I.

Nursing as a Profession
A. Profession
1. Definition
a. Profession is a calling that requires special knowledge, skill
and preparation.
b. An occupation that requires advanced knowledge and skills
and that it grows out of societys
needs for special
services.
2. Criteria
1. To provide a needed service to the society.
2. To advance knowledge in its field.
3. To protect its members and make it possible to practice
effectively.
B. Nursing

1. Definition

a. A disciplined involved in the delivery of health care to the

society.
b. A helping profession
c. Service-oriented to maintain health and well-being of people.
d. An art and a science.

2. Characteristics

1. Nursing is caring.
2. Nursing involves close personal contact with the recipient of
3.

4.

5.
6.

care.
Nursing is concerned with services that take humans into
account as physiological, psychological, and sociological
organisms.
Nursing is committed to promoting individual, family,
community, and national health goals in its best manner
possible.
Nursing is committed to personalized services for all persons
without regard to color, creed, social or economic status.
Nursing is committed to involvement in ethical, legal, and
political issues in the delivery of health care.

3. Focus: Human Responses

a. These are the responses of individuals to actual or

potential health problems are the phenomena of concern
to nurses. Human responses include any observable need,
concern, condition, event, or fact of interest to nurses that
may be the target of evidence-based nursing practice.

4. Personal and Professional Qualities of a Nurse:

a. Must have a Bachelor of Science degree in nursing.
b. Must be physically and mentally fit.
c. Must have a license to practice nursing in the country.
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.

C. History of Nursing
1. In the world
I.

Period of Intuitive Nursing/Medieval Period

II.

Nursing was untaught and instinctive. It was

performed of compassion for others, out of the wish to
help others.
Nursing was a function that belonged to women. It was
viewed as a natural nurturing job for women. She is
expected to take good care of the children, the sick
and the aged.
No caregiving training is evident. It was based on
experience and observation.
Primitive men believed that illness was caused by the
invasion of the victims body of evil spirits. They
believed that the medicine man, Shaman or witch
doctor had the power to heal by using white magic,
hypnosis, charms, dances, incantation, purgatives,
massage, fire, water and herbs as a mean of driving
illness from the victim.
Trephining drilling a hole in the skull with a rock or
stone without anesthesia was a last resort to drive evil
spirits from the body of the afflicted.

Period of Apprentice Nursing/Middle Ages

Care was done by crusaders, prisoners, religious

orders
Nursing care was performed without any formal
education and by people who were directed by more
experienced nurses (on the job training). This kind of
nursing was developed by religious orders of the
Christian Church.
Nursing went down to the lowest level

III.

wrath/anger of Protestantism confiscated properties

of hospitals and schools connected with Roman
Catholicism.
Nurses fled their lives; soon there was shortage of
people to care for the sick
Hundreds of Hospitals closed, there was no
provision for the sick, no one to care for the sick
Nursing became the work of the least desirable of
women prostitutes, alcoholics, prisoners
Pastor Theodore Fliedner and his wife, frederika
established the Kaiserswerth Institute for the
training of Deaconesses (the 1st formal training
school for nurses) in Germany.
This was where Florence Nightingale received her
3-month course of stude in nursing.

Period of Educated Nursing/Nightingale Era 19th20th century

The development of nursing during this period was

strongly influenced by:
a) trends resulting from wars Crimean, civil war
b) arousal of social consciousness
c) increased educational opportunities offered to women.

Florence Nightingale was asked by Sir Sidney Herbert

of the British War Department to recruit female nurses
to provide care for the sick and injured in the Crimean
War.

In 1860, The Nightingale Training School of Nurses

opened at St. Thomas Hospital in London.

The school served as a model for other training

schools. Its graduates traveled to other countries to
manage hospitals and institute nurse-training
programs.

Nightingale focus vision of nursing Nightingale

system was more on developing the profession
within hospitals. Nurses should be taught in
hospitals associated with medical schools and that
the curriculum should include both theory and
practice.

It was the 1st school of nursing that provided both

theory-based knowledge and clinical skill building.
Nursing evolved as an art and science
Formal nursing education and nursing service begun

FACTS ABOUT FLORENCE NIGHTINGALE

Mother of modern nursing. Lady with the Lamp

because of her achievements in improving the
standards for the care of war casualties in the Crimean
war.
Born may 12, 1800 in Florence, Italy
Raised in England in an atmosphere of culture and
affluence
Not contended with the social custom imposed upon
her as a Victorian Lady, she developed her selfappointed goal: To change the profile of Nursing
She compiled notes of her visits to hospitals and her
observations of the sanitary facilities, social problems
of the places she visited.
Noted the need for preventive medicine and god
nursing
Advocated for care of those afflicted with diseases
caused by lack of hygienic practices
At age 31, she entered the Deaconesses School at
Kaiserswerth inspite of her familys resistance to her
ambitions. She became a nurse over the objections of
society and her family.
Worked as a superintendent for Gentlewomen Hospital,
a charity hospital for ill governesses.

IV.

Disapproved the restrictions on admission of patients

and considered this unchristian and incompatible with
health care
Upgraded the practice of nursing and made nursing an
honorable profession for women.
Led nurses that took care of the wounded during the
Crimean war
Put down her ideas in 2 published books: Notes on
Nursing, What It Is and What It Is Not and Notes on
Hospitals.
She revolutionized the publics perception of nursing
(not the image of a doctors handmaiden) and the
method for educating nurses.

Period of Contemporary Nursing/20th Century

Licensure of nurses started

Specialization of Hospital and diagnosis

Training of Nurses in diploma program

Development of baccalaureate and advance degree

programs

Scientific and technological development as well as

social changes mark this period.

a) Health is perceived as a fundamental human right

b) Nursing involvement in community health
c) Techological advances disposable supplies and
equipments
d) Expanded roles of nurses was developed
e) WHO was established by the United Nations
f) Aerospace Nursing was developed
g) Use of atomic energies for medical diagnosis,
treatment
h) Computers were utilized-data collection, teaching,
diagnosis, inventory, payrolls, record keeping, billing.
i) Use of sophisticated equipment for diagnosis and
therapy.
2. In the Philippines
Early Beliefs, Practices and Care of the sick

Early Filipinos subscribed to superstitious belief and

practices in relation to health and sickness
Diseases, their causes and treatment were associated
with mysticism and superstitions
Cause of disease was caused by another person (an
enemy of witch) or evil spirits
Persons suffering from diseases without any identified
cause were believed bewitched by mangkukulam
Difficult childbirth were attributed to nonos
Evil spirits could be driven away by persons with
powers to expel demons

Belief in special Gods of healing: priest-physician, word

doctors, herbolarios/herb doctors

Early Hospitals during the Spanish Regime religious

orders exerted efforts to care for the sick by building
hospitals in different parts of the Philippines:
Hospital Real de Manila
San Juan de Dios
Hospital
San Lazaro Hospital
Hospital de Aguas Santas
Hospital de Indios

Prominent personages involved during the Philippine

Revolution
1) Josephine Bracken wife of Jose Rizal installed a
field hospital in an estate in Tejeros that provided
nursing care to the wounded night and day.
2) Rose Sevilla de Alvaro converted their house into
quanters for Filipino soldiers during the PhilAmerican War in 1899.
3) Hilaria de Aguinaldo wife of Emlio Aginaldo
organized the Filipino Red Cross.
4) Melchora Aquino (Tandang Sora) nursed the
wounded Filipino soldiers, gave them shelter and
food.
5) Captain Salomen a revolutionary leader in Nueva
Ecija provided nursing care to the wounded when
not in combat.
6) Agueda Kahabagan revolutionary leader in
Laguna also provided nursing services to her
troops.
7) Trinidad Tecson (Ina ng Biak na Bato) stayed in
the hospital at Biac na Bato to care for the
wounded soldiers.

School Of Nursing
1) St. Pauls Hospital School of Nursing, Intramuros
Manila 1900
2) Iloilo Mission Hospital Training School of Nursing
1906

1909 distinction of graduating the 1st trained nurses

in the Phils.
With no standard requirements for
admission of applicants except their willingness to
work

April 1946 a board exam was held outside of Manila.

It was held in the Iloilo Mission Hospital thru the
request of Ms. Loreto Tupas, principal of the school.
3) St. Lukes Hospital School of Nursing 1907;opened
after four years as a dispensary clinic.
4) Mary Johnston Hospital School of Nursing 1907
5) Philippines General Hospital school of Nursing
1910

College of Nursing

1. UST College of Nursing 1st College of Nursing in

the Phils: 1877
2. MCU College of Nursing June 1947 (1st College
who offered BSN 4 year program)
3. UP College of Nursing June 1948
4. FEU Institute of Nursing June 1955
5. UE College of Nursing Oct 1958

1909 3 female graduated as qualified medicalsurgical nurses

1920 1st board examination for nurses was

conducted by the Board of Examiners, 93 candidates
took the exam, 68 passed with the highest rating of
93.5%-Anna Dahlgren
theoretical exam was held at the UP
Amphitheater of the College of Medicine and
Surgery. Practical exam at the PGH Library.
1921 Filipino Nurses Association was established
(now PNA) as the National Organization Of Filipino
Nurses
PNA: 1st President Rosario Delgado
Founder Anastacia Giron-Tupas

1919 The 1st Nurses Law (Act#2808) was enacted

regulating the practice of the nursing profession in the
Philippines Islands. It also provided the holding of
exam for the practice of nursing on the 2nd Monday of
June and December of each year.
1953 Republic Act 877, known as the Nursing
Practice Law was approved.

D. Development of Modern Nursing

The intellectual revolution of the 18 th and 19th centuries led to a

scientific revolution. With the discovery and exploration of new
continents, an economic revolution evolved, after which nations
became more interdependent through trade. The Industrial
Revolution displaced workers from cottage craftsmen to factory
laborers. With these changes came stressors to health. New
illnesses, transmitted in the holds of ships by seamen and
stowaway rodents, jumped national boundaries and continents. The
closeness of factory work, the long hours, and the unhealthy
working conditions led to the rapid transmission of communicable
disease such as cholera and plague. Lack of prenatal care,
inadequate nutrition, and poor delivery techniques resulted in a
high rate of material and infant mortality. Many orphaned children
died in workhouses of neglect or cruelty.

During this time, a proper womans role in life was to maintain a

gracious and elegant home for her family. The common women
worked as servants in private homes or were dependent on their
husbands wages. The provision if care for the sick in hospitals or
private homes fell to the uncommon women often prisoners or
prostitutes who had little or no training in nursing. Because of this
nursing had little acceptance and no prestige. The only acceptable

nursing role was within a religious order where services were

provided as part of Christian charity.

The creation of the institute of Protestant Deaconesses at

Kaiserswerth, Germany, changed the Order of Deaconesses ignited
recognition of the need for the services of women in the care of the
sick, the poor, children, and female prisoners. The training school
for nurses at Kaiserswerth included care of the sick in hospitals,
instruction in visiting nursing, instruction in religious doctrine and
ethics, and pharmacy. The deaconess movement eventually spread
to four continents, including North America, North Africa, Asia,
and Australia.

Florence Nightingale, the most famous Kaiserswerth pupil, was

born to a wealthy and intellectual family. Her education included
the mastery of several ancient and modern languages, literature,
philosophy, history, science, mathematics, religion, art and music.
It was expected that she would follow the usual path of a wealthy
and intelligent woman of the day: marry, bear children, and
maintain an elegant home. Nightingale believed she was called by
God to help others [and] to improve the well-being of mankind
(Schuyler 1992, p.4). She was determined to become a nurse, in
spite of opposition from her family and the restrictive societal code
for affluent young English women. As a well-traveled young
woman of the day, she visited Kaiserswerth in 1847, where she
received three months training in nursing. In 1853, she studied in
Paris with the Sisters of Charity, after which she returned to
England to assume the position of superintendent of a charity
hospital for ill governesses.

During the Crimean War, the inadequacy of care for the soldiers
led to public outcry. Florence Nightingale was asked by Sir Sidney
Herbert of the British War Department to recruit a contingent of
female nurses to provide care to the sick and injured in the Crimea.
Nightingale and her nurses transformed the military hospital by
setting up diet kitchens, a laundry, recreation centers, and reading
rooms, and organizing classes for orderlies. Mary Grant Seacole, a
Jamaican born and trained nurse also went to the Crimean to assist
Nightingales nurses in their care of the injured.

When she returned to England, Nightingale was given an

honorarium of 4500 by a grateful English public. She later used
this to develop the Nightingale Training School for Nurses, which
opened in 1860. The school served as a model for other training
schools. Its graduates traveled to other countries to manage
hospitals and institute nurse training programs. The efforts of
Florence Nightingale and her nurses changed the status of nursing
to a respectable occupation for women.

E. Growth of Professionalism
1. Profession
a. Specialized education
Becoming a specialized nurse can enhance your
professional growth by giving you more earnings
potential, and increase your competency and
credibility. It requires you to first find the right

area for you and then learn as much as you can

about it.
With around 80 nursing specialties, it is
important to carefully consider which area you
are best fit to work in. Consider your personality
and how it influences your interaction with
patients, what you enjoy learning about, and
what environments you prefer to work in. Nurses
spend most of their time dealing directly with
people, whether patients or physicians. It is
important that the best parts of their
personalities are brought out by those that they
work with.
You should also take note of the areas of
medicine that you are the most interested in
learning about. Certain specialties may address
different issues, topics, and treatments, and it is
your job to know everything you can about
them.
Nurses spend a lot of time in their place of
employment, so its vital that it is an
environment that they can thrive in. While
places of employment in the health care
industry can be similar in their function, some
may have slightly different environments than
others. Where a nurse will work can often
depend on their specialty, so its important to
think about which types of environments you
are most comfortable in.
Once you have figured out which area of
medicine you prefer working in, you will have to
become an expert in it by learning all that you
can about it.
The best way to do this is by earning a specialty
certification
through
professional
nursing
organizations or associations. The first step in
certification is meeting eligibility requirements.
These requirements typically differ depending
on specialty and credentialing organization.
Requirements usually include a certain level of
college education, a minimum number of hours
working within a related field, and possessing a
current and unrestricted nursing license.
After meeting initial requirements, you will be
required to pass a certification examination.
These types of exams are meant to assess ones
knowledge of the specialized area as well as
their ability to apply that knowledge in medical
situations. After successfully completing the
exam, a certificate is issued that serves as a
validation of ones expertise in the field.
Certifications usually will last a number of years
before
one
will
be
required
to
seek
recertification
through
re-examination
or
continuing education courses.

b. Body of Knowledge
Nursing knowledge has become more complex
and specialized and is constantly evolving. New
types of knowledge will continue to be evident the complexities of practice create more debate
than the old, ritualistic care-giving.
What could be called nursing knowledge comes
from a variety of sources including both
theoretical and practice perspectives - clinical
decisions should be based on what is evidence
rather than just opinion or belief. The aim for the
profession should be to improve practice by
questioning findings from all sources.
Gaining knowledge raises an awareness of
personal and professional accountability and the
dilemmas of practice. Knowledge is what
improves care if the nurse is aware of the best
knowledge or evidence to use in practice. The
question of what nursing knowledge is should
remain central to research, practice and
teaching because it is essential in ensuring the
provision of high-quality care for patients.
c. Ethics
Ethics is defined as the standards or principles
of moral judgment or actions. It provides a
methodical system in differentiating right from
wrong basing on a certain belief.
Ethics reflects the standards that govern a
proper conduct in a particular profession. For
instance, the nurse on duty knows that she is
obligated to act for the good of the client and to
prevent any incident to harm the patient. This
principle of doing no harm to the client is the
intervention of knowing the ethics in nursing.
d. Autonomy
Professional autonomy means having the
authority to make decisions and the freedom to
act in accordance with one's professional
knowledge base. An understanding of autonomy
is needed to clarify and develop the nursing
profession in rapidly changing health care
environments and internationally there is a
concern about how the core elements of nursing
are taken care of when focusing on expansion
and extension of specialist nursing roles.
2. Carpers four patterns of knowing
a. Nursing Science
Based on the assumption that what is known is
accessible through the physical senses: seeing,
touching and hearing.
1. Reality exists and truths about it can be
understood
A pattern of knowing that draws on traditional
ideas of science
Expressed in practice as scientific competence

1. Competent action grounded in scientific

knowledge including theories and formal
description
2. Involves conscious problem solving and
logical reasoning
3. Nursing theory
b. Nursing Ethics
The component of moral knowledge in nursing.
Guides and directs how nurses conduct their
practice
Requires
1. Experiential knowledge of social values
2. Ethical reasoning
Focus is on:
1. Matters of obligation, what ought to be
done
2. Right , wrong and responsibility
3. Ethical codes of nursing
4. Confronting and resolving conflicting
values, norms, interests or principles
Sources of Ethical knowing:
1. Nursings ethical codes and professional
standards
2. An
understanding
of
different
philosophical positions
a. Consequentialism
b. Deontology
c. Duty
d. Social justice
c. Nursing Aesthetics
The art of nursing.
Expressed through:
1. Actions, bearing, conduct, attitudes,
narrative and interaction
2. Knowing what to do without conscious
deliberation
Involves:
1. Deep appreciation of the meaning of a
situation
2. Moves beyond the surface of a situation
3. Often shared without conscious exchange
of words
4. Transformative art/acts
5. Brings together all the elements of a
nursing care situation to create a
meaningful whole