NSC 202 MAY 2024

NSC 201 LECTURES

DEFINITION OF NURSING

INTRODUCTION

What is nursing?

 Florence Nightingale defined nursing as “the act of utilizing the environment

of the patient to assist him in his recovery “Nightingale considered a clean,
well-ventilated, and quiet environment essential for recovery. Nurses were no
longer untrained housekeepers, but people educated in the care of the sick.
 Virginia Henderson was one of the modern nurses to define nursing. She
wrote ‘the unique function of the nurse is to assist the individual, sick or well,
in the performance of those activities contributing to health or its recovery (or
to peaceful death) that he would perform unaided if he had the necessary
strength, will, or knowledge, and to do this in such a way as to help him gain
independence as rapidly as possible”. Both of them described nursing in
relation to the client and the client’s environment. But unlike Nightingale,
Henderson saw the nurse as concerned with both healthy and ill individuals,
acknowledged that nurses interact with clients even when recovery may not be
feasible, and mentioned the teaching and advocacy roles of the nurse.
 American Nurses Association (ANA) defined “Nursing as the protection,
promotion and optimization of health and abilities, prevention of illness and
injury, alleviation of suffering through diagnosis and treatment of human
response, and advocacy in the care of individuals, families, communities, and
populations”
 International Council of Nursing (ICN) defined “Nursing as encompassing
autonomous and collaborative care of individuals of all ages, families, groups
and communities, sick or well and in all settings; including the promotion of
health, prevention of illness, and care of ill, disabled and dying people”

Certain things common to many of these definitions:

 Nursing is caring
 Nursing is an art
 Nursing is a science
 Nursing is holistic
 Nursing is adaptive
 Nursing is concerned with health promotion, health maintenance, and
health restoration.
 Nursing is a helping profession.

Who are the recipients of Nursing?

 They are the consumers, or sometimes patients and at times clients.
 A consumer uses a commodity or services. They are consumers of health
services.
 A patient is one who is waiting for, or undergoing medical treatment and care.
 A client is the one who engages the advice or services of another who is
qualified to provide service.
 Client is the receiver of healthcare as a collaborator in the care, meaning one
who is also responsible for his own health.

Scope of nursing
1. Nurses provide care for 3 types of clients : individuals, families and
communities.
2. Nursing practice involve 4 areas
 Promoting health and wellness,
 preventing illness,
 restoring health, and
 caring for the dying.
1. Promoting Health and Wellness:
Nurses promote wellness in clients who are both healthy and ill.
This may involve individual and community activities to enhance healthy life
styles like
 improving nutrition, and physical fitness,
 preventing drug and alcohol misuse,
 Restricting smoking, and preventing accidents and injury in the home and work
place.

2. Preventing Illness
The goal of prevention program is maintain optimal health by preventing
disease.
Nursing activities that prevent illness include:
 immunization
 Prenatal and infant care and
 Prevention of sexually transmitted infections
Restoring health focuses on ill client, and it extends from early detection of disease
through helping the client during the recovery period.

Nursing activities include the following:

 Providing healthcare to the ill person, such as medication, baths, and specific
procedures and treatments.
 Performing diagnostic and essential procedures such as measuring blood
pressure and examining feces for occult blood.
 Consulting with other health professionals about client problems.
 Teaching them about recovering activities, like exercises that will accelerate
recovery after a stroke.
 Rehabilitating clients to their optimal functional levels of physical or mental
illness, injury or chemical addiction.

Setting for nursing

 In the past, acute care hospital was the main practice setting open to most
nurses.
 Today , many nurses work in hospitals, but increasingly, they work in client’s
homes, community agencies, ambulatory clinics, long-term care facilities,
health maintenance organizations and nursing practice centres.
 Nurses have different degrees of nursing autonomy and responsibility in the
various settings.
 They may provide direct care, teach clients and support persons, serve as
nursing advocates and agents of change, and help determine health policies
affecting consumers in the community and in hospitals.
Roles and functions of the nurse
 Nurses assume a number of roles when they provide care to clients.
 Nurses often carry out these roles concurrently, not exclusively of the one
another.
 E.g. the nurse may act as a counselor while providing physical care and
teaching aspects of that care.
 The roles required at a specific time depend on the needs of the client and
aspects of the particular environment.
1. Caregiver:
 This role has traditionally included those activities that assist the client
physically and psychologically while preserving the client’s dignity.
  The required nursing actions may involve full care for the completely
dependent client, partially dependent client, and supportive- educative care
to assist clients attaining their highest possible level of health and wellness.
 Care giving includes the physical, psychological, developmental, cultural
and spiritual levels.
 A nurse may provide care directly or delegate it to other caregivers.
2. Communicator:
 Communication is integral to all nursing roles. Nurses communicate with the
client, support persons, other professionals, and people in the community.
 In the role of a communicator, nurses identify client problems and then
communicate these verbally or in writing to other members of the health
team.
 The nurse must be able to communicate clearly and accurately in order for
the client’s healthcare needs to be met.
3. Teacher :
As a teacher the nurse helps clients learn about their health and healthcare
procedures they need to perform to restore or maintain their health.
The nurse assesses client learning needs and then plan and teach the clients.
4. Case Manager:
Nurse case manager works with the multidisciplinary healthcare team to ensure
the effectiveness of the case of the case management plan and to monitor
outcomes. Each agency or unit specifies the role of of the nurse manager.
5. Client Advocate:
A client advocate acts to protect the client.
In this role the presents the client’s needs to other health professionals, like
relaying the client’s wishes for information to the physician.
6. Counselor :
The nurse counsels primarily healthy individuals with normal adjustment
difficulties and focuses on helping the person develop new attitudes, feelings
and behaviors by encouraging the client to look at alternative behaviors,
recognize the choices, and develop a sense of control.

7. Change agent :
 The nurse assists the client to make modifications in their behavior.
 She also acts to make changes in the health care system like clinical, if it is not
helping a client to health.
8. Leader:
 A leader influences others to work together to accomplish a specific goal.
 The leader role can be employed at different levels: individual client, family,
groups of clients, colleagues, or the community.
9. Manager:
 The nurse manages the nursing care of individuals,families and communities.
The manager also delegates nursing activities to ancilliary workers and other
nurses and supervises and evaluates their performances.
10. Research Consumer:
Nurses often use research to improve clients care. In a clinical area, nurses need to:
a). have some awareness of the process and language of research
b). be sensitive to issues related to protecting the rights of human subjects
c). participate in the identification of significant researchable problems and
d). be a discriminating consumer of research findings.

Fields and Opportunities in Nursing

1. Hospital/Institutional Nursing
 A nurse working in an institution with patients
 Example: rehabilitation, lying-in, etc.
2. Public Health Nursing/Community Health Nursing
 Usually deals with families and communities. (no confinement, OPD only)
 Example: Health Center
3. Private Duty/special Duty Nurse
 Privately hired
4. Industrial/Occupational Nursing
 A nurse working in factories, office, companies
5. Nursing Education
 Nurses working in school, review center and in hospital as a CI.
6. Military Nurse
 Nurses working in a military base.
7. Clinic Nurse
 Nurses working in a private and public clinic.
8. Independent Nursing Practice
 Private practice, BP monitoring, home service.
 Independent Nurse Practitioner.
Is Nursing An Art And A Science?
The Art of Nursing
 Florence Nightingale was the first to coin the phrase, the Art of Nursing.
 She understood that Nursing is a profession in which physical tasks must be
adapted into individualized patient care, making Nursing an educated art form.
 Empathy and compassion are at the forefront of what makes Nursing an art
 Empathy is the ability to feel the emotions of others. As Nurses, we care for
patients when they are most vulnerable. When patients seek medical attention,
they can often be fearful, sad, or even angry. To care for these patients
respectfully and efficiently, Nurses must be able to empathize with patients to
facilitate a strong Nurse-patient relationship to promote healing.
 Compassion is the emotional response to empathy or sympathy while
experiencing a desire to help. Nursing is a helping profession and to be an
excellent Nurse, you must genuinely want to help others.
 The task-oriented approach to Nursing can sometimes challenge Nurses to
maintain a human connection to our patient. Still, we must always strive to
connect with and understand our patients to ensure they are cared for
comprehensively.
 Compassion and empathy with an anxious patient will do more good to heal
them than a gruff hand that is in a rush to get the job done. For example, many
patients are nervous before going into surgery. As a nurse, you may prepare
several patients a day and see all of them come out alright. For you, this is
normal, routine. For the patient, however, this is something scary, even
terrifying.
 Taking the time to talk to them and address their fears may take a few extra
minutes, but the patient will be much more ready to go into surgery and will
remember you for your kindness and empathy.
 The emotions behind why we do the things we do is what makes Nursing an art
form. In this case, the artistry of nursing – the ability to calm and truly help
patients – is a necessity. Being able to quell the nerves of your patients and help
them relax enough so that you can finish your tasks is where the art of nursing
comes in.
 Another aspect of nursing being an art is in the distinct collaborative work that
needs to be accomplished. Nurses are generally part of a team, and they must
work as such.
 Knowing how to work well with other nurses, doctors, even orderlies is an art
that many non-nurses may not completely understand. The work in a hospital or
 clinic is like a relay race that requires the participation of all team members to
achieve success.
 A good nurse, one who is effective, valuable, and successful, is able to
cooperate with others for the greater good – the health of the patient. They will
put their own pride and desire for personal success behind the drive to heal.
 Being a good nurse is easy – follow the science you’ve learned and have the
knowledge you need to perform certain tests and procedures. But being
a great nurse means learning the art of the human touch, of empathy, of
teamwork. It means understanding that a patient’s emotional or mental turmoil
is often comparable to their physical turmoil.
 And some days you’ll find that the art is more important than the science.
The Science of Nursing
 The science of Nursing is the ‘why’ behind the tasks we carry out daily.
 The Nursing profession is built on evidence-based practice.
 Evidence-based practice collects, processes, and implements research findings
into clinical practice and improves patient outcomes.
 If you are a nurse, science is your forte. You’ve studied human anatomy and
learned the ins and outs of diseases, disorders, and disabilities.
 You are acutely aware of the task at hand and what is required of you. But even
more than the actual nursing side of things, you must also be aware of new
policies and procedures at your hospital or clinic.
 Even something as simple-seeming as paperwork needs to be completed with a
scientific mind and an attention to detail.
 As Nurses, we strive to provide our patients with the best care possible, so we
must ensure that our actions and tasks are well researched and have been shown
to improve the health and safety of our patients.
 This is what the science of Nursing is all about, having a reason behind our
actions and an understanding that our interventions improve the outcomes of
patients.
 Education is also at the foundation of the science of Nursing.
 To become a Nurse, we must complete coursework that prepares us to meet the
diverse needs of our patients and become safe healthcare professionals.
 Nursing coursework includes detailed education on the intricacies of the human
body, disease processes, health policy, and hands-on instruction to develop
clinical skill sets.

FACTS ABOUT A PROFESSION

A profession refers to a field of work that requires specialized training or a
particular skill. Professionals in a given field adhere to ethical standards and are
recognized by the public as possessing special knowledge and skills derived from
a widely accepted body of learning. Here are a few aspects of what constitutes a
profession:

 Occupation with Training and Skill: A profession involves a type of work

that demands prolonged training and often requires a formal qualification.
Examples include careers like medicine, law, and teaching, etc.
 Group of Individuals: It encompasses the collective group of people engaged
in a specific profession. For instance, the legal profession includes lawyers,
judges, and legal experts.
 Public Recognition: Professionals are acknowledged by society for their
expertise and specialized knowledge. Their work is often respected due to the
high level of education and skill involved.
 A profession combines expertise, ethical standards, and specialized skills,
shaping various fields of work and contributing to society’s well-being.

CRITERIA FOR A PROFESSION

The concept of a profession encompasses several key criteria that distinguish it

from other types of work.

 Education and Specialized Training: A profession typically

requires prolonged education and specialized training. Professionals acquire
formal qualifications and expertise in their field.
 Ethical Behavior and Standards: Professionals adhere to ethical
guidelines and conduct themselves with integrity. Honesty, transparency, and
sincerity are essential characteristics.
 Autonomy and Discretion: Professionals exercise discretion in decision-
making. They have the authority to make informed choices based on their
expertise.
 Accountability and Responsibility: Professionals are accountable for their
actions. They take ownership of their work and fulfill commitments.
 Recognition by Society: Professions are acknowledged by society as
possessing specialized knowledge. Public recognition and respect are associated
with professional status.
  Occupational Control and Monopoly: Professions often have controlled
entry into their field. Some professions enjoy a monopoly over certain services
(e.g., legal representation).
 High Standards of Conduct: Professionals maintain a code of
conduct specific to their field. Ethical behavior and competence are paramount.
 Continuous Learning and Development: Professionals engage in lifelong
learning to stay updated. They adapt to changes in their field and enhance their
skills.
 Public Trust and Reputation: Professions build trust with clients, patients, or
the public. Reputation is crucial for professional success.
 Recognition by Authorities: Professions are often regulated by governing
bodies.
 Licensing, certifications, and professional associations play a role.
Whether a field qualifies as a profession depends how well these criteria are met
and its societal impact.

PROFESSIONALS VERSUS NON-PROFESSIONALS

The differences between professionals and non-professionals. These

distinctions can vary:
1. Education and Training:
a. Professional Jobs: These careers typically require advanced education and
specialized training. Professionals often hold degrees (such as bachelor’s, master’s,
or doctorate) in their field. Examples include doctors, lawyers, teachers, and
scientists.
b. Non-professional Jobs: These roles usually start with minimal training or
education. They often provide on-the-job training and allow individuals to
develop skills as they work. Examples include cashiers, sales people, and customer
service representatives.
2. Experience and Advancement:

a. Professional Jobs: Professionals often rely on their advanced education and

may need to continue learning or earn additional certifications for career
advancement. For instance, surgeons require extensive education, while plumbers
gain experience through hands-on training.

b. Nonprofessional Jobs: Advancement in nonprofessional fields often depends

on gaining work experience.
3. Equal Employment Opportunity Commission (EEOC) Classification: The
EEOC distinguishes between professional and non-professional jobs based on
college degrees. Professional jobs require degrees, while non-professional jobs do
not necessarily need one. However, exceptions exist, so other factors are
considered.
4. autonomy of practice,
5. adherence to an established code of ethics,
6. A common culture and values present among members.

Is Nursing A Profession?
A professional nurse therefore, is a person who has completed a basic nursing
education program and is licensed in his country to practice professional
nursing.
Nursing is indeed a profession within the healthcare sector. It focuses on
promoting and restoring health, preventing illness, and providing care to
individuals, families, and communities. The responsibilities of nursing encompass
various aspects, including:

1. Patient assessment
2. Medication administration
3. Wound care
4. Patient education
5. Emotional support

A profession ensures competent performance of individuals within its ranks (ANA,

2021). Typically, within the US, professions are distinguished by certain specific
characteristics; these include, but are not limited to

Institutions of Higher Education

 A profession must have a clear educational pathway into the practice and a
constantly growing body of knowledge within institutions of higher learning
Currently, there are many pathways for nursing education, ranging from
three-year degree programs to bachelor to direct-entry masters and doctorate
programs.
 Regardless, programs at every level of study share the common pedagogical
goal of providing students with the practical knowledge and theoretical basis
 to deliver safe and effective health care as integral members of the inter-
professional healthcare team.
 Despite the variety of nursing programs and the range of advanced degrees
they offer, all students have their basic professional nursing skills assessed
by the National Council Licensure Examination. ( In Nigeria, NMCN)
 All students must pass the Council Examination before entering the
workforce or progressing towards more advanced degrees;
 Professional standards are clearly established, and all prospective nurses are
held to a uniform standard of proficiency.
 Successful completion of the Council exam permits any Registered Nurse
(RN) to practice under the nursing practice act of an individual state.
 This is another indication the BSN is progressing becoming the level of
entry for nursing practice.
 Nursing as a profession is constantly expanding its scope of practice and
challenging its workforce to continue its education.
 One specific quality of a profession is that a profession operates
independently with legislature in creating policy and it supervises its own
professional standards and the practices of its practitioners.
 Nationwide, individual state boards of nursing have the autonomy to
determine nursing’s standards of practice, allowing nurses to operate
autonomously within their established scopes of practice.
 In some states, advanced practice nurses can embark on their own practices.
Over time, individual state nurse practice acts have been steadily granting
nurse practitioners increasing levels of autonomy within their spectrum of
practice.
 The practice of medicine is an example of the development of a profession,
as medicine developed into a profession the autonomy of physicians
continued to expand.
 Nursing will see a growth in the level of autonomy in everyday practice as
nursing becomes more recognizable as a profession.
 The ability to determine one’s course of action is often identified as a
characteristic of a profession.
 In the nursing work environment, this freedom could best be translated as
empowerment.

Code of Ethics
 Another quality identified by Joel & Kelly (2002) is that a profession must
have an established code of ethics that guides the profession as well as
defines the relationship between professional and client.
 Nurses have traditionally placed a high value on the worth and dignity of
others.
 The nursing profession requires integrity of its members, that is, a member is
expected to do what is right regardless of the personal cost.
 Ethical codes change as the needs and values of the society change.
 Nursing has developed its own codes of ethics and in most instances, has set
up means to monitor the professional behavior of its members.
 Nursing relies on the Code of Ethics established by the American Nurses
Association (ANA) as ethical standard for conduct that guides professional
practice. There are nine provisions to the Code of Ethics.
 These provisions codify the fundamental values of nursing, establish the
boundaries of nursing duty, and articulate the ethical responsibility of the
nurse (ANA, 2008).
 These are the guiding principles, obligations, and commitments of the
nursing profession.
 Ethics in health care includes the rights, responsibilities, and obligations
of professional and clients.
 The Code of Ethics directs the goals, values, and ethics for nurses to
uphold .
 With a defined code of ethics, the nurse is able to recognize and face ethical
challenges for a complex patient population.
 The nursing profession is never independent of current culture and context
of professional ethics.
 The Code of Ethics holds the nurse accountable for his or her actions along
with those of the individuals to whom the nurse delegates tasks involving
patient care.
 Fowler, (1989) describes the Code of Ethics as assurance to the public that
nurses are proficient and capable of providing safe and effective care.
 The nurse adheres to the Code of Ethics as a framework to guide in decision
making.
 Nurses rely on ethical codes and standards to guide care, understanding
these standards result in the most positive patient outcomes.
 Following standards ensures each professional abides by a defined set of
principles that protect the integrity of the profession.

Body of Knowledge
 As a profession, nursing is establishing a body knowledge and expertise. A
number of nursing conceptual frameworks contribute to the knowledge base of
nursing and give direction to nursing practice, education, and on-going
research’

Increasing Knowledge

 It is required that a profession to engage in enlarging its body of knowledge. In

addition, this body of knowledge must be well defined and organized in order
for it to be applied within the complex healthcare environment.

 Given the current speed at which healthcare is increasing in complexity, nursing

is necessarily a constantly changing profession with all nurses having an
obligation to remain current and knowledgeable regarding advancing health
care practices.

 Nurses must possess a strong knowledge base developed through evidence-

based practice, continuing education, skill validation, and annual
competency reviews.

 These practices assist nurses in broadening knowledge and allow

professional nursing organizations to maintain uniform standards, as the
nurse’s role evolves.

 Current nursing educational programs provide tools necessary for nurses to

stay abreast of the advancement’s healthcare. Many nurses are encouraged to
continue their education.

 The ANA holds the view that the registered nurse is responsible for maintaining
clinical competency through continued education (ANA, 2008).

 Most nurses are required to accrue a number of continuing education hours

before each license renewal cycle. This continued education is so important that
many health care facilities offer tuition reimbursement to encourage their
employees to continue their education.

 As nursing requires a broad-based education encompassing many health care

disciplines, continued learning in nursing satisfies another attribute of the
profession criteria by ensuring a current growing foundation of knowledge that
protects the patient from risk of harm.
On-Going Research

Increasing research in nursing is contributing to nursing practice. In early 1940s ,

nursing research was at a early stage of development. In the 1950s, an increased
Federal funding and professional support helped establish centers for nursing
research in US. Most early research was directed to the study of nursing education.
In the 1960s, studies were often related to the nature of the knowledge base
underlying nursing practice.

Service Orientation

A service orientation differentiates nursing from an occupation pursued primarily

for profit. Many consider altruism (a selfless concern for others ) the hall mark of
a profession. Nursing has a tradition of service to others. This service however
must be guided by rules, policies, or code of ethics. Today, nursing is an important
component of the healthcare delivery system.

Culture and Norms

 Joel and Kelly (2002) explicitly identify the existence of a shared culture as
well as a set of norms within a profession.
 Nursing tends to attract those who have a desire to provide care to people.
 This desire manifests in multiple forms; for example, there are nurses who
prefer to care for babies or children, nurses who desire to care primarily
for cancer patients, and nurses who wish to care specifically for women.
 Although nurses may choose to focus on providing care for specific patient
population, the common bond that holds nurses together is the desire to
provide care to another.
 An occupation or job may be described as providing labor, completing a task, or
delivering a service in exchange for remuneration.
 A profession is similar in that a service is provided for remuneration, but also
includes a shared culture.
 As all specialties of nursing encompasses a passion for the increasing well-
being of patients, a desire to provide specialized skills, and a desire to grow as a
nurse.
 A desire to enable patients, families, and communities to achieve an optimal
health status,is a core value of nursing.
 This goal is accomplished through the application of altruism, excellence,
caring, ethics, respect, communication, and accountability. These characteristics
are ingrained within the culture of nursing and considered a norm for the
nursing profession.
 The Gallup Poll (2022) has consistently found the nursing profession to be
ranked as the number one trusted profession in its annual polls of Americans.
 Nursing has been ranked as the most trusted profession by 80% of Americans
since 2005. This ranks nurses above pharmacists, medical doctors, and
members of the clergy.
 Indeed, the nursing culture has promoted a norm of caring which is recognized
by the public and elevated the nursing profession to the number one most
trusted profession.

What Is the Nursing Code of Ethics?

Why Ethics in Nursing Matters

 Registered nurses routinely encounter issues that may have ethical implications.
 Nurses work with patients whose lives may be at stake.
 It’s a nurse’s job to follow protocol and best practices while treating the patient
as an individual with their own wishes and preferences for care.
 These decisions may warrant discussion with the larger care team, or they may
require swift action in a moment of crisis.
 Understanding ethics and the consequences of their actions can help a nurse
make the best decision when it isn’t always apparent.

 The American Nurses Association (ANA) Code of Ethics for Nurses with
Interpretive Statements (Code of Ethics) has been a guide and reference for
registered nurses since its development in the 1950s.

 It serves as a moral compass to promote high levels of care, an ethical standard

for those entering the nursing profession, and a commitment to society
affirming the responsibilities of the registered nurse.
 The Code of Ethics has been revised over time to reflect technological
advances, societal changes, and the expansion of the nursing practice. Every
day, nurses draw upon ethical nursing principles to make patient care decisions.
That’s one reason that for over two decades, nurses have led Gallup’s annual
ranking of professions for high honesty and ethics.

American Nurse Association Code of Ethics

The American Nurses Association Code of Ethics for Nurses With Interpretive
Statements is an ethical standard that guides nursing practice and ethical decision-
making. It states, “Individuals who become nurses are expected to adhere to the
ideals and moral norms of the profession and also to embrace them as a part of
what it means to be a nurse. The ethical tradition of nursing is self-reflective,
enduring, and distinctive. A code of ethics makes explicit the primary goals,
values, and obligations of the profession.”

The Code of Ethics for Nurses contains nine provisions. Each provision contains
several clarifying or “interpretive” statements. Read a summary of the nine
provisions below

Nine Provisions of the ANA’s Code of Ethics for Nurses

Provision 1: The nurse practices with compassion and respect for the inherent
dignity, worth, and unique attributes of every person.

Provision 2: The nurse’s primary commitment is to the patient, whether an

individual, family, group, community, or population.

Provision 3: The nurse promotes, advocates for, and protects the rights, health,
and safety of the patient.

Provision 4: The nurse has authority, accountability, and responsibility for nursing
practice; makes decisions; and takes action consistent with the obligation to
promote health and to provide optimal care.

Provision 5: The nurse owes the same duties to self as to others, including the
responsibility to promote health and safety, preserve wholeness of character and
integrity, maintain competence, and continue personal and professional growth.
Provision 6: The nurse, through individual and collective effort, establishes,
maintains, and improves the ethical environment of the work setting and conditions
of employment that are conducive to safe, quality health care.

Provision 7: The nurse, in all roles and settings, advances the profession through
research and scholarly inquiry, professional standards development, and the
generation of both nursing and health policy.

Provision 8: The nurse collaborates with other health professionals and the public
to protect human rights, promote health diplomacy, and reduce health disparities.

Provision 9: The profession of nursing, collectively through its professional

organizations, must articulate nursing values, maintain the integrity of the
profession, and integrate principles of social justice into nursing and health policy.

Ethical Principles

Ethical principles are used to define right from wrong action. Although there are
many ethical principles that guide nursing practice, foundational ethical principles
include respect for autonomy (self-determination), beneficence (do good), non
maleficence (do no harm), justice (fairness), fidelity (keep promises), and veracity
(tell the truth)

1. Autonomy

 The ethical principle of autonomy recognizes each individual’s right to self-

determination and decision-making based on their unique values, beliefs, and
preferences.
 The American Nurses Association (ANA) defines autonomy as, “the capacity
to determine one’s own actions through independent choice, including
demonstration of competence.”
 Autonomy is a nursing principle that recognizes a patient’s right to make
decisions and determinations for themselves.
 Nurses adhere to this principle by making sure that patients have all the
information needed to make a decision, including any treatment options, risks,
benefits and complications.
 When the patient has this information, the nurse respects their right to make a
decision that aligns with their goals and wishes, even if they don’t necessarily
agree with the decision.
 Certain factors can impact a patient’s decision to receive or refuse treatment,
including their culture, general health, gender, age or social support system.
 A nurse can serve as an advocate for the patient, particularly with other
members of the medical staff who may disagree with or forget what the patient
requested in their care.
 The nurse’s primary ethical obligation is client autonomy.
 Based on autonomy, clients have the right to refuse nursing care and medical
treatment.

2.Beneficence

 Beneficence is defined by the ANA as, “the bioethical principle of benefiting

others by preventing harm, removing harmful conditions, or affirmatively
acting to benefit another or others, often going beyond what is required by law.”
 When caring for clients with mental health disorders, nurses implement
beneficence when advocating for evidence-based treatment for clients’ mental
health. Do good to others.
 It refers to actions that benefit others. Actions guided by compassion and
consideration of the welfare of others are considered beneficial, and nurses can
apply the principles of charity and kindness when caring for patients and the
communities they serve.
 This principle also involves showing patients, their families and extended
communities empathy and courtesy in all circumstances. Successful nurses
demonstrate compassion and respect toward their colleagues and even
themselves.

3.Non-Maleficence

 Nonmaleficence is defined by the ANA as, “the bioethical principle that

specifies a duty to do no harm and balances avoidable harm with benefits of
good achieved.” Nonmaleficence means to do no harm.
 Of the nursing ethics, this is one of the most well-known as it also applies to
physicians and others in the health care industry.
 The responsibility of nurses is to choose care, interventions and treatment
options that will do the least amount of harm.
 This principle protects the patient when receiving care. The principle of
nonmaleficence also applies to nurses when treating patients who may cause
harm to themselves or another person, and they need intervention.
 A classic example of doing no harm in nursing practice is reflected by nurses
checking medication rights three times before administering medications.
 In this manner, medication errors can be avoided, and the duty to do no harm is
met.
 An example of nurses implementing nonmaleficence in mental health care is
ensuring that clients are not harmed by adverse effects of psychotropic
medications (such as lithium toxicity or tardive dyskinesia).

4.JUSTICE

 Justice is defined by the ANA as, “a moral obligation to act on the basis of
equality and equity and a standard linked to fairness for all in society.”
 The principle of justice requires health care to be provided in a fair and
equitable way.
 Nurses provide quality care for all individuals with the same level of fairness
despite their personalities or characteristics, such as financial status, cultural
beliefs, religion, gender, or sexual orientation.
 Nurses have a social contract to “provide compassionate care that addresses
the individual’s needs for protection, advocacy, empowerment, optimization
of health, prevention of illness and injury, alleviation of suffering, comfort,
and well-being.”
 An example of a nurse using the principle of justice in mental health care
settings is ensuring that quality care is provided to all clients, even those
who do not have the cognitive ability to communicate their needs.

5. FIDELITY

Role fidelity is defined as being responsible for providing competent nursing care.
An example of role fidelity in nursing is remaining up-to-date with evidence-based
practice and implementing effective mental health interventions.

6.VERACITY

Veracity means telling the truth. An example of veracity in health care is informed
consent. Nurses ensure that clients have a good understanding of the benefits and
risks of a prescribed procedure or psychotropic medication.

CODE OF PROFESSIONAL CONDUCT

 The Code of Professional Conduct places the client/patient at the center of Nursing
activities.

The purposes of the Code of Professional Conduct are to:

 Inform Professional Nurses of the Standards of Professional Conduct

required of them in the exercise of their professional accountability and
practice.
 Inform the public, other professions and employers, of the standard of
Professional Conduct that they can expect of a Registered Practitioner.

Code of Professional Ethics By Nursing And Midwifery Council Of Nigeria

Who is a nurse?

A Nurse is a person who has received authorized education, acquired specialized

knowledge, skills and attitudes, and is registered and licensed with the Nursing and
Midwifery Council to provide promotive, preventive, supportive and restorative
care to individuals, families and communities, independently, and in collaboration
with other members of the health team.

The Nurse must provide care in such a manner as to enhance the integrity of the
profession, safeguard the health of the individual client/patient and protect the
interest of the society.

The Professional Nurse and the Health Care Consumer

The Nurse must:
 Provide care to all members of the public without prejudice to their age, religion,
ethnicity, race, nationality, gender, political inclination, health or social economic
status.
 Uphold the health consumer's human rights as provided in the constitution.
 Ensure that the client/patient of legal age of 18 years and above gives informed
consent for Nursing intervention. In case the health consumer is under aged, the
next of kin or the parents can give the informed consent on his behalf.
 Keep information and records of the client confidential except in consultation with
other members of the health team to come up with suitable intervention strategies
or in compliance with a court ruling or for protecting the consumer and the public
from danger.
 Avoid negligence, malpractice and assault while providing care to the
client/patient.
 Relate with a consumer in a professional manner only.
 Not take bribe or gifts that can influence you to give preferential treatment.
 Consider the views, culture and Beliefs of the client/patient and his family in
the design and implementation of his care/treatment regimen.
 Know that all clients/patients have a right to receive information about their
condition.
 Be sensitive to the needs of clients/patients and respect the wishes of those
who refuse or are unable to receive information about their condition.
 Provide information that is accurate, truthful and presented in such a way as
to make it easily understood.
 Respect clients and patients' autonomy, their right to decide whether or not
to undergo any health care intervention even where a refusal may result in
harm or death to themselves or a foetus, unless a court of law orders to the
contrary.
 Presume that every patient and client is legally competent unless otherwise
assessed by a suitably qualified practitioner. A patient or client who is
legally competent can understand and retain treatment information and can
use it to make an informed choice.
 Know that the principles of obtaining consent apply equally to those people
who have a mental illness.
 Ensure that when clients and patients are detained under statutory powers
(e.g. Mental Health Act), you know the circumstances and safeguards
needed for providing treatment and care without consent.
 Provide care in emergencies where treatment is necessary to preserve life
without clients/patients consent, if they are unable to give it, provided that
you can demonstrate that you are acting in their best interests.
 The Professional Nurse and the Nursing Profession
The Nurse must:
 Attend workshops, conferences, seminars and courses that are recognized by the
Nursing and Midwifery Council of Nigeria and which are relevant to the
profession, at least, once a year.
 Engage in behaviour and activities that uplift the social status and integrity of
Nurses.
 Always appear Neat and decently dressed, without using bogus/dangling earrings,
long and big wigs (all hair do must not extend below the neck level), high heeled
shoes, long painted nails and bogus make up while on duty and in uniform.
 Not fight or steal.
 Be courteous, honest and resourceful.

 Not wear Uniforms and Overall outside the hospital premises.

 Not strap babies/children on her back while in Uniform.
 Provide care, using current evidence based principles and practice and the Nursing
Process.
 Participate in the training of Student Nurses/Midwives and Students of health
related disciplines.
 Co-operates and collaborates with Professional Associations to secure good
Conditions of Service.
 Demonstrate skills and abilities required for lawful, safe and effective Professional
practice without direct supervision.
The Professional Nurse And Nursing Practice
The Nurse must:
 Be personally accountable for the care that she provides to clients/patient
This means that she is answerable for her actions and omissions regardless
of advice or directives from other health professionals.
 Be punctual to duty and hand over, patients and equipment physically after
duty.
  Switch off her telephone/handsets when providing care to clients/patients
and when teaching in the classroom.
 Avoid the use of self in the advertisement, promotion or sale of commercial
products, services and illicit trade such as trafficking in hard drugs.
 Reject any form of gift, favor or gratification which might appear to have
undue influence or advantage towards obtaining preferential treatment.

Professional Nurse And Professional Colleagues

The Nurse must:
 Work cooperatively and collaboratively with Professional Colleagues and
other members of the health team for ethical procedure ONLY.
 Exhibit 'Espirit de corps' in all situations except when it involves fraudulent
and unethical practices.
 Delegate functions and responsibilities to subordinates according to their
abilities and competencies, supervising them accordingly.
 Not ridicule Professional Colleagues and especially NOT in the presence of
Clients/Patients or other members of the health team.

The Professional Nurse And The Public

The Nurse must:
 Protect the public against danger or harmful agents
 Have regard to the environment of care and its physical, psychological and social
effects on the client/patient.
 Access the adequacy of resources and make known to appropriate persons and
authorities, any circumstances which could place clients/patients in jeopardy or
which militate against safe standards of practice.
 Contribute to policy making.
The Professional Nurse And The Global Health Organization
 The Nurse must:
 Implement global health initiatives and instruments to which the country, the
Nursing and Midwifery Council of Nigeria, National Association of Nigeria
Nurses and Midwives (NAMMN) are signatory.
 Participate actively in International and National Conferences and Conventions and
contribute her quota to the development of Nursing Sciences.
 The Code of Professional Conduct highlighted in this document is intended to
empower the Professional Nurse Practitioner to provide effective care to
individuals, families and communities.
 The Nursing and Midwifery Council of Nigeria subscribes to the fact that Nursing
is an inalienable right of citizens and as such the professional Nurse has the
responsibilities of assisting them to attain the optimal level of health.
 The Nursing and Midwifery Council of Nigeria believes that this Code of
Professional Conduct will serve as a springboard for providing effective
NURSING Care in Nigeria.

THE ICN CODE OF ETHICS FOR NURSES

An international code of ethics for nurses was first adopted by the International
Council of Nurses (ICN) in 1953. It has been revised and reaffirmed at various
times since, most recently with this review and revision completed in 2021.

Purpose Of The Code

The ICN Code of Ethics for Nurses is a statement of the ethical values,
responsibilities and professional standards of nurses. It guides everyday ethical
nursing practice and can serve as a regulatory tool to guide and define ethical
nursing practice.

The ICN Code of Ethics for Nurses provides ethical guidance in relation to
nurses’ roles, responsibilities, behaviours, decision-making and relationships
with patients and people who are receiving nursing care.
It is to be used in combination with the laws, regulations and professional
standards of countries that govern nurses’ practice.

The values and obligations expressed in this Code apply to nurses in all
settings, roles and domains of practice, and should be aspired to by all nursing
students.

Preamble

From the origins of organised nursing in the mid-1800s, nurses have

consistently recognised four fundamental nursing responsibilities:

1. to promote health,
2. to prevent illness,
3. to restore health, and
4. to alleviate suffering.
The need for nursing is universal. Inherent in nursing is a respect for human
rights, including cultural rights, the right to life and choice, to dignity and to be
treated with respect.

Nursing care is respectful of and unrestricted by considerations of age, colour,

culture, disability or illness, gender, sexual orientation, nationality, politics,
race, religious or spiritual beliefs, legal, economic or social status.

Nurses render health services to the individual, the family, community and
populations and coordinate their services with those of other health care
professionals and related groups.

THE ICN CODE The ICN Code of Ethics for Nurses has four principal
elements that outline the standards of ethical conduct.

These four elements,

1. nurses and patients or people requiring care,

2. nurses and practice,
3. nurses and the profession, and
4. nurses and global health, give a framework for the standards of ethical
conduct.

ELEMENTS OF THE CODE

1. Nurses And Patients Or People Requiring Care1

1. Nurses’ primary professional responsibility is to people requiring nursing

care whether individuals, families, communities or populations
(hereinafter referred to as either ‘patients’ or ‘people requiring care’).
2. Nurses promote an environment in which the human rights, values,
customs, religious and spiritual beliefs of the individual, family and
community are respected and promoted by everyone.
3. Nurses ensure that the individual receives accurate, sufficient and timely
information in a culturally appropriate manner on which to base consent
for care and related treatment.
4. Nurses hold in confidence personal information and respect the privacy,
confidentiality and interests of patients in the lawful collection, use,
access, transmission, storage and disclosure of this information.
5. Nurses respect the privacy and confidentiality of colleagues and people
requiring care and uphold the integrity of the nursing profession in
person and in all media, including social media.
6. Nurses share with society the responsibility for initiating and supporting
action to meet the health and social needs of all people.
7. Nurses advocate for equity and social justice in resource allocation,
access to health care and other social and economic services.
8. Nurses demonstrate professional values such as respect, justice,
responsiveness, compassion, empathy, trustworthiness and
integrity.Nurses provide evidence-informed, person-centred care,
recognising and using the values and principles of primary health care
and health promotion.
9. Nurses encourage a culture of safe health care and raise any concerns
regarding the safety of people and health services.
10.Nurses support and protect the right to self-determination of all patients
and other health care professionals.
11.Nurses ensure that use of technology and scientific advances are
compatible with the safety, dignity and rights of people. In the case of
devices, such as robots, nurses ensure that care remains person-centred
and that such devices support and do not replace human relationships.
The two terms ‘patients’ and ‘people requiring care’ are used
interchangeably. The two terms refer to the patient, family, community
and populations requiring care.

2. NURSES AND PRACTICE

a. Nurses carry personal responsibility and accountability for nursing practice,

and for maintaining competence by continual learning. They engage in
continuous professional development and lifelong learning.
b. Nurses maintain fitness to practice so as not to compromise the ability to
provide care.
c. Nurses practise within the limits of their individual competence and use
judgement when accepting and delegating responsibility.
d. Nurses value their own dignity, well-being and health. They know that
positive practice environments, characterised by professional recognition,
education, support structures, adequate resourcing, management practices
and occupational health and safety, are pivotal to achieve them.
e. Nurses, at all times maintain standards of personal conduct which reflect
well on the profession and enhance its image and public confidence. In their
professional role, nurses recognise and maintain personal relationship
boundaries.
f. Nurses share their knowledge and provide feedback, mentorship and
guidance for the professional development of nursing students, novice
nurses, other nurses and other health care providers.
g. Nurses foster and maintain a practice culture that promotes ethical behaviour
and open dialogue.
h. Nurses may conscientiously object to participating in a particular medical
procedure or research study but must ensure that people receive care.
i. Nurses maintain a person’s right to give and withdraw informed consent to
access their genetic information, including activities linked to genetic and
genomic-based research. They protect the use, privacy and confidentiality of
genetic information and human genome materials. They also foster the
equitable access to genomic technologies.
j. Nurses develop and sustain collaborative and respectful relationships with
colleagues and other members of the health care team. They recognise and
respect their knowledge, skills and perspectives.
k. Nurses take appropriate actions to safeguard individuals, families and
communities when their health is endangered by a co-worker, any other
person, policy, practice or misuse of technology.
 l. Nurses are active participants in the promotion of patient safety. They
promote ethical conduct when errors or near misses occur, speak up when
patient safety is threatened, and work with others to reduce the potential of
errors.

3. NURSES AND THE PROFESSION

 Nurses assume the major role in determining and implementing acceptable

standards of clinical nursing practice, management, research and education.
 Nurses are active in developing a core of research-based, updated professional
knowledge that supports evidence-informed practice.
 Nurses are active in developing and sustaining a core of professional values.
 Nurses, through their professional organisations, participate in creating a
positive practice environment that supports individual practice and ensures safe
quality care, and maintains safe, equitable social and economic working
conditions for nurses.
 Nurses contribute to positive and ethical organisational environments and
challenge unethical practices and settings.
 Nurses engage in the creation, dissemination and use of research.
 Nurses prepare for and respond to emergencies, disasters, conflicts, epidemics
and conditions of scarce resources

4. NURSES AND GLOBAL HEALTH

 Nurses value access to health care as a human right, affirming the need for
universal health coverage.
 Nurses uphold the dignity, freedom and worth of all human beings and
oppose all forms of exploitation, such as human trafficking and child labour.
 Nurses lead or contribute to health policy development.
 Nurses support and work towards the achievement of the United Nations
Sustainable Development Goals.
 Nurses recognise the significance of the social determinants of health. They
contribute to, and advocate for, policies and programmes that address them.
 Nurses collaborate and practice to preserve, sustain and protect the natural
environment and are aware of its consequences on health. They advocate for
initiatives that reduce environmentally harmful
 practices in order to promote health and well-being.
 Nurses collaborate with other health professions and the public to uphold
principles of justice by promoting responsibility in human rights, equity and
fairness and by promoting the public good and a healthy planet.
Concept of health and illness

1. Defining health and wellbeing

 The World Health Organisation (WHO) defines health as ‘a state of

complete physical, mental and social wellbeing and not merely the absence
of disease or infirmity’ (WHO, 1948).
 This is consistent with the biopsychosocial model of health, which considers
physiological, psychological and social factors in health and illness, and
interactions between these factors.

 Health is also defined as “the state of being hale, sound, or whole, in body,
mind, or soul; especially, the state of being free from physical disease or
pain. It differs from the traditional medical model, which defines health as
the absence of illness or disease and emphasizes the role of clinical
diagnosis and intervention.

 The WHO definition links health explicitly with wellbeing, and

conceptualizes health as a human right requiring physical and social
resources to achieve and maintain. ‘Wellbeing’ refers to a positive rather
than neutral state, framing health as a positive aspiration.

 This definition was adapted by the 1986 Ottawa charter, which describes
health as ‘a resource for everyday life, not the object of living’. From this
perspective health is a means to living well, which highlights the link
between health and participation in society.

 A major criticism of this view of health is that it is unrealistic, because it

‘leaves most of us unhealthy most of the time’ few, if any people will have
complete physical, mental and social wellbeing all the time, which can make
this approach unhelpful and counterproductive .

 It fails to take into account not just temporary spells of ill health, but also the
growing number of people living with chronic illnesses and disabilities.
Furthermore, it might be argued that focusing on ‘complete’ health as a goal
contributes to the over medicalisation of society by pathologising
suboptimal health states.
  Huber proposed a new definition of health as ‘the ability to adapt and to
self-manage’, which includes the ability of people to adapt to their
situation as key to health. It also acknowledges the subjective element of
health; what health and wellbeing mean will differ from one person to the
next, depending on the context and their needs.

 This is considered by many to be a limitation of broader definitions of

health, on the grounds that wellbeing is neither objective nor measurable. A
further limitation of this approach is that it is very individualistic and takes
little account of the wider determinants of health. Responsibility for health is
seen as individual rather than collective, with little scope to promote it as a
human right.

2. Mental health and wellbeing

 Broadening definitions of health has contributed to improving understanding

of the mental dimension of health and wellbeing, and increasing recognition
of public mental health as integral to public health.
 Mental health is recognised as equally important to physical health in the
development, delivery and provision of health and social care services.
 Public mental health policy aims to improve population mental health and
wellbeing, prevent the onset of mental and emotional distress, and increase
resilience.

The relationship between mental and physical health

 Mental health and physical health are inextricably linked, with evidence for a
strong relationship between the two accumulating over recent decades and
challenging the historical notion of mind-body duality.
 Mechanisms for this association can be physiological, behavioural and social,
as identified by the biopsychosocial model of health. The nature of this
relationship is two-way, with mental health influencing physical health and vice
versa.
 Mammalian stress responses (i.e. fight, flight or freeze) are known to affect
physiological processes regulated by the autonomic nervous system, including
cardiovascular, respiratory, digestive, repair and defence functions.
 A number of medical conditions have been linked to stress, such as irritable
bowel syndrome, asthma and migraine headaches.
 Likewise, stronger immune function has been associated with high levels of
social support and hardiness, both of which may modify experiences of stress
and its physiological manifestations.
 Whilst it is clear that physical ill-health can be accompanied by mental health
problems such as anxiety and depression, the resulting psychological state may
in turn impede the recovery or stabilisation of medical conditions, thus
producing a vicious circle in which wellbeing is difficult to attain.

Determinants of Health

The range of personal, social, economic and environmental factors that

influence health status are known as determinants of health. These can be
classified as:
1. The social and economic environment
2. The physical environment
3. The person’s individual characteristics and behaviours
There are many commonly accepted determinants of health but there is no
single definition. The Office of Disease Prevention and Health Promotion
(ODPHP) has broadly categorised the determinants of health and these have
been summarised below:

1. Policy-making

Policies at the local, state and federal levels effect individual and population
health. Increasing taxes on tobacco sales, for example, can improve population
health by reducing the number of people using tobacco products. Unfavorable
conditions can result due to substandard policies and programmes, inadequate
governance and unfair economic arrangements

2. Social Factors

Social and physical determinants of health reflect the conditions of the

environment in which people are born, live, learn, play, work and age. Also
known as social determinants of health, they impact a wide range of health,
functioning and quality-of-life outcomes. They represent economic and
political systems, physical and social environments, as well as health service
access. Social determinants of health (SDOH) have a major impact on people’s
health, well-being, and quality of life.

Examples include:

 Availability of resources to meet daily needs, such as educational and job

opportunities, living wages or healthful foods
 Social norms and attitudes such as discrimination
 Exposure to crime, violence and social disorder
 Social support and social interactions
 Socioeconomic conditions such as concentrated poverty
 Quality schools
 Transportation options
 Urbanisation and the built environment such as buildings or
transportation
 Worksites, schools and recreational settings
Poor health outcomes are associated with adverse conditions leading to social
risk factors.
Social determinants of health (SDOH) have a major impact on people’s health,
well-being, and quality of life.Other Examples of SDOH include:
 Safe housing, transportation, and neighborhoods
 Racism, discrimination, and violence
 Education, job opportunities, and income
 Access to nutritious foods and physical activity opportunities
 Polluted air and water
 Language and literacy skills

3. Health Services
Both access to health services and the quality of health services can impact
health. Barriers to accessing health services include lack of availability, high
cost, lack of insurance coverage and limited language access. These barriers to
accessing health services lead to unmet health needs, delays in receiving
appropriate care, inability to get preventive services as well as hospitalisations
that could have been prevented.

4. Individual Behaviour :Individual behaviours such as diet, physical

activity, alcohol, tobacco and other drug use also play a role in health
outcomes.
5. Biology and Genetics
Some biological and genetic factors affect specific populations more than
others. Examples of biological and genetic determinants of health include age,
sex, inherited conditions and genetic make-up.
Some biological and genetic factors affect specific populations more than
others. For example, older adults are biologically prone to being in poorer
health than adolescents due to the physical and cognitive effects of aging.
Sickle cell disease is a common example of a genetic determinant of health.
Sickle cell is a condition that people inherit when both parents carry the gene
for sickle cell. The gene is most common in people with ancestors from West
African countries, Mediterranean countries, South or Central American
countries, Caribbean islands, India, and Saudi Arabia.
 Examples of biological and genetic social determinants of health include:
Age
 Sex
 HIV status
 Inherited conditions, such as sickle-cell anemia, hemophilia, and cystic
fibrosis
 Carrying the BRCA1 or BRCA2 gene, which increases risk for breast and
ovarian cancer
 Family history of heart disease

1. Definitions of sickness, illness and disease

Although the terms are often used interchangeably, sickness, illness and disease
have different meanings that reflect different perspectives.

Disease is an objective term referring to diagnosable abnormalities in organs,

body systems or physiology. We can presume that disease is an abnormal,
pathological state that affects either parts of a human being or all the parts of
individual. Disease is often interpreted as a medical condition that is associated
with explicit indicators and signs. Disease is a pathological process which makes
an individual to deviate from his normal state of being. In medical sociology, a
disease is defined as “an adverse physical state consisting of a physiological
dysfunction within an individual, as compared to an illness (psychological
awareness of a disease) or a sickness (a social state)”

Illness is a subjective term referring to an individual’s experience of mental

and physical sensations or states, and may not necessarily indicate the presence
of disease. Illness on the other hand is defined is seen as the socio-cultural
dimension within which a person experiences disease. Susser tried to define the
term “illness” by referring it to the inner sense of an individual’s feeling unwell.
According to him, illness does not refer to any explicit pathology, but refers to a
person’s subjective understanding of it, such as discomfort, tiredness, or general
malaise.

Sickness encompasses both disease and illness. We can even regard the concept
of sickness as such a notion that combines the biomedical model (disease) with the
socio-cultural context of the patient (illness).. So, sickness = disease + illness
where disease is the biological/physiological malfunctioning(clinical perspective).
And illness is the experience and perception of disease within the sociocultural
context including spirituality and religion.

The difference between illness and disease was summarised thus, “Illness is
what the patient feels when he goes to the doctor, disease is what he has on the
way home”.

The view of illness as a social role is based on the premise that the behaviour of
patients, doctors and careers is related to social perceptions or constructs of
sickness.

2. The sick role

Sick role’ is the rights and responsibilities of people who are sick. Rights
include exemption from normal responsibilities, e.g. work, household or caring
duties, and not being blamed for their illness; responsibilities include a duty to
want to recover, and to seek medical assistance in doing so. It is assumed that
these rights and responsibilities are temporary and universal, and that they work
together for the benefit of the patient and in the interests of wider society.
The Concept

What is a health continuum and why is it used?

A health continuum, also called an illness-wellness continuum, is a visual tool

that can be used to help people make healthy choices in their lives. At one end
of the continuum is premature death, while optimal health lies at the other end.
The health continuum can be a tool for nurses to use as they help patients on
the path to better health.

Nurses must wear many different hats during a workday. One of these hats is that
of educator. Part of a nurse's job is to educate and inspire patients to work towards
better health. A helpful tool in educating patients is the health continuum, also
called the illness-wellness continuum. A health continuum definition is not
complete without an image of the continuum, below. The diagram shows a
connection between the treatment and wellness paradigms, which meet in the
middle at the neutral point.

The health continuum shows patients the path to a better, healthier lifestyle. The
far left end of the continuum, in the treatment paradigm, is premature death. As
patients move to the right, they reach the neutral point, leaving the treatment
paradigm solely in the wellness paradigm. Finally, at the far right of the continuum
is high-level wellness.
One of the health continuum benefits is that it is visual tool patients can use to see
and plan their journey to better health. It is a roadmap leading to a healthier
lifestyle and optimal health wherever a patient begins.

Dr. John W. Travis developed the illness-wellness continuum in 1972. According

to him a person is not only considered to be healthy based on the absence of
disease but also wellness of mental and emotional health.In this Travis model right
side shows a high level of wellness i.e. achievement of optimum health and the
left side shows premature death.
He observed that doctors and nurses usually treat illness, disabilities, and
symptoms, which bring a patient to the neutral zone. However, Dr. Travis did not
believe the neutral zone should be the end goal. Instead, he thought wellness is a
process and that nurses and doctors should educate and help their patients move
further down the continuum towards high-level wellness. According to Dr. Travis,
this could be done through awareness, education, and growth.
The individual’s state of health is one of continual change.He moves back and
forth from health to illness and back to health again. His condition is rarely
constant. He may wake up feeling great, develop a headache mid-morning, and feel
fine again by noon.The health-illness continuum illustrates this process of change,
in which the individual experiences various states of health and illness (ranging
from extremely good health to death) that fluctuate throughout his life.

The Health, Illness - Wellness Continuum

Health
Absence of symptoms of illness and ability to carryout activities.
Illness
A state in which the person feels unhealthy may or may not related to disease.
Wellness
A state of optimal health or optimal functioning.

Wellness is a process, never a static state.

The illness- wellness continuum, illustrate the process of change, in which the
individual experiences various states of health and illness (ranging from extremely
good health to death that fluctuate throughout life. People move back and forth
with in this continuum day by day) the illness wellness continuum composed of
two arrows pointing in opposite direction and joined at neutral point.
1. Movement to the right on the arrows (towards high level wellness) equals and
increasing level of health and wellbeing.
Achieved in three stages; a Awarness b Education c Growth
2. Movement to the left on the arrows (towards pre matured death ) equals a
progressively decreasing state of health.Achieved in three stages: a Signs
b Symptoms c Disability
3. Most important is the direction the individual is facing on the pathway.

a If towards high level heath, a person has a positive outlook despite is/her health
status. b If towards premature death, a person has negative outlook about is/her
health status.

4. Compares treatment model with wellness model a If treatment model is used

and individual can move right only to the neutral point. (eg.) client with
hypertension takes only medication without making any other life style changes.
b If a wellness model is used, and individual can move right past the neutral point.
(eg) client with hypertension not only takes his medication but stops smoking,
loose weight etc

Role of nurse in achieving health

 Nurse can determine clients stage of health and position at health illness
model.
 Nurse can also recognise risk factors that are causing degradation in health
of client, it may be genetics, or physiological.
 She can also prevent the illness through awareness, educating the client.
Dunn’s high level of wellness and grid model
Dunn’s wellness grid model contains two axis like health axis and environment
axis.
The Health axis starts from extreme wellness (Peak wellness) to death. The
environment axis starts from a very favourable environment to a very unfavourable
environment.
Health axis and environment axis intersect each other and form four quadrants.
 High level of wellness with a very favourable environment. A person
maintaining optimum health and his surrounding environment like family,
society interacts well and support him will live in this quadrant.
 For example, A person lives a healthy lifestyle means taking proper diet,
regularly doing exercises, regular check-up of health with that doing
meditation, keeping healthy relationship with society makes a person achieve
optimum health.

 Emergent high-level wellness in an unfavourable environment. A person

who knows how to maintain health but could not fulfill it due to certain
circumstances will be in this quadrant.For example, A software engineer knows
he needs to do exercise regularly and take proper nutrition, but due to work
pressure, he could not fulfil it.
 Protected poor health in a favourable environment. A person who has some
kind of illness but he has access to healthcare facilities and other resources to
protect his health.For example, A wealthy person who is living in a big city
meets an accident. He got admitted to a reputable hospital. After discharge, he
is taking physiotherapy.
 Poor health with unfavourable environment. A person having illness and do
not have any facility for treatment. For example, A person leaving in a tribal
area suffering from diarrhoea drinks dirty water from a pond due to the
unavailability of clean water.

MAN AND HIS ENVIRONMENT

Care Of Patient’s Environment

Purpose: To provide and maintain cleanliness as a precaution against the

spread of infection.

Rules for General cleaning

1. Collect all articles required before commencing work

2. Brooms, dusters, polishers and water must be clean

3. Sweep first, except for high dusting, with a proper brush, of walls blinds
etc.

4. Dusting should be done with a damp duster, polish surface and dry,
afterwards with a soft dry duster. Dust from top to bottom of articles using
firm even strokes.

5. All rubbish must be removed from tables and lockers (with patient’s
permission) when dusting, scrub and tidy insides of lockers weekly for long-
term patients.

6. Furniture ( including locker tops and tables) should be polished once a week
using furniture’s cream sparingly.

7. Painted works should be washed with soapy water, cleaning powder used
only to remove marks.

8. Use all cleaning materials with care and economy

9. Cleaning should be done in the following order:

I. Bed table

II. Lockers
 III. Bed stead

10.Start from cleaner areas to less clean areas

11.Damp-dusting is done first followed by dry-dusting to avoid scattering dust.

12.Discard any rubbish into the receiver for it.

13.Polished surfaces should be dry-dusted but sinks and taps are cleaned with
vim powder.

14.Wax polishing is done twice a week,

15.The entire ward is left neat and tidy

16.Replace dirty towels.

Requirements
It is a trolley procedure

Top shelf
I. A jug of cold water and a jug of hot water
II. 2 bowls of water with containing detergent and the other disinfectant (jik
1:6).

Bottom shelf
I. A receiver with 4 or more dusters
II. A receiver for used dusters
III. A bucket of water
IV. A receiver for detergent
V. A receiver for wooden furniture and brush
VI. A receiver for bottle of jik
VII. A receiver for gloves.
Note: The beds must have been made and ward swept about 30 minutes
before the commencement of the damp dusting.

Method/Procedure
1. Wet one of the dusters in soapy water, sqeeze out the excess water and use the
duster to clean.
2. Rinse the same duster in the disinfectant solution and use it to wipe.
3. Use the dry duster to dry the area cleaned.
4. Clean all the surfaces in the ward in this manner until the whole ward has been
completely cleaned.
5. As soon as the dry duster becomes wet, drop it in the receiver at the lower shelf
and pick another.
6. Change the water as soon as it becomes dirty.
7. After damp-dusting has been completed, wash all used equipment.
8. Place in the appropriate position
9. Dry the dusters in the sun and keep them for the next day.
NOTE:
General ward cleaning is usually done by ward orderlies, but nurses must
know how it should be done so that one may supervise cleaning and do it
herself when necessary.
1. Clean all trolleys daily before commencing work in the morning
2. Dust metal frames of screens before commencing work
3. Weekly, remove dirt from wheels of screens and trolley
4. Oil wheels weekly to prevent stiffness.

ASSISTED BATHING
See page 22 of the procedure manual.

Assignment : Theories used in nursing practice.