Chapter 5
The six defining characteristics are delineated by statements of the "particulars of nursing":
"particulars of nursing": purpose, mode of intervention, domain,domain, focus, value base, and commitment to partnership.
American Nurses Association
"the protection, promotion and optimization of health and ability, prevention of illness and injury, alleviation of suffering through the diagnosis and treatment of human response, and advocacy in the care of individuals, families, communities and populations"
Definitions Focus Educational Curricula and Research Agendas
A definition of nursing provides a good starting point for curriculum development. nurse researchers cannot easily determine phenomena of interest for nursing unless they are clear about the boundaries and purposes of nursing actions that a definition of nursing sets in place.
Professional Association Definitions
ANA, ICN, RCN In the United States nursing hasdefined itself as the health discipline that "cares," although recent discussion suggests that limiting nursing to "caring" only overlooks the significant role that nurses have in the curative processes of health care
Martha Rogers
Another pioneer nursing theorist, Martha Rogers, included the concept of the nursing process in her definition: "Nursing aims to assist people in achieving their maximum health potential. Maintenance and promotion of health, prevention of disease, nursing diagnosis, intervention, and rehabilitation encompass the scope of nursing's goals" (Rogers, 1961, p. 86).
Becoming a Nurse: Shaping your Professional Identity
Being a student of nursing is the first of many steps in socializing you into professional practice: the goal of socialization is the development of professionalism. The goal of your nursing education is not simply teaching you the tasks of nursing, although they are important elements of your practice. The overriding goal of your education is to teachyou to think like a nurse, to see the world of health care through the lens of nursing, and to respond to your educational and clinical experiences with the development of professionalism.
Definitions Differentiate Nursing from Other Health Occupations
Defining nursing amid these new providers became even more important to avoid losing the core identity of nursing. Nurses have had to name and claim for their own what it is that nurses do. Furthermore, with the implementation of health care reforms, nursing must be clearly defined and its importance within the health care system unmistakable. Nurses understand that they have the skills and expertise to address a wide variety of health issues; keeping nurses in key positions of influence as the health care system continues to take shape in the next few years is crucial to fulfilling nursing's social contract with the public, which you read about in previous chapters. The ANA's Nursing's Social Policy Statement: The Essence of the Profession explicates this contract.
Dorothea Orem
Dorothea Orem was one of the important theorists who began work during this early period of theory development. Her 1959 definition captures the flavor of her later, more completely elaborated self-care theory of nursing: "Nursing is perhaps best described as the giving of direct assistance to a person, as required, because of the person's specific inabilities in self-care resulting from a situation of personal health" (Orem, 1959, p. 5). Orem's belief that nurses should do for a person only those things the person cannot do without assistance emphasized the patient's active role.
Cohen identified the first stage in her model, stage I, as unilateral dependence. Because they are inexperienced and lack knowledge, students at this stage rely on external limits and controls established by authority figures such as teachers.
During stage I, students are unlikely to question or analyze critically the concepts teachers present, because they lack the necessary background to do so. An example of a student operating in a unilateral dependent stage would be the student who agrees to a clinical assignment without questioning the clinical faculty's thinking about the appropriateness of the assignment or what the student may gain from the assignment. The student absorbs the faculty's direction and discussion about the patient without yet making linkages of his or her own in thinking about the patient's condition. Fundamentally, students at this stage do as they are told because they lack the experience and knowledge to question.
Nightingale Defines Nursing
Florence Nightingale was the first person to recognize the complexities of nursing that led to difficulty in defining it. as contemporary concepts. Remember that during Nightingale's day, formal education in nursing was just beginning. she became the first person to attempt a written definition of nursing, stating, "And what nursing has to do ... is put the patient in the best condition for nature to act upon him" (Nightingale, 1946, p. 75). She also wrote:
Henderson's earlier definition had evolved into a statement with such universal appeal it was adopted by the ICN:
Henderson's earlier definition had evolved into a statement with such universal appeal it was adopted by the ICN: The unique function of the nurse is to assist the individual, sick or well, in the performance of those activities contributing to health or its recovery (or to a peaceful death) that he would perform unaided if he had the necessary strength, will or knowledge. And todo this in such a way as to help him gain independence as rapidly as possible. (Henderson, 1960, p. 3)
Hildegard Peplau (1952
Hildegard Peplau (1952), widely regarded as a pioneer among contemporary nursing theorists and herself a psychiatric nurse, defined nursing in interpersonal terms: "Nursing is a significant, therapeutic, interpersonal process. Nursing is an educative instrument that aims to promote forward movement of personality in the direction of creative, constructive, productive, personal, and community living" (p. 16). Peplau reinforced the idea of the patient as an active collaborator in his or her own care.
informal socialization
Informal socialization includes lessons that occur incidentally, such as the unplanned observation of a nurse teaching a young mother how to care for her premature infant, participating in a student nurse association, or hearing nurses discuss patient care in the nurses' lounge.
Bennett's theory
Novice to Expert Novice : has no professional experience Beginners: can note recurrent meaningful situational components but not priortize between them Competent: begins to understand actions in term of long range gials Proficient: perceives situations as whole, rather than in terms of aspects Expert: has intuitive gasp of the situation and zeroes in on the accurate region of the problem
From Student to Nurse: Facilitating the Transition
Nursing faculty are concerned with creating educational experiences that encourage and facilitate the transition from student to professional nurse. Learning any new role is derived from a mixture of formal and informal socialization.
Definitions Clarify Purposes and Functions
Nursing is a complex enterprise that is often confusing to its own practitioners as well as to the public. Defining nursing assists people to grasp its nuances, many of which are not readily observable. The profession of nursing benefits when the public, other health care providers, policy makers, insurers, and journalists, among others, understand who nurses are and what they do.
Definitions Developed by State Legislatures
One of the most significant definitions of nursing is contained in the nursing practice act of the state in which a nurse practices.
Benner's Stages of Nursing Proficiency (Basic Student Socialization)
Patricia Benner, a nurse, was curious about how nurses made the transition from inexpert beginners to highly expert practitioners. She described a process consisting of five stages of nursing practice, on which she based her 1984 book, From Novice to Expert. The stages Benner described are "novice," "advanced beginner," "competent practitioner," "proficient practitioner," and "expert practitioner." Advancing from stage to stage occurs gradually as nurses gain more experience in patient care. Clinical judgment is stimulated when the nurse's "preconceived notions and expectations"
Definitions Influence Health Policy at Local, State, and National Levels
Policymakers, such as legislators and regulators, need a clear understanding of the role and scope of nursing. Without that understanding, they cannot institute good health care policy that maximizes use of nurses' particular skills to protect and improve the health of the public. A key reason to define nursing is that nursing practice is regulated at the state level.
definition includes six essential features of contemporary nursing practice (ANA, 2003, p. 5) that the ANA still recognizes:
Provision of a caring relationship that facilitates health and healing • Attention to the range of human experiences and responses to health and illness within the physical and social environments • Integration of objective data with knowledge gained from an appreciation of the patient or group's subjective experience • Application of scientific knowledge to the processes of diagnosis and treatment through the use of judgment and critical thinking • Advancement of professional nursing knowledge through scholarly inquiry • Influence on social and public policy to promote social justice
Reflective practice
Reflective practice can help nurses cope with their role in a complex, emotionally charged health care system and concurrently help them develop their knowledge and nursing practice
Early 20th-Century Definitions
Shaw's Textbook of Nursing (1907) defined nursing as an art: "It properly includes, as well as the execution of specific orders, the administration of food and medicine, the personal care of the patient" (pp. 1-2). Harmer's Textbook of the Principles and Practice of Nursing (1922) elaborated on Shaw's bare-bones definition: "The object of nursing is not only to cure the sick ... but to bring health and ease, rest and comfort to mind and body. Its object is to prevent disease and to preserve health" (p. 3) . The fourth edition of the Harmer text, which showed the influence of coauthor and visionary Virginia Henderson, redefined nursing: "Nursing may be defined as that service to an individual that helps him to attain or maintain a healthy state of mind or body" (Harmer and Henderson, 1939, p. 2). Henderson's perceptions represented the emergence of contemporary nursing and were so inclusive that they remained useful over a long time. We will encounter her influence again in the next section.
In stage IV (interdependence), students' needs for both independence and mutuality (sharing jointly with others) come together.
Students develop the capacity to make decisions in collaboration with others. The successfully socialized student completes stage IV with a self-concept that includes a professional role identity that is personally and professionally acceptable and compatible with other life roles. Faculty appreciate the maturity and trustworthiness that students exhibit when they reach this stage in their professional development. These students are often highly self-directed, seeking out learning experiences to maximize their knowledge before the completion of their formal education. Table 5.1 summarizes the key behaviors associated with each of Cohen's stages.
International Council of Nurses
The ICN is a federation of national nurses associations representing more than 13 million nurses worldwide in more than 130 countries. Although ICN's membership is diverse, its definition of nursing is similar to that of single-nation organizations such as the ANA and RCN. According to the ICN: Nursing encompasses autonomous and collaborative care of individuals of all ages, families, groups and communities, sick or well and in all settings. Nursing includes the promotion of health, prevention of illness, and the care of ill, disabled and dying people. Advocacy, promotion of a safe environment, research, participation in shaping health policy and in patient and health systems management, and education are also key nursing roles. (ICN, 2015)
The RCN definition of nursing has a core statement supported by six defining characteristics
The RCN definition of nursing has a core statement supported by six defining characteristics: 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.
Royal College of Nursing
The RCN is the United Kingdom's voice of nursing and is the largest professional union of nurses in the world.
Factors Influencing Socialization
These include personal feelings and beliefs, Yet the very first statement in the Code of Ethics for Nurses (ANA, 2001) requires that nurses work with all patients regardless of their beliefs. Nurses need to be aware of their biases Failure to address one's biases may adversely affect the nursing care provided to certain patients.
In stage II (negativity/independence), students' critical thinking abilities and knowledge bases expand.
They begin to question authority figures. Cohen called this occurrence cognitive rebellion. Students at this level begin to free themselves from external controls and to rely more on their own judgment. They think critically about what they are being taught. This is a stage when students begin to question, "Why do I have to learn about this? This isn't nursing!" or complain, "I will never learn to give an injection to a patient if I have to sit here reading about the nursing process!" This can be a stage where a student's fledgling independence may cause some lack of judgment in the clinical setting; at this stage, students might not consult with their clinical faculty before attempting a new procedure because they do not appreciate the safety net the clinical faculty brings to the situation. In addition, students at this stage may begin to demand to care for additional or more complex patients, resisting their faculty's (more informed) judgment that the student is not yet ready.
Stage III (dependence/mutuality) is characterized by what Cohen described as students' more reasoned evaluation of others' ideas.
They develop an increasingly realistic appraisal process and learn to test concepts, facts, ideas, and models objectively. Students at this stage are more impartial; they accept some ideas and reject others. This is a time when students begin to appreciate the usefulness of the nursing process in organizing care and begin to use more sophisticated critical thinking skills.
Shape your adentity
Values and ethics: a set of core values and principles that guide conduct Knowledge: analysis and application of information derived from nursing and other discipline, experience, critical reflection and scientific discovery Leadership: inspiring self and others to transform a shared vision into reality Professional comportment: a nurse professional behaviour demonstrated through word , action and presence
Evolution of Definitions of Nursing
While nursing was progressing as a more formal academic discipline and practice profession
Post-World War II Definitions
World War II helped advance the technologies available to treat people, which, in turn, influenced nursing.
Why Define Nursing?
definition establishes the parameters (or boundaries) of the profession and delineates the purposes and functions of the work of nursing. In addition, a definition guides the educational preparation of aspiring practitioners and guides nursing research and theory development. Importantly, a clear definition makes the work of nursing visible and valuable to the public and to policymakers who determine when, where, and how nurses can practice. Norma Lang, Professor and Dean Emerita at the University of Pennsylvania, described the need for definition succinctly: "If we cannot name it, we cannot control it, finance it, research it, teach it, or put it into public policy. It's just that blunt!" (Styles, 1991).
Lai and Lim 2012
described two conditions—structural and cultural—that are part of professional socialization in nursing. Structural conditions are those in which one's professional role is shaped by rules (e.g., job descriptions, workplace policies, carrying out prescriptions for care by physicians and other providers). Cultural conditions are those in which traditions, symbols, language, andother idea systems in a society are at work in shaping how one becomes a fully socialized professional nurse. The goal, then, of socialization as a professional nurse is the development of a professional identity such that the attributes of nursing become "part of a nurse's personal and professional self-image and behavior" (p. 32).
formal socialization
formal socialization includes lectures, online activities, assignments, and clinical experiences, such as planning nursing care, writing a paper on professional ethics, learning steps of a physical examination of a healthy child, starting an intravenous line, practicing communication skills with a psychiatric patient, or spending time with a mentor (Fig. 5.1). A faculty member may serve as your first nursing mentor. Formal socialization proceeds in an orderly, building-block fashion, such that new information is based on previous information. For that reason, more advanced nursing students are often encouraged to manage a larger number of patients than they did as novice students, when their skills were fewer and less tested.
A New Factor Influencing Socialization: Distance Learning
professional socialization—can be effectively achieved through distance education.
Cohen's Model of Basic Student Socialization
proposed a model of professional socialization consisting of four stages.
socialization
socialization is much more than the transmission of knowledge and skills. Socialization serves to develop a common nursing consciousness and is the key to keeping the profession vital and dynamic while preserving its fundamental focus on human responses in health and illness.
