Defining Nursing

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Defining Nursing

• Joan Pollner, RN, BSN, CHPN
• October 18, 2006

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Objectives

• Identify characteristics of a profession.
• Distinguish between the characteristics of
  professions and occupations.
• Describe how professions evolve.
• Evaluate nursings position on the
  professionalism continuum.
• Explain the elements of nursings contract with
  society.
• Recognize characteristic behaviors of
  professional nurses.

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Objectives (continued)

• Define the benefits of defining nursing and
  nursings scope of practice.
• Recognize the evolutionary nature of definitions.
• Compare early definitions of nursing with
  contemporary ones.
• Recognize the impact of historical, social,
  economic, and political events on definitions of
  nursing and scope and standards of practice.

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Objectives (continued)

• Identify commonalities in existing definitions of
  nursing.
• Develop personal definitions of nursing
• Name four documents every professional nurse
  should possess and tell why they are important.

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Characteristics of a Profession

• Abraham Flexner Early 1900s
• Richard H. Hall 1968
• Task Force on Professionalism - 2000

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Abraham Flexner

• Intellectual (as opposed to physical)
• Body of knowledge through research
• Practical as well as theoretical
• Highly specialized professional education
• Strong internal organization of members

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Richard H. Hall

• Professional organization
• Belief in value of public service
• Belief in self regulation
• Commitment beyond economic incentives
• Sense of autonomy in practice

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Task Force on Professionalism

• Prolonged specialized training
• Service orientation
• Ideology based on original faith
• Binding ethic
• Unique body of knowledge
• Technique formed by set of skills

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Task Force on Professionalism (cont)

• Guild of those entitled to practice
• Licensure or certification
• Recognized setting
• Theory of societal benefits

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Major Similarities

• Service/altruism
• Specialized knowledge
• Autonomy/ethics

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Professions vs Occupations

• Professions
• College or University
• Prolonged education
• Mental creativity
• Decisions based on science or theoretical
  constructs
• Values, beliefs ethics integral part of
  preparation
• Strong commitment
• Autonomous
• Unlikely to change professions
• Commitment gt reward
• Individual accountability

• Occupations
• On the job training
• Length varies
• Largely manual work
• Guided decision making
• Values, beliefs ethics not part of preparation
• Commitment may vary
• Supervised
• Often change jobs
• Motivated by reward
• Employer is primarily accountable

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Evolution of a ProfessionProfessionalization

• Practitioners perform full-time work in the
  discipline
• Determine work standards, identify a body of
  knowledge and establish educational programs
• Promote organization into effective occupational
  associations (licensure/certification)
• Establish codes of ethics

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Barriers to Professionalism

• Variability in educational preparation
• Gender issues
• Historical influences
• External conflicts
• Internal conflicts

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What about Nursing???

• Profession
• or
• 
  Occupation

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What the experts say!!

• Genevieve and Roy Bixler 1945
• Lucie Kelly, RN, PhD, FAAN 1981
• Barbara Miller 1984
• Nurses themselves

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Bixler Bixler

• Specialized knowledge
• Expands knowledge by scientific method
• Institutions of higher education
• Services vital to human and social welfare
• Autonomously forms professional policy
• Intellectual and personal qualities
• Compensation freedom, professional growth and
  economic security

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Lucie Kelly, RN, PhD, FAAN

• Services vital to humanity and society
• Knowledge continually enlarged through research
• Individual accountability
• Educated in institutions of higher education
• Autonomy
• Motivated by altruism
• Code of ethics
• Association high standards of practice

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Millers Wheel of Professionalism in Nursing

• Education in univ. scientific background
• Professional organization
• Self-regulatory autonomy
• Research development, use evaluation
• Continuing education competence
• Community service
• Theory development, use evaluation
• Adherence to Code of Ethics for Nurses
• Publication and communication

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Nurses Themselves

• Nurses Social Policy Statement 2003
• Code of Ethics for Nurses American Nurses
  Association - 2001

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Nurses Code of Ethics

• American Nurses Association
• 9 provisions
• Fundamental values and commitments of the nurse
• Boundaries of duty and loyalty
• Duties beyond patient encounters
• Entire document at
• www.nursingworld.org/ethics/code/ethicscode150.htm
  

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CollegialityStandard of ANA Scope and
Standards of Practice, 2004

• According to Bruhn - 2001
• Be civil
• Be ethical
• Be honest
• Be the best
• Be consistent
• Be a communicator
• Be accountable

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Collegiality (cont)

• Be collaborative
• Be forgiving
• Be current
• Be involved
• Be a model

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Why define Nursing???

• Defines parameters of the profession
• Clarifies purposed and functions of the work
• Guides educational preparation
• Guides research and theory development
• Provides visibility and value to general public
  and policy makers

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Evolution of Definitions of Nursing

• Florence Nightingale
• Early twentieth-century definitions
• Post-World War II definitions
• Professional association definitions
• Developing definitions

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Florence Nightingdale

• Notes on Nursing What It Is and What It Is Not
  (1859)
• And what nursing has to dois put the patient in
  the best condition for nature to act upon him
• Recognized the difference between a nurse
  providing care and a layperson providing care.

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Early Twentieth-century Definitions

• Shaws Textbook of Nursing 1907
• Harmers Textbook of the Principles and Practice
  of Nursing 1922
• Influence of Henderson with Harmer - 1939

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Post-World War II Definitions

• Hildegard Peplau 1952
• Active collaborator
• Dorothea Orem 1959
• Self-care
• Virginia Henderson 1960
• Adopted by International Council of Nurses
• Martha Rogers 1961
• Maximum health potential

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Professional Association Definitions

• American Nurses Association
• Royal College of Nursing
• International Council of Nursing

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American Nurses Association2003

• Caring relationship
• Human experiences and responses
• Objective data
• Scientific knowledge
• Advancement of professional knowledge
• Influence on social and public policy

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Royal College of Nursing2003

• Core statement
• Nursing is the use of clinical judgment in the
  provision of care to enable people to improve,
  maintain, or recover health, to cope with health
  problems, and to achieve the best possible
  quality of life, whatever their disease or
  disability, until death.

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How do you define Nursing??

• Mary Ally Rob
• Judy Liam
  Terry
• Jane Bill
• Mike Sue
  Tracey
• John Claudia
  Michelle
• Brenda Nancy Florence Andy
  Beth Suzanne

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International Council of Nurses2003

• Autonomous and collaborative care
• Promotion of health, prevention of illness
• Care of ill, disabled and dying
• Advocacy
• Research
• Health policy shaping
• Education

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Four document nurses should possess and READ

• State Nurse Practice Act
• Nursings Social Policy Statement (ANA)
• The Code of Ethics for Nurses (ANA)
• Scope and Standards of Clinical Practice (area
  specific or ANA)

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Additional Resources

• Take this self test http//davisplus.fadavis.com/c
  atalano/Assessment_Tools/Assessment_Professionalis
  m.pdf
• Royal College of Nursing http//davisplus.fadavis.
  com/catalano/Assessment_Tools/Assessment_Professio
  nalism.pdf
• Royal College of Nursing http//www.rcna.org.au/co
  ntent/professional_self-regulation_march_03_-_unde
  r_review_-_25nov04.pdf
• University of Utah College of Nursing
  http//www.rcna.org.au/content/professional_self-r
  egulation_march_03_-_under_review_-_25nov04.pdf

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Reference

• Chitty, K.K. (2005). Professional nursing
  Concepts and challenges. 4th ed. Philadelphia
  Saunders.