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Nursing
INTRODUCTION
Nursing, in general, the process of caring for, or nurturing, another individual. More specifically, nursing refers to the functions and duties carried out by persons who have had formal education and training in the art and science of nursing. Professional nurses combine many different disciplines, including aspects of biology and psychology, to promote the restoration and maintenance of health in their clients. There are two major categories of nurses: licensed practical nurses and registered nurses. In recent years, efforts have been made by several professional nursing organizations to designate two categories of registered nurses, technical and professional, that would reflect the educational preparation of the individual.
NURSING EDUCATION
Formal nursing education in the United States had its antecedents in Europe and England. One of the first formal training programs for nurses was begun in 1836 in Kaiserswerth, Germany, by Pastor Theodor Fliedner for the Order of Deaconesses. Other religious orders were also providing formalized training for nurses in Europe at that time, but Fliedner's school is noteworthy for having given the British nursing reformer Florence Nightingale her formal training. Her experience at Kaiserswerth gave her the impetus to organize nursing care on the battlefields of the Crimean War and, later, to establish a nurse training program at Saint Thomas's Hospital in London. In the late 1800s training schools patterned after this model were established in the United States.
Originally, nurses received little or no classroom preparation. Most of the training was based on apprenticeship, with older students teaching the younger ones how to care for patients. All programs were directed by hospitals, and nursing students provided low-cost service to the institutions; upon graduation, most of them worked as private-duty nurses in patients' homes. Hospital-based programs still exist today and are known as diploma schools of nursing. They offer a sound educational background for nursing practice in a program that contains both theoretical information and practical experience, but the diploma they grant is not an academic degree. Most diploma schools, however, are affiliated with a college where the nursing students can take courses for academic credit. In recent years, some hospitals have applied to their state boards of higher education for permission to award an associate degree in nursing. This trend has sparked debate within the nursing profession over the question of whether a hospital can qualify as an institution of higher education. The major focus of diploma education is to prepare nurses to give direct bedside care in hospitals, nursing homes, and other institutional settings. Graduates of these programs are eligible to take the licensing examination in the state in which they wish to practice. Upon passing, they may legally practice nursing and are allowed to use the initials RN (registered nurse) after their names.
Many diploma schools closed after 1965, when the American Nurses' Association (ANA) published a position paper stating that all nursing education should take place in institutions of higher learning. The organization also recommended two levels of nursing practice: professional and technical; the professional nurse would have a baccalaureate or higher degree, the technical nurse would have an associate degree, and the technical nurse would work under the direct supervision of the professional nurse.
Associate degree nursing programs were introduced in the United States in 1952. They are primarily offered by community colleges, although a number can be found in four-year institutions. It is a two-year program that strongly emphasizes technical skills supported by a basic foundation in biological and behavioral sciences. The associate degree graduate also takes the state licensing examination and can practice nursing using the initials RN. Baccalaureate degree programs in nursing are found in colleges and universities throughout the United States. The program takes four years to complete and provides a strong base of liberal education in the arts, sciences, and humanities. These programs also emphasize bedside patient care, and provide courses in community health nursing, leadership and management, and nursing research. Graduates take the same licensing examination as other graduates and also receive the RN designation.
Master's and doctoral degrees in nursing usually require the applicant to be a graduate of an accredited baccalaureate nursing program. The emphasis of graduate programs is primarily on research, advanced clinical practice, and the preparation of nursing educators and administrators.
The practical nurse has an education and license very different from that of the registered nurse. The program for practical nurses takes approximately one year and includes classroom work and practical training in a hospital. Such programs are usually offered through vocational or technical schools, and graduates must also take a licensing examination in order to practice. The test, however, is different from that taken by RNs. After passing the examination, these graduates may use the initials LPN (licensed practical nurse) or LVN (licensed vocational nurse) after their names. These nurses practice under the supervision of the registered nurse.
FUNCTIONS AND DUTIES
As members of the largest health care profession in the nation, registered nurses practice wherever people need nursing care, including such common sites as hospitals, homes, schools, workplaces, and community centers, and uncommon areas such as children's camps, homeless shelters, and tourist sites. Based on the outcome desired, nurses intervene to promote health, prevent illness, or assist with activities that contribute to recovery from illness or to achieving a peaceful death. They may initiate treatments themselves or perform interventions initiated by advanced practice RNs or other licensed health care providers.
Nurses have both dependent and independent functions. The former are those that must be carried out under the orders of a licensed physician or dentist, including such duties as administering medications and changing dressings on wounds. Independent functions are those that nurses carry out based on their own professional judgment. Such duties include bathing patients, positioning them to prevent joint contractures, teaching people how best to care for themselves, and providing nutritional counseling. In the United States, a nurse's functions are defined and controlled by the nurse practice act of the state involved.
With the explosion of technical knowledge in the field of health care since World War II, nurses have also begun to specialize in particular areas of nursing care. These include medical-surgical, maternal-child, psychiatric, and community-health nursing. Within each of these specialties there are opportunities for further specialization. In addition, a new and expanded role for nurses was developed during the 1960s-that of the advanced practice nurse (APN). There are four types of APNs: nurse practioners (NPs), certified nurse-midwives (CNMs), clinical nurse specialists (CNSs), and certified registered nurse anesthetists (CRNAs). NPs provide a wide range of primary and preventive health care services, prescribe medication, and diagnose and treat common minor illnesses and injuries. CNMs provide well-woman gynecological and low-risk obstetrical care. CNSs handle a wide range of physical and mental health problems and also work in consultation, research, education, and administration. CRNAs administer anesthetics to patients.
ORGANIZATIONS
The ANA is the professional organization for nurses in the United States. Only registered nurses are admitted to its membership. It is made up of state and local organizations, and its major purposes are to promote high standards of nursing care, to improve the quality and availability of health care, and to foster the professional development of nurses.
Another organization supporting the profession is the National League for Nursing (NLN); its membership includes nurses, persons from other health professions, and interested laypersons. One major function of the NLN is the accreditation of educational programs in nursing. It also offers testing and consultation services.
The International Council of Nurses (ICN) is a worldwide organization established as a federation of national nursing organizations. The ANA represents the United States in this council. In addition to the above organizations, a variety of professional groups focus on particular nursing specialties. The American Association of Critical-Care Nurses (AACN) is such an organization.
HISTORY OF NURSING
In earlier centuries, nursing care was usually provided by volunteers who had little or no training-most commonly men and women of various religious orders. During the Crusades, for example, some military orders of knights also provided nursing care, most notably the Knights Hospitalers. Toward the end of the 18th century nursing was considered an unsuitable occupation for "proper" young women, undoubtedly due to the fact that hospitals in those days were dirty and pestilent places where patients usually died. As a result, those who provided nursing care were commonly persons who had been imprisoned for drunkenness or who could not find work elsewhere.
Modern nursing began in the mid-19th century with the advent of the Nightingale training schools for nurses. In the United States, the Spanish-American War and, later, World War I established the need for more nurses in both military and civilian life. As a result, nursing schools increased their enrollments, and several new programs were developed. In 1920 a study funded by the Rockefeller Foundation and known as the Goldmark Report recommended that schools of nursing be independent of hospitals and that students no longer be exploited as cheap labor. Following the publication of this report, several university schools of nursing were opened.
During the depression of the 1930s, many nurses were unemployed, and the number of schools declined. World War II, however, brought about another increased demand for nurses. The Cadet Nurse Corps, established in 1943, subsidized nursing education for thousands of young people who agreed to engage in nursing for the duration of the war. Since the end of World War II, technological advances in medicine and health have required nurses to become knowledgeable about sophisticated equipment, to learn about an increasing number of medications, and to design nursing care appropriate for the health care delivery system during a period of rapid change.
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