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Nursing

Nursing school

A Nursing school is a type of educational institution, or part thereof, providing education and training to become a fully-qualified nurse. The nature of nursing education and nursing qualifications varies considerably across the world.

History of nursing schools

Nursing in the United Kingdom

Florence Nightingale was one of the pioneers in establishing the idea of nursing schools from her base at St Thomas' Hospital, London in 1860 when she opened the 'Nightingale Training School for Nurses'. Her intention was to train nurses to a qualified level, with the key aim of learning to develop observation skills and sensitivity to patient needs, then allow them to work in hospital posts across the United Kingdom and abroad. Her influence flourished and nursing is now a course taught at a number of British universities. The University of Manchester was one of the first English institutions to offer the course at degree level.

Entry level courses, sought by most universities, are often five Standard Grades/GCSEs, including English, maths and a science (preferably biology), and two Highers/A-Levels. Mature students, over the age of twenty-one, have the option of entering upon completion of a college access course, and experience in jobs such as being a health/nursing assistant are also worthy for consideration into the course.

Currently, nursing is a three-year course in the UK with a balance between course work in classes and practical placements in a health care setting. The first year is foundation, where students learn anatomy and physiology and basic health care. In Second Year, students then split into one of four chosen branches-- adult nursing, paediatric nursing, mental health or learning disability nursing-- that they wish to specialise in and nursing placements usually involve working within the chosen branch area (for example, paediatric student nurses would only be sent to paediatric units) learning skills essential to that setting. Students complete their course after their Third Year, with the choice of undertaking degree essays during that final year or graduating with only a diploma. Those studying midwifery follow a different pathway, specialising in this area from the first day of First Year. Newly qualified nurses then have to register with the Nursing and Midwifery Council in order to apply for jobs and legally practice.

Nursing in the United States

In 1909 The University of Minnesota was the first university based nursing program. Yale School of Nursing became the first autonomous school of nursing in the United States in 1923. It had its own dean, faculty, budget, and degree meeting the standards of the University. The curriculum was based on an educational plan rather than on hospital service needs. In 1956, the Columbia University School of Nursing became the first in the United States to grant a master's degree in a clinical nursing specialty.

Pre-requisites often include math, English, and other basic level courses. Basic courses in biology, anatomy and physiology are required. Core coursework includes anatomy, physiology, pathology, and pharmacology. Additionally, a strong emphasis is placed on procedural education such as insertion of intravenous and urinary catheters, sterile dressing changes, proper administration of medications, physical examinations, caring bedside manner, and other vital skills. After the first semester basic skills are obtained, students rotate through Obstetrics, Mental Health, Medical, Surgical, Oncology, Critical Care and Pediatric Units to get a holistic view of nursing and what it encompasses. Many nursing students and nursing schools use medical and healthcare educational software as a study or training aid.

In the United States, students graduate from nursing education programs qualified to take the national licensing exam for Licensed Practical Nurses (LPNs) or Registered Nurses (RNs).

Nursing is a healthcare profession focused on the detail-oriented care of individuals, families, and communities in attaining, maintaining, and recovering optimal health and functioning. A nurse follows the directions of a doctor, and typically provide anything from basic triage care to assistance in serious trauma care and surgery.

Modern definitions of nursing describe it as a science and an art that focuses on promoting quality of life as defined by populations, communities, families, and individuals, throughout their life experiences from birth through the end of life.

History of nursing

Nursing comes in various forms in every culture, although the definition of the term and the practice of nursing has changed greatly over time. The former being known as a wet nurse and the latter being known as a dry nurse. In the 15th century, this developed into the idea of looking after or advising another, not necessarily meaning a woman looking after a child. Nursing has continued to develop in this latter sense, although the idea of nourishing in the broadest sense refers in modern nursing to promoting quality of life.

Prior to the foundation of modern nursing, nuns and the military often provided nursing-like services. The religious and military roots of modern nursing remain in evidence today in many countries. For example: in Britain, senior female nurses are known as ‘‘sisters’’. It was during time of war that a significant development in nursing history arose when Florence Nightingale, working to improve conditions of soldiers in the Crimean War, laid the foundation stone of professional nursing with the principles summarised in the book Notes on Nursing. Other important nurses in the development of the profession include: Mary Seacole, who also worked as a nurse in the Crimea; Agnes Elizabeth Jones and Linda Richards, who established quality nursing schools in the USA and Japan, and Linda Richards who was officially America's first trained nurse, graduating in 1873 from the New England Hospital for Women and Children in Boston.

New Zealand was the first country to regulate nurses nationally, with adoption of the Nurses Registration Act on the 12th of September, 1901. Ellen Dougherty was the first registered nurse. North Carolina was the first state in the United States to pass a nursing licensure law in 1903.

Nurses have experienced difficulty with the hierarchy in medicine that has resulted in an impression that nurses primary purpose is to follow the direction of medics. This tendency is certainly not observed in Nightingale's Notes on Nursing, where the doctors are mentioned relatively infrequently and often in critical tones, particularly relating to bedside manner.

The modern era has seen the development of nursing degrees and nursing has numerous journals to broaden the knowledge base of the profession. Nurses are often in key management roles within health services and hold research posts at universities.

Nursing as a profession

The authority for the practice of nursing is based upon a social contract that delineates professional rights and responsibilities as well as mechanisms for public accountability. In almost all countries, nursing practice is defined and governed by law, and entrance to the profession is regulated at national or state level.

The aim of the nursing community worldwide is for its professionals to ensure quality care for all, while maintaining their credentials, code of ethics, standards, and competencies, and continuing their education. There are a number of educational paths to becoming a professional nurse, which vary greatly worldwide, but all involve extensive study of nursing theory and practice and training in clinical skills.

Nurses care for individuals who are healthy and ill, of all ages and cultural backgrounds, and who have physical, emotional, psychological, intellectual, social, and spiritual needs. The profession combines physical science, social science, nursing theory, and technology in caring for those individuals. In order to work in the nursing profession, all nurses hold one or more credentials depending on their scope of practice and education. A Licensed practical nurse(LPN) (also referred to as a Licensed vocational nurse, Registered practical nurse, Enrolled nurse, and State enrolled nurse) works under a Registered nurse. A Registered nurse (RN) provides scientific, psychological, and technological knowledge in the care of patients and families in many health care settings. ($30,000-$50,000/yr base). Registered nurses may also earn additional credentials or degrees enabling them to work under different titles.

There is no profession which offers as many opportunities for diversified roles as does nursing. Nurses may follow their personal and professional interests by working with any group of people, in any setting, at any time. Some nurses follow the traditional role of working in a hospital setting.

The high demand for nurses in the US

The demand for nurses has been on the rise for several years, spurred by various economic and demographic factors. And demand for nurses is likely to continue to increase. Candidates for nursing jobs that are in highest demand include registered nurses, licensed practical nurses, certified nurse assistants, and certified medical assistants.

According to the US Department of Labor Bureau of Labor Statistics, employment for registered nurses is expected to increase 23% between 2006 and 2016. Here is a breakdown of The Bureau's estimated increase percentage per nurse employer type:

25% - Offices of physicians

23% - Home health care services

34% - Outpatient care centers, except mental health and substance abuse

33% - Employment services

23% - General medical and surgical hospitals, public and private

23% - Nursing care facilities

Nursing practice

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Nursing practice is primarily the caring relationship between the nurse and the person in their care. In providing nursing care, nurses are implementing the nursing care plan, which is based on a nursing assessment.

Nursing Definition

Although nursing practice varies both through its various specialities and countries,is the International Council of Nurses offers the following definition:

Nursing encompasses autonomous and collaborative care of individuals of all ages, families, groups and communities, sick or well and in all settings. Nursing includes the promotion of health, prevention of illness, and the care of ill, disabled and dying people. Advocacy, promotion of a safe environment, research, participation in shaping health policy and in patient and health systems management, and education are also key nursing roles.

The use of clinical judgement in the provision of care to enable people to improve, maintain, or recover health, to cope with health problems, and to achieve the best possible quality of life, whatever their disease or disability, until death.

Nursing is the protection, promotion, and optimization of health and abilities; prevention of illness and injury; alleviation of suffering through the diagnosis and treatment of human responses; and advocacy in health care for individuals, families, communities, and populations.

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.

Nursing theory and process

In general terms, the nursing process is the method used to assess and diagnose needs, plan and implement interventions, and evaluate the outcomes of the care provided. Like other disciplines, the profession has developed different theories derived from sometimes diverse philosophical beliefs and paradigms or worldviews to help nurses direct their activities to accomplish specific goals. Currently, two paradigms exist in nursing, the totality paradigm and the simultaneity paradigm.

Nursing Practice settings

Nurses practice in a wide range of settings, from hospitals to visiting people in their homes and caring for them in schools to research in pharmaceutical companies. Nurses work in occupational health settings (also called industrial health settings), free-standing clinics and physician offices, nurse-run clinics, long-term care facilities and camps. They also work on cruise ships and in military service. Nurses act as advisers and consultants to the healthcare and insurance industries. Some are attorneys and others work with attorneys as legal nurse consultants, reviewing patient records to assure that adequate care was provided and testifying in court. Nurses can work on a temporary basis, which involves doing shifts without a contact in a variety of settings, sometimes known as per diem nursing, agency nursing or travel nursing.

Nursing Work Environment

Internationally, there is a serious shortage of nurses. One reason for this shortage is due to the work environment in which nurses practice. In a recent review of the empirical human factors and ergonomic literature specific to nursing performance, nurses were found to work in generally poor environmental conditions. DeLucia, Ott, & Palmieri (2009) concluded, "the profession of nursing as a whole is overloaded because there is a nursing shortage. Individual nurses are overloaded. They are overloaded by the number of patients they oversee. They are overloaded by the number of tasks they perform. They work under cognitive overload, engaging in multitasking and encountering frequent interruptions. They work under perceptual overload due to medical devices that do not meet perceptual requirements (Morrow et al., 2005), insufficient lighting, illegible handwriting, and poor labeling designs. They work under physical overload due to long work hours and patient handling demands which leads to a high incidence of MSDs. In short, the nursing work system often exceeds the limits and capabilities of human performance. HF/E research should be conducted to determine how these overloads can be reduced and how the limits and capabilities of performance can be accommodated. Ironically, the literature shows that there are studies to determine whether nurses can effectively perform tasks ordinarily performed by physicians. Results indicate that nurses can perform such tasks effectively. Nevertheless, already overloaded nurses should not be given more tasks to perform. When reducing the overload, it should be kept in mind that underloads also can be detrimental to performance (Mackworth, 1948). Considering both overloads and underloads are important to consider for improving performance."

Nursing Regulation of practice

The practice of nursing is governed by laws that define a scope of practice, generally mandated by the legislature of the political division within which the nurse practices. Nurses are held legally responsible and accountable for their practice. The standard of care is that of the "prudent nurse."