What is Nursing? Exploring Theory and Practice

Exploring Theory and Practice

Carol Hall, Dawn Ritchie, SAGE Publications Ltd

• Publisher: Learning Matters
• Year: 2013
• Print ISBN: 9780857259752, 9781446257029
• eBook ISBN: 9780857259769
• Edition: 3
• Topic: Medicine
• Subtopic: Nursing Skills

This book helps new nursing students, and those applying to nursing programmes, understand what being a nurse is all about. It explores the essential issues, processes and theories of nursing practice, and is therefore an ideal introductory text as you start your nursing programme, or as pre-course reading.

This revised edition includes a new first chapter on being a nursing student, with insights from students themselves, and explains what will be expected of you in the new all-degree programmes. Interviews with real nurses in each of the fields of practice gives you an important view into the real world of nursing.

• The revised third edition includes a new chapter on being a nursing student, with student tips and stories
• Updated with, and linked to, the new NMC Standards and Essential Skills Clusters for degree-level education
• Activities, case studies and scenarios helps you apply theory to practice
• Particularly suitable for first-year students and those applying to pre-registration programmes

This book is part of the Transforming Nursing Practice Series, the first series of books designed to help students meet the requirements of the NMC Standards and Essential Skills Clusters for the new degree programmes.

Chapter 1

Defining contemporary UK nursing

Carol Hall

NMC Standards for Pre-registration Nursing Education

As this chapter is concerned with defining contemporary nursing, it will use the generic standards for competence as a baseline.

Domain 1: Professional values

All nurses must act first and foremost to care for and safeguard the public. They must practise autonomously and be responsible and accountable for safe, compassionate, person-centred, evidence-based nursing that respects and maintains dignity and human rights. They must show professionalism and integrity and work within recognised professional, ethical and legal frameworks. They must work in partnership with other health and social care professionals and agencies, service users, their carers and families in all settings, including the community, ensuring that decisions about care are shared.

Domain 2: Communication and interpersonal skills

All nurses must use excellent communication and interpersonal skills. Their communications must always be safe, effective, compassionate and respectful. They must communicate effectively using a wide range of strategies and interventions including the effective use of communication technologies. Where people have a disability, nurses must be able to work with service users and others to obtain the information needed to make reasonable adjustments that promote optimum health and enable equal access to services.

Domain 3: Nursing practice and decision making

All nurses must practise autonomously, compassionately, skilfully and safely, and must maintain dignity and promote health and wellbeing. They must assess and meet the full range of essential physical and mental health needs of people of all ages who come into their care. Where necessary they must be able to provide safe and effective immediate care to all people prior to accessing or referring to specialist services irrespective of their field of practice. All nurses must also meet more complex and coexisting needs for people in their own nursing field of practice, in any setting including hospital, community and at home. All practice should be informed by the best available evidence and comply with local and national guidelines. Decision making must be shared with service users, carers and families and informed by critical analysis of a full range of possible interventions, including the use of up-to-date technology. All nurses must also understand how behaviour, culture, socioeconomic and other factors, in the care environment and its location, can affect health, illness, health outcomes and public health priorities and take this into account in planning and delivering care.

Domain 4: Leadership, management and team working

All nurses must be professionally accountable and use clinical governance processes to maintain and improve nursing practice and standards of healthcare. They must be able to respond autonomously and confidently to planned and uncertain situations, managing themselves and others effectively. They must create and maximise opportunities to improve services. They must also demonstrate the potential to develop further management and leadership skills during their period of preceptorship and beyond.

Chapter aims

After reading this chapter, you will be able to:

• define nursing from your own understanding and from existing theoretical perspectives;
• understand how nursing has developed as a modern profession and how it is changing today;
• outline some key historical and legislative guidance, and show how it has impacted on the contemporary definition of nursing;
• provide a professional definition of nursing.

Introduction

This chapter will help you to develop your knowledge about how nursing has been defined and developed as a modern profession. It will challenge you to think of how nursing is perceived by you and by others in light of history, and how nursing has emerged in relation to the way it is defined today. You will also be able to explore examples of the way nursing has developed as the result of legal and professional regulation. This will help you to be aware of the implications of regulation in nursing, as well as to reflect on your own views and values, as you begin to engage with, and commit to, the principles of becoming a nurse. Finally, you will be introduced to material that will consider your role as a nurse in promoting health and in nursing the sick person. There will be an opportunity to explore nursing across a range of patients, including adults, children, those with mental health concerns and individuals who have special learning needs, which may result in a requirement for nursing and social care.

This chapter is intended to underpin and provide context for the remaining chapters of the book, so it is important to expect to see reference made to elements to be found in later chapters. You can follow these references immediately if you wish, in order to develop a specific area of learning, or view them as indicators and return to them later.

Defining nursing: what do you think?

Nursing may not be easy to describe, but patients know when they get good nursing and when they do not.

Nursing requires a high level set of skills and understanding which taken separately may seem commonplace and undemanding but combined as a whole is far more complex and powerful. (Christine Beasley, former Chief Nursing Officer for England (DH, 2006, p4))

In exploring definitions of nursing it is essential to consider your own perspectives and allow these to form part of the context of your thinking. Like the patients described by Beasley (2006) above, it is reasonable to assume that you already have some views from your life experience of what may define a nurse. This chapter will, therefore, begin with your own ideas and then use this backdrop to start comparing the thinking of others.

Activity 1.1 Research and evidence-based practice

The Department of Health for the UK employs a team of advisers who consider all areas of nursing and healthcare. The Chief Nursing Officer (CNO) is the Government’s most senior nursing adviser. In England, the CNO has responsibility for delivering the Government’s strategy for nursing and leads nearly 600,000 nurses, midwives and health visitors and allied health professionals (DH, 2007a). There are also CNOs for Scotland, Wales and Northern Ireland.

Look up the CNO’s page on the Department of Health Website: www.dh.gov.uk/en/Aboutus/Chiefprofessionalofficers/Chiefnursingofficer/index.htm

Make a note of any recent topics or correspondence accessible from this page. What appear to you to be the most pressing issues for nurses today?

As what you find will depend on topical developments, there is no outline answer at the end of the chapter.

Activity 1.2 will enable you to start exploring nursing definitions from your own perceptions. The definition that you create will be referred to as you progress through the chapter and you will be able to develop your own ideas. It may be useful to consider this work for inclusion in your professional portfolio.

Activity 1.2 Reflection

From what you already know, think about how you might define a nurse and jot down your own ideas.

Now look at your notes – reflect over the following.

• How did you try to define nursing?
• What do you already know and how has this influenced you?
• Did you try to identify what nurses do, for example: ‘they care for people’?
• Did you try to identify nurses by what they know, for example: ‘they know about medications’ or by their image or attitude or behaviour, for example: ‘they wear a uniform’, ‘they are professional’?

As this activity is based on your own reflection, there is no outline answer at the end of the chapter.

You are now beginning to consider the same issues as have been preoccupying some very eminent nurses for many years, and the above exercises may have shown you that nursing is complex and difficult to define. In respect of having a unique body of knowledge usually associated with a profession, this is even more difficult.

Nursing is influenced by where it happens, who is being nursed and by the resources that might be needed and the availability of these. In this chapter, we will explore how nursing is portrayed and defined as the result of existing knowledge around nursing. How nursing as a profession is perceived is also influenced by image and by experience, and these elements will be addressed in more detail in the next chapter. The concept of nursing as a profession will be addressed too. Nursing is finally defined by beliefs and this will be addressed in more detail in Chapter 4, where values, philosophies and models around delivering nursing are considered in more depth.

Why is having a clear definition of nursing important?

Defining nursing is essential for a number of reasons, and these are succinctly summarised in the Royal College of Nursing (RCN, 2003) document Defining Nursing, where the following reasons for a definition of nursing are identified. A definition of nursing enables nurses to:

• describe nursing to people who do not understand it;
• clarify their role in the multidisciplinary healthcare team;
• influence the policy agenda at local and national level;
• develop educational curricula;
• identify areas where research is needed to strengthen the knowledge base of nursing;
• inform decisions about whether and how nursing work should be delegated to other personnel;
• support negotiations at local and national level on issues such as nurse staffing, skill mix and nurses’ pay.
  (Adapted from RCN, 2003, p4)

Activity 1.3 Critical thinking

Take a critical look at the RCN summary document Defining Nursing, which can be found at www.rcn.org.uk.

Examine the different definitions that are outlined within it and consider the following questions.

• Do you agree with the final statement that is drawn?
• Does the paper describe nursing for everyone?
• Are there any limitations of this definition?

After reading this paper, try to think of how you would now describe nursing to a friend who does not know what it is. Jot down your ideas in about 5–6 key words. Have your original ideas changed?

As this activity is based on your own reflection, there is no outline answer at the end of the chapter.

Concept summary: What is the Royal College of Nursing?

The Royal College of Nursing (RCN) is a UK-wide ‘professional organisation’ for nursing. This means it is a non-profit-making membership organisation that seeks to further the profession of nursing and act in supporting its members in their relationships with employers. The RCN develops professional documents and journals for nursing, arranges conferences to share nursing knowledge, and consults members to lobby the Government, and other organisations, to improve nursing. It also works with the International Council of Nurses (ICN) and the World Health Organization (WHO) to represent UK interests in the global nursing arena. The RCN also acts as a union for its members. Unite/Amicus and UNISON are also trade unions that represent nurses. For more information on all these organisations, visit www.rcn.org.uk, www.icn.ch, www.who.int, www.unison.org and www.amicustheunion.org.

It is important to recognise that the RCN is not the only group that has tried to define nursing, and while Defining Nursing makes a useful contribution to British thinking, nursing is carried out globally and it is important to think of nursing across countries as well as within them. The RCN’s ideals are identified as being commensurate with a wider definition of nursing globally, which is addressed by the International Council of Nurses (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, 2010)

For the purpos...

Table of contents

• Cover Page
• Title
• Copyright
• Contents
• Foreword
• About the authors
• Contributors
• Acknowledgements
• Introduction
• 1. Defining contemporary UK nursing
• 2. Being a student nurse
• 3. The professional nurse: image and values in nursing
• 4. Theory and practice: understanding the nature of nursing as a caring activity
• 5. Doing nursing
• 6. Nursing as a global activity
• 7. Becoming a Registered Nurse
• 8. Exploring the world of nursing by those working in it
• References
• Index