Nursing

Nursing is a health care profession that "integrates the art and science of caring and focuses on the protection, promotion, and optimization of health and human functioning; prevention of illness and injury; facilitation of healing; and alleviation of suffering through compassionate presence". Nurses practice in many specialties with varying levels of certification and responsibility. Nurses comprise the largest component of most healthcare environments. There are imbalances between the supply and demand for qualified nurses in many countries. Nurses develop a plan of care, working collaboratively with physicians and physician assistants, therapists, patients, families of patients, and other team members that focuses on treating illness to improve quality of life. In the United Kingdom and the United States, clinical nurse specialists and nurse practitioners diagnose health problems and prescribe medications and other therapies, depending on regulations that vary by state. Nurses may help coordinate care performed by other providers or act independently as nursing professionals. In addition to providing care and support, nurses educate the public and promote health and wellness. In the U.S., nurse practitioners are nurses with a graduate degree in advanced practice nursing, and are permitted to prescribe medications.…

Nursing is a health care profession that "integrates the art and science of caring and focuses on the protection, promotion, and optimization of health and human functioning; prevention of illness and injury; facilitation of healing; and alleviation of suffering through compassionate presence". Nurses practice in many specialties with varying levels of certification and responsibility. Nurses comprise the largest component of most healthcare environments. There are imbalances between the supply and demand for qualified nurses in many countries. Nurses develop a plan of care, working collaboratively with physicians and physician assistants, therapists, patients, families of patients, and other team members that focuses on treating illness to improve quality of life. In the United Kingdom and the United States, clinical nurse specialists and nurse practitioners diagnose health problems and prescribe medications and other therapies, depending on regulations that vary by state. Nurses may help coordinate care performed by other providers or act independently as nursing professionals. In addition to providing care and support, nurses educate the public and promote health and wellness. In the U.S., nurse practitioners are nurses with a graduate degree in advanced practice nursing, and are permitted to prescribe medications. They practice independently in a variety of settings in more than half of the United States. In the postwar period, nurse education has diversified, awarding advanced and specialized credentials, and many traditional regulations and roles are changing.

History

Premodern

Nursing historians face challenges of determining whether care provided to the sick or injured in antiquity is called nursing care. In the fifth century BC, for example, the Hippocratic Collection in places described skilled care and observation of patients by male "attendants", who may have provided care now provided by nurses. Around 600 BC in India, it is recorded in Sushruta Samhita, Book 3, Chapter V about the role of the nurse as "the different parts or members of the body as mentioned before including the skin, cannot be correctly described by one who is not well versed in anatomy. Hence, anyone desirous of acquiring a thorough knowledge of anatomy should prepare a dead body and carefully, observe, by dissecting it, and examining its different parts." In the Middle Ages, members of religious orders such as nuns and monks often provided nursing-like care. Examples exist in Christian, Islamic, Buddhist, and other traditions. The biblical figure of Phoebe is described in many sources as "the first visiting nurse". These traditions were influential in the development of the ethos of modern nursing. Its religious roots remain in evidence in many countries. One example in the United Kingdom is the use of the historical title "sister" to refer to a senior nurse. During the Reformation, Protestant reformers shut down monasteries and convents, allowing a few hundred municipal hospices to remain in operation in northern Europe. Nuns who had been serving as nurses were given pensions or told to marry and stay home. Nursing care went to the inexperienced as traditional caretakers, rooted in the Roman Catholic Church, were removed from their positions. The nursing profession in Europe was extinguished for approximately 200 years.

19th century

During the Crimean War, Grand Duchess Elena Pavlovna called for women to join the Order of Exaltation of the Cross (Krestodvizhenskaya Obshchina) for a year of service in military hospitals. The first section of twenty-eight "sisters", headed by Aleksandra Petrovna Stakhovich, the Directress of the Order, reached Crimea early in November 1854. was an influential figure in the development of modern nursing. No uniform had been created when Nightingale was employed during the Crimean War. Often considered the first nurse theorist, Nightingale linked health with five environmental factors: (1) pure or fresh air, (2) pure water, (3) efficient drainage, (4) cleanliness, and (5) light, especially direct sunlight. Deficiencies in these five factors resulted in a lack of health or illness. Both the role of nursing and education were first defined by Nightingale.]] Florence Nightingale laid the foundations of professional nursing after the Crimean War, in light of a comprehensive statistical study she made of sanitation in India, leading her to emphasize the importance of sanitation. "After 10 years of sanitary reform, in 1873¹, Nightingale reported that mortality among the soldiers in India had declined from 69 to 18 per 1,000". Nightingale believed that nursing was a social freedom and mission for women. She believed that any educated woman could help improve the care of the ill. Her Notes on Nursing (1859) was a popular call to action. The Nightingale model of nursing education led to one of the first schools of nursing to be connected to a hospital and medical school. It spread widely in Europe and North America after 1870. Nightingale included five factors that helped nurses in her time who worked amidst poor sanitation and little education. These factors include fresh air, clean water, a working drainage system, cleanliness, and good light. Nightingale believed that a clean working environment was important in caring for patients. In the 19th century, this theory was ideal for helping patients, providing a guide for nurses to alter the environment around patients for the betterment of their health. Nightingale's recommendations built upon the successes of Jamaican "doctresses" such as Mary Seacole, who like Nightingale, served in the Crimean War. Seacole practised hygiene and the use of herbs in healing wounded soldiers and those suffering from diseases in the 19th century in the Crimea, Central America, and Jamaica. Her predecessors had great success as healers in the Colony of Jamaica in the 18th century, and they included Seacole's mother (Mrs. Grant), Sarah Adams, Cubah Cornwallis, and Grace Donne, the mistress and doctress to Jamaica's wealthiest planter, Simon Taylor. Other important nurses in the development of the profession include: Agnes Hunt from Shropshire was the first orthopedic nurse and was pivotal in the emergence of the orthopedic hospital, the Robert Jones & Agnes Hunt Hospital in Oswestry, Shropshire. Valérie de Gasparin opened, with her husband Agénor de Gasparin, the world's first nursing school: , in Lausanne, Switzerland. Agnes Jones established a nurse training regime at Brownlow Hill infirmary, Liverpool, in 1865¹. Linda Richards established nursing schools in the United States and Japan, and was officially the first professionally trained nurse in the US, graduating in 1873 from the New England Hospital for Women and Children in Boston. Clarissa Harlowe "Clara" Barton was a pioneer American teacher, patent clerk, nurse, and humanitarian, and the founder of the American Red Cross. Saint Marianne Cope was a Sister of St. Francis who opened and operated some of the first general hospitals in the United States, instituting cleanliness standards that influenced the development of America's hospital system. Red Cross chapters, which began appearing after the establishment of the International Committee of the Red Cross in 1863, offered employment and professionalization opportunities for nurses (despite Nightingale's initial objections). Catholic orders such as Little Sisters of the Poor, Sisters of Mercy, Sisters of St. Mary, St. Francis Health Services, Inc. and Sisters of Charity built hospitals and provided nursing services during this period. The modern deaconess movement began in Germany in 1836. Within a half century, over 5,000 deaconesses had surfaced in Europe. Formal use of nurses in the military began in the latter half of the nineteenth century. Nurses saw active duty in the First Boer War, the Egyptian Campaign (1882), and the Sudan Campaign (1883).

20th century

.]] In the 19th and early 20th century, nursing was considered a woman's profession, just as doctoring was a profession for men. With increasing expectations of workplace equality during the late 20th century, nursing became an officially gender-neutral profession, though in practice the percentage of male nurses remained well below that of female physicians in the 21st century. Hospital-based training became standard in the US in the early 1900s, with an emphasis on practical experience. The Nightingale-style school began to disappear. Hospitals and physicians saw women in nursing as a source of free/inexpensive labor. Exploitation of nurses was not uncommon by employers, physicians, and education providers. Many nurses saw active duty in the First World War, but the profession transformed again during the Second World War. British nurses of the Army Nursing Service were part of every overseas campaign. More nurses volunteered for service in the US Army and Navy than any other occupation. The Nazis had their own Brown Nurses, numbering 40,000. Two dozen German Red Cross nurses were awarded the Iron Cross for heroism under fire. The development of undergraduate and post-graduate nursing degrees came after the war. Nursing research and a desire for association and organization led to the formation of professional organizations and academic journals. Nursing became recognized as a distinct academic discipline, initially tasked to define the theoretical basis for practice.

Supply and demand

]] Nurses are perceived to be in higher demand than supply around the world, particularly in South East Asia and Africa. A global survey by McKinsey & Company in 2022 found that between 28% and 38% of nurse respondents in the United States, the United Kingdom, Singapore, Japan, and France said they were likely to leave their role in direct patient care in the next year. The top five factors which they said would make them stay were: Safe working environment Work-life balance Caring and trusting team-mates Meaningful work Flexible work schedule Pay ranked eighth on the list. A 2023 American survey found that around 30% were considering leaving patient care.

Definition

According to the traditional interpretation physicians are concerned with curing or treating medical conditions, while nurses focus on care. In healthcare settings this line is often blurred, complicating the task of distinguishing the professions. Although nursing practice varies both through its various specialties and countries, nursing organizations offer the following definitions:

Professional nursing

PAIGC hospital, 1973]] , India ]] The practice of nursing is based upon a social contract that delineates professional rights and responsibilities as well as accountability mechanisms. In almost all countries, nursing practice is defined and governed by law, and entrance to the profession is regulated at the national or state level. The nursing community worldwide aims for professional nurses to ensure quality care, while maintaining their credentials, code of ethics, standards, and competencies, and continuing their education. Multiple educational paths lead to becoming a professional nurse; these vary by jurisdiction; all involve extensive study of nursing theory and practice as well as training in clinical skills. Nurses provide care based on the individual's physical, emotional, psychological, intellectual, social, and spiritual needs. The profession combines physical science, social science, nursing theory, and technology. Nurses typically hold one or more formal credentials. Roles and responsibilities follow the level of education. For example, in the United States, Licensed Practical Nurses (LPN) have less education than Registered Nurses (RN) and accordingly, a narrower scope of practice.

Assessment

Assessment is an essential nursing skill. Nurses assess patients' physical and mental health. In hospital settings, nurses regularly perform assessments to notice any acute changes in their patients. Nurses also assess a patient's response to medication or other treatments, such as physical activity and blood transfusions. Nurses may also take health histories. Nurses also must assess a patient's understanding of their health status and their medications. Critical thinking is an important skill for nurses to have. In emergency situations, nurses must quickly assess a patient and determine the best course of action.

Medication

Medication management and administration are common hospital nursing roles, although prescribing authority varies across jurisdictions. In many areas, RNs administer and manage medications prescribed by others. Nurses are responsible for evaluating patients throughout their care – including before and after medication administration – adjustments to medications are often made through a collaborative effort between the prescriber and the nurse. Regardless of the prescriber, nurses are legally responsible for the drugs they administer. Legal implications may accompany an error in a prescription, and the nurse may be expected to note and report the error. In the United States, nurses have the right to refuse to administer medication that they deem to be potentially harmful. Some nurses take additional training that allows them to prescribe medications within their scope of practice.

Patient education

Effective patient/family education leads to better outcomes. Nurses explain procedures, recovery, and ongoing care, while helping everyone cope with the medical situation. Many times, nurses are busy, leaving little time to educate patients. Patients' families needs similar education. Educating both patients and their families increases the chance for a better outcome. Nurses have to communicate in a way that can be understood by patients. Education techniques encompass conversations, visuals, reading materials, and demonstrations.

Daily living assistance

Nurses manage and coordinate care to support activities of daily living (ADL) such as hygiene and toileting. This includes assisting in patient mobility, such as moving an activity intolerant patient within a bed. They often delegate such care to nursing assistants.

Occupational hazards

The international nursing shortage is in part due to their work environment. In a recent review of the literature specific to nursing performance, nurses were found to work in generally poor environmental conditions. Some jurisdictions have legislation specifying acceptable nurse-to-patient ratios. The fast-paced and unpredictable nature of health care places nurses at risk for injuries and illnesses, including high occupational stress. Nurses consistently identify stress as a major work-related concern and have among the highest levels of occupational stress among all professions. This stress is caused by the environment, psychosocial stressors, and the demands of nursing, including mastering new technology, emotional labor, physical labor, shift work, and high workload. This stress puts nurses at risk for short-term and long-term health problems, including sleep disorders, depression, mortality, psychiatric disorders, stress-related illnesses, and overall poor health. Nurses are at risk of developing compassion fatigue and moral distress, which can damage mental health. They have high rates of occupational burnout (40%) and emotional exhaustion (43.2%). Burnout and exhaustion increase the risk for illness, medical error, and suboptimal care provision.

Nursing ethics

Professional abuse by nurses can be mitigated by nursing ethics and professional responsibility.

By country

Africa

Americas

United States

Canada

Latin America/Caribbean

Latin American nursing is based on three levels of training: (a) professional/registered, (b) technical, and (c) auxiliary. Nursing education in Latin America and the Caribbean includes the principles and values of universal health and primary health care. These principles are based on critical and complex thinking development, problem-solving, evidence-based clinical decision-making, and lifelong learning.

United Kingdom

India

Japan

Philippines

Taiwan

In Taiwan, the Ministry of Health and Welfare regulates nursing. The Taiwan Union of Nurses Association (TUNA) organizes nurses.

Australia

Iran

Israel

Nurses in Israel has responsibilities including hospital care, patient education, wound care, prenatal and other monitoring, midwifery, and well-baby clinics. Nurses and midwives are regulated by the Israeli Ministry of Health. Nursing in Israeli Jewish culture traces its origins to Shifra and Puah, two Hebrew midwives depicted in the Book of Exodus helping women in ancient Egypt give birth and keep their infants safe. Modern-day nursing was established by nurses sent to Mandatory Palestine and later Israel by the Hadassah organization, as well as at a nursing school founded by Henrietta Szold in 1918¹. The United Kingdom regulated midwifery in Mandatory Palestine, but nurses were not mentioned in the regulation decree.

References

External links

UNCG Library Betty H. Carter Women Veterans Historical Project: Nurse

Text derived from https://en.wikipedia.org/w/index.php?oldid=1378220392 under CC BY-SA 4.0; modifications have been made.