UNIT 1

Introduction to Nurse and

Nursing

Prepared by
Poonam Khadka Chhetri
Lecturer
MMIHS
2080/81
 Unit 1: 5 hours
Introduction to nurse and nursing
 Definition of terms: nurse and nursing
 Qualities of nurse
 Role and responsibilities of the nurse in the
institutional and community setting
 Historical overview of nursing in the world
 Historical overview of nursing in the Nepal
 Ethics in nursing : ICN code of ethics
 Client’s right
 Nurse
The word nurse comes from the
Latin word Nutritious, which
means nourish, foster and
protect.
Nurse is one who cares for sick,
injured and physically, mentally &
emotionally disabled.
A nurse is a person who provides
educated and licensed in the
practice of nursing; one who is
concerned with the diagnosis and
treatment of human responses to
actual or potential health
problems.
American Nurses Association
A nurse is a person who has completed a
program of basic nursing education and
in qualified and authorized in his/her
country to provide responsible and
competent professional services for the
promotion of health, prevention of
illness, care of the sick and
rehabilitation of the disabled.
International Council of Nurses(ICN)
 NURSING
Nursing is a profession within the
health care sector focused on the
care of individuals, families, and
communities so they may attain,
maintain or recover optimal health
and quality of life.
As a science, nursing is based on a
body of knowledge that is always
changing with new discoveries and
innovations.

Nursing is the care which puts a

person in the best possible condition
for nature to restore or preserve
health, to prevent or to care disease
or injury.
Florence Nightingale
Nursing as the protection, promotion,
and optimization of health and abilities;
prevention of illness and injury;
alleviation of suffering through the
diagnosis and treatment of human
response; and advocacy in the care of
individuals, families, communities, and
population
American Nurses Association (ANA)
Nursing is an art and science based on
knowledge, skill and attitude, aimed at
assisting the individual, the family and
community in health and illness, to
maintain health, to prevent illness, to
alleviate physical, biological and
psychological pain, to avoid complication
and to fulfill self-reliance in meeting
daily health needs. WHO
Qualities of nurse
Honesty Good personality
Well balanced Friendly and
Tactful helpful
Discipline Empathy and

Creativity sympathy
Poise
Healthy
Clean and pleasant
Intelligent
appearance
Courageous
Interested
Honest:
Honesty is very important and essential
in the care of patients and for
maintaining harmonious relationship
with the patients and their relatives as
well as with their team members.
A nurse must learn to accept her
mistakes although it is difficult. It will
help her to become an honest
professional.
 Well-balanced/Emotional stability:
 It is a quality that they should develop in their
nursing career, and practice to control emotion in
difficult circumstances.
 A nurse works in many different situations, with
different people and with all types of patients.
These relationships may be conflicting at times.
 The nurse at times has to be responsible for the
patients' lives. So if a nurse is well-balanced, she
will be able to work or act smoothly and take care
of patients properly.
 The nurse must have matured behavior with full
control of emotions even under pressure or in
difficult circumstances.
Tactful:
A nurse must be sensitive to the needs and
feelings of patients and should deal
appropriately with them in any situation.
 Nurses have to deal with a variety of
conditions and people in different situations.
She should be able to cope with any kind of
difficult situation, and also with different
people by applying appropriate judgment.
 She should be tactful in dealing with any
circumstances at working place.
 Discipline:
A nurse must be able to be well disciplined then
only she will be able to provide better nursing
care without any disturbances or tension.
 Discipline means self- control or to develop habit
of obedience to the rules and regulations set by
the organization or the system.
 There are always certain rules and regulations to
follow to achieve the goal of an organization.
 It is necessary to maintain good discipline within
a working framework by each member of the
organization or the unit in order to work
effectively
Creative: ……………

Creativity is an important skill to solve the

problem and create a new idea
 Healthy:
 The physical, mental and spiritual health will
influence everything that a person deals with.
 If a nurse is not healthy mentally and physically,
she does not look pleasant, confident and energetic.
 A healthy nurse always looks smart and pleasant
and will be able to organize her work properly and
confidently.
 Spiritually, healthy means to be able to secure owns
religious beliefs as well as to meet the spiritual
needs of other people because they should work
with and care for people of many different religious
beliefs.
Intelligent:
 Intelligent means mental ability. It means
having the power of perceiving, leaning,
understanding and knowing, which is an
essential quality for a good nurse.
The practice of nursing requires a high degree
of knowledge and numerous complex skills.
A nurse has to work with different categories
of personnel in different situations that
become a challenge for a nurse
She has to make a quick and right decision
regarding patient care.
Courageous:
Courageous means to be brave or not to be
afraid. A nurse has to work with various
kinds of personnel in many difficult
situations.
So courage is necessary for nurses because
they are responsible for life and death of
patients e.g, a nurse has to go to remote
places to work where she does not know
anybody but she has to face the situation
courageously.
 Good personality:
 Personality implies certain physical and mental
traits which are characteristics of a given
individual.
 These characteristic traits determine, to some
extent, the individual's behavior or adjustments to
his surroundings.
 Good personality is necessary for any professional.
 It is said, "The first impression is the last one". If
a nurse looks groomed, she will have strong
influence upon her work and relationship. A neat,
clean and pleasant appearance always makes a
deep impression upon others, especially the
patients.
Friendly and helpful:
 A nurse must have a friendly and helpful
nature
To be friendly an helpful is one of the most
important and satisfying relationships one
can have to gain the confidence of others.
To gain a patient's faith, a nurse must have
good relationship with the individual,
society and community.
Communication skill:

A communication skill is one of the

important qualities
Communication is central to successful
caring relationships and team working.
 A great nurse has excellent communication
skills that include speaking and listening.
Empathy and sympathy:

Empathy is the ability to emotionally

understand what other people feel, see things
from their point of view, and imagine yourself
in their place………………
Sympathy is an expressed interest or
concern regarding the problem,
emotions or status of mind of others.
Sympathy is more of an external
expression of emotion, while empathy
is an internal emotional response.
Poise:
 A nurse works in many different situations,
with a number of people and with all types
of patients.
She must have matured behaviour with full
control of emotions even under pressure or
in difficult circumstances.
Poise is very important for the physical and
psychological welfare of the patients and
other personnel when these situations do
arise.
Clean and pleasant appearance:

Clean and pleasant appearance should

always be practiced because it makes a
deep sense of impression upon others
as well as her own self and inside
feelings
Interested :
Interested means having special willing for
some objects or showing concern.
Interest promotes desire and makes the
nurse alert to perform her jobs.
Interests outside the profession are also
helpful.
So they should participate in community
and social activities. It brings them into
contact with people who are in other types
of work and it makes great satisfaction by
personal relationships
Patience:

For nurses in any career field or specialty,

patience is an integral part of success.
 Great nurses understand that patience can
overcome anxiety, misunderstandings and
help patients and colleagues feel
empowered by good decisions.
Dedicated:
Successful nurses focus on the needs of their
patients and provide the best possible care
under any circumstances. These dedicated
nurses continue to enhance their education,
become leaders in their field, and teach
novice nurses in their specialty.
Attentiveness:
Nurses are ethically obligated to attend not
only to their patients, but also to the needs of
their colleagues, employer, and community
so nurses should attentive in their duties.
Patient Responsiveness:
As a part of a multi-disciplinary treatment
team, nurses are typically the professionals
that have more regular contact with the
patient.
Nurses have the ethical responsibility to
monitor the patient's responses to treatment
and intervention and to communicate the
information to other professionals on the
treatment team.
Roles of the nurse
1. Caregiver /care provider

The caregiver role includes those activities

that assist the client physically and
psychologically while preserving the client’s
dignity.
2. Communicator
Nurses communicates with the client ,
support persons, other health
professionals and people in the
community.
3. Change agent
The nurse acts as a change agent for client
and self to make modifications in their
behaviors.

Nurses also often act to make changes in a

system such as clinical care. As a change
agent PHC nurses change their attitude,
behavior and view of people towards health
and eliminate harmful and hazardous
practices prevalent in community.
4. Client advocate
Nurses act as a client advocate to
protect the client from harm.
In this role the nurse may
represent the client’s needs and
wishes to other health
professionals.
They also assist client; in
exercising their rights and help
them speak up for themselves
5. Counselor

Counseling is a process of helping a

client to recognize and cope with
stressful psychological or social
problems to develop/improve
interpersonal relationships and
personal growth.
6. Coordinator:
 In hospital, the nurse collaborate with
the patient and also with health team
members in assessing, planning,
implementing, and evaluating
interventions.

 Inthe community she has to work with

rich as well as poor, political leaders as
well as persons of developmental sectors
as agriculture, banking, industry,
education, communication, animal
husbandry to promote the health status
7. Teacher

As a teacher, the nurse helps

clients/ community learn about
their health and the health
care procedures they need to
perform to restore or
maintain their health.
8. Leader

A leader influences others to work

together to accomplish a specific goal.

Effective leadership is a learned process

requiring an understanding of the needs
and goals that motivate people, the
knowledge to apply leadership skills and
the interpersonal skills to influence
9. Manager

Management is the process of getting things

done by others by using man , money,
materials and time.

The nurse managers the nursing care of

individual, families and communities. The
nurse manager also delegates nursing
activities to subordinates and supervises and
evaluates their performance.
10. Motivator:
A nurse motivates the community
people to find their health needs,
increase interest to adopt healthy
lifestyle and increase awareness
regarding health, sanitation, hygiene
etc. ………
Until people are interested and
become aware of their needs, they
will not consume the health service
provided to them.
So the nurse increases awareness
and motivates them to promote and
maintain their own health.
11. Supervisor:
As supervisor a nurse observes the
subordinates at work to see that
they are working according to plans
and policies of the organization
and keeping the time schedule and
to help them in solving their work
12. Researcher
A nurse keeps the record of the facts
related to nursing practice/patient
problems that could serve as the
baseline data for research in future or
she could directly involved in
conducting the research.

13. Facilitator:
Convey information to people. Role in
health education, training, waste
disposal.
14. Evaluator
Evaluation should be done
continuously to find out whether
the predetermined goals are
fulfilled or not.
A nurse evaluates the work done
to improve the quality and
effectiveness in the community.
15. Problem solver:
Help people to solve the health
problem arising in her working
areas such as in hospital and
community.

16. Advisor:
The nurse advises the patient,
family and community in practical
and emergency matters related to
health.
17. Nurse Entrepreneur:
A nurse who has an advanced degree,
and manages health related business.
18. Nurse Administrator:
A nurse is responsible for the
management and administration of
resources and personnel involved in
giving patient care.
RESPONSIBILITIES OF THE NURSE

 Isaccountable and takes responsibility for

own nursing actions and professional conduct.

 Functionswithin own level of competence ,

within the legally recognized scope of
practice.

 Assess own practice and undertakes

activities to improve practice and meet
identified learning goals on an ongoing
basis………….
Takes action to promote the
provision of safe, appropriate and
ethical care to clients

Advocates for and or helps to

develop policies and practices
consistent with the standards of
the profession……….
Maintains own physical,
psychological and emotional
fitness to practice
Understand the role of
regulatory body and relationship
of the regulatory body to one’s
own practice.
 Functions of Nurse

1. Promote health and wellness:

 Engaging in attitudes and
behavior that enhance the
quality of life and maximize
personal potential for both
healthy and ill. …….
Involves the individuals and
community in the activities to
enhance healthy lifestyle,
such as improving nutrition and
physical fitness, preventing drug
and alcohol misuse, restricting
smoking, and preventing accidents
and injury in the home and
workplace.
Preventing illness
The goal is to maintain optimal
health by preventing disease.
Nursing activities include
immunization, prenatal and
infant care and prevention of
sexually transmitted disease.
Pain/suffering alleviations:

The goal is to provide relief from

pain to promote comfortable
healing process.
Restoring health:

 Focuses on the ill client & extends from

early detection of disease to helping
the client during the recovery period.
 Nursing activities:
 Providing direct care to the ill person:
administering medications, baths and
specific procedures and treatments.
 Providing diagnostic and assessment
procedures: measuring BP and
examining stool for occult blood….
Consulting with other health care
professionals about the client’s problem.
Teaching clients about recovery activities
exercise that will accelerate recovery
after stroke.
Rehabilitating clients to their optimal
functional level following physical or mental
illness, injury or chemical addiction.
Creation of spiritual environment
Function of nursing practices involve
comforting and caring for people
…………….
HISTORICAL OVERVIEW OF
NURSING IN WORLD
In English language , a nurse is a woman
employed to suckle and or generally
care for a younger child.
 The former being known as a wet
nurse and the latter 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.
Prior to the foundation of modern nursing
nuns and military provided nursing like
services

With the establishment of churches in

Christian era, groups were organized as
orders whose primary concern was to
care for the sick, the poor, orphans,
widows, the aged, slaves and prisoners.
During 17th century in Europe,
nursing care was provided by men and
women serving punishment. It was
often associated with prostitutes and
other female criminals serving time.

Beginning in the 18th century, nurses

donned uniforms that allowed nurses
to effectively treat patients, while
also maintaining a respectable
appearance.
It was during time of Crimean war
(1854-1856) 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 summarized in the book
Notes on Nursing
 Florence Nightingale
Born in Italy on 1820 in a wealthy
family as second child
Parents: Edward and Frances
Nightingale
Developed interest in the social
service
Objection from family………..
Took 3 months nursing training in
Kaiserworth
Crimean War: FN arrived at
Barrack Hospital in Scutari with
38 nurses and served the injured
for 4 months.
Established Nightingale Training
School for nurses at St. Thomas
Hospital.
Died: at the age of 90 in her own
home (1910 A.D)
 Important nurses in the
developments of nursing
Mary Seacole who also worked as a nurse in
the Crimean war

Agnes Elizabeth and Linda Richards who

established quality nursing schools in the
USA and Japan.

Linda Richards , who was officially America’s

first trained nurse, graduating in 1873 from
the New England Hospital for Women and
Children in Boston
Cont..
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
The modern era has seen the development
of nursing degree and nursing has
numerous journals to broaden the
knowledge base of the profession.

Nurses are in key management roles within

health services and hold research posts at
universities.

Today nursing is becoming a pioneer

profession among the youth throughout
the world with its advancement in quality
of service.
History of Nursing in
Nepal

04/17/2024 08:44 AM 68
HISTORY OF NURSING EDUCATION
Nursing existed in Nepal from the
very beginning.

At first, the mother or other women

at home provided nursing care to the
sick, injured and old

Nursing has passed many phases but

the inner spirit of nursing is the
same-care of people.

04/17/2024 08:44 AM 70
The concept of nursing has
changed.
These changes are mainly due to
change in the concept of health,
pattern of illness and disease, and
progress in science and technology

04/17/2024 08:44 AM 71
Now it has come out of the hospital
to the community with the concept
of primary health care.
The nurses role is more expanded
towards the promotion of health,
prevention of disease rather than
just providing care to the sick.
 History before 1972

When nursing was first

introduced, various difficulties
were encountered.
Few girls were educated and nurse
training was socially unacceptable.

04/17/2024 08:44 AM 73
Only 15% of student population in the
country was girls, and the attitude of
the society was another problem.
 Nursing was considered to be a very
low type of service in the society.
Most parents from high classes were
opposed to the idea of sending their
children to study nursing.
These difficulties were the same in
Miss Nightingale's day but over the
past century, nursing has become a
respectable profession in Europe.

Nepal's acceptance and respect for

nurses was greatly encouraged by
Princess Prekshya Rajya Laxmi Devi
Shah, who took nurse training
during 1973-1976.

04/17/2024 08:44 AM 75
Before 1956 A.D.(2013 B.S.) in
Nepal, nursing service consisted of
a few midwives trained in India and
some local trained compounders.
Bir Hospital (Estd:1890
A.D./1947 B.S.) first hospital of
Nepal

But nursing service was

practically non-existent.
 Medicines and dressings were
done by doctors or compounders.

04/17/2024 08:44 AM 77
 First Nurses of Nepal

 Vidhyawati Kansakar
 Dharma Devi Kansakar
 Radha Devi Malakar
 Bishnu Devi Rai

They were sent to Allahabad, India for 18

months midwifery training in 1928 A.D After
training posted in female ward Bir Hospital

04/17/2024 08:44 AM 78
2nd lot of ladies,
Miss Dr. Uma Devi Das and
Miss Rukmini Charan Shrestha
were sent for staff nurse
training in India in 1952 or 2009
B.S

 The course was 3yrs 9 months

and one year internship, all
together 4 yrs and 9 months.
04/17/2024 08:44 AM 79
 In 1953 (2010 B.S.),the 3rd lot of
ladies(8)
Miss Tara Devi Tuladhar,
Rupa, Mithai, Krishna Vijaya,
Padmabati
Rupakesari and Vidhya Thapa were
sent to India for 18 months' midwifery
training. After training statred to
work in Prasuti Griha
 In the same year, other four ladies
were sent to Sri Lanka for
Tuberculosis Nursing for a period of
two years. After training started to
 In 1956 A.D., with the effort and
influence of Late King Mahendra and
 Juanita Fleming,RN, a nurse missionary,
the Nursing School of Nepal was opened
at Surendra Bhawan, Sanepa, with the
help of the WHO, which was the start

of Formal training in Nursing in

Nepal.
At first, the school was managed and run by
WHO nurses ,
Miss [Link] (London),
Miss [Link] (New Zealand) and
Miss [Link] (Ireland).

Later it was shifted in Chetrapati and Bir

hospital compound at Mahaboudha.

Currently it is located in Maharajgunj

(2042) with name Nursing Campus
Maharajgunj, Mother institute of nursing
education of the country.
In 1959, another school of nursing
under the "United Mission to Nepal"
was established in Nirbhawan and
from separated from HMG school
of nursing Mahaboudha
Before 1960, most students
were accepted in the nursing
programme just under
matriculation (i.e. SLC
incomplete).

To maintain the standard of

nursing education, the entrance
requirement of the programme
changed in 1969.
04/17/2024 08:44 AM 84
The new requirement for
admission into the programme was
now S.L.C. Pass.

At that time the training

programme was run by His
Majesty's Government and the
duration of the nursing course was 3
and1/2 years.
In 1959, another school of nursing
under the "United Mission to Nepal"
was established in Nirbhawan and
from separated from HMG school of
nursing Mahaboudha

In 1972, when Nir Bhawan Nursing

School came under the Institute of
Medicine
It became branch of the Mahaboudha
Nursing campus and later the
Maharajgunj Nursing Campus.
04/17/2024 08:44 AM 86
In 1991,the Nir Bhawan Nursing
Campus became independent from the
Maharajgunj Nursing Campus, but
directly under the IOM Dean's
Office
The new name of campus was changed
to lalitpur Nursing Campus.
In 1961 , Nursing association was
established became member of ICN in
1969 AD,
The name of the association was trained
Nurses Association of Nepal(TNAN) at
the beginning.
It has renamed as Nursing Association
of Nepal (NAN) in 2041.

Nepal nursing council took the
examination and gave registration
certificate to passed students.

But it was remain dysfunctional after

change in educational system in 1972.

Now nursing council has started taking

license exam and provide license to
those who passed license exam
 Different schools of nursing and ANM
training centers

School of nursing in Surendrabhawan in 2013

BS
School of nursing in Nirbhawan Sanepa 2016
BS
ANM training center in Bharatpur in 2019 BS
ANM training center in Biratnagar in 2023
BS
ANM training center in Nepalgunj in 2026
HISTORY AFTER 1972
In 1972, all health programs were placed
under Institute of Medicine, Tribhuvan
University

Nursing Education then entered into the

main stream of education.

The curriculum for staff nurse course was

revised to increase its breadth and
scientific knowledge had expanded, and it
was renamed as Proficiency in Certificate
(PCL) Nursing.
04/17/2024 08:44 AM 91
After 1972, the training schools
were called campuses

This change reinforced the

compulsory SLC pass for new
admissions.
HISTORY AFTER 1972…
Duration was changed from three and half
years to three years of study

Liberal art subjects like English, Nepali and

Introduction to Nepal (sociology) and
Psychology was added in Nursing curriculum
as the compulsary subjects.

In 1973, Princess Prekshya Rajya Laxmi

Devi Shah joined the nursing training, which
brought a great change in social outlook in
nursing.
04/17/2024 08:44 AM 93
 HISTORY AFTER 1972….
In 1980, the university semester system
changed back into the annual system but the
nursing education remained for three years.

Since 1981, admission requirement has

been S.L.C. pass with second division
scoring merit in Science, Mathematics and
English.

The PCL nursing was given the status as

equivalent to any other certificate level
programme offered in under the Tribhuvan94
04/17/2024 08:44 AM
IOM upgraded the ANM and
AHW campus to PCL nursing
campus.

The nursing program changed

from an annual system to
the semester system of studies
to match the rest of the
university programs
HISTORY AFTER 1972….

In 1989 (2046 B.S.), Bir Hospital Nursing

Campus was opened by HMG and affiliated
to Tribhuvan University

In 1986, all certificate nursing programs

enrolled 10% male students in their
programs. But after four batches of intake
this policy was stopped.

04/17/2024 08:44 AM 96
The NESP (Nepal Education System
Plan) had given special emphasis on the
expansion of technical and
professional education
Bachelor Program of Nursing began at
Maharajgunj Nursing Campus(then
Mahaboudha Nursing Campus) in 1977
(2033 B.S.) with more emphasis on
midwifery…………… 04/17/2024 08:44 AM 97
 Adult nursing in 1983(2040 B.S.)
 Child health nursing in 1984(2041)
 Community health nursing, in 1980.
 In 1988 (2045),
 All Bachelor Nursing Curricula were
reorganized and a two track B.N. program
was initiated with specialization in
Community nursing and Hospital nursing.
 Now the three tract hospital, community
and psychiatric programs are running
 Decade of 1980s golden era for nursing
education- qualitative and quantitative
growth
In 1996 (2053) Basic [Link]. Nursing a
four year program was established in
BPKIHS Dharan.

 KU launched the programme since 2004.

Nursing Campus Maharajgunj and colleges

affiliated to PU have launched the [Link].
Nursing programme since 2005.

Pokhara University started [Link] Nursing

programme since 2006.
LNC started BSC nursing in 2011

99
Masters program (Masters in Women
Health and Women development) in
Nursing was started at the Nursing
Campus, Maharajgunj from 1995, and
now the institution serves masters
program in other the speciality area
Paediatric Nursing 2001 and
Adult Health Nursing 2000,
psychiatry 2015
04/17/2024 08:44 AM 100
In the year 2008, BPKIHS, Dharan
started [Link] Nursing, a 3 yrs course.

Currently the Institution runs

masters program in five speciality
area
 Community Health Nursing,
 Mental Health Nursing,
 Paediatric Nursing,
 Maternal Health Nursing and (2011)
Medical-Surgical Nursing (2012)
Lalitpur Nursing Campus started master
programs with specialty in women health in
2010 and added adult nursing in 2011.
Pokhara Nursing Campus started Masters
programe in 2011 in adult nursing
Nursing college at Chitwan school of medical
sciences , a private institute affiliated with
TU started master programme in 2010

04/17/2024 08:44 AM 102

In 2049, NEC (National Education
Commission) Report made two
recommendations.

 First, to move all PCL program

University by 2057 B.S. and bring
them along with all vocational training
under CTEVT.

Second, the recommendation was that

BN program should be increased to 3
calendar year.04/17/2024 08:44 AM 103
Phase out PCL nursing program from
university program(2072BS/2015 AD)
LNC got affiliated with PAHS
Bir Hospital with NAMS
 ……………..
ETHICS IN NURSING
Ethics refers to the study of
philosophical ideals of right and
wrong behavior.

 Ethics is the study of good

conduct, character, and motives.
It is concerned with determining
what is good or valuable for all
the people.
 Definitions of Terms

Ethics:
Rules or principles that
determine which human actions
are right or wrong.
Bioethics:
Ethics concerning life.
Bioethical dilemma:
A situation involving competing rules or
principles that appears to have no
satisfactory solution.
A choice between two or more equally
undesirable alternatives.
Bioethical issues:
Subjects that raise concerns of right
and wrong in matters involving human
life. i.e., euthanasia, surrogacy, abortion
Ethical dilemma

Ethical dilemma occurs when there is

a conflict between two or more
ethical principles
This result in Problem in making decision
because there is no clear correct or
right choice
Having to choose an action that
promotes one principle or value but
violates another one
 Ethical Principles
The ethical principles provide a
foundation for nursing practice.

Ethical principles are defined as basis

for nurse’s decisions on consideration
of consequences and of universal
moral principles when making clinical
judgments.
The most fundamental of these
principles is the respect for persons.
 Ethical principles
Fundamental values or assumptions
about the way individuals should be
treated and cared for.
These include autonomy,
beneficence, nonmaleficence,
justice, fidelity and veracity.
The primary and basic ethical
principles are the following:

o Respect for autonomy

o Nonmaleficence
o Beneficence
o Justice
o Veracity
o Confidentiality
o Fidelity
 Respect for autonomy
Principle of respect for the person
Autonomy refers to freedom from external control
People are free to form judgments and actions
as long as they do not infringe on others
Concepts of freedom and informed consent
are grounded in this principle.
Informed consent is a method that promotes
and respects a person’s autonomy…………
For a client to make an autonomous
decision and action, he or she must be
offered enough information and
options to make up his or her mind free
of coercion or external and internal
influences.
The consent that patients read and sign before
surgery documents this respect for autonomy.
 Nonmaleficence

Maleficence refers to harm or hurt

Nonmaleficence means duty to do no
harm.
 Nonmaleficene is the principle that
obliges us not to inflict harm
intentionally or unintentionally……
Ethicalpractice involves not only the
will to do good, but the equal
commitment to do no harm.

The health care professional tries to

balance the risks and benefits of care
while striving at the same time to do
the least harm possible.
 Beneficence
Beneficence is the “doing good”
theory.
 It requires that health-care
providers do good for patients under
their care.
To promote goodness, kindness, and
charity
To abstain from injuring others and to
help others further their well-being by
removing them from harm
 Justice
Justice refers to fairness
Justice is the professional obligation to
be fair, equitable, and appropriate
treatment to all individuals.
It concerns the issue that all the
individuals have the right to be treated
equally and fairly regardless of their
sex, race, social class or religion.
 Veracity
Principle of truth-telling
This principle expresses the concept
that professionals have a duty to be
honest and trustworthy in their
dealings with people.
 Veracity or truthfulness requires that
health-care providers not intentionally
deceive or mislead patients.
 Confidentiality
Confidentiality means that
information entrusted to
professionals in the line of duty
should not be revealed to
others.
 Fidelity

Fidelity is the individual’s

obligation to keep the
commitments he/she has made.
It holds that a person should
faithfully fulfill his/her duties
and obligations.
Civil and Common Law Issues in
Nursing Practice

Torts
A tort is a civil wrong made
against a person or property.
Torts can be classified as
unintentional or intentional.
Intentional Torts are willful acts
that violate another’s rights.
Examples are assault, battery,
invasion of privacy, and
defamation of character.
Quasi-intentional torts are acts in
which intent is lacking but volitional
action and direct causation occur such
as in invasion of privacy and
defamation of character
Assault
Assault is any intentional threat
to bring about harmful or
offensive contact.
It is an assault for a nurse to
threat to give a client an injection
or to threaten to restrain a client
for an x-ray procedure when the
client has refused consent. No
actual contact is necessary.
Battery

Battery is an intentional
touching without consent.
The contact can be harmful to
the client and cause an injury,
or it can by merely offensive
to the client’s personal dignity.
A battery always includes assault.
E.g. if the same nurse actually gives
the injection to the patient without
consent, then it is considered
battery.
For e.g. if the client gives consent
for appendectomy and the physician
performs a tonsillectomy, battery
has occurred………..
Invasion of Privacy:
Typically invasion of privacy is
the release of a patient’s medical
information to an unauthorized
person such as a member of the
press, the patient’s employer, or the
patient’s family………….
Invasion of Privacy:
The tort of invasion of privacy protects
the client’s right to be free from
unwanted interruption into his or her
private affairs.
……..
 Clients are entitled to confidential
healthcare. For e.g. in a classic case,
reporters published photographs of a
female client in her hospital room
without her consent.
A claim for invasion of privacy was held.
 The information that is in a patient’s medical
record is a confidential communication that
may be shared with health care providers for
the purpose of medical treatment only
Defamation of character

Defamation of character is the

publication of false statements
that result in damage to a person’s
reputation.
Defamation (slander)- something
untrue was said to ruin the
reputation of a person
Defamation (Libel)- something
untrue was written to ruin the
reputation of person
 Unintentional Torts

Negligence

Malpractice
Negligence is conduct that falls
below the standard of care.
The standard of care is established
by law for the protection of others
against an unreasonably great risk
of harm.
Malpractice is a type of
negligence; it is referred to as
professional negligence.
Nursing malpractice results when
nursing care falls below the
standard of care.
Nurses can be found liable for
malpractice if the following criteria
are established:

The nurse did not carry out that duty

The client was injured
The nurse’s failure to carry out the
duty caused the injury
 Common Negligent Acts
Medication errors that result in
injury to clients.
IV therapy errors resulting in
infiltrations or phlebitis.
Burns to clients caused by equipment,
bathing, or spills of hot liquids and
foods.
Falls resulting in injury to clients
Failure to use aseptic techniques
when required.
Common Negligent Acts Contd..

Errors in sponge, instrument, or

needle counts in surgical cases.
Failure to give a report, or giving an
incomplete report, to an oncoming
shift.
Failure to adequately monitor a
client’s condition.
Failure to notify a physician of a
significant change in client’s status
Liability-it is a legal doctrine that makes
a person responsible for the damage and
loss caused by his / her acts and omissions
regardless of culpability (fault).

A nurse is legally responsible for actions

that fails to meet the standard of care or
for failing to act and thereby causing harm.

For example- when a nurse gives a wrong

medication to a patient and the patient
suffers harm, the nurse will be liable
negligent administration of drug.
Suit- a case in low court, legal
proceeding
Crime- act that is a violation of
duty or breach of law, punishable by
the state by fine or imprisonment.
Bill- Drafts or temporary outline of
what the act will be.
Act- written document which has
been formally passed by government
eg health act, NNC act
 Consent
A signed consent form is required
for all routine treatment,
hazardous procedures such a
surgery, chemotherapy, radiation
therapy, and research involving
clients.
A client signs general consent
forms when admitted to the
hospital.
Separate special consent or
treatment forms must be signed
by the client or a
representative before
specialized procedures or
treatments are performed
Informed consent
Informed consent is a
person’s agreement to allow
something to happen, such as
surgery or an invasive
diagnostic procedure, based on
a full disclosure of risks,
benefits, alternatives, and
consequences of refusal.
………….
Informed consent requires
providing adequate
information for the client to
form a decision and
documenting that decision.
The following factors are
required for informed consent
(Guido, 2001):

Brief,complete explanation of
the procedure or treatment
must be given……………
Names and qualifications of persons
performing and assisting in the
procedure should be provided.

A description of the serious harms,

including death, which may occur as a
result of the procedure, as well as
anticipated pain and/or discomfort,
should be provided…………
An explanation of alternative
therapies to the proposed
procedure/treatment should be
provided as well as the risks of
doing nothing.

The client needs to be informed

of his or her right to refuse to
the procedure/treatment without
discontinuing other supportive
care………….
The client may refuse the
procedure/treatment even
after it has begun.
Parents are usually the legal
guardians of pediatric clients
and therefore they are the
person who must sign consent
forms for treatment………..
If the parents are divorced,
the parent and legal custody
must give consent.

If the client is unconscious,

consent must be obtained from
a person legally authorized to
give consent on the client’s
behalf………………..
 In emergency situations, the procedure
required to benefit the client or save a
life may be undertaken without liability
for failure to obtain consent.

 Psychiatric clients must also give consent.

They retain the right to refuse the
treatment until a court has legally
determined that they are incompetent to
decide for themselves
CLIENT RIGHT
The client rights also called the
patient’s bill of right. Which
include:
1. Right to considerate and
respectful care
2. Right to be informed about
illness, possible treatments
3. Right to know the names and
roles of persons who are involved
in care
4. Right to consent or refuse in
treatment
5. Right to have an advance
directive
6. Right to privacy
7. Right to expect that medical
records are confidential
8. Right to review the medical record
and to have information explained
9. Right to expect hospital will provide
necessary health services
10. Right to know if the hospital has
relationship with outside parties that
may influence treatment or care.
11. Right to consent or refuse to
take part in research
12. Right to be told of realistic
care alternatives when hospital
care is no longer appropriate
13. Right to know about hospital
rules that affect treatment and
about charges and payment
methods
THANK YOU