Nursing is flourishing the health facilities, promotion, and development of health and abilities, prevention of illness and injury, through diagnosis and treatment of a person’s psychological and physiological behavior , and advocacy in the care of individuals, families, communities, and populations. (American Nurses Association (ANA).The basic perception one gets of the word nursing is to take care,it is a profession of providing care for the sick one. Nursing provides health care to the individuals and communities, thus its social importance should be recognized and should be number one public priority .A strong and intelligent person is required who should be emphatic and should be psychologically strong to aid the ill one . Earlier nursing was considered as a job to carry out the instructions of the physicians, but over the period of time, it is taken into consideration that they merely carry out the instructions of the physician. They should be trained to provide care to the patients in their own right way, whether it is the physical care or manipulation of the environment or the situation for patient’s well being. This paper will explore the historical aspects of nursing and that all patients with illness and problems require care which should be beyond any racism, socio economic disturbances, psychological or cultural differences. The first section of this paper will discuss the relationship of development of nursing theory to the profession of nursing , its influence or impact both socially and medically, also the structure of nursing reasoning would be highlighted and strategies to further substantiate this process would be discussed. Finally the essay will conclude with further developments in nursing theories to the profession.
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What Do We Know About the History?
The history of nursing is as old as medicines, the midwife used to assist during child birth and this was considered as her prime duty. Over the period of time, the practice of nursing dramatically enhanced and also improved to great deal. In regard to roughly the first formal nursing center or the beginning of this profession,”The Sisters of Charity” (1633) was founded by St. Vincent de Paul, for taking care of people in the hospitals and asylums. The Sisters of Charity were introduced by Mother Elizabeth Seton in 1809 in America, known to be “Daughters of Charity” later. The history of nursing helps us to focus on the societal factors and the issues that might be the hindrances in this profession. In the American revolutionary war (1775-1783), the sick suffered much and women provided their nursing services and also a matron was allotted to attend to every 100 sick or wounded. The Civil War (1861-1865) played a vital role in the growth of Nursing in the United States where women provided humanitarian services both to the union and confederate armies. In the Spanish- American war (1898) potentially qualified women were appointed and this profession was taken seriously and many women signed governmental contracts some nurses even died during their duty oblivious of their own health as they were so involved in their profession. these later became the permanent corps of the Medical department (Army Reorganization Act (31 Stat. 753)).During World War I (1917-1918), almost 12,000 nurses were on active duty and served almost 198 stations and more than 400 nurses sailed to France to provide medical assistance to them. More than 200 also died during their jobs due to influenza and diphtheria. Col. Anna Mae Hays was promoted to brigadier general after attaining a Flag Rank for the first time in the history of American army on June 11, 1970, in Vietnam serving the fighting forces. Manifestation of nursing can also be seen in the Korean War (1950-1953), that served in Mobile Army Surgical Hospitals (MASH). Role played by these great human beings who served as Nurses in the History and served Humanity to the last of their breaths, was the real milestone in the formation of nursing theories that shaped into full time profession that we know today.
Nursing Theories and their Applications in the Profession
Now talking about the theories which throw light on the prominent role of nurses and the major impact they have on the society as a whole, Florence Nightingale (mother and founder of nursing) during civil war observed that the duty of nurse is not only to assist the physician .Considering this point of view and keeping in view its emerging need she proposed first theory of nursing that centered facilitation of body’s reparative processes by altering the surrounding environment. This theory is a stepping stone for further nursing theories. Theory of Peplau (1952) and King (1971) takes into account the importance of communicating with patients that help them to recover rapidly. Peplau states that nursing is actually a service in specific situation to facilitate patients in their natural ongoing tendencies and make the environment more suitable for recovery. It refers nursing as an educative instrument that can be used to promote constructive and productive community living.”The theory of Orlando( 1962) , Johnson’s (1968) and Rogers (1970)focuses that the client’s (patient) have certain needs that are when fulfilled, minimizes stress and provide increase competence and euphoria. This shows how a person overcomes the psychological and physiological pain in this respect the major part is done by the nurse who ought to be mentally and emotionally strong. The goal of nursing is to lessen the anxiety and provide a stress free environment to the client to move towards recovery (Johnson, 1968). Orem (1971) and Roy (1979) theories are Self-care depict theories, that state that nursing becomes important for all those patients who are unable, due to the lack of self care or relatives or family, to fulfill their human need be it biological, psychological or social. Thus nursing can be described as a humanistic aspect of life. (Watson, 1979). All these theories substantiate the efforts and the work nurses perform and that their role is equally efficient and cannot be neglected when compared to a doctor or physician.
Nursing theory consists of four levels, practice level that consists of four step i.e. factor isolating, factor relating, situation relating and situation-producing control. The second level of nursing theory i.e. middle range theory focuses on research and practice, this level is highly important and is the foundation on which the capabilities of nurses depend largely. Third level of nursing theory i.e. grand theory broadens the perspective for nursing practice in the global viewpoint. The forth level of nursing theory is Meta theory, which is abstract of the experiences of nurses from around the world of different situations and structures.
“To achieve the benefits of a defined body of theory in nursing a better patient care, enhanced professional status for nurses, improved communication between nurses, and guidance for research and education is required” (Nolan, 1996) Nursing theories have defined the goals and framework of nursing that is to deliver nursing care for individual, to assist the client gain his independence as rapidly as possible, and reduce his anxiety by manipulating the environment to pace up his recovery. Help client achieve maximal level of wellness and to sustain the confidence in him so that the patient is optimistic about his health and use of communication to help client to re establish adaptation to environment are the fundamental goals of nursing.
Clinical Reasoning
Human being have two major systems, the biological system focuses on medicine, and behavioral system focuses on nursing, in fact a nurse has to take the responsibility of both. It is the duty of the nurse to understand about patient’s problem whether it is mental or physical, from initial meeting through diagnosis, treatment, recovery or unfortunate death and should morally train the patient to face everything. This process when undergone with different situations and subjects, evolves into a clinical reasoning.
Clinical reasoning is to develop a solution after applying knowledge and expertise to a certain clinical situation (Carr, S., 2004). It has its own merits and uses that help to automate awareness of their own knowledge that can be applied in the professional field to yield new developments and understandings.
In nursing, clinical reasoning skills help in comprehending and the practice. Clinical reasoning form basis of research studies. These researches use processes and innovative strategies of the used by the experienced nurses to improve the existing nursing structures or devise the new ones. Although this is a useful method but it requires a strong and quick thinking process in during which a nurse isn’t expected to panic and should deal the situation wisely. It is basically dependent on ability to describe and verbalize the reasoning process. More nursing research is needed to explore the clinical reasoning process. Therefore, Investment in teaching and learning methods is needed to enhance clinical reasoning skills in nurses.
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Analysis and Conclusion
The importance of nursing profession cannot be denied and this is accounted as a prominent profession which is mandatory for the social development and ensures the basic health facilities to the individuals. It might not have got the due importance hence to rectify the negligence and to elevate the status of this profession and nurses as a whole certain steps should be taken. The impact of self regulated reflective learning skills should be well checked, teaching and learning process both should complement each other to get the desired results in short; metacognative, critical thinking skills , reflective and clinical reasoning developments should be made. An analysis into cognative and metacognative thinking initiates a more appropriate global learning process.
Nursing guidelines are important as they ensure a formal and uniform outline whereby nurses act according to the prescribed laws and it aids in developing a better understanding and response for the various and complementary roles that nurses have.Training institutes should be made especially for teaching and proper training of nurses in this respect government ought to perform an important role by increasing the salaries of nurses and also subsidizing these training institution.
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