This second edition of Foundations of Nursing Practice has been revised and updated specifically to meet the needs of nursing students in all fields of practice The book explains how and why sensitive, safe, evidence-based holistic nursing care is carried out, including topics common to all fields of practice. Core nursing skills are emphasised to reflect the importance of clinical skills as well as the underpinning theory.
Aids to learning in each chapter:
- Interactive boxes for all age groups and fields of nursing practice
- Key words and phrases for literature searching
- Useful websites, references and further reading.
This book provides a comprehensive introduction to nursing that will meet the needs of students, nurses returning to practice, mentors and other registered nurses.
- Relevant to all branches of nursing settings: infants, children, adults, pregnant women, older people and people with a learning disability or mental health problems
- Themes relevant to all stages and fields of nursing practice include safety, infection prevention and control, managing stress, communication, managing wounds and pressure ulcers, and dealing with loss
- Scenarios develop the skills of evidence-based practice, critical thinking, reflection and health promotion, and encourage further learning
- The areas of psychology, sociology, physiology and pathology are clearly related to nursing practice
- Key principles of health promotion, the law and ethics, the human lifespan and development are explained in earlier chapters, then applied in later chapters
- Cultural diversity information helps with understanding the needs of people from different backgrounds
- Person-centred approach encourages problem solving and application to practice
- Evidence-based practice is explicit throughout, and best-practice guidelines underpin exploration/explanation of nursing care.
- Easy-reference Glossary at the back of the book.
- Meets the requirements of the new pre-registration nursing curriculum including the NMC (2010) competencies and Essential Skills Clusters
- Greater emphasis on safeguarding vulnerable people, maternal health and first aid
- Self-test questions with answers available on accompanying website.
School of Acute and Continuing care Nursing, Napier University, Edinburgh
2 Evolution of contemporary nursing
This chapter will help you:
• Appreciate how nursing has evolved since the 1700s
• Explore contemporary nursing and how it is influenced by society
• Outline the different approaches to organizing nursing care
• Describe how to become a nurse in the twenty-first century, showing insight into the four fields of nursing practice
• Develop an awareness of the diverse roles undertaken by nurses in different settings.
Nursing has always developed in response to the changing needs of society. As the structure of society alters, new nursing habits, customs, values and knowledge emerge in response to changes in the population and its health issues. Because of the influence of history and its corresponding knowledge-base on nursing, the evolution of contemporary nursing will be considered using a chronological approach from the 1700s to the present day and this chapter will demonstrate how nursing, which does not exist in isolation, has been influenced by society and the sociopolitical agenda of the day. The chapter explores how contemporary nursing and nursing roles have developed in response to the challenges facing healthcare delivery and what it means to become or be a twenty-first century nurse. Approaches to nursing practice are considered along with some key nursing roles in different settings. It is hoped that this chapter will provide a useful introduction for those embarking or enrolled on a pre-registration nursing programme.
Evolution of nursing
To most of us, the term ‘evolution’ suggests something that changes over time and this is not always easy to map out. This section outlines how early practices provided impetus for subsequent developments. Nursing activities such as understanding, empathy, sensitivity and advocacy, to name but a few, remain steadfast aims in nursing practice. Nursing as a discipline is not defined easily by the many examples located in history, instead it draws its fuller meaning from the women and men who seek to preserve nursing activities in everyday practice such as a caring look, gently holding someone’s hand or providing a listening ear.
There is no exact time or place when nursing began. There is, however, a period in history to which we can attribute defining texts that convey the principles of nursing. This section outlines nursing at different periods since the 1700s and some of the main events and contexts that influenced these changes are explored. Florence Nightingale, Mary Seacole and Ethel Fenwick are women who wrote about nursing, and respectively set protocols, policy and shaped nurse registration. Nursing is a responsive ever-evolving profession demanding from those who work within it an ability to translate its developments against the backdrop of historical and political changes. The influence of both World Wars (1914–1918 and 1939–1945), the inception and development of the NHS and the more recent developments in professional regulation and education, are considered together with changes to specialist nursing such as the care of children and people with mental health problems.
Nursing in the eighteenth and nineteenth centuries
In the 1700s, in times of accident or sickness, hospitals, as we know them today, did not exist and being cared for in one’s own home was the norm, with lay people largely performing nursing roles in the community. ‘Nursing’ was also associated with maternity care and the term could be extended to female neighbours who wet-nursed or delivered babies in the local community.
The influence of Florence Nightingale
Florence Nightingale was born in Florence, Italy, in 1820 of wealthy, middle-class parents. After several attempts to receive formalized training in 1850 and 1851, she spent brief periods in Germany at a Protestant institution that trained deaconesses in childcare and nursing. Soon afterwards, Florence Nightingale became Superintendent of Nurses at the Institution for the Care of Sick Gentlewomen in Distressed Circumstances in London. For this she received no pay but was able to display her skills in nursing and nursing administration, which included greatly improved standards of nurses and nursing care, and also the expectation that care should be based on compassion, observation and knowledge. One of her legacies, was the ‘Nightingale ward’, a ward layout where long rooms have beds spaced out on each side, which can still be found in some areas today. While working in the military hospital during the Crimean War, she established hygienic care and reduced overcrowding; and consequently, reduced the mortality rate of wounded soldiers. In addition, her caring attitude towards the wounded soldiers led to her becoming known as the ‘Lady with the Lamp’.
Because Florence Nightingale wrote about nursing, collating information about how nurses worked and recording the nursing activities that produced positive outcomes, an evidence-based structure and philosophy of nursing was established. By observing and testing its rudimentary practices, nursing could become more evidence-based. Florence Nightingale recorded nursing practices and produced statistical outcomes, now known as ‘model forms’. As a result of this revolutionary way of working and her model forms – that we would identify today as pie-charts – many now regard her as the first research nurse. Although Nightingale found she was a heroine, she never enjoyed her fame and disliked the sentimental reference that her name inspired. The only testimonial she would accept was a fund, heavily subscribed to by the public and named in her honour, which she used to found training schools for nurses.
The success of the Nightingale reforms led to the rapid expansion of nurse training schools, initially in London voluntary hospitals. This led to the growth of larger provincial voluntary hospitals, and finally to new hospitals being built by local government and poor law authorities (McDonald 2011). Despite this, there was still a lack of hospitals, which led to a need for nursing people at home and Nightingale worked closely with William Rathbone to establish training for district nurses. District nursing started as a voluntary service, run by voluntary committees, until the value of the service was recognized and local authorities gradually began to accept more responsibility for sick people in the community. Professional regulation marginalized those who had previously practiced in often maverick and ungoverned ways, e.g. in the delivery of babies or attempting to cure mental distress through quackery, deception and even rudimentary surgery.
As a result of her work, Nightingale was able to define the role of nursing clearly and how nursing was distinct from, and not subservient to, medicine (Box 2.1). This led to the establishment of nursing as a profession with a sound and specific education base.
Box 2.1 Reflective practice
Florence Nightingale’s values
Nursing is a calling
• Religious beliefs in the existence of ‘natural laws’ could be discovered and used to help people improve their health and existence
• Nursing was all-consuming in terms of time commitment, i.e. more than an occupation
• Nursing work was so important that it should be thought of as a religious vow.
Nursing is an art and a science
• The science of nursing needs formal education
• The art of nursing gave freedom to act, to be creative, proactive and function as an advocate for the patient.
Mankind can achieve perfection
• People can control the outcomes of their lives
• People can pursue perfection by understanding ‘nature’s laws’. This understanding would enable people to readily use these laws to benefit their existence, so pursuing perfect health
• The role of the nurse was to provide the optimum environment in which perfect health could be achieved.
Nursing requires a specific education
• Education for nurses was revolutionary in the nineteenth century
• The Nightingale approach required a blend of theoretical and clinical experience.
Nursing is distinct and separate from medicine
• Although physician and nurse deal with the same client population, nursing is aimed at discovering the ‘natural laws’ that will assist in putting the patient in the best possible condition so that nature can affect a cure.
• Reflect on the values above and consider...