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Trends in nursing are closely tied to what is happening to healthcare in general.

Trends are
fascinating phenomena, but they do not exist in vacuums. Most are interrelated; one trend often
spawns another. Although trends are more than fads, they are far from money-back guarantees.
We watch to anticipate the direction that a particular trend will take us, to remove the element of
surprise. When we look back on trends, however, some will have heralded permanent changes,
but others might have been no more than blips on the radar screen.
Trend #1: Where Art Thou, Nurse?
There are nearly 2.7 million nurses in the United States, comprising the largest division of the
healthcare workforce. Yet in 2004, we continue to face a slowly growing shortfall of nurses.
Although this is not the first nursing shortage our nation has faced, there are some worrisome
differences this time. This shortage is not caused by any single factor in isolation, such as the
voluntary cutbacks in the nursing labor force of the 1990s, which could be solved by ramping up
recruitment efforts. This shortage is caused by a convergence of many pressures, including
financial constraints, a dissipating workforce, and an increasingly complicated and stressful work
environment. Furthermore, the global nature of this shortage makes it impractical to recruit
nurses from other countries to fill vacancies in the United States.
Many registered nurses (RNs) have left nursing for better opportunities and higher paying jobs.
In 2002, there were nearly half a million licensed nurses not employed in nursing.
[1]
When
experienced nurses leave their positions after only a few years in the profession, they are often
replaced with recently graduated and inexperienced staff members. This is the revolving door
syndrome, the worst possible model of workforce replacement for a profession such as nursing.
Notwithstanding the tragic loss of nursing expertise that occurs when a nurse leaves the
profession, new nurses who are usually mentored by the older, experienced nurses after
graduation must then learn to cope without such guidance.
Job dissatisfaction and wages have both been cited as factors contributing to the nursing exodus.
A 2000 survey of nurses found lower levels of job satisfaction, particularly among staff nurses,
than in surveys of previous years.
[1]
Nurses are in the best position to evaluate the quality of care,
and they believe that it is declining. In addition, wage growth of RNs in the United States is, on
average, relatively flat. After adjusting for inflation, RNs have seen no real increase in
purchasing power of their salaries over the last 9 years.
[2]

Another important factor relating to the nursing shortage is the "aging RN factor" -- the
demographic that paints the gloomiest picture of our healthcare future:
Retirement is looming for baby-boomer nurses (those born between 1946 and 1964). More than a
million new and replacement nurses will be needed in the United States by the year 2010.
[3]
It is
estimated that we will lack 29%, or more than 434,000 nurses by 2020.
[2]
The situation is just as
dire in Canada. The Canadian Nurses Association predicts that by 2011, they will be short
78,000 RNs and by 2016, they will be short 113,000 nurses.
[4]

Fewer college students are choosing nursing as a profession now compared with several decades
ago. New graduate RNs declined by 26% from 1995 to 2000.
[5]
Nursing's negative image and
low status, relatively low pay, and a wealth of alternative opportunities for women are among the
reasons for the decline. Right now, there are not enough students in the educational pipeline to
replace the number of nurses leaving the workforce.
[6]

This year will bring more efforts to improve the image of nursing to encourage more young
people to choose nursing as a career. Are we already too late to avert a crisis in patient care? Will
demographics be our downfall? Much depends on whether employers and policymakers pay as
much attention to retaining the current experienced workforce as they do to increasing
enrollments. Everyone has to care about the nursing shortage, both now and in the future,
because everyone will be affected by it at some point in time.

The Patient Safety Imperative
A vigorous demand for increased patient safety is being heard from all sectors. Patient safety will
be paramount in 2004. Although a greater focus on patient safety has been a trend since the
Institute of Medicine's landmark report in 1999 estimating that 44,000-98,000 people die yearly
as a result of medical errors,
[7]
several recent studies have turned the spotlight on nursing as a
safety net. Reflect upon these sentiments expressed by the authors of a major new report about
nurses and patient safety: "how well we are cared for by nurses affects our health, and sometimes
can be a matter of life or death...in caring for us all, nurses are indispensable to our safety".
[8]

When nurses' workloads are too heavy, safety can too easily become compromised. Can we
expect nurses caring for too many patients or working too many hours to continue to intercept
86% of the medication errors made by physicians and pharmacists that they usually intercept
before such errors reach the patient?
[9]
Can we expect the same outcomes of care that are
achieved with more reasonable workloads? To no one's surprise, heavier patient loads are
associated with higher rates of infection, gastrointestinal bleeding, pneumonia, cardiac arrest,
and death from these and other causes.
[10]

The typical work environment of nurses harbors many latent conditions that are sources of
threats to patient safety.
[8]
Sicker patients, inadequate orientation for new nurses, communication
failures, interruptions, and distractions were among the environmental factors found to contribute
to errors. A new report from the Institute of Medicine finds that "the work environment of nurses
needs to be substantially transformed to better protect patients from healthcare errors."
[8]
The
report calls for changes in how nurse staffing levels are established and mandatory limits on
nurses' work hours as part of a comprehensive plan to reduce problems that threaten patient
safety by strengthening the work environment in 4 areas: management, workforce deployment,
work design, and organizational culture
Born Earlier and Living Longer
Neonatal nurses have witnessed a flood of premature babies in the past several years, a trend that
is likely to continue in 2004. The increase in prematurity is partly a consequence of the
popularity of assisted reproductive technology (ART). In 2000, 53% of infants born through
ART were twins, triplets, or higher-order multiples compared with 3% of the general
population.
[15]
Twins and other multiples are more often premature and/or of low birth weight,
and often require neonatal intensive care.
As a group, the number of premature infants may be getting larger, but individually, it seems that
premature infants are getting smaller all the time -- the phenomenon of "the incredible shrinking
preemie." Though it is extremely difficult and heart-wrenching at times, neonatal nurses and
physicians cannot shrink from the question of how small is too small. It is a question that has
been asked for decades now, and still has no easy answer.
Decades of research and experience in perinatology and neonatology have convinced us that the
best approach is to prevent preterm labor if at all possible. The focus in 2004 will be on the
prevention of prematurity in a broad sense, instead of focusing on more high-tech ways to save
the lives of increasingly immature newborns. Look for a high-profile media campaign from the
March of Dimes aimed at both professionals and the general public so that everyone gets the
message -- babies are better off born at term.
[16]

On the other end of the life spectrum, people are expected to live longer (77.2 years, in 2001).
[17]

The "over 85s" are the fastest growing segment of the older population.
[17]
In fact, the whole
population is getting older. The percentage of people over the age of 65 years in the United
States is now 12%, compared with 8% just 50 years ago.
[17]
We can expect this to rise further as
the first of the baby boomers enter their sixties just 2 years from now.
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Shorter Lengths of Hospital Stay
The latest data on national trends in hospitalization show that hospital stays are declining.
According to the National Hospital Discharge Survey, the average length of stay (LOS) for
hospital inpatients in the United States was 4.9 days in 2001 (the latest year for which data are
available), down from 7.3 days in 1980.
[18]
In 2001, most patients stayed in the hospital for 3
days or less, 27% stayed for 4 to 7 days, and only 16% stayed longer than a week.
[18]

Forces that have exerted pressure on the hospital LOS include:
[18]

A shift from a Medicare cost-based to a prospective payment system for hospitals,
beginning in the 1980s
Greater development and coverage of postacute care alternatives to hospitalization
The growth in utilization review programs
Increased enrollment in managed care plans
Advances in technology and drug therapies that allow earlier diagnosis and treatment of
acute conditions and safer and less invasive surgeries.
LOS for children did not change significantly in 2001.
[19]
Neonatal intensive care unit LOS for
preterm infants is closely tied to gestational age at birth and birthweight.
[20]
A recent analysis of
147,224 premature infants confirmed that mean hospital LOS decreases with increasing
gestational age and birth weight. For example, for an infant born at 25 weeks gestation, mean
LOS was 92 days, and for an infant of 30 weeks gestation, mean LOS was 30.4 days.
[18]

One group for whom LOS has actually increased is postpartum women. After LOS following
uncomplicated vaginal delivery fell to an average low of 1.4 days during the "drive-through
delivery" days of the late 1980s to mid 1990s,
[20]
it has now rebounded and stabilized at around
2.5 days
Healthcare Consumerism and "E-Health"
"Americans want the best healthcare someone else will pay for."
[21]
Consumerism is an
intriguing trend that bears close watching in 2004. "Consumerism" is a buzzword that means
different things to different people with different interests. In its truest sense, consumerism is "a
movement seeking to protect the rights of consumers by requiring such practices as honest
packaging, labeling, and advertising, fair pricing, and improved safety standards."
[22]
No
argument there!
In healthcare, a consumer has come to mean a more informed participant, perhaps one who uses
the Internet to obtain information about health, disease, and quality ratings of providers and
hospitals. Defined as such, consumerism is a positive development in healthcare. However, in
industry, consumerism also refers to a type of health insurance plan called a consumer-directed
health plan that gives the consumer (the employee) more choices about how his or her insurance
dollars will be spent. And, in practice, this means, plainly stated, that the consumer is paying for
more of the healthcare costs.
The big push behind the consumerism movement is the hope that it will ultimately drive down
healthcare costs. However, employers have been shifting more of the costs of health insurance
premiums to employees for years now, yet the cost of health insurance keeps soaring. Are the
majority of Americans suddenly going to adopt healthier lifestyles to save money on out-of-
pocket medical expenses? We are taking the risk that many Americans are simply going to
forego spending money on healthcare whenever possible. And since we are already in the midst
of epidemics of obesity and diabetes in this country, we could end up paying with our health.
Further, it is believed that information technology will help consumers make better choices about
healthcare, getting more "value for money." Indeed, use of healthcare Web sites by consumers
tripled in 2002 as individuals spent more time exploring their options before making healthcare
decisions.
[23]
The problem is, even with a boatload of information about disease, diagnostic tests,
and treatment options, someone with a healthcare background can have difficulty making
decisions about what is necessary and what is fluff, particularly when faced with the crisis of a
serious illness. How is the average lay consumer to accomplish this?
Hospital and physician "report cards" and other forms of quality ratings will become more
prevalent, purportedly to help consumers make choices about where to spend their healthcare
dollars. It remains to be seen if people will shop for healthcare services the way they do for a car
or a television set, or if they will continue to rely on word of mouth, convenience, and what they
are comfortable with, just as they have done in the past.
Complementary and Alternative Medicine
Hand-in-hand with the healthcare consumerism movement is a trend known as complementary
and alternative medicine, or CAM. CAM is a group of diverse medical and healthcare systems,
practices, and products that are not presently considered to be part of conventional medicine.
[24]

In 1999, the National Center for Complementary and Alternative Medicine became 1 of 27
institutes and centers of the US National Institutes of Health.
[24]

In attempts to improve their health and/or combat illness, approximately 4 in 10 Americans will
use CAM therapy this year,
[25]
and many parents will also provide CAM for their children.
[26]

Most healthcare consumers will use the Internet to find information about alternative therapies.
While some scientific evidence exists regarding some CAM therapies, for most there are key
questions still unanswered.
[24]

Nurses will not only be questioned about complementary and alternative therapies, but they will
need to be proactive and open dialogues with patients about their use of CAM in order to address
safety issues. In the very near future, nurses might have a greater role in providing CAM in some
healthcare settings, including hospitals. The flurry of interest in CAM has stimulated a
movement to integrate CAM into the conventional healthcare system,
[25]
and has led to funding
for clinical trials to determine safety and efficacy of CAM therapies.
Technological Wonders and Woes
Imagine a wireless, disposable endoscopy camera in a capsule that provides real-color images of
the gastrointestinal tract after being swallowed and moved along by peristalsis. Or picture an
antibody-coated stent that prevents restenosis of coronary arteries. And envision in the works --
an artificial pancreas and a robot that performs delicate surgery inside of an MRI chamber.
Consider the possibility of delivering a baby by Cesarean section -- halfway -- so that the baby
can be intubated and resuscitated before clamping the umbilical cord, all because there is a large
tumor growing on the baby's trachea.
[27]
These miracles of modern medicine are the feel-good
side of high-tech, the side we cannot get enough of.
In sharp contrast to the way healthcare embraces new technology for diagnostic and treatment
purposes, hospitals have lagged far behind other industries when it comes to the adoption of
information technology. We are still wallowing in paper, while the paperless, or electronic,
medical record that has been talked about for years is still mostly just talked about. It looks as
though this will soon be changing, though. The US Department of Health and Human Services is
in the process of developing a standardized model of an electronic health record, expected to be
ready sometime this year.
More nurses can look forward to experiencing the challenges of working with new information
technology systems in 2004. Computerized provider (or physician) order entry and barcode-
enabled point-of-care medication management systems are new applications designed to improve
efficiency and reduce medication and other errors in the clinical setting.
[28]
Computerized
provider (or physician) order entry systems were highly anticipated to replace handwritten
prescribing by the end of 2003.
[29]
Barcode medication management systems are designed to
prevent medication administration errors.
[28]
Both are slowly making their way into more of the
nation's hospitals.
Web-Based Nursing Degrees
Online advanced degree programs in nursing have multiplied rapidly in the past few years.
Today, it is possible to get an RN to BSN degree, an RN (bridge) to MSN degree, or an MSN in
an array of clinical or nonclinical advanced practice majors. Do you already have your master's?
There are even online post-master's certificate programs for nurses who want to become nurse
practitioners.
Some online programs are entirely Web-based, using online lectures, libraries, discussion
groups, conferencing, and email for communication between instructor and student. Others
conduct coursework online but require site visits one or more times per semester for laboratory
or clinical practice. Some are self-paced (asynchronous), while others follow a typical college
schedule with all students participating simultaneously (synchronous). To date, there is little
uniformity in online nursing degree programs -- many different combinations of online
coursework and campus attendance requirements exist.
When nursing degree programs first went online in the late 1990s, some concerns were voiced
over whether Internet education was appropriate for a practice-oriented discipline like nursing
and whether the same high standards of traditional classroom learning could be maintained.
[30]

Since then, the growth of such programs has been impressive, and students and faculty alike
express satisfaction with distance learning programs in nursing.
[31]
Despite unresolved questions
about quality of the curriculum, clinical standards, accreditation, and jurisdiction issues,
[31]
it
appears that online degree programs in nursing are here to stay.
Disparities in Healthcare
The year 2004 will witness the emergence of an even more diverse nation, and thus a more
diverse patient population, largely due to the rapid growth of the Latino population. On the 2000
US census, 71% of the population identified themselves as white, 12.1% as black, 12.5% Latino,
2.8% Asian, and 1% Native American/Alaskan Native.
[32]
These and countless other individuals
from countries all over the world reside in the United States and are consumers of US healthcare.
Why is this important to the healthcare professional? Over and above the need to understand and
incorporate cultural differences into the provision of care, there are some basic, alarming facts
about the health of racial and ethnic minorities that all healthcare clinicians need to be aware of.
In 2004, despite the tremendous strides we have made in modern medicine and technology,
minority Americans face serious disparities in disease incidence, morbidity, mortality, and in the
healthcare they receive.
[33]

People in racial and ethnic minorities tend to receive lower-quality healthcare than whites do,
even when insurance status, income, age, and severity of conditions are comparable, according to
a 2002 report from the Institute of Medicine.
[34]
Infant mortality is approximately 2.5 times
higher in black infants as it is in white infants. Differences in the way heart disease, cancer, and
HIV infection were treated contributed in part to higher mortality rates for minorities. Also
responsible are bias, prejudice, and stereotyping on the part of healthcare professionals.
[33]

Because healthcare disparities are so serious and pervasive, this issue deserves immediate
attention from nurses and all healthcare clinicians. Possible interventions to combat inequities
include increasing public and professional awareness of disparities, the promotion of consistent
care through evidence-based practice, better patient education, and empowerment and the
integration of cross-cultural education into the training of all health professionals
Living With Chronic Disease
A total of 72% of all deaths in the United States are attributable to 4 major diseases: heart
disease, cancer, chronic obstructive pulmonary disease, and diabetes.
[35]
These and innumerable
other preventable and nonpreventable conditions such as asthma, arthritis, stroke, kidney disease
-- the list goes on and on -- represent a way of life for millions of Americans living with a
chronic disease. When chronic disease is complicated by comorbidities such as obesity and
hypertension, management becomes that much more difficult. Although chronic diseases are
among the most common and costly health problems, they are also among the most preventable.
As the elderly proportion of the population grows, chronic disease could very well overtake
acute illness as our primary healthcare concern. Prevention of chronic disease, its complications,
and optimal disease management require a different approach to healthcare than we have been
used to, and we will have to adapt accordingly. In order to turn the tide on chronic disease for
future generations, we need to redouble our efforts to help young and old clients avoid the
known risk factors such as tobacco use, and encourage them to adopt healthy diets, exercise, and
stress management.
It started with AIDS. Before 1981, incurable infections were ancient history, or so it was
believed. But when HIV started its worldwide spread, it became clear that, as a society, we were
not as safe from twentieth century plagues as we thought we were.
Our complacency, which stemmed from our success with antibiotics and vaccine programs, has
been shaken further by the recent appearance of antibiotic-resistant infections, caused by
pathogens that have flourished in the era of antibiotic overuse. We have witnessed lethal strains
of influenza, West Nile virus, SARS, and multiple-drug-resistant tuberculosis. Mad-cow disease
has become a domestic menace. The AIDS virus continues to mutate and spread throughout the
world.
[35]
The threat of bioterrorism, carrying the risk of infecting millions with smallpox or
anthrax, is all too real.
Government agencies are keenly aware of these problems, but the solutions, such as newer
antibiotics, antivirals, and vaccine programs, are unlikely to be ready in time to combat
pathogens as fast as they appear on the scene.
[36]
Nurses and other healthcare professionals must
be prepared to contain and prevent the spread of infectious diseases. They must increase their
awareness of the threat of communicable diseases and their role in preventing and managing the
bona fide public health crises they represent. And the time to do this is before an outbreak or
attack occurs.
An Opportunity for Nurses
It is a tumultuous time for nursing, but also a time of tremendous opportunity for both the
profession and for nurses as individuals. This year's nursing trends present many opportunities
for individual nurses to expand, advance, or strengthen their practice. Web-based health for
consumers, CAM, and chronic disease care are but a few of the areas ripe for nursing
involvement and expertise. And when hospitals and other organizations sit down to address
problems such as patient safety or nursing work environments, nurses must demand a seat at the
table. It would be a shame to waste the opportunity created by the intense public focus on our
profession as a result of the nursing shortage and well-publicized patient safety concerns. This is
our chance to define and demonstrate nursing's unique contribution to healthcare.


















Development of nursing education in india: Pre-indpendence

Introduction:
Nursing originated independently, existed many centuries without contact with modern medicine. The
member of the family at home met the nursing needs of the sick. Evolution of medicine, surgery and
public health into complicated technical area requiring many procedures by persons specially trained
and having understanding of scientific principles, which brought two professions closer and together.
1. Nursing in Pre-historic Times
There are no historical evidence available on ancient history on nursing care of sick in primitive times
discovered through myths, songs and archeologistTo get rid of 'evil spirit' unpleasant conditioning like
beating, starving, magic rites, nauseous medicines, loud noises sudden fright are used
methods. Primitive man had the skill of massaging, fermentation bone setting, amputation, hot and
cold bath, heat to control hemorrhages.
Role of Nurse in Primitive Period
Women were protecting and caring for their children, aged, sick members of the family. Nursing
evolved to response to the desire to keep healthy as well as provide comfort to sick. This was reflecting
in caring, comforting, nourishing and cleansing aspect of the patient. These love and hope were
expressed in empirical practice of nursing.
2. Nursing - Vedic Period (3000 B.C - 1400 B.C)
Indian medicines are found in the sacred books of "Vedas". The 'Ayur-veda' is thought to have been
given by Brahma. 1400 BC Sushruta, known as 'Father of Surgery' in India wrote a book on surgery years
later 'Charaka' wrote a book on internal medicine. By these writings we can learn that those days
surgery had advanced to a high level, also had 4 wings of treatment 'Chatushpada Chikitsa'.
1. Physician - Bhishak
2. Nurse - Upacharika (Attendent - Anuraktha)
3. Therapeutic drugs - Dravya
4. Patient - Adhyaya
Characters of Upacharika (Nurse)
Shuchi - Pure or clean in physical appearance and mental hygiene.
Daksha - Competency
Anuraktha - Willing to care
Buddhiman - Co-ordinator with the patient and doctor / intelligent.
3. Nursing Post Vedic Period (600 BC - 600 AD)
Medical education introduced in ancient Universities of 'Nalanda' and 'Thakshashila'. King Ashoka (272-
236 BC) constructed hospitals for the people and animals. Prevention of the disease was given first
importance and hygienic practices were adopted. Cleanliness of the body was religious duty. Doctors
and midwives were to be trust worthy and skillful. They should wear clean cloths and cut their nails
short. Lying rooms were kept well ventilated. Religious ceremonies and prayer precede co-
operations. The nurses were usually 'men' or 'old women'. Women are restricted activities at home and
cared for sick members in the family during 1 AD period superstition and black magic replaced more in
daily practices. Medicines are remained in the hands of priest - physicians, who refused to touch the
blood and pathological tissues. Dissection was for bidden. Other religious restriction and superstitious
practices probably declined the development of nursing.
4. Nursing in Mogul Period (1000 AD)
'Unani' system of medicine developed during the Arab civilization. It was practiced in Indo-Pakistan
subcontinent. The basic framework are consists of blood, phlegm, yellow bile and back
bile. Temperament, strengthening of body and nature are the real physician.
Not believed in eradication of disease greatly depend on defense mechanism of the body and self-care
and positive health habits. Therefore, it becomes part of Indian medicine practice.
5. British period (16
th
Century onwords)
After the Mogul period the nursing in India hindered due to various reasons like low state of women,
system of "pardha" among Muslims, caste system among Hindus, illiteracy, poverty, political unrest,
language difference and nursing looked upon as servants work. During the 16
th
century, nursing
development in India taken three dimensions.
1. Military Nursing
2. Civilian Nursing
3. Missionaries Nursing
1. Military Nursing:
Military nursing born during 1
st
world war but developed very slowly. British officers informed need of
nurses to take care British officials and soldiers in India.
On 1888 Feb. 21
st
- 10 fully qualified certified nurses from Florence Nightingales, arrived to Bombay to
lead nursing in India. This pave the way to develop one of the best nursing in the world. 1894 regular
system of training for men for hospital work (orderliness) started. Medical officers given lecturing to
them. Some men were voluntary did the course and applied for the nursing certificate. After two
months of practical posting to ward, on the account of supervised sister's report, first time hospital
'orderlines' issued certificate and had official status. This system laid the possible foundation to existing
system of training and higher education.
1927 - Description of Indian Military Nursing services formed with 12 matrons, 18 sisters, 25 staff
nurses. They are responsible for supervision, instruction and training of nursing services for entire
Indian hospital corps.
2
nd
world war expanded nursing services to India and overseas under the direction of chief principal
matron. 3 year training carried out in selected military hospital preliminary training schools. After
completion sent to military hospital for training. After successful training certificate issued as
"Registered Nurse" and they are members of Indian Military Nursing Services Auxiliary Nursing Services
Shortage of trained nurses in India after the 2
nd
world war, the Govt., initiated short course of intensive
training in 1942 which led to the Auxiliary Nursing Services. Basic training for 6
th
month is selected civil
hospital after passing examination at military hospitals in India sent to overseas to serve in the capacity
of 'Assistant Nurses' 3000 women given auxiliary training.
2. Civilian Nursing in India
1664 - East India company built Government General Hospital at Madras for civilian. 1871 - this hospital
undertook training of nurses. On 1854 midwives training school granted certificates of 'Diploma in
Midwifery' for passed student and 'sick nursing' for failed students. First time 6 nurses came out as
Diploma in Midwifery Nurses.
3. Missionary Nursing:
Missionary nursing started training for Indian people as nurses. Various other countries supported. This
brought fully qualified Indian nurses. Those days there were several obstacles for nursing development.
1. Girls were not allowed to do work.
2. Degrading and unworthy attitude of people.
3. Hindus were hold back due to deep seated caste system.
4. Muslims held under 'paradha' system.
So Christian girls encouraged and trained first.
Frequent disappointment, degradation difficulties nursing training came into existence and look its own
shape. In the beginning there is not uniformity in nursing education. There is no particular standards
were given. After the course of lecturing 18 months to two years, written examination conducted. If
failed training extended to 3 years.
From 1888-93 five years various experts like doctors, surgeons, nursing superintendent, pharmacists -
draw up a curriculum for training. 1907-10 North India united Board of Examiner formed to maintain
nursing administration and standards. 1928 - Hindi Text book for nurses developed. 1939 - helped to
develop post graduation school for nurses.
Community Health Nursing :
William Rathbone formed Visiting Nurse's Association at England. She emphasized on charity free care
etc. Florence Lees improved the Visiting Nurses by giving specialized training for their work. It is
influenced in India, because of terrible condition, under which children were born recognised as cause
for high mortality rate. Because untrained 'Dais' are attending women at the time of child birth.
Dais were unwilling to trained and patients will to accept the old customary methods. In 1926 -
Midwives Registration Act formed for the purpose of better training of midwives. Slowly Community
Nursing Training needs felt by the Government. In 1946 - Community Health Nursing was integrated in
Basic Nursing Programme at Delhi, Vellore and Madras.
Trained Nurses Association of Indian (TNAI)
In 1908 - TNAI formed to uphold the dignity and honor of the nursing profession. Florence Mac
Haughton was the first president of TNAI. In 1910 TNAI published journals. In 1912 - TNAI affiliated to
international Nursing Council as a 8
th
Association in the world. In 1917 June 16
th
under the Registration
Act No:XXI of 1860 - TNAI got registered. In 1922 - SNA formed.
Bibliography
1. Wilkinson, A. (1965). 'History of Nursing in India and Pakistan'. New Delhi, TNAI.
2. Annamma, K.V. (189). 'A New Text book for Nurses in India'. Madras, B. I. Publications.
3. Honda, U. and Gulani, K. K. (1995). 'Community Health Nursing', New Delhi, Ignon Publications.
4. Sandaranarayanan, B. and Sindhu, B. (2003), 'Learning and Teaching Nursing', Calicut, Brainfill.
5. Neeraja K. P. (2003), 'Text Book of Nursing Education', New Delhi: Jaypee Brothers.
6. TNAI (2000). 'History and trends in Nursing in India', New Delhi.
7. Hurndr, R. and Letiman, B. (183). 'Nursing Education in India', New Delhi.
8. TNAI (1995). 'Indian Nursing Year Book', 1993-95, New Delhi - TNAI.
9. TNAI (2002), 'Indian Nursing Year Book', 2000, New Delhi - TNAI.











Code of Professional Conduct

Preface
The Washington Hospital Healthcare System (WHHS) is committed to excellence in:
1. Patient care
2. Education and training
3. Research
4. Stewardship of District resources
WHHS follows the Patient First Ethic; all decisions made and actions taken are based on what is
in the best interest of the patient.
To further the goal of excellence and the Patient First Ethic, all at WHHS are expected to adhere
to the Code of Professional Conduct in their interactions with patients, colleagues, other health
professionals, students, and the public.
For the Code, there is reference to "staff". In this context, the term staff includes, the Board of
Directors, employees, members of the Medical Staff, volunteers, contracted workers, students
and instructors.
The Code of Professional Conduct is a series of principles that govern professional interactions.
The Code consists of two complementary sections: professional obligations and professional
ideals. "Obligations" refer to professional behaviors that are required by the ethical foundation of
the WHHS Ethics Statement. "Ideals" refer to professional behaviors that professionals at all
levels should attempt to acquire because they enhance professional excellence.
The Code applies to all staff at WHHS involved in the clinical, teaching, research and
administrative activities of the Center. Because of its broad reach, certain portions of the Code
will be more directly applicable to some disciplines than to others. For example, the clinical
portions apply to physicians, nurses, technicians and all other professionals engaged in patient
care. Similarly, those portions pertaining to teaching and research apply to all professionals
engaged in teaching and research regardless of discipline or level of training. The portions
pertaining to students apply to trainees at all levels. The general portions of the Code, which
discuss confidentiality, conflicts of interest, interpersonal relations and the professional ideals
apply to all WHHS staff.
Failure to meet the professional obligations described below represents a violation of the WHHS
Code of Professional Conduct. Infractions of the professional obligations of the Code will be
dealt with by the appropriate WHHS disciplinary committees and processes. Failure to meet the
professional ideals, although less serious, also may be grounds for disciplinary review.


Professional conduct refers to the manner in which a person behaves while acting in a professional capacity.
A. Professional Obligations
1. Respect for Persons
* Maintain the Patient First Ethic.
* Treat patients and staff with the same degree of respect you would wish them to show you.
* Treat patients with kindness, gentleness and dignity.
* Respect the privacy and modesty of patients.
* Do not use offensive language, verbally or in writing, when referring to patients or their
illnesses.
* Do not harass others physically, verbally, psychologically or sexually.
* Do not discriminate on the basis of sex, religion, race, disability, age or sexual orientation.
* Refrain from behavior that includes intimidation, foul language, threats of violence or
retaliation.
* Refer to patients by their name, not by their diagnosis or location.
* Avoid the use of first names without permission in addressing adult patients.
* Respect with tolerance, the religion, culture and customs of patients, visitors and staff.
* Realize that patients and their visitors are in an environment that can be unfamiliar and
frightening. Communicate frequently in language that a layperson can understand.
2. Respect for Patient Confidentiality
* Do not share medical information with anyone except those health care professionals integral
to the care of the patient or within the context of Hospital operations.
* Do not discuss patients or their illnesses in public places where the conversation may be
overheard.
* Do not publicly identify patients, in spoken words or in writing, without adequate justification.
* Do not invite or permit unauthorized persons into patient care areas of the institution.
* Do not share your confidential computer system passwords.
* Do not access confidential patient information without a professional "need to know."
* Do not misuse electronic mail.
* Do not remove confidential patient information from the premises. Staff that must do this in
the scope of their job must assure appropriate safeguards are in place to protect the
information.
3. Honesty
* Be truthful in verbal and in written communications.
* Do not cheat, plagiarize, or otherwise act dishonestly.
* Maintain accurate, honest records of patient care and business activities, which include
following procedures to correct and amend records and to make late entries in medical records.
4. Integrity
Integrity means strict adherence to a code or set of values such as this Code of Professional
Conduct, the American Nurse's Association's Code of Ethics for Nurses, or the American Medical
Association's Code of Ethics.

* Acknowledge your errors of omission and commission to colleagues, supervisors and patients.
* Make patient care decisions based on patients' needs and desires not on financial preferences
or compensation.
* Do not knowingly mislead others.
* Do not abuse special privileges, e.g., making unauthorized long-distance telephone calls.
5. Responsibility for Patient Care
* Obtain the patient's informed consent for diagnostic tests or therapies and respect the
patient's right to refuse care or procedures.
* Assume responsibility for the patients under your care until you have handed off (transferred)
the care to another professional and that professional has acknowledged the transfer of care.
* Follow up on ordered laboratory tests and complete patient record documentation promptly
and conscientiously.
* Assure that all patients' tests and treatments are completed and followed up appropriately.
* Coordinate with your team the timing of information sharing with patients and their families
to present a coherent and consistent treatment plan.
* Do not abuse alcohol or drugs that could diminish the quality of patient care or your
professional performance.
* Do not develop romantic or sexual relationships with patients; if such a relationship seems to
be developing, seek guidance and terminate the professional relationship.
* Do not abandon a patient. If you are unable/unwilling to continue care, you have an obligation
to assist in making a referral to another competent practitioner willing to care for the patient.
6. Professional Growth & Awareness of Limitations
* Be aware of your personal limitations and deficiencies in knowledge and abilities and know
when and whom to ask for supervision, assistance or consultation.
* Know when and for whom to provide appropriate supervision.
* Students and other trainees should have all patient workups and orders reviewed and
countersigned by the appropriate supervisor.
* Do not involve patients in personal issues or solicit for personal gain.
* Do not engage in unsupervised involvement in areas or situations where you are not
adequately trained.
7. Deportment as a Professional
* Clearly identify yourself and your professional level to patients and staff; wear your name
badge at all times above the waist and in plain view.
* Always maintain the confidentiality of business information and trade secrets.
* Dress in a neat, clean, professionally appropriate manner. Maintain professional composure
despite the stresses of fatigue, professional pressures, or personal problems.
* Do not make offensive or judgmental comments about patients or staff, verbally or in writing.
* Do not criticize the medical decisions of colleagues in the presence of patients or staff or in the
medical record.
* Do not access confidential staff information without a professional need to know.
* Do not abuse alcohol or drugs that could diminish the quality of patient care or professional
performance.
* Do not participate in political campaigns including the wearing of political buttons and
discussion of political issues while on WHHS premises.
8. Avoiding Conflicts of Interest
* Resolve clinical conflicts of interest in favor of the patient.
* While on the premises do not accept gifts of value from drug companies or vendors or
suppliers.
* Do not participate in vendor incentive programs without disclosure.
* Do not refer patients to laboratories or other healthcare facilities in which you have a direct
financial stake without disclosure.
* Do not accept a "kickback" (any payment intended to influence decisions) for any patient
referral.
* For staff in decision-making positions, disclose any outside financial interests or commercial
activities, including those of immediate family members, domestic partners or others with a
significant personal relationship, that may represent a conflict of interest and affect professional
performance.
9. Responsibility for Peer Behavior
* Take the initiative to identify and help impaired staff with the assistance of the Employee
Assistance Program, Employee Health Services, Physicians' Well-Being Committee or other
appropriate referrals. (Impairment includes, but is not limited to, alcohol and/or drug abuse,
depression, other physical or mental illness).
* Report serious breaches of the Code of Professional Conduct to the appropriate person, if
unsure, discuss the situation with your supervisor or department chair. You may report directly
to the Compliance Officer.
* Indicate disapproval or seek appropriate intervention if you observe less serious breaches.
* No action of retaliation or reprisal shall be taken against anyone who reports suspected fraud
or improper conduct.
* Anyone who attempts to or encourages others to retaliate against an individual who has
reported a violation will be subject to disciplinary action.
10. Respect for Personal Ethics
* You are not required to perform procedures (e.g., elective abortions, termination of medical
treatment) that you, personally, believe are unethical, illegal, or may be detrimental to patients.
* Should a patient request a treatment contrary to your personal values but consistent with
current standards of care, you have a duty to refer the patient to another practitioner or facility
for such treatment.
11. Respect for Property and Laws
* Adhere to the regulations and policies of WHHS, e.g., policies governing fire safety, hazardous
waste disposal and universal precautions.
* Adhere to local, state and federal laws and regulatory standards.
* Do not misappropriate, destroy, damage, or misuse property of WHHS.
12. Integrity in Research
* Report research results honestly in scientific and scholarly presentations and publications.
* When publishing and presenting reports, give proper credit and responsibility to colleagues
and others who participated in the research.
* Report research findings to the public and press honestly and without exaggeration.
* Avoid potential conflicts of interest in research; disclose funding sources, company ownership
and other potential conflicts of interest in written and spoken research presentations.
* Adhere to WHHS policies and procedures that govern research using human subjects.
13. Use of WHHS' Computer Systems
* Obtain proper authorization before using WHHS computing resources.
* Do not use WHHS computing resources for purposes beyond those for which you are
authorized.
* Do not share access privileges (account numbers and/or passwords).
* Do not electronically transmit or distribute material that would be in violation of existing
WHHS policies or guidelines.
* Respect the privacy of other users. More specifically, do not read, delete, copy, or modify
another user's data, information, files, e-mail or programs (collectively, "electronic files")
without the other user's expressed permission.
* Do not intentionally introduce any program or data intended to disrupt normal operations
(e.g., a computer "virus" or "worm") into WHHS computer systems.
* Do not perform forgery or attempt forgery of e-mail messages.
* Do not circumvent or attempt to circumvent normal resources limits, log-on procedures, or
security regulations.
* Do not use WHHS information technology resources for any private activity. Do not export
WHHS systems for personal use.
* Endeavor to use WHHS information computing resources in an efficient and productive
manner. Avoid game playing, use of streaming video or audio, printing excessive copies of
documents, files, data, or programs; or attempting to crash or tie-up computer resources.
14. Respect for Business Ethics
* Charge patients for all and only clinical services provided at the appropriate level as defined by
WHHS policy.
* Ensure that payment requests from vendors, employees and other payees are processed
promptly, accurately and with the appropriate level of documentation.
* Do not promise payments to vendors or other payees or sign contracts that are beyond the
scope of your authority.
* Report all and only hours worked on employee timecards.
* Submit authorized employee timecards that follow the rules and regulations of the bargaining
unit, WHHS, the State of California and the Federal government.
* Do not take or borrow property or cash from patients, visitors or WHHS.
* Do not use WHHS supplies for personal use.
* Record all financial transactions accurately and promptly.
* Provide reports and other information that is accurate, complete, relevant, timely and
understandable.
* Do not offer patients discounts or write/offs without proper approval.
* Maintain the confidentiality of employee information.
* Maintain the confidentiality of WHHS' financial information.
* Code medical records accurately, consistent with industry guidelines. Do not upcode to
improve reimbursement.
B. Professional Ideals
1. Clinical Virtues
* Cultivate and practice clinical virtues, such as caring, empathy and compassion.
2. Conscientiousness
* Fulfill your professional responsibilities conscientiously.
* Notify the responsible supervisor if something interferes with your ability to perform tasks
effectively.
* Learn from experience and grow from the knowledge gained from errors to avoid repeating
them.
* Dedicate yourself to lifelong learning and self-improvement by implementing a personal
program of continuing learning and continuous quality improvement.
* Complete all tasks accurately, thoroughly, legibly and in a timely manner, this may include
attending and participating in meetings and conferences.
* Follow through on whatever you have agreed to do.
* Avoid patient involvement when you are ill, distraught or overcome with personal problems.
3. Collegiality/Cooperation
* Cooperate with all other members of the Health Care System.
* Teach others.
* Be generous with your time when answering questions from staff, patients and visitors.
* Shoulder your fair share of the institutional burden by adopting a spirit of volunteerism and
altruism.
* Use communal resources (equipment, supplies and funds) responsibly and equitably.
4. Objectivity
* Avoid providing professional care to members of your family or to persons with whom you
have a close, personal relationship.
5. Responsibility to Community
* Avoid unnecessary patient or societal health care monetary expenditures.
* Provide appropriate emergency services to all patients regardless of their ability to pay.
* Avoid behaviors that impair the community's confidence in the Healthcare System.
* Demonstrate behavior that ensures the future viability of the Healthcare System for the
residents of the District.
Additional guidelines regarding Professional Conduct exist in some departments and affiliated
organizations of WHHS including, but not limited to, the Medical Staff, Volunteers Services and
Information Services.






Eight aspects of professional conduct
In discharging his/her duty in a professional capac
ity, each nurse shall act,
at all times, in such
a manner as to:
1.
Respect the dignity, uniqueness, values, cult
ure and beliefs of patients/clients and their
families in the provision of nursing care.
2.
Hold in confidence personal informa
tion obtained in a professional capacity.
3.
Safeguard informed decision-making and
the wellbeing of patients/clients in the
provision of care.
4.
Provide safe and competent nursing care.
5.
Maintain the agreed standard of practice.
6.
Foster the trust that is inherent in the
privileged relationship between nurses and their
patients/clients.
7.
Uphold the image of nurses and the
profession by refusing advantages.
8.
Practise in accordance with laws of H
ong Kong relevant to the area of nursing
practice
Nurses practise in a safe and competent manner.
2. Nurses practise in accordance with the standards of
the profession and broader health system.
3. Nurses practise and conduct themselves in
accordance with laws relevant to the profession and
practice of nursing.
4. Nurses respect the dignity, culture, ethnicity, values
and beliefs of people receiving care and treatment,
and of their colleagues.
5. Nurses treat personal information obtained in a
professional capacity as private and confidential.
6. Nurses provide impartial, honest and accurate
information in relation to nursing care and health
care products.
7. Nurses support the health, wellbeing and informed
decision-making of people requiring or receiving
care.
8. Nurses promote and preserve the trust and privilege
inherent in the relationship between nurses and
people receiving care.
9. Nurses maintain and build on the communitys trust
and confidence in the nursing profession.
10. Nurses practise nursing reflectively and ethically.


















NURSING AS A PROFESSION
by Admin October 8, 2007
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Profession is a calling that requires special knowledge, skill and preparation.
An occupation that requires advanced knowledge and skills and that it grows
out of societys needs for special services.
Criteria of Profession:
1. To provide a needed service to the society.
2. To advance knowledge in its field.
3. To protect its members and make it possible to practice effectively.
Characteristics of a Profession:
1. A basic profession requires an extended education of its members, as well as a basic
liberal foundation.
2. A profession has a theoretical body of knowledge leading to defined skills, abilities
and norms.
3. A profession provides a specific service.
4. Members of a profession have autonomy in decision-making and practice.
5. The profession has a code of ethics for practice.
NURSING >is a disciplined involved in the delivery of health care to the society.
>is a helping profession
>is service-oriented to maintain health and well-being of people.
>is an art and a science.
NURSE - originated from a Latin word NUTRIX, to nourish.
Characteristics of Nursing:
1. Nursing is caring.
2. Nursing involves close personal contact with the recipient of care.
3. Nursing is concerned with services that take humans into account as physiological,
psychological, and sociological organisms.
4. Nursing is committed to promoting individual, family, community, and national
health goals in its best manner possible.
5. Nursing is committed to personalized services for all persons without regard to color,
creed, social or economic status.
6. Nursing is committed to involvement in ethical, legal, and political issues in the
delivery of health care.
Personal Qualities of a Nurse:
1. Must have a Bachelor of Science degree in nursing.
2. Must be physically and mentally fit.
3. Must have a license to practice nursing in the country.
A professional nurse therefore, is a person who has completed a basic nursing
education program and is licensed in his country to practice professional
nursing.
Roles of a Professional
1. Caregiver/ Care provider
the traditional and most essential role
functions as nurturer, comforter, provider
mothering actions of the nurse
provides direct care and promotes comfort of client
activities involves knowledge and sensitivity to what matters and what is important to clients
show concern for client welfare and acceptance of the client as a person
2. Teacher
provides information and helps the client to learn or acquire new knowledge and technical skills
encourages compliance with prescribed therapy.
promotes healthy lifestyles
interprets information to the client
3. Counselor
helps client to recognize and cope with stressful psychologic or social problems; to develop an
improve interpersonal relationships and to promote personal growth
provides emotional, intellectual to and psychologic support
focuses on helping a client to develop new attitudes, feelings and behaviors rather than
promoting intellectual growth.
encourages the client to look at alternative behaviors recognize the choices and develop a sense
of control.
4. Change agent
initiate changes or assist clients to make modifications in themselves or in the system of care.
5. Client advocate
involves concern for and actions in behalf of the client to bring about a change.
promotes what is best for the client, ensuring that the clients needs are met and protecting the
clients right.
provides explanation in clients language and support clients decisions.
6. Manager
makes decisions, coordinates activities of others, allocate resource
evaluate care and personnel
plans, give direction, develop staff, monitors operations, give the rewards fairly and represents
both staff and administrations as needed.
7. Researcher
participates in identifying significant researchable problems
participates in scientific investigation and must be a consumer of research findings
must be aware of the research process, language of research, a sensitive to issues related to
protecting the rights of human subjects.
Expanded role as of the nurse
1 Clinical Specialists- is a nurse who has completed a masters degree in specialty and has
considerable clinical expertise in that specialty. She provides expert care to individuals,
participates in educating health care professionals and ancillary, acts as a clinical consultant
and participates in research.
2. Nurse Practitioner- is a nurse who has completed either as certificate program or a
masters degree in a specialty and is also certified by the appropriate specialty organization.
She is skilled at making nursing assessments, performing P. E., counseling, teaching and
treating minor and self- limiting illness.
3. Nurse-midwife- a nurse who has completed a program in midwifery; provides prenatal
and postnatal care and delivers babies to woman with uncomplicated pregnancies.
4. Nurse anesthetist- a nurse who completed the course of study in an anesthesia school
and carries out pre-operative status of clients.
5. Nurse Educator- A nurse usually with advanced degree, who beaches in clinical or
educational settings, teaches theoretical knowledge, clinical skills and conduct research.
6. Nurse Entrepreneur- a nurse who has an advanced degree, and manages health-related
business.
7. Nurse administrator- a nurse who functions at various levels of management in health
settings; responsible for the management and administration of resources and personnel
involved in giving patient care.
Fields and Opportunities in Nursing
1. Hospital/Institutional Nursing a nurse working in an institution with patients
Example: rehabilitation, lying-in, etc.
2. Public Health Nursing/Community Health Nursing usually deals with families and
communities. (no confinement, OPD only)
Example: brgy. Health Center
3. Private Duty/special Duty Nurse privately hired
4. Industrial/Occupational Nursing a nurse working in factories, office, companies
5. Nursing Education nurses working in school, review center and in hospital as a CI.
6. Military Nurse nurses working in a military base.
7. Clinic Nurse nurses working in a private and public clinic.
8. Independent Nursing Practice private practice, BP monitoring, home service.
- Independent Nurse Practitioner.