CONCEPT OF NURSING
(ANA, 1980)
Definitions Of Nursing
◦ “The act of utilizing the environment
of the patient to assist him in his
recovery” (Nightingale, 1860/1969)
◦ “The unique function of the nurse is
to assist the individual, sick or well,
in the performance of these
activities contributing to heath or its
recovery (or to peaceful death) that
he would perform unaided if he had
Recipients of Nursing
the necessary strength, will, or
knowledge, and to do this in such a
way as to help him gain
independence as rapidly as possible”
(Henderson, 1966)
◦ Certain themes are common to
many of these definitions:
1. Nursing is caring
2. Nursing is an art
3. Nursing is a science
4. Nursing is client centered
5. Nursing is holistic
6. Nursing is adaptive
7. Nursing is concerned with health
promotion, health maintenance, and
Scope of Nursing
health restoration
8. Nursing is a helping profession
9. “Direct, goal oriented, and
community during health and
illness”(ANA, 1973)
10. Nursing is the diagnosis and
treatment of human responses to
actual or potential health problems”
11. “Nursing is the protection,
promotion, and optimization of
health and abilities, preventions of
illness and injury, alleviation of
suffering through diagnosis and
treatment of human response, and
advocacy in the care of the
individuals, families, communities,
and populations” (ANA, 2015)
◦ Consumer- is an individual, a group
of people, or a community, that uses
a service or commodity.
◦ Patient- is a person who is waiting
for or undergoing medical treatment
and care. Patient comes from a Latin
word meaning “to suffer” or “to
bear”.
◦ Client is a person who engages the
advice or services of another who is
qualified to provide their service.
The term client presents the
receivers of health care as
collaborations in the care, that is, as
people who are also responsible for
their own health.
1. Individuals- is a unique being who is
different from every other human
being, with a different combination
of genetics, life experiences, and
environmental interactions.
2. Families- is a basic unit of society. It
consist of those individuals, male or
female, youth or adult, legally or not
 legally related, genetically or not
genetically related, who are
considered by others to represent
their significant people.
3. Communities- is a collection of
people who share some attribute of
their lives and interact with other in
some way.
NURSING AS A PROFESSION, SCIENCE, AND
ART
Nursing as a Profession
• The patient is the center of you care.
Your patient includes individuals,
families, and/or communities.
• Nursing is not simply a collection of
specific skills, and you are not simply
a person trained to perform specific
tasks. Nursing is a profession
• To act professionally , use your
critical thinking skills to administer
quality evidenced-based, patient-
centered care in a safe, prudent, and
knowledgeable manner.
Science and Art of Nursing Practice
◦ Nursing is both an art and a science,
nursing practice requires a blend of
current knowledge and practice
standards with an insightful and
compassionate approach to your
patients’ health care needs.
◦ Clinical expertise takes time and
commitment
◦ According to Benner (1984), an
expert nurse passes through five
levels of proficiency when acquiring
and developing generalist or
specialized nursing skills.
◦ Expert clinical nursing practice is a
commitment to the application of
knowledge, ethics, aesthetics, and
clinical experience.
Benner: From Novice to Expert
• Novice: Beginning nursing student or
any nurse entering a situation in
which there is no level of
experience.
• Advanced Beginner: a nurse who
has had some level of experience
with the situation.
• Competent: a nurse who has been in
the same clinical position for 2 to 3
years. This nurse understands the
organization and specific care
required by the type of patients.
• Proficient: A nurse with more than
2-3 years of experience in the same
clinical position.
• Expert: A nurse with diverse
experience who has an intuitive
grasp of an existing or potential
clinical problem.
Scope and Standards of Practice
• When giving care, it is essential to
provide a specified service according
to standards of practice and to
follow a code of ethics (ANA 2015).
• Professional practice includes
knowledge from social and
behavioral sciences, biological and
psychological sciences, and nursing
theories.
• Nursing practice incorporates ethical
and social values, professional
autonomy, and a sense of
commitment and community. (ANA
2015)
◦ Standards of Professional Nursing
Practice. Contain authoritative
statements of the duties that all
registered nurses, regardless of role,
population, or specialty, are
expected to perform competently
(ANA 2015).
◦ Code of Ethics. Is a statement of
philosophical ideals of right and
wrong that define the principles you
will use to provide care to your
patients.
◦ Standards of Professional
Performance. Describe a competent
level of behavior in the professional
role (ANA, 2015)
1. Ethics
2. Culturally Congruent Care
3. Communication
4. Collaboration
5. Leadership
6. Education
7. Evidence-Based Practice and
Research
8. Quality of Practice
9. Professional Practice Evaluation
10. Resources Utilization
11. Environmental Health
Professional Responsibilities and
Roles
◦ Autonomy and Accountability-
autonomy is an essential element of
professional nursing that involves
the initiation of independent nursing
interventions without medical
orders.
◦ With increased autonomy
comes grater responsibility
and accountability.
◦ Accountability means that
you are responsible
professionally and legally for
the type and quality of
nursing care provided.
◦ Caregiver- as a caregiver you help
patient maintain and regain health,
manage disease and symptoms, and
attain a maximal level of function
and independence through the
healing process.
◦ Advocate- as a patient advocate you
protect your patient’s human and
legal rights and provide assistance in
asserting these rights if need arises.
As an advocate you act on behalf of
your patients and secure your
patient/s health care rights
(Kowalski, 2016).
◦ Educator- As an educator you
explain concepts and facts about
health, describe the reason for
routine care activities, demonstrate
procedures such as self-care
activities, reinforce learning or
patient behavior, and evaluate the
patient’s progress in learning.
◦ Communicator- As an effective
communicator is central to the
nurse-patient relationship. It allows
you to know your patients, including
their preferences, strengths,
weakness, and needs.
◦ Manager- Nurse managers need to
establish an environment for
collaborative patient-centered care
to provide safe, quality care with
positive outcomes.
CAREER DEVELOPMENT
◦ Provider of Care. Most nurses
provide direct patient care in an
acute care setting.
◦ Advanced Practice Registered
Nurses. Is the most independently
functioning nurse. An APRN has a
master’s degree or Doctor Of
Nursing Practice degree in nursing,
advanced education in
pathophysiology, pharmacology, and
physical assessment; and
certification and expertise in a
specialized area of practice (AACN,
2011)
◦ Clinical Nurse Specialist
◦ Nurse Practitioner
◦ Certified Nurse-Midwife
◦ Certified Registered Nurse
Anesthetist
◦ Nurse Educator. Works significantly
in schools of nursing, staff
development departments of health
care agencies, and patient education
departments.
◦ Nurse Administrator. Manages
patient care and the delivery of
specific nursing services within a
health care agency. Nursing
administrators begins with positions
such as clinical care coordinators.
◦ Nurse Researcher. Conducts
evidence-based practice and
research to improve nursing care
and further define and expand the
scope of nursing practice.
Historical Influences
◦ In times of war, they responded by
meeting the needs of the wounded
on combat zones and military
hospitals in the US and abroad.
◦ Today nurses are active in
determining best practices in a
variety of areas such as injury
prevention, wound care
management, pain control,
nutritional management, and care of
individuals across the life span.
◦ Knowledge of the history of the
nursing profession increases your
ability to understand the social an
intellectual origins of the discipline.
Florence Nightingale
◦ In notes on Nursing: What It Is and
What Is Not, Florence established
the first nursing philosophy based on
health maintenance and restoration
(Nightingale, 1860).
◦ She saw the role of nursing as having
“charge of somebody’s health”
based on the knowledge of “how to
put the body in such a state to be
 free of disaster or to recover from
disease (Nightingale, 1860).
◦ Nightingale was the first practicing
nurse epidemiologist. Her statistical
analyses connected poor sanitation
with cholera and dysentery.
◦ She volunteered during Crimean
War in 1853 and traveled the
battlefield hospitals at night,
carrying her lamp; thus, she was
known as the “lady with the lamp”
◦ The sanitary, nutritional, and basic
condition in the battlefield hospitals
were poor, and she was asked to
ensure the quality of sanitation
facilities.
THE CIVIL WAR TO THE BEGINNING
OF THE TWENTIETH CENTURY
◦ The Civil War (1860-1865)
stimulated the growth of nursing in
the United States.
◦ Clara Barton, founder of American
Red Cross cared for soldiers on the
battlefields, cleaning their wounds,
meeting their basic needs, and
comforting them at end of life.
◦ Dorothea Lynde Dix, Mary Ann Ball
(Mother Birkerdyke), and Harriet
Tubman also influenced nursing
during the Civil War (Donahue,
2011).
◦ Dix and Birkerdyke organized
hospitals and ambulances,
appointed nurses, cared for the
wound soldiers, and oversaw and
regulated supplies to the troops.
◦ Tubman was active in the
Underground Railroad movement
and assisted in leading more than
300 slaves to freedom (Donahue,
2011).
◦ The first professionally educated
African-American nurse was Mary
Mahoney.
◦ Isabel Hampton Robb helped found
the Nurse’s Association Alumnae of
the US and Canada in 1896.
◦ Nursing hospitals expanded in late
nineteenth century. However,
nursing in the community did not
increase significantly until 1893,
when Lilian Wald and Mary Brewster
opened the Henry Street Settlement,
which focused on the health needs
of poor people who lived in
tenements in New York City.
Twentieth Century
◦ A movement toward developing a
scientific, research-based defined
body of nursing knowledge and
practice evolved. Nurse began to
assume expanded roles.
◦ Mary Adelaide Nutting, who became
the first nursing professor at
Columbia Teachers College in 1906,
was instrumental in moving nursing
education into universities
(Donahue, 2011)
Twenty-First Century
◦ Nurses are revising nursing practice
and school curricula to meet ever-
changing needs of society, including
aging population, bioterrorism,
 emerging infections, and disaster
management.
◦ Advances in technology and
informatics, the high-acuity level of
care of hospitalized patients, and
early discharge from health care
institutions require nurses in all
settings to have strong and current
knowledge base from which to
practice.
CONTEMPORARY INFLUENCES
◦ Importance of Nurses’ Self-Care
◦ Health Care Reform and Cost
◦ Demographic Changes
◦ Medically Underserved