Nursing Profession

The concept of nursing has changed from the past to present.These changes are mainly due to change in the concept of health patterns of illness and diseases, and also the progress made in science and technology.In the past,people used to think of nursing only within the four walls of hospitals,where the role is limited to caring for sick and assisting the doctors in treatment.

Now the concept of nursing has expanded from hospital to community with emphasis on preventive and promotional aspect of health care;the role of the nurse is more expanded towards the promotion of health and prevention of diseases rather than just providing care to the sick in the hospital.

It was believed previously that profession is an occupation which is permed with a special preparation.The profession must have a declaration of belief and loyalty on the jobs done by the professionals.There are many kinds of profession which is striving to attain professionalism by fulfilling certain criteria.
The criteria given by Gene View and Ray W.Bixler are as follows:

Ancient history shows records of nursing.What we know about the care of the sick in ancient times has been discovered through songs and findings of archaeologists.People were interested in the mysteries of life,birth,disease and death.Men lived very close to nature;life was very simple;people made few changes except when men were compelled to do so.Men attributed spiritual value to all natural objects,believing that objects in nature such as trees or rivers had spirit or soul.Objects in nature became friends such as water and trees,while storms and poisonous plants became enemies.Attitudes changed according to man's ability to control nature.They thanked friendly harmless objects for their help and tried to cooperate with the unfriendly,threatening situations.

Disease was believed to be caused by evil spirits within the body.The body had to undergo unpleasant experiences to get rid of these evil spirits.Men thought disease was caused by their failure to satisfy the gods, or was punishment for their sins.These ideas are still prevalent today even among highly civilized and intelligent people.

People were ignorant of the laws of nature.People were beaten to get rid of evil spirits;sudden fright,loud noises and magic ceremonies were also used to get rid of evil spirit.Holes on the bodies were made for the evil spirits to escape.Sacrifices were offered as a treatment.Care was given by the man who knew the signs and symptoms of evil spirits and knew what to do in certain conditions.He wore a strange dress and used magic words.He took his role as a priest.He attempted to understand and control the forces of health and disease.The skill of primitive men in fighting disease has given us many medical and surgical treatments.Massage,fomentation,triphining,bone setting,amputations,hot and cold baths,abdominal sections and heat to control haemorrhage are some of the skills gained from primitive men.

The earliest Indian medicine was Ayur Veda Medicine found in Veda 5000 B.C.About 1400 B.C. Charaka,the father of medicine,wrote a book on internal medicine.From these books we learn the hospitals were large and well equipped.Surgery had advanced to a high level.Doctors and attendants or nurses had to be people of high moral character.King Ashoka B.C.226-250,built monasteries and houses for travellers;hospitals for men and animals were founded.Hygienic practise was adapted;cleanliness of body was a religious duty.First importance was given to prevention of diseases.Doctors and nurses were expected to be skillful and trustworthy.They had to keep their nails short.Nurses were usually men or old women.

China was quite advanced in medicine.Before 2000 B.C.,medical professionals were allowed to practice dissection.They knew about circulation of blood.They had good description of internal organs.Sen-Lung was known as the father of medicine.The doctors used systematic method of diagnosis.Their slogan was Look,Listen,Ask and Feel.By 100B.C. they used vaccination.They recognized syphilis,gonorrhoea,used liver diets for anaemia,seaweed or iodine for thyroid conditions and chaulmoogra oil for leprosy by 3000 A.D.

Bathing and wearing clean clothes were advised and practised.Importance was given to hygiene.But nursing was not practised as they believed that disease was due to evil spirits in the patient and they might enter anyone who touched the sick person.Medical progress was therefore hindered by this belief in common people.

During 1500 B.C. Egyptians used Castor oil and lead and copper salts as remedies for diseases.There were well specialised doctors for eyes and tooth.They had good knowledge of community health.There were planned cities and public baths.They had underground drains and midwives for deliveries.

People in Greece believed that medicine was of divine origin and was represented by many gods.Apollo,the sun god,represented health and medicine,his son Aesculapius, was the god of healing and his daughter, Hygeia, was the goddess of health.Temples were built for gods.A priest physician was in charge of it.People came to the temple and believed that during their sleep god would appear and prescribe them treatment.They used special diets and massage bath.

Hippocrates gave scientific views to medicine.He was known as the father of medicine.He taught doctors signs and symptoms of diseases.The treatment was based on diagnosis.He developed ways of doing physical examination and taking histories.Stress was given on good health by giving good diet, fresh air and maintaining cleanliness.He gave instructions in hot applications,poultices,cold sponge for fever,fluid for kidney diseases and mouth washes.Rome learnt a lot from Greece about medicine.Rome built good sanitation,good roads and bridges.There were pubic baths for men and women;drinking water was brought by channel or large pipes.Drainage system and sewage were made.They built market places and hospitals.

Old women and men of good character did nursing in those days.

The modern form of nursing was started by Florence Nightingale.Before that,it was influenced by religious groups.In the 15th and 16th centuries,nursing was dominated in Europe by religious bodies including Benedictine and Augustinian sisters,Franciscan brothers and sisters of charity.Original motivation for caring for the sick was in order to ensure one's salvation by engaging in self-sacrificing work.That is why nursing was considered as a noble work.Today,the salvation has been replaced by a desire to serve people,nation and the world with the help of scientific technology.

Actually,Florence Nightingale (1820-1910)revived nursing during her life time.She said,"Nursing is to help the patient to live."

She was one of the most influential reformers of her time.Even today,her writings remain as relevant as they were 120 years ago.Her own practical experiences combined with her own aims for the nursing profession gave her a greater insight into problems of hospital administration than her contemporaries.Her social position enabled her to give ideas to the committees,which controlled the voluntary hospitals in those days.But above all,she had the determination to use every weapon she possessed including charm and social pressure to achieve the objective she had in mind,thus becoming the greatest publicist the profession has ever had.After the Crimean War of 1854,nursing could never be the same again.Florence Nightingale's adventure in Crimea,drew public attention on an enormous scale to the problems of nursing role in transforming the recruitment,training and practice of the new profession.

Nursing in Nepal before 1972:
Nursing existed in Nepal from the very beginning.At first,the mother or other women at home provided nursing care to the sick,injured and old.Nursing has passed many phases but the inner spirit of nursing is the same-care of people.To be successful in nursing,nurses must enjoy their work.Nursing is a service which can be practised with personal satisfaction, and earn a living at the same time.
But now,the concept of nursing has changed.These changes are mainly due to change in the concept of health,pattern of illness and disease, and progress in science and technology.Now it has come out of the hospital to the community with the concept of primary health care.The nurses role is more expanded towards the promotion of health,prevention of disease rather than just providing care to the sick.
Nursing exists to serve society;as conditions and needs of society have changed,practices have altered in response to these changes.Today,nurses world-wide work in a variety of health areas.Such changes have occurred in Nepal also.
But there were,however,certain nursing implications that affected nursing negatively.When nursing was first introduced,various difficulties were encountered.Few girls were educated and nurse training was socially unacceptable.There were many difficulties to overcome in the beginning.Only 15% of student population in the country were girls,and the attitude of the society was another problem.Nursing was considered to be a very low type of service in the society.Most parents from high classes were opposed to the idea of sending their children to study nursing.
These difficulties were the same in Miss Nightingale's day but over the past century,nursing has become a respectable profession in Europe.Nepal's acceptance and respect for nurses was greatly encouraged by HRH Princess Prekshya Rajya Laxmi Devi Shah,who took nurse training during 1973-1976.Education for girls is now widely promoted and the number desiring to enter the profession has increased greatly.There is greater awareness of the need for health care;as a result of demand for nurses,their skill is increasing.
Before 1956 A.D.(2013 B.S.) in Nepal,nursing service consisted of a few midwives trained in India and some local trained compounders.Hospital in Nepal was first established in 1890 A.D.(1947 B.S.)and that is Bir Hospital.But nursing service was practically non-existent.Medicines and dressings were done by doctors or compounders.
In the early 19th century,Nepali people become little aware of health,specially the Rana family.So they started to send Nepali ladies for nursing training in India,time to time.
During the Rana period,from 1928 to 1985 B.S..four ladies,Vidhyawati Kansakar,Radha Devi Malakar,Dharma Devi Kansakar and Bishnu Devi Rai were sent to Allahabad,India for 18 months midwifery training.After completion of their training,all of them were put at Bir Hospital for their service.Among these four ladies,two of them,Vidyawati and Radha Devi,worked as nurses,almost their whole life in Bir Hospital,but the other two worked for a short period.At present,Bishnu Devi Rai is the Campus Chief of Lalitpur Nursing Campus.
The second lot,Miss(Dr.)Uma Devi Das and Miss Rukmini C.Shrestha were sent for staff nurse training in India in 1952 or 2009 B.S.The course was 3yrs p months and one year internship,all together 4 yrs and 9 months.After finishing the training both ladies came back to Nepal in 1956 and 1957 A.D.(2013 and 2014 B.S.)respectively and started working in the HMG School of Nursing,which is the Nursing Campus,Maharajgunj,at present.Miss Das is the Director of Nursing Education Department.
In 1953(2010 B.S.),the 3rd lot of ladies,Miss Tara Devi Tuladhar,Rupa,Mithai,Krishna Vijaya,Rupakesari and Vidhya Thapa were sent to India for 18 months' midwifery training.After coming back from training,all of them were appointed to Prasuti Griha,Thapathali,as midwives.Most of them are still working in different places.In the same year,other four ladies were sent to Sri Lanka,then "Ceylon", for Tuberculosis Nursing for a period of two years.
Later on with the effort and influence of Late King Mahendra and Juanita Fleming,RN,a nurse missionary,the Nursing School of Nepal was opened at Surendra Bhawan,Sanepa,Lalitpur,in 1956 A.D. with the help of the WHO.Moreover,the changing pattern of the health concepts of the people of Nepal specially the intellectuals and health personnel determined the need of nursing service in Nepal.At first,the school was managed and run by WHO nurses,Miss D.M.Ross,London,Miss J.Miles,New Zealand and Miss P.G.Cannon,Ireland.There were fifteen students in the first intake of the nursing school,out of which,eleven students passed successfully and four discontinued their education.
After three years of nursing education,the school was moved from Surendra Bhawan to Chhetrapati and a few years later,the school was moved to Bir Hospital compound,at Mahabauddha.There it stayed for a few years by the name:"HMG School of Nursing,Mahabauddha."In 1972,it was named Mahabauddha Nursing Campus,after Tribhuvan University took over all the health related education programmes in Nepal.Finally the campus moved to Maharajgunj on the 1st Chaitra of 2042(14 March 1986)in its own building and renamed Maharajgunj Nursing Campus.The present campus is built by the government of Japan.
Before 1960,most students were accepted in the nursing programme just under matriculation(i.e.SLC incomplete).To maintain the standard of nursing education,the entrance requirement of the programme changed in 1969.The new requirement for admission into the programme was now S.L.C. Pass.At that time the training programme was run by His Majesty's Government and the duration if the nursing course was 31/2 years.In 1959,another school if nursing under the "United Mission to Nepal" was established in Nirbhawan,separate from HMG School of Nursing,Mahabauddha.Both schools were accredited by the Nepal Nursing Council which gave the final examination and registration to the graduates.In 1972,when Nirbhawan Nursing School came under the Institute of Medicine,it became a branch of the Mahabauddha Nursing Campus.In 1991,the UMN(Nir Bhawan) Nursing Campus became independent from the Maharajgunj Nursing Campus,but directly under the IOM Dean's Office.The name of the new campus was changed to Lalitpur Nursing Campus.Academically,it follows the rules and policies of T.U.,IOM, but it is financially supported by the United Mission to Nepal.

Nursing in Nepal after 1972:
In 1972,all health programs were placed under Tribhuvan University.So the Nursing School Mahabauddha became Nursing Campus Mahabauddha.This change reinforced the compulsory S.L.C. pass for all new admissions.The nursing program changed from an annual system to the semester system of studies to match the rest of the university programs.The nursing students had to take the same compulsory courses as other university students.There were more theory classes with fixed internal examinations and semester examinations.Students received certificates in medical science from the university when they passed their final examinations.Nursing education was now reduced from three and half years to three years of study.In 1973,HRH Princess Prekshya Rajya Laxmi Devi Shah joined the nursing training.This brought a great change in social outlook in nursing.Now nursing is accepted by society and many young girls join the nursing training.
In 1980,the university semester system changed back into the annual system but the nursing education remained for three years.Since 1981,admission requirement has been S.L.C. pass with second division scoring merit in Science,Mathematics and English.At present,there are seven nursing campuses in the country:Maharajgunj,Lalitpur,Bir Hospital,Pokhara,Biratnagar,Birgunj and Nepalgunj.Earlier,there were five ANM extension campuses,but at present,there are only two campuses running under IOM Tribhuvan University;they are in Bharatpur and Tansen.The first ANM school was opened at Bharatpur in 1962 with the help of USAID.Later,another ANM extension campus opened in Biratnagar in 1966; likewise in Nepalgunj in 1969,in Tansen in 1973 and in Chhetrapati in 1975.
Nursing education advanced gradually.Some of the ANM extension campuses were upgraded to certificate nursing campuses,such as Biratnagar Nursing Campus was upgraded in 1982 and Nepalgunj Nursing Campus in 1987.Pokhara Nursing Campus was upgraded from Community Medical Assistant(CMA) School in 1985;Birgunj Campus was also upgraded from Health Assistant School to Nursing Campus in 1986.One more nursing campus was added in 1989 (2046 B.S.),Bir Hospital Nursing Campus,which is opened by HMG and affiliated to Tribhuvan University.Great changes occurred in 1986,all certificate nursing programs enrolled 10% male students in their programs.But after four batches of intake this policy was stopped.
A great shortage of nurses is expected.In this connection,the ANM campus at Tansen is also being upgraded for the training of nurses.
A Bachelor Program of Nursing began at Maharajgunj Nursing Campus in 1977(2034 B.S.) with more wmphasis on midwifery.Later in 1987,the emphasis was changed to community health nursing,adult nursing in 1983(2040) and child health nursing in 1985(2042).In 1988(2045),all Bachelor Nursing Curricula were reorganized and a two track B.N. program was initiated with specialization in community nursing and hospital nursing.A masters program in Nursing has been started at the Nursing Campus,Maharajgunj from 1995.

Nursing is not simply a job but it is a career which is highly idealistic.As a nurse,one has to be honest,well-balanced,patient,cheerful and tactful at her working situation.A nurse must have a helping attitude and a sense of care for the patients.She should be neat and clean and be a model for others.If she lacks these qualities,she will fail to be a true nurse.Therefore,as a nurse,one must think positively to develop all these qualities.So a nurse must have certain qualities which distinguishes as a care giver.The qualities are as follows:

Intelligent means having the power of perceiving,learning,understanding and knowing; intelligence is also the"Mental ability",which is an essential quality for a good nurse.A nurse has to work with different categories of personnel in different situations.Such situations become a challenge for a nurse to work in as the situations are demanding.She has to make a quick and right decision regarding patient care;in such conditions,her nursing diagnosis and planning of patient care depends on the way she perceives and understands the patient's condition which later affects the recovery of patient.

It is one of the important qualities of a nurse- essential for maintaining harmonious relationship with the patients and with team members.A nurse needs to be honest and sincere in her daily life and work.
A nurse needs to be honest,meaning truthful,but in some situations,she has to be experience and confidence.For example,when a patient suffering from cancer wants to know about the disease,the nurse should tell him in such a way that she does not hurt him.It is very difficult to do so,but the nurse should be tactful and kind.To be honest is not only a quality but also an art.
The nurse must learn to accept her mistakes;although it is difficult,it will help her to become an honest professional.It will also help develop confidence and courage in her profession.What she must remember is that the nurse is a responsible person and has to work with human lives.

The making of 'well-balanced' should be understood by all nurses.It is a quality that they should develop in their nursing career, and practice to control emotion in difficult circumstances.A nurse works in many different situations, with different people and with all types of patients.These relationships may be conflicting at times.The nurse at times has to be responsible for patients' lives.So if a nurse is well-balanced,she will be able to work or act smoothly and take care of patients properly.
If she is well-balanced;it means that she will behave with dignity and gracefully.It is an important quality that a professional nurse must develop in her career.

A nurse must be sensitive to the needs and feelings of patients and should deal appropriately with them in any situation.She should be able to cope with any kind of difficult situation, and also with different people by applying appropriate judgement.She should be tactful in dealing with any circumstances at working place.

Discipline means self-control or to develop habit of obedience to a set of rules and regulations set by an organization or a system.There are always certain rules and regulations to follow to achieve the goals of an organization.It is necessary to maintain good discipline within a working framework by each member of the organization or the unit, in order to work effectively.A nurse must be well disciplined,then only she will be able to provide better nursing care without any disturbances or tension.Discipline also helps to improve the status or situation of the working place.

Courage means to be brave or not to be afraid.Courage is necessary for any professional, but specially for a member of health profession such as the nurses and doctors,etc. because they are responsible for the life and death of patients.The nurses have to deal with a variety of conditions and people in different situations.For example,a nurse has to go to remote places to work where she does not know anybody, but she has to face the situation courageously.A nurse must always think about patient care and welfare of the people.To gain a patient's faith,the nurse must have good relationship with the individual,society and community.It often takes great courage to follow the principles that are important to the care of patients or the welfare of the profession.Courage may not be recognized,but it is a quality that is practiced daily by the nurses in their daily life.

A nurse must be creative to be able to act with new ideas to provide comfort to the patients.Creativity is a divine power which brings change in mind for the repeated manifestations.A creative nurse works best and usually works hard for a long period.This kind of nurse is always future-oriented than past-oriented.A creative nurse is always flexible and accepts reasonable changes because she expects something mew and good for the patients and organization.A creative nurse manages her work by respecting the following characteristics such as-attention,appreciation,articulation,awareness and admiration.

A nurse must be physically and mentally healthy.Her sound health influences her work.If a nurse is not healthy-mentally and physically,she does not look pleasant,confident and energetic.A healthy nurse always looks smart and pleasant and will be able to organize her work properly and confidently.A healthy nurse always looks happy and adjusts to the situations very easily.A nurse must be healthy because she needs to take care of both the sick and healthy individuals of the community.If a nurse does not maintain her health,she may become ill.So,she must try to maintain her health to prevent her from getting ill,so that she can provide good service to the patients as well as to the organization.

Personality is another good quality of a good nurse,as it is said,"the first impression is the last one".If a nurse look well-groomed,she will have strong influence upon her work and relationship.A neat ,clean and pleasant appearance always makes a deep impression upon others,especially the patients.Pleasant appearance is known to add a feeling of peace.So a nurse must be well-groomed while on duty to make her patients feel at peace and free from tension.

"Primary health care is the strategy for achieving health for all.It establishes the broad based principles that give to people the right to health services,where they live ,work and play.It also makes people feel responsible for promoting health of their own and of their society":the Primary Health Declaration.
The primary health care mainly focuses on solving the health problems in the community by providing promotional,preventive,curative and rehabilitative services to individuals,communities and the country as a whole.

The Roles and Responsibilities of a PHC Nurse
A primary health care nurse:

1. Provides care at all levels of health services
2. Is a member of the health organization of the country
3. Has an organization structure at hand
4. Possesses and controls massive amount of information
5. Is frequently the main connection between the individual,family and other health
6. Has competency,knowledge and specialized skills which require constant updating through advanced education and research
7. Has access to communication channel