The nurse provides a chance to share feelings, talk about
expectations, and learn about death and the process of dying. Family members can find
great support and stress relief through family conferences.
 Co-ordination of care: There should be coordination and supervision of care 7 days a
week, 24 hrs a day between the interdisciplinary team. The interdisciplinary team

35
includes doctor, nurses, social workers, councilors, pharmacist, and clerks etc who
provide physical, social and emotional support to the client.
 Bereavement Care: Bereavement is the time of mourning following a loss. The
provides support to the family members through visits, phone calls, letters and through
support groups.
XVI) Rehabilitation Nurse:
Rehabilitation nurse is a nurse who specializes in assisting persons with disabilities and
chronic illness to attain optimal function, health and adapt to an altered life style.
Rehabilitation nurse can practice in hospitals, impatient rehabilitation center, outpatient
rehabilitation centers, long term care facilities, community and home health settings,
insurance companies, private practice.
Functions:
 Assists patients in their move towards independence by setting realistic goals
 They work as a part of multidisciplinary team and often co-odinate patient care and
team activities
 Rehabilitation nurse provides care that helps to restore and maintain functions and
prevent complications
 Provides patient and family education, counseling and case management.
 Serves as a patient and family advocate and participates in social that helps improve
the practice of rehabilitation.
XVII) Office Nurse:
Office nurse is also called as clinic nurse. Office nurse provides patient care along with
physician in settings such as, physician officers, surgi centers and medical office
buildings. The main focus is on diagnosis and treatment of specific illness rather than
health promotion. But now the patient enrole to have regular physical examination.
Functions:
 Identifies trends in the types of problems client present and treating them.
 Provides health promotion activities by health education and health counseling.
 Acts as problem solver who helps with referral questions
 Performs clerical duties like managing the flow of clients through the office and
dealings with physician concerned.

36
 Is an important bridge between physician and population of clients
 Supervision of secretarial and medical assistance staff and medical record personnel.
XVIII) Nurse Epidemiologist:

THEORY OF FLORENCE NIGHTINGALE

The goal of nursing is “to put the patient in the best condition for nature to act upon him”. -
Nightingale
INTRODUCTION
Born - 12 May 1820 Founder of modern nursing. The first nursing theorist.
Also known as "The Lady with the Lamp" She explained her environmental theory in her
famous book Notes on Nursing: What it is, What it is not .She was the first to propose
nursing required specific education and training. Her contribution during Crimean war is
well-known. She was a statistician, using bar and pie charts, highlighting key points.
International Nurses Day, May 12 is observed in respect to her contribution to Nursing. Died
- 13 August 1910
ASSUMPATIONS OF NIGHTINGALE'S THEORY
Natural laws
Mankind can achieve perfection
Nursing is a calling
Nursing is an art and a science
Nursing is achieved through environmental alteration
Nursing requires a specific educational base
Nursing is distinct and separate from medicine
NIGHTINGALE’S CANONS: MAJOR CONCEPTS
Ventilation and warming
Light, Noise
Cleanliness of rooms/walls
Health of houses
Bed and bedding
Personal cleanliness

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Variety
Chattering hopes and advices
Taking food. What food?
Petty management/observation
NURSING PARADIGMS
Nightingale's documents contain her philosophical assumptions and beliefs regarding all
elements found in the metaparadigm of nursing. These can be formed into a conceptual
model that has great utility in the practice setting and offers a framework for research
conceptualization. (Selanders LC, 2010)
NURSING
Nursing is different from medicine and the goal of nursing is to place the patient in the best
possible condition for nature to act.
Nursing is the "activities that promote health (as outlined in canons) which occur in any
caregiving situation. They can be done by anyone."
PERSON
People are multidimensional, composed of biological, psychological, social and spiritual
components.
HEALTH
Health is “not only to be well, but to be able to use well every power we have”.
Disease is considered as dys-ease or the absence of comfort.
ENVIRONMENT
"Poor or difficult environments led to poor health and disease".
"Environment could be altered to improve conditions so that the natural laws would allow
healing to occur."
NIGHTINGALE'S THEORY AND NURSING PRACTICE
APPLICATION OF NIGHTINGALE'S THEORY IN PRACTICE:
"Patients are to be put in the best condition for nature to act on them, it is the responsibility
of nurses to reduce noise, to relieve patients’ anxieties, and to help them sleep."
As per most of the nursing theories, environmental adaptation remains the basis of holistic
nursing care.
CRITICISMS
She emphasized subservience to doctors.
She focused more on physical factors than on psychological needs of patient.
CONCLUSION

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Florence Nightingale provided a professional model for nursing organization.
She was the first to use a theoretical foundation to nursing.
Her thoughts have influenced nursing significantly.

OREM’S GENERAL THEORY OF NURSING

Orem’s general theory of nursing in three related parts:-
Theory of self care
Theory of self care deficit
Theory of nursing system
A. THEORY OF SELF CARE
This theory Includes:
Self care – practice of activities that individual initiates and perform on their own behalf in
maintaining life ,health and well being
Self care agency – is a human ability which is "the ability for engaging in self care" -
conditioned by age developmental state, life experience sociocultural orientation health and
available resources
Therapeutic self care demand – "totality of self care actions to be performed for some
duration in order to meet self care requisites by using valid methods and related sets of
operations and actions"
Self care requisites - action directed towards provision of self care. 3 categories of self care
requisites are-
Universal self care requisites
Developmental self care requisites
Health deviation self care requisites
1. Universal self care requisites
Associated with life processes and the maintenance of the integrity of human structure and
functioning
Common to all , ADL
Identifies these requisites as:
Maintenance of sufficient intake of air ,water, food
Provision of care assoc with elimination process

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Balance between activity and rest, between solitude and social interaction
Prevention of hazards to human life well being and
Promotion of human functioning

2. Developmental self care requisites

Associated with developmental processes/ derived from a condition…. Or associated with an
event
E.g. adjusting to a new job
adjusting to body changes
3. Health deviation self care
Required in conditions of illness, injury, or disease .these include:--
Seeking and securing appropriate medical assistance
Being aware of and attending to the effects and results of pathologic conditions
Effectively carrying out medically prescribed measures
Modifying self concepts in accepting oneself as being in a particular state of health and in
specific forms of health care
Learning to live with effects of pathologic conditions
B. THEORY OF SELF CARE DEFICIT
Specifies when nursing is needed
Nursing is required when an adult (or in the case of a dependent, the parent) is incapable or
limited in the provision of continuous effective self care. Orem identifies 5 methods of
helping:
Acting for and doing for others
Guiding others
Supporting another
Providing an environment promoting personal development in relation to meet future
demands
Teaching another
C. THEORY OF NURSING SYSTEMS
Describes how the patient’s self care needs will be met by the nurse , the patient, or both

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Identifies 3 classifications of nursing system to meet the self care requisites of the patient:-
Wholly compensatory system
Partly compensatory system
Supportive – educative system
Design and elements of nursing system define
Scope of nursing responsibility in health care situations
General and specific roles of nurses and patients
Reasons for nurses’ relationship with patients and
Orem recognized that specialized technologies are usually developed by members of the
health profession
A technology is systematized information about a process or a method for affecting some
desired result through deliberate practical endeavor, with or without use of materials or
instruments.
CATEGORIES OF TECHNOLOGIES
1. SOCIAL OR INTERPERSONAL
Communication adjusted to age, health status
Maintaining interpersonal, intra group or inter group relations for coordination of efforts
Maintaining therapeutic relationship in light of psychosocial modes of functioning in health
and disease
Giving human assistance adapted to human needs ,action abilities and limitations
2. REGULATORY TECHNOLOGIES
Maintaining and promoting life processes
Regulating psycho physiological modes of functioning in health and disease
Promoting human growth and development
Regulating position and movement in space
OREM’S THEORY AND NURSING PROCESS
Nursing process presents a method to determine the self care deficits and then to define the
roles of person or nurse to meet the self care demands.
The steps within the approach are considered to be the technical component of the nursing
process.
Orem emphasizes that the technological component "must be coordinated with
interpersonal and social processes within nursing situations.
Nursing Process

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Orem’s Nursing Process
Assessment
Diagnosis and prescription; determine why nursing is needed. analyze and interpret –make
judgment regarding care
Design of a nursing system and plan for delivery of care
Production and management of nursing systems
Step 1-collect data in six areas:-
The person’s health status
The physician’s perspective of the person’s health status
The person’s perspective of his or her health
The health goals within the context of life history ,life style, and health status
The person’s requirements for self care
The person’s capacity to perform self care
Nursing diagnosis
Plans with scientific rationale
Step 2
Nurse designs a system that is wholly or partly compensatory or supportive-educative.
The 2 actions are:-
Bringing out a good organization of the components of patients’ therapeutic self care
demands
Selection of combination of ways of helping that will be effective and efficient in
compensating for/ overcoming patient’s self care deficits
Implementation
evaluation
Step 3
Nurse assists the patient or family in self care matters to achieve identified and described
health and health related results. collecting evidence in evaluating results achieved against
results specified in the nursing system design
Actions are directed by etiology component of nursing diagnosis
Evaluation

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 ROY'S ADAPTATION MODEL

INTRODUCTION
Sr.Callista Roy- nurse theorist, writer, lecturer, researcher and teacher
Professor and Nurse Theorist at the Boston College of Nursing in Chestnut Hill
Born at Los Angeles on October 14, 1939.
Bachelor of Arts with a major in nursing - Mount St. Mary's College, Los Angeles in 1963.
Master's degree program in pediatric nursing - University of California ,Los Angeles in 1966.
Master’s and PhD in Sociology in 1973 and 1977.
Worked with Dorothy E. Johnson
Worked as f faculty of Mount St. Mary's College in 1966.
Organized course content according to a view of person and family as adaptive systems.
RAM as a basis of curriculum i at Mount St. Mary’s College
1970-The model was implemented in Mount St. Mary’s school
1971- she was made chair of the nursing department at the college.
ASSUMPTIONS (ROY 1989; ROY AND ANDREWS 1991)
EXPLICIT ASSUMPTIONS
The person is a bio-psycho-social being.
The person is in constant interaction with a changing environment.
To cope with a changing world, person uses both innate and acquired mechanisms which are
biological, psychological and social in origin.
Health and illness are inevitable dimensions of the person’s life.
To respond positively to environmental changes, the person must adapt.

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The person’s adaptation is a function of the stimulus he is exposed to and his adaptation
level
The person’s adaptation level is such that it comprises a zone indicating the range of
stimulation that will lead to a positive response.
The person has 4 modes of adaptation: physiologic needs, self- concept, role function and
inter-dependence.
"Nursing accepts the humanistic approach of valuing other persons’ opinions, and view
points" Interpersonal relations are an integral part of nursing
There is a dynamic objective for existence with ultimate goal of achieving dignity and
integrity.
IMPLICIT ASSUMPTIONS
A person can be reduced to parts for study and care.
Nursing is based on causality.
Patient’s values and opinions are to be considered and respected.
A state of adaptation frees an individual’s energy to respond to other stimuli.
MAJOR CONCEPTS
Adaptation -- goal of nursing
Person -- adaptive system
Environment -- stimuli
Health -- outcome of adaptation
Nursing- promoting adaptation and health
ADAPTATION
Responding positively to environmental changes.
The process and outcome of individuals and groups who use conscious awareness, self
reflection and choice to create human and environmental integration
PERSON
Bio-psycho-social being in constant interaction with a changing environment
Uses innate and acquired mechanisms to adapt
An adaptive system described as a whole comprised of parts
Functions as a unity for some purpose
Includes people as individuals or in groups-families, organizations, communities, and society
as a whole.
ENVIRONMENT

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Focal - internal or external and immediately confronting the person
Contextual- all stimuli present in the situation that contribute to effect of focal stimulus
Residual-a factor whose effects in the current situation are unclear
All conditions, circumstances, and influences surrounding and affecting the development
and behavior of persons and groups with particular consideration of mutuality of person and
earth resources, including focal, contextual and residual stimuli
HEALTH
Inevitable dimension of person's life
Represented by a health-illness continuum
A state and a process of being and becoming integrated and whole

NURSING
To promote adaptation in the four adaptive modes
To promote adaptation for individuals and groups in the four adaptive modes, thus
contributing to health, quality of life, and dying with dignity by assessing behaviors and
factors that influence adaptive abilities and by intervening to enhance environmental
interactions
SUBSYSTEMS
Cognator subsystem — A major coping processCognator subsystem — A major coping
process involving 4 cognitive-emotive channels: perceptual and information processing,
learning, judgment and emotion.
Regulator subsystem — a basic type of adaptive process that responds automatically
through neural, chemical, and endocrine coping channels
RELATIONSHIPS
Derived Four Adaptive Modes
500 Samples of Patient Behavior
What was the patient doing?
What did the patient look like when needing nursing care?
FOUR ADAPTIVE MODES
Physiologic Needs
Self Concept
Role Function
Interdependence

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THEORY DEVELOPMENT
PHILOSOPHICAL ASSUMPTIONS
Persons have mutual relationships with the world and God
Human meaning is rooted in an omega point convergence of the universe
God is intimately revealed in the diversity of creation and is the common destiny of creation
Persons use human creative abilities of awareness, enlightenment, and faith
Persons are accountable for the processes of deriving, sustaining, and transforming the
universe
Adaptation and Groups
Includes relating persons, partners, families, organizations, communities, nations, and
society as a whole

ADAPTIVE MODES
A. Persons
Physiologic
Self Concept
Role Function
Interdependence
B. Groups
Physical
Group Identity
Role Function
Interdependence
ROLE FUNCTION MODE
Underlying Need of Social integrity
The need to know who one is in relation to others so that one can act
The need for role clarity of all participants in group
ADAPTATION LEVEL
A zone within which stimulation will lead to a positive or adaptive response
Adaptive mode processes described on three levels:
Integrated

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Compensatory
Compromised
INTEGRATED LIFE PROCESSES
Adaptation level where the structures and functions of the life processes work to meet
needs
Examples of Integrated Adaptation
Stable process of breathing and ventilation
Effective processes for moral-ethical-spiritual growth
COMPENSATORY PROCESSES
Adaptation level where the cognator and regulator are activated by a challenge to the life
processes
Compensatory Adaptation Examples:
Grieving as a growth process, higher levels of adaptation and transcendence
Role transition, growth in a new role
COMPROMISED PROCESSES
Adaptation level resulting from inadequate integrated and compensatory life processes
Adaptation problem
Compromised Adaptation Examples
Hypoxia
Unresolved Loss
Stigma
Abusive Relationships
THE NURSING PROCESS
RAM offers guidelines to nurse in developing the nursing process.
The elements :
First level assessment
Second level assessment
Diagnosis
Goal setting
Intervention
evaluation

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USEFULNESS OF ADAPTATION MODEL
Scientific knowledge for practice
Clinical assessment and intervention
Research variables
To guide nursing practice
To organize nursing education
Curricular frame work for various nursing colleges
CHARACTERISTICS OF THE THEORY
interrelated
logical in nature
relatively simple yet generalizable
can be the basis for the hypotheses that can be tested
contribute to and assist in increasing the general body of knowledge of a discipline
can be utilized by the practitioners to guide and improve their practice
consistent with other validated theories, laws and principles
Testable
Roy Adaptation Model
Assumptions
• The person is a bio-psycho-social being. The person is in constant interaction with a
changing environment.
• To cope with a changing world, person uses both innate and acquired mechanisms which
are biological,
psychological and social in origin.
• To respond positively to environmental changes, the person must adapt.
• The person has 4 modes of adaptation: physiologic needs, self- concept, role function and
inter-dependence.
Major Concepts
• Adaptation -- goal of nursing
• Person -- adaptive system
• Environment -- stimuli
• Health -- outcome of adaptation
• Nursing- promoting adaptation and health

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Adaptation
• Responding positively to environmental changes.
• The process and outcome of individ…
[4:04 pm, 17/11/2023] Shrikant: Four Adaptive Modes
Physiological, Self-Concept, Role Function, Interdependence
Physiological mode: Behavior in this mode is a manifestation of the physiological activity of
all the cells, tissues, organs,
& systems of the body.
• 5 needs serve to promote physiological integrity, (oxygenation, nutrition, elimination,
activity and rest, and
protection).
• 4 processes which help maintain physiological integrity (senses, fluid and electrolytes,
neuro, and endocrine
function)
Self-concept mode: deals with the person’s beliefs & feelings about himself/herself. Basic
underlying need: psychic
integrity (physical perceptions, ideals, goals, moral/ethical beliefs)
Physical self: how one sees his own physical being
(1) body sensation: ability to express sensations/feel symptoms
(2) body image: how one sees himself as a physical being
Personal self: how one views his qualities, values, worth
(1) self-consistency: one’s self-description of qualities; also includes self-organization
behavior
(2) self-ideal/self-expectancy: what one would like to do or be
(3) moral-ethical-spiritual self: values, beliefs, religion self-esteem: the value one places on
himself/herself
Role function mode: involves the position one occupies in society; behaviors associated with
one’s position (role) in
society. Basic underlying need: social integrity
Primary role: role based on age, sex, developmental state
Secondary role: role(s) a person assumes to complete tasks associated with a primary role or
developmental
stage

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Tertiary role: a role freely chosen; temporary; associated with accomplishments of tasks or
goals
Interdependence mode: associated with one’s relationships and interactions with others and
the giving and receiving of
love, respect, and value. Basic underlying need: nurturance and affection
Significant others: intimate relationships (spouse, parent, God)
Support systems: less intimate relationships (coworkers, friends)
Giving behaviors: giving love, nurturance, affection
Receiving behaviors: receiving/taking in love, nurturance, affection
Roy Model and the Nursing Process: Utilizes a bi-level assessment to problem solve
Assessment of behaviors:
• Behavior is an action or reaction under specified circumstances; behavior may be
observable, or not.
• Normally, a person adapts to stimuli positively, maintaining a “steady state” but in times of
stress when coping
mechanisms are overwhelmed (i.e., illness), the person’s ability to adapt to a new situation
is impaired.
• The nurse observes behaviors (signs/symptoms) or responses of the patient and makes a
judgment as to whether the
behavior is adaptive or ineffective.
• How does the nurse do this? Assessment phase of nursing process
Assessment of stimuli:
• Stimuli are the underlying causes or factors contributing to the behaviors observed in first
level assessment; those
things which provoke a response.
• Nurse identifies stimuli in all 4 adaptive modes; stimuli are manipulated via interventions
to achieve patient goals
Summary
• 5 elements - person, goal of nursing, nursing activities, health and environment
• Persons are viewed as living adaptive systems whose behaviors may be classified as
adaptive or ineffective.
• These mechanisms work within 4 adaptive modes.
• The goal of nursing is to promote adaptive responses in relation to 4 adaptive modes,
using information about

50
person’s adaptation level, and various stimuli.
• Nursing activities involve manipulation of these stimuli to promote adaptive responses

PEPLAU'S THEORY OF INTERPERSONAL RELATIONS:

INTRODUCTION
Theorist -Hildegard. E. Peplau Born in Reading, Pennsylvania [1909], USA Diploma program
in Pottstown, Pennsylvania in 1931.BA in interpersonal psychology - Bennington College in
1943.MA in psychiatric nursing from Colombia University New York in 1947.EdD in
curriculum development in 1953.Professor emeritus from Rutgers university Started first
post baccalaureate program in nursing Published Interpersonal Relations in Nursing in 1952
1968 :interpersonal techniques-the crux of psychiatric nursing Worked as executive director
and president of ANA. Worked with W.H.O, NIMH and Nurse Corps .Died in 1999.
Theory of interpersonal relations is a middle range descriptive classification theory. The
theory was influenced by Harry Stack Sullivan's theory of inter personal relations (1953).The
theorist was also influenced by Percival Symonds, Abraham Maslow's and Neal Elger Miller.
Peplau's theory is also refered as psychodynamic nursing, which is the understanding of
ones own behavior.

MAJOR CONCEPTS
The theory explains the purpose of nursing is to help others identify their felt difficulties.
Nurses should apply principles of human relations to the problems that arise at all levels of
experience. Peplau’s theory explains the phases of interpersonal process, roles in nursing
situations and methods for studying nursing as an interpersonal process.
Nursing is therapeutic in that it is a healing art, assisting an individual who is sick or in need
of health care. Nursing is an interpersonal process because it involves interaction between
two or more individuals with a common goal.The attainment of goal is achieved through the
use of a series of steps following a series of pattern.The nurse and patient work together so
both become mature and knowledgeable in the process.
DEFINITIONS
Person: A developing organism that tries to reduce anxiety caused by needs.

51
Environment: Existing forces outside the organism and in the context of culture
Health: A word symbol that implies forward movement of personality and other ongoing
human processes in the direction of creative, constructive, productive, personal and
community living.
Nursing: A significant therapeutic interpersonal process. It functions cooperatively with
other human process that make health possible for individuals in communities.

ROLES OF NURSE
Stranger: receives the client in the same way one meets a stranger in other life situations
provides an accepting climate that builds trust.
Teacher: who imparts knowledge in reference to a need or interest
Resource Person : one who provides a specific needed information that aids in the
understanding of a problem or new situation
Counsellors : helps to understand and integrate the meaning of current life
circumstances ,provides guidance and encouragement to make changes
Surrogate: helps to clarify domains of dependence interdependence and independence and
acts on clients behalf as an advocate.
Leader : helps client assume maximum responsibility for meeting treatment goals in a
mutually satisfying way

Additional Roles include:

1. Technical expert
2. Consultant
3. Health teacher
4. Tutor
5. Socializing agent
6. Safety agent
7. Manager of environment
8. Mediator
9. Administrator
10. Recorder observer
11. Researcher

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PHASES OF INTERPERSONAL RELATIONSHIP
Identified four sequential phases in the interpersonal relationship:

1. Orientation
2. Identification
3. Exploitation
4. Resolution

ORIENTATION PHASE
Problem defining phase
Starts when client meets nurse as stranger Defining problem and deciding type of service
needed Client seeks assistance ,conveys needs ,asks questions, shares preconceptions and
expectations of past experiences Nurse responds, explains roles to client, helps to identify
problems and to use available resources and services

FACTORS INFLUENCING ORIENTATION PHASE

IDENTIFICATION PHASE
Selection of appropriate professional assistancePatient begins to have a feeling of belonging
and a capability of dealing with the problem which decreases the feeling of helplessness and
hopelessness

EXPLOITATION PHASE
Use of professional assistance for problem solving alternatives Advantages of services are
used is based on the needs and interests of the patients Individual feels as an integral part of
the helping environment They may make minor requests or attention getting techniques The
principles of interview techniques must be used in order to explore, understand and
adequately deal with the underlying problem Patient may fluctuates on independence Nurse
must be aware about the various phases of communication Nurse aids the patient in
exploiting all avenues of help and progress is made towards the final step

RESOLUTION PHASE
Termination of professional relationship The patients needs have already been met by the
collaborative effect of patient and nurse Now they need to terminate their therapeutic

53
relationship and dissolve the links between them.Sometimes may be difficult for both as
psychological dependence persists Patient drifts away and breaks bond with nurse and
healthier emotional balance is demonstrated and both becomes mature individuals

INTERPERSONAL THEORY AND NURSING PROCESS

Both are sequential and focus on therapeutic relationship Both use problem solving
techniques for the nurse and patient to collaborate on, with the end purpose of meeting the
patients needs Both use observation communication and recording as basic tools utilized by
nursing

Assessment
Data collection and analysis [continuous]
May not be a felt need Orientation
Non continuous data collection
Felt need
Define needs
Nursing diagnosis
Planning
Mutually set goals
Identification
Interdependent goal setting
Implementation
Plans initiated towards achievement of mutually set goals
May be accomplished by patient , nurse or family
Exploitation
Patient actively seeking and drawing help
Patient initiated
Evaluation
Based on mutually expected behaviors
May led to termination and initiation of new plans
Resolution Occurs after other phases are completed successfully

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Leads to termination
PEPLAU’S WORK AND CHARACTERISTICS OF A THEORY
Interrelation of concepts
Four phases interrelate the different components of each phase.
Applicability
The nurse patient interaction can apply to the concepts of human being, health,
environment and nursing.
Theories must be logical in nature -
This theory provides a logical systematic way of viewing nursing situations

Key concepts such as anxiety, tension, goals, and frustration are indicated with explicit
relationships among them and progressive phases
Generalizability
This theory provides simplicity in regard to the natural progression of the NP relationship.
Theories can be the bases for hypothesis that can be tested
Peplau's theory has generated testable hypotheses.
Theories can be utilized by practitioners to guide and improve their practice.
Peplau’s anxiety continuum is still used in anxiety patients
Theories must be consistent with other validated theories, laws, and principles but will leave
open unanswered questions that need to be investigated.
Peplau's theory is consistent with various theories
LIMITATIONS
Personal space considerations and community social service resources are considered less.
Health promotion and maintenance were less emphasized Cannot be used in a patient who
doesn’t have a felt need eg. With drawn patients, unconscious patients
Some areas are not specific enough to generate hypothesis

RESEARCH BASED ON PEPLAU’S THEORY

Hays .D. (1961). Phases and steps of experimental teaching to patients of a concept of
anxiety: Findings revealed that when taught by the experimental method, the patients were
able to apply the concept of anxiety after the group was terminated.

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Burd .S.F. Develop and test a nursing intervention framework for working with anxious
patients: Students developed competency in beginning interpersonal relationship.

56