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Nursing is a healthcare profession focused on the care of individuals, families, and communities so they may attain, maintain, or recover optimal health and quality of life from birth to the end of life.

Nurses work in a large variety of specialties where they work independently and as part of a team to assess, plan, implement and evaluate care.

History of nursing

Nursing comes in various forms in every culture, although the definition of the term and the practice of nursing has being known as a wet nurse and the latter being known as a dry nurse. In the 15th century, this developed into the idea of looking after or advising another, not necessarily meaning a woman looking after a child. Nursing has continued to develop in this latter sense, although the idea of nourishing in the broadest sense refers in modern nursing to promoting quality of life.

Prior to the foundation of modern nursing, nuns and the military often provided nursing-like services. The religious and military roots of modern nursing remain in evidence today in many countries, for example in the United Kingdommarker, senior female nurses are known as ‘‘sisters’’.It was during time of war that a significant development in nursing history arose when English nurse Florence Nightingale, working to improve conditions of soldiers in the Crimean War, laid the foundation stone of professional nursing with the principles summarised in the book Notes on Nursing. Other important nurses in the development of the profession include: Mary Seacole, who also worked as a nurse in the Crimea; Agnes Elizabeth Jones and Linda Richards, who established quality nursing schools in the USA and Japan, and Linda Richards who was officially America's first trained nurse, graduating in 1873 from the New England Hospital for Women and Childrenmarker in Bostonmarker.

New Zealandmarker was the first country to regulate nurses nationally, with adoption of the Nurses Registration Act on the 12th of September, 1901. Ellen Dougherty was the first registered nurse. North Carolinamarker was the first state in the United States to pass a nursing licensure law in 1903.

Nurses have experienced difficulty with the hierarchy in medicine that has resulted in an impression that nurses primary purpose is to follow the direction of medics. This tendency is certainly not observed in Nightingale's Notes on Nursing, where the doctors are mentioned relatively infrequently and often in critical tones, particularly relating to bedside manner.

The modern era has seen the development of nursing degrees and nursing has numerous journals to broaden the knowledge base of the profession. Nurses are often in key management roles within health services and hold research posts at universities.

Nursing as a profession

The authority for the practice of nursing is based upon a social contract that delineates professional rights and responsibilities as well as mechanisms for public accountability. In almost all countries, nursing practice is defined and governed by law, and entrance to the profession is regulated at national or state level.

The aim of the nursing community worldwide is for its professionals to ensure quality care for all, while maintaining their credentials, code of ethics, standards, and competencies, and continuing their education. There are a number of educational paths to becoming a professional nurse, which vary greatly worldwide, but all involve extensive study of nursing theory and practice and training in clinical skills.

Nurses care for individuals who are healthy and ill, of all ages and cultural backgrounds, and who have physical, emotional, psychological, intellectual, social, and spiritual needs. The profession combines physical science, social science, nursing theory, and technology in caring for those individuals.

In order to work in the nursing profession, all nurses hold one or more credentials depending on their scope of practice and education. A Licensed practical nurse (LPN) (also referred to as a Licensed vocational nurse, Registered practical nurse, Enrolled nurse, and State enrolled nurse) works under a Registered nurse. A Registered nurse (RN) provides scientific, psychological, and technological knowledge in the care of patients and families in many health care settings. Registered nurses may also earn additional credentials or degrees enabling them to work under different titles.

Nurses may follow their personal and professional interests by working with any group of people, in any setting, at any time. Some nurses follow the traditional role of working in a hospital setting.

Nursing practice

Nursing practice is primarily the caring relationship between the nurse and the person in their care. In providing nursing care, nurses are implementing the nursing care plan, which is based on a nursing assessment.

Definition

Although nursing practice varies both through its various specialities and countries, these nursing organizations offer the following definitions:

Nursing theory and process

In general terms, the nursing process is the method used to assess and diagnose needs, plan and implement interventions, and evaluate the outcomes of the care provided. Like other disciplines, the profession has developed different theories derived from sometimes diverse philosophical beliefs and paradigms or worldviews to help nurses direct their activities to accomplish specific goals. Currently, two paradigms exist in nursing, the totality paradigm and the simultaneity paradigm.

Practice settings

Nurses practice in a wide range of settings, from hospitals to visiting people in their homes and caring for them in schools to research in pharmaceutical companies. Nurses work in occupational health settings (also called industrial health settings), free-standing clinics and physician offices, nurse-run clinics, long-term care facilities and camps. They also work on cruise ships and in military service. Nurses act as advisers and consultants to the healthcare and insurance industries. Some are attorneys and others work with attorneys as legal nurse consultants, reviewing patient records to assure that adequate care was provided and testifying in court. Nurses can work on a temporary basis, which involves doing shifts without a contact in a variety of settings, sometimes known as per diem nursing, agency nursing or travel nursing. Nurses work as researchers in laboratories, universities and research institutions.

Work Environment

Internationally, there is a serious shortage of nurses. One reason for this shortage is due to the work environment in which nurses practice. In a recent review of the empirical human factors and ergonomic literature specific to nursing performance, nurses were found to work in generally poor environmental conditions. DeLucia, Ott, & Palmieri (2009) concluded, "the profession of nursing as a whole is overloaded because there is a nursing shortage. Individual nurses are overloaded. They are overloaded by the number of patients they oversee. They are overloaded by the number of tasks they perform. They work under cognitive overload, engaging in multitasking and encountering frequent interruptions. They work under perceptual overload due to medical devices that do not meet perceptual requirements (Morrow et al., 2005), insufficient lighting, illegible handwriting, and poor labeling designs. They work under physical overload due to long work hours and patient handling demands which leads to a high incidence of MSDs. In short, the nursing work system often exceeds the limits and capabilities of human performance. HF/E research should be conducted to determine how these overloads can be reduced and how the limits and capabilities of performance can be accommodated. Ironically, the literature shows that there are studies to determine whether nurses can effectively perform tasks ordinarily performed by physicians. Results indicate that nurses can perform such tasks effectively. Nevertheless, already overloaded nurses should not be given more tasks to perform. When reducing the overload, it should be kept in mind that underloads also can be detrimental to performance (Mackworth, 1948). Considering both overloads and underloads are important to consider for improving performance."

Regulation of practice

The practice of nursing is governed by laws that define a scope of practice, generally mandated by the legislature of the political division within which the nurse practices. Nurses are held legally responsible and accountable for their practice. The standard of care is that of the "prudent nurse."

Nursing specialties

Nursing is the most diverse of all healthcare professions. Nurses practice in a wide range of settings but generally nursing is divided depending on the needs of the person being nursed.

The major divisions are:-

There are also specialist areas such as cardiac nursing, orthopedic nursing, palliative care, perioperative nursing and oncology nursing, or the specialization to cancer.

Nursing by country

See also



References

  1. Florence Nightingale (1820 — 1910)
  2. UNC-TV Nursing Then and Now Retrieved July 2009
  3. Nightingale, Florence (1860) Notes on Nursing Full text online Accessed 14 August 2007
  4. International Council of Nurses Accessed August 2007
  5. BMJ (2002) Global Nursing Shortages Retrieved July 2009


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