Foundations of Adult Nursing

Dianne Burns, Dianne Burns

• Publisher: SAGE Publications Ltd
• Year: 2018
• ISBN:
  9781526453914
• Edition: 2
• Topic: Medicine
• Subtopic: Nursing

Covering the issues, themes and principles that explain what it means to be a nurse today, this book provides the theory students need to know and applies it to the diverse patient groups and settings that students will encounter on their placements.

Key features of the book are:

• It introduces the core aspects of adult nursing
• An evidence-based approach with discussion of literature, policy and research and suggested further reading for every chapter
• Over 30 c ase studies to help students understand the realities of practice across a range of settings including primary care and the community
• Stop and think boxes which challenge assumptions and encourage reflection
• A companion website with sample questions for lecturers to use in seminars, multiple choice questions for student revision and free SAGE journal articles

The book has been closely mapped to theNMC?s 2018 Standards for Proficiency, Education and Trainingand supports students across their entire degree programme as they develop into nurses of the future ready to deliver and lead care.

Part 1 Theory and Context in Relation to Adult Nursing

1 Essentials of Nursing: Values, Knowledge, Skills and Practice

Joanne Timpson

Elizabeth Lee-Woolf

Jane Brooks

Chapter Objectives

• Outline the landmarks of nursing history and highlight how these have influenced nursing practice across the UK;
• Explain how legal and ethical principles provide a core framework for our professional practice;
• Define the core values that underpin nursing and recognise their application to practice;
• Understand the principles of The Code (Nursing and Midwifery Council or NMC, 2018a) by which we practise and how these define our fitness to practise;
• Highlight the challenges to modern nursing and relate these to our professional values in regard to cultural competence, emotional IQ and resilience.

As you begin your studies in nursing we hope that you will be as full of questions, as you are enthusiasm, for your chosen profession and trust that you are prepared for the challenge ahead. Our aim is to engage you with our passion for nursing and instil an ethos of nursing as a privilege. Together, we will review the essentials of nursing knowledge and values, exploring how these will underpin your practice in a way that we hope will excite your professional imagination, intelligence and curiosity.

Related NMC proficiencies for registered nurses

The overarching Nursing and Midwifery Council (NMC) requirement is that all nurses act in the best interests of people, putting them first and providing nursing care that is person centred, safe and compassionate. They should act professionally at all times and use their knowledge and experience to make evidence-based decisions about care. They communicate effectively, are role models for others and are accountable for their actions. Registered nurses continually reflect on their practice and keep abreast of new and emerging developments in nursing, health and care (NMC, 2018b).

To achieve entry to the nursing register you must be able to

• Understand and act in accordance with The Code: Professional Standards of Practice and Behaviour for Nurses and Midwives and fulfil all registration requirements (NMC, 2018a);
• Act as an ambassador, upholding the reputation of your profession and promoting public confidence in nursing, health and care services;
• Understand and apply relevant legal, regulatory and governance requirements, policies and ethical frameworks to all areas of practice, differentiating where appropriate between the devolved legislatures of the United Kingdom;
• Demonstrate resilience and emotional intelligence and be capable of explaining the rationale that influences your judgements and decisions in routine, complex and challenging situations;
• Understand and maintain the level of health, fitness and wellbeing required to meet people’s needs for mental and physical care;
• Understand the demands of professional practice and demonstrate how to recognise signs of vulnerability in yourself or your colleagues and the action required to minimise risks to health;
• Understand and apply the principles of courage, transparency and the duty of candour, recognising and reporting any situations, behaviours or errors that could result in poor care outcomes;
• Demonstrate an understanding of and the ability to challenge discriminatory behaviour;
• Take responsibility for continuous self-reflection, seeking and responding to support and feedback to develop your professional knowledge and skills.

(Adapted from NMC, 2018b)

Background

To understand the role of the contemporary adult nurse in the UK, it is useful to know a little of nursing’s history and to recognise key landmarks over the last 150 years that signal the development towards the professional nursing practice we have today. However, it is not our intention to provide a detailed history of nursing here and you are advised to explore the Further Reading section at the end of this chapter, which illustrates in more detail the historical threads that bring us to this point.

Although caring, and the role of carer, has existed throughout history, nursing in its modern sense is a relatively recent concept. It is recognised that the words ‘nurse’ and ‘nursing’ are derived from the Old French nourice and the Late Latin nutrire, meaning to nourish and care (Oxford English Dictionary, 2014a), but their use in today’s sense has occurred only from the seventeenth century onwards. It is often suggested that nursing can be traced back through history to its earliest times. If you accept that this reflects the act of carer and caring then this is undoubtedly true. The themes that run through the earliest annals of history involve those who provided succour (i.e. assistance and support in times of hardship or distress) for families, communities or for those injured in battle, for example. What is perhaps more important here for modern notions of nursing are those involved with what Reverby, O’Brian D’Antonio, and Mann Wall have called ‘professed-nursing’, namely the care of sick strangers (Reverby, 1987; O’Brien D’Antonio, 1993; Mann Wall, 1998). This distinction is crucial because, if we understand modern professional nursing as caring for those people who are not our friends or family, this means that it is a very different undertaking from caring for those who are. Nevertheless, often the carers who nursed ‘sick strangers’ were influenced by religious values and altruism, believing that it would be wrong to gain monetarily from their work. There was, however, a more insidious ideology at work: once a lady worked for money, she was no longer considered a lady. To cite historian Hawkins, ‘they forfeited their respectability’ (Hawkins, 2010: 29). Given that nursing reformers in the nineteenth century wished to increase the number of educated middle-class women in the occupation this was clearly a problem. Hence the vocation or calling to nurse has been the province of those who had a desire to care with little thought of reward or perhaps, more pertinently, were felt not to want such financial reward because they were respectable. Either way, whilst philanthropy may indeed be admirable, such notions influenced the status of the nurse and, perhaps, some might argue, limited the evolution of nursing as a highly skilled profession (Helmstadter, 1993, 1996).

Throughout the eighteenth century we can see the appearance of what might be termed the ‘modern hospital’ in Britain. This was also the Age of Enlightenment – a movement made up of intellectuals who wished to see development in many areas of life through reasoned argument and science rather than adhering to traditions without thought. This influence can be seen in the funding of modern ‘voluntary hospitals’ by wealthy benefactors such as Thomas Guy who funded Guy’s Hospital in London (1719), followed by the Edinburgh Royal Infirmary (founded in 1729), St Bartholomew’s Hospital (opened in 1730, funded by public subscription), the Middlesex Hospital (opened in 1745, funded by public subscription) and the Manchester Royal Infirmary (in 1752). These hospitals had a charitable remit to provide treatment for the poor which was recognised by an Act of Parliament in 1836. However, they needed to provide care only for the ‘deserving poor’, and all voluntary hospitals tended to focus on acute illnesses that could be treated and would therefore provide excellent advertisements for future possible benefactors. This system excluded the chronically sick, the elderly and infirm, the mentally ill and those with learning disabilities. The last two types of patients were cared for in separate ‘asylums for the insane’ whereas the elderly and chronically sick were cared for in Poor Law Hospitals. The Poor Law Hospitals were described as ‘murderous pesthouses’ into which ‘the dense mass of living creatures were crammed’ (cited in White, 1978: 18).

• How do people today consider the work carried out by nurses in intensive care units in acute hospitals?
• How do people view the nursing of older people with dementia?
• What sort of facilities do we offer to each of these groups of patients?
• The thing about history is that there are often reasons in our past that go some way to explaining the ways in which services develop over time.
• Are you able to identify any links with history for the care of olde...