Fundamentals of Nursing - Ostravská univerzita v Ostravě

Transcription

Supporting Material
Fundamentals of Nursing
Darja Jarošová
OSTRAVA 2012
This project is co-financed by the European Social Fund and the public budget of the Czech Republic.
The material was created as part of the OP VK project:
Modernization – Diversification – Innovation
Registration number: CZ.1.07/2.2.00/28.0247
CONTENTS
INTRODUCTION ................................................................................................. 6
1
Nursing as scientific discipline ............................................................. 8
2
Health .................................................................................................. 17
3
Illness .................................................................................................. 23
4
History of nursing................................................................................ 28
5
International nursing activities ............................................................ 37
6
Social aspects of nursing ..................................................................... 47
7
Professional education of nurses ......................................................... 56
8
Conception of nursing ......................................................................... 62
REFERENCES ............................................................................................... 72
APPENDICES ................................................................................................ 74
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SYMBOLS AND THEIR MEANING
Study guide – the author enters the text; specific means of communicating
with the student, of encouraging him, and of supplying additional
information.
Keywords
Time needed to read the chapter
Example – example taken from life, practice or social reality used to clarify
or concretize the problem.
Terms to remember
Summary – summing up the subject-matter, summary of the chapter.
References – books quoted in the study material or used to
supplement/extend it.
Questions and exercises – testing the student's understanding of the text and
the subject-matter; checking out whether he/she remembers the essential
information and is able to apply it when solving problems.
Tasks – have to be carried out immediately as they help mastering the
following subject-matter.
Mail tasks – when carrying them out the student follows instructions and
proves his/her ability to take initiative. Tasks are being registered and
evaluated throughout the course.
Questions to think about
Section for those who want to know more – contains information and
exercises expanding the basic course. The passages and tasks are not
mandatory.
Tests and questions – solutions, answers and results are included in the
supportive material.
Solutions and answers – to individual tasks, assignments and tests.
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5
Introduction
Dear students,
this distance supportive material presents the first theoretical insight into
the discipline of nursing which you are beginning to study. Given only a
limited space I will try to outline the development of the discipline, describe
its theoretical and philosophical basis and related factors which shape its
existence and orientation. You will also learn how nursing is regulated in
the Czech Republic; the attention is paid to its teaching, practice and formal
organization. Every chapter includes – besides the summary and the list of
literature recommended for further reading – questions and tasks you will
be able to answer and carry out after having studied the chapter. Symbols
used are supposed to navigate you throughout the text.
I wish you success in your studies.
Having studied the text you will know:
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the basis of nursing as scientific discipline;
the essential concepts, models and determinants of health;
the basic theories of illness, personality of the ill and experiencing
illness;
the historical development of nursing in the world and in the Czech
Republic;
international activities of nursing, nursing organizations;
legislation of nursing and nursing care;
the role of the nurse and the ill in the process of nursing care;
the professional education of nurses in EU and in the Czech
Republic, the function of nurses;
the basic conception of the discipline of nursing in the Czech
Republic.
You will be able to:
 define the discipline and basic metaparadigmatic terms and concepts
of nursing;
 explain holism as the essential philosophy of nursing;
 approach health in positive context;
 understand illness in the context of a lifestyle and behavior of an
individual, to distinguish three dimensions of illness;
 explain the development of nursing in the historical context, to
evaluate influence of the historical landmarks and personalities;
 understand the relation between the orientation and individual
activities of nursing and the international WHO programs;
 to orientate himself/herself in the legal and control system of the
discipline and nursing care;
 understand the roles of the ill and the nurse and their relation;
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 orientate himself/herself in the system of education of nurses in the
Czech Republic and EU;
 define the orientation of the Czech nursing according to the concept
of the discipline.
Time needed to read the course material: 5.5 hours
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1 NURSING AS SCIENTIFIC DISCIPLINE
In this chapter you will learn:
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about differences between nursing and medicine;
the essential definitions of the discipline of nursing;
about the essential features and components of the discipline of
nursing;
about the components of nursing as science.
Keywords:
definition of nursing, nursing as science, features and components of the
discipline.
Time needed to read the chapter: 50 min.
Definition and conception of nursing
medicine – natural science (applied biology) – finding and solving the
problem posed by the illness;
nursing – one of the disciplines of the humanities and a social science –
dysfunction in human needs.
Aims of nursing: to take care of human needs which change in relation
to different conditions of one's life and health, to do so systematically,
holistically and using appropriate methods;
 to support and improve health;
 to take part in recovery;
 to alleviate the suffering of the ill;
 to provide for calm dying and maintain dignity in dying.
Definition of nursing
Nightingale: Nursing is a non-medical activity which offers patients the
best possible conditions for natural behavior. The conditions improve the
environment, thus improving health. Medicine (e.g. surgery) serves to mend
the ill part of the body, while nursing helps patients achieve the optimal
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health condition: ... the act of utilizing the environment of the patient to
assist him in his recovery. (Nightingale, 1860)
Henderson: The unique task of a nurse is to assist the ill or healthy
individuals in activities improving their health, helping them recover or die
calmly and which they would do unassisted if they had the necessary
abilities, will or knowledge. Nurses aim at helping patients become
independent as soon as possible.
ICN (International Council of Nurses): As an integral part of the health
care system nursing includes health support, prevention of illness and care
for the physically and mentally ill of various age in all medical and
community centers. In such a wide range of health care nurses focus on
reactions of individuals, families and groups to actual or potential health
problems. The reactions are to a significant degree based on reactions to the
illness of an individual which should lead to recovery. The reactions should
establish a process of achieving a long-time health of the population.
MZČR (Ministry of Health of the Czech Republic): Nursing is an
independent scientific discipline which concentrates on identifying and
satisfying biological, mental and social needs of the ill and healthy to
provide health care.
Essential features of nursing
1. Individualized care and the complex approach to the ill
Individualized nursing care is based on the complex (holistic) approach of
nurses to the ill who are considered to be biopsychosocial units. It assumes
establishing and systematically fulfilling the basic life needs which a
functionally independent individual satisfies on his/her own or which are
under normal conditions satisfied in the family.
2. Preventive character of nursing care
Primary prevention deals with preventing illness or other health problems
(e.g. low birth weight) by means of health education, vaccination,
improvement of nutrition, of health environment and of appropriate prenatal
care. The aim of secondary prevention is to prevent deterioration of
independence of an individual on his surroundings (e.g. preventing illness of
risk patients, helping patients maintain and regain as much self-reliance as
possible). Tertiary prevention aims at preventing or decreasing the risk of
illness complications by means of appropriate and early nursing care.
3. Nursing as team work
With growing specialization of medicine nursing becomes realized by the
joint work of a group of health care professionals who are functionally
dependent on each other. Team work requires nurses to be able to cooperate
with individual team members and to be skilled in communicating
information concerning the ill within the team.
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4. Scientific features of nursing
Nursing needs more than empirical generational experience – a solid
scientific basis. With such a basis nurses work consciously, they know the
causes of phenomena and are able to predict the changes of the patient's
state and the needs of appropriate care. To approach nursing as scientific
discipline nurses have to be acquainted with the theory of nursing, including
various conceptual models, and with the knowledge of biology and the
humanities.
5. Active nursing care
Active care is nursing practice carried out creatively, vigorously and with
serious interest. Active nursing care is defined by identifying and satisfying
the needs of the ill, by making them active and interested in recovering.
Passive nursing care is usually carried out in a doctor's office, it is a result
of stereotypical activities in a workplace or of frequently repeated requests
of the ill. Passive care is motivated from the outside, active care is a result
of nurse's inner motivation to carry out a nursing activity. The modern
nursing model combines active and passive nursing care.
Nursing care in the Czech Republic (especially regarding the secondary
care) is still oriented mainly biologically and medicinally; it stresses more
active role of nurses in treating patients. Nursing abroad (in Western
Europe, USA, Canada) concentrates more on health safety and stresses
independent role of nurses in preventive care inside and outside of health
centers and hospitals.
Recipients of nursing
Consumers of health care are individuals, groups or communities of people
using health services or products of health care. Patient is an individual
who expects or uses a medical treatment or care. The word patient is of
Latin origin and means patience. "Patient" traditionally refers to an
individual receiving health care. Client is an individual receiving advice or
services provided by others who are qualified to provide such services. We
prefer to use this term because a significant number of receivers of health
services are not ill.
Nowadays a disease oriented health care connected with concentrating
patients in hospitals is losing prominence. WHO promotes a new strategy of
health care suggesting that the majority of patients should be treated and
nursed at home. The philosophy of home care is based on the fact that every
individual is responsible for his/her health. In case he/she is not able to take
care of himself/herself, the person should be assisted by his/her family or by
health care volunteers. Specialized health care service of the professionals is
the last choice. All services should help the patient stay in the family
surroundings as long as possible.
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The essential values of nursing:
 to acknowledge and respect every human being;
 to understand human beings in their complexity (holism);
 to acknowledge factors which influence experiencing health and illness;
 to acknowledge the need to support and preserve health throughout the
entire life;
 the conviction that human beings have the right to take part in decisions
concerning their treatment.
Nursing includes a system of typical nursing activities which concern
individuals, families or groups/communities of people. It concentrates
mainly on preservation and support of health, on alleviating suffering of the
terminally ill and on providing for calm dying and death. Conception of
nursing and nursing care differs from conception of medical disciplines by
its focus on human needs. Nursing professionals identify, remove, alleviate
and prevent problems in the realm of human needs. All disciplines
represented in medical teams are specific and irreplaceable. Having
analyzed the differences in irreplaceableness of the two closely cooperating
medical disciplines – i.e. nursing and medicine – it can be generally said
that the activities carried out by nursing professionals concentrate on finding
a solution of dysfunctions in human needs, while activities of medical
professionals focus on finding a solution for illness. Nurses assist
individuals and families outside and inside of the hospital care to be able to
satisfy their needs independently. Nurses guide the ill to take care of
themselves, they instruct the surroundings to provide nonprofessional care.
The ill who are not able or are not willing to take care of themselves are
given professional nursing care.
Development of nursing
 disease oriented nursing;
 patient oriented nursing – nursing with holistic care, a client is ill and a
nurse works in a hospital;
 health oriented nursing – nurses concentrate also on the healthy, they
work in families and communities.
Nursing as scientific branch
Scientific branch is a scientific discipline involving a system of theoretical
scientific knowledge of a certain scientific area (nursing) which is defined
by the subject of its study and by methodology of research. Nursing draws
on the humanities, natural and social sciences which deal with human
beings, their behavior, health and relation to the environment and
society. Nursing is a diverse young discipline which can be (unofficially)
divided into basic and applied branches.
Basic branches – theory of nursing, history of nursing, methodology of
nursing.
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Applied branches – internal, surgical, gynecological and obstetric,
pediatric, physiotherapeutic, geriatric nursing, community nursing, nursing
in primary care etc.
Nursing draws on and cooperates with other disciplines – medicine,
psychology, sociology, pedagogy, ethics, philosophy etc.
As scientific branch nursing has::
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subject of its study (paradigm of the discipline = metaparadigm) –
human being – health – environment – nursing;
methodology of research – primary and secondary nursing research;
theory – a set of findings, terminology (specific vocabulary);
philosophy – holistic approach to individuals;
practical method – systematic nursing process;
system of education – pregradual, postgradual;
professional organization – national, international.
SUBJECT OF STUDY – metaparadigm (paradigm of the discipline)
Every scientific discipline deals with certain phenomena which are
characterizing it. Metaparadigm forms the core/basis of a discipline. It
presents a complex view of every scientific discipline; as such it
distinguishes one from another. Metaparadigms specify conceptions and
theories of a discipline. Scientific disciplines usually have only one
metaparadigm with a number of conceptual models. A number of disciplines
can share one metaparadigm (e.g. sociology and psychology – human
behavior), however, every discipline studies certain conceptions from a
different point of view.
Metaparadigm of nursing is developing since the times of Florence
Nightingale (i.e. the beginning of professional nursing) who was the first
one in history to deal with theory of nursing ("theory defines what is and
what is not nursing"); in her works she described the four essential concepts
of nursing (human being, environment, health, nursing). Metaparadigm of
nursing was, however, explicitly defined no sooner than in the half of the
last century. Metaparadigm (complex view, subject) is composed of four
specific phenomena (basic conceptions defining nursing) which are outlined
by following terms:
1. individual – recipient of nursing care; includes individuals, families,
communities and other groups of people;
2. environment/surroundings – which influences an individual, his/her
health and state of health;
3. health – range of one's state from well-being to illness;
4. nursing care – activities of nurses carried out for the benefit of an
individual and in cooperation with him/her.
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These four essential conceptions of the metaparadigm of nursing interact
with each other and are defined in all significant nursing models and
theories (forming their basis). The formulations are often different
depending on particular philosophies and assumptions the authors base their
models or theories on.
METHOD OF RESEARCH – research in nursing
Research is a systematic, controlled form of human activity which
concentrates on examining, recognizing, exploring and interpreting new
natural and social phenomena. Its aim is to reveal facts. Research in nursing
focuses on examining phenomena defined by the subject of nursing as a
scientific discipline (individual – environment – health – nursing care).
Nursing research contributes to spreading knowledge of the phenomena and
their relations. Basis of findings which is thus created can be brought to
practice (Evidence Based Practice) and serves as the platform to build the
nursing theory upon. Nursing research is carried out at research institutes,
educational institutes, medical, social or community centers. It is taught at
educational institutes where nurses are educated in scientific and research
methodology. Nursing research is distinguished as primary or secondary,
basic or applied.
THEORY OF NURSING
Theories form the basis of scientific knowledge. As well as models, theories
reflect conceptions and relations in certain areas; theories are more specific
than models (they are dealing with specific individuals, situations and
events). Terms have to be clearly defined for a theory to be empirically (i.e.
scientifically)
verifiable.
Theory
is
a
complex
of
notions/thoughts/assumptions which explain certain phenomena. Theories
follow certain models which they are sometimes derived from. They are
more specific than models. Theories contain conceptions and assumptions
(hypotheses), they specify relations in models. Theories can be scientifically
verified/tested.
Nursing theory is a relatively specific complex of concepts and statements
explaining or characterizing phenomena which form the subject of nursing.
It aims at creating new knowledge of a certain area of nursing. It is a
methodically rendered system of relatively abstract and relatively general
findings (concepts, statements, assertions) concerning particular aspects of
the studied object. It (a) describes, (b) explains and (c) predicts phenomena
and events which are the subject of nursing.
Theoretic models of nursing
 are trying to find ways to reach the aims of nursing;
 are helping nurses plan nursing care;
 are helping identify problems and studying nursing activities and
interventions.
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PHILOSOPHY OF NURSING – holism
Rapid development in medicine made nurses concentrate on performing
complicated diagnostic and therapeutic procedures. Purely nursing care thus
no longer paid attention to human beings and their needs. Nurses realized
this deficiency and started introducing practical principles which were
supposed to secure the balance between technology and human needs. By
doing so nurses elevated their role and became "defenders of patient's
rights" – they are stressing individualized approach to a patient's needs and
the importance of sustaining dignity and quality of his/her life, which are the
basic ethical principles.
Holism means whole (it is derived from a Greek word holos meaning
whole, entire)
It is a philosophical approach of integrality which developed in the second
decade of the 20th century from philosophical idealism. Its name was
introduced by South African military leader Jan Christiaan Smuts in his
book Holism and Evolution (1926). According to holistic theory, living
organisms in their entirety are composed of many parts which are
dynamically interacting, i.e. not of static parts. Thus disorder in one part
brings disorder into the whole system. In nursing holistic care of human
beings means paying attention to bio-psycho-social and spiritual dimension.
Human beings are approached as wholes, entire and individual beings;
nurses do not pay attention only to a part of the body/function which needs
treatment. When taking care of body and soul nurses have to respect
patient's rights, his autonomy and social status.
The importance of holistic theory in modern nursing
As long as holism is the philosophy of modern nursing, the unique role of
nurses on all levels of care (preserving health, experiencing illness,
recovering or dying) is defined by fulfilling patient's physical, mental and
social needs. Seen from holistic perspective of nursing care, everybody is
personally responsible for his/her health, for its preservation and – in case
of illness – for mobilizing his/her own powers to recover. Our view of
psychosomatic interaction influences our view of ourselves, of our health
and of the others. Fulfilling the needs of patients is sometimes not an easy
task; nurses often experience stress and have to know how to manage it (i.e.
to take care of their own health). If nurses know themselves, know their
limits and are able to control themselves, they are able to help others under
stressful conditions. The principle of holism is sustained in nursing care
which pays attention to physical, spiritual, emotional, cognitive and social
needs of the ill. Care is focused on human beings in their entirety, not on a
particular illness or ill part of body. Holism forms a basis of nursing
theories, models, ethical principles and outlines the values of the
discipline.
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METHOD OF NURSING PRACTICE – process of nursing
Holistic philosophy in modern nursing stresses the need to change the
organization of nursing work and of approach to the ill. According to
holistic approach, nursing should involve systematic logging and analyzing
of information concerning the ill, planning, realization and evaluation of the
effect of given care. The method presents a new approach to the ill and
suggests certain changes in systems of organization. Responsible and wellexecuted nursing care secures that relationship between the nurse, the ill and
his/her family is balanced, i.e. it resembles partnership. It also guarantees
the continuity of individualized nursing care. Method of nursing process
presents a systematic progression of sequential steps in individualized,
complex care of healthy or ill individuals. It brings to nursing practice the
abstract levels of nursing science – it mediates the relation between
conceptual models and theories and nursing.
1. Assessment – logging of information concerning the client/patient; this
step is directly related to the second essential unit of the conceptual
model, i.e. to the recipient. E.g. if the model is oriented on self-care, the
patient/client is assessed from this point of view.
2. Diagnostics – identifying actual and potential problems (diagnoses) by
analyzing logged information with regard to the applied model.
3. Planning – means setting the aims and final criteria and creating the
plan of nursing activities which are in accordance with the aims of the
model.
4. Realization – actual realization of individual steps of nursing care
according to the current scientific knowledge; the model suggests nurses
what should be carried out, but not how it should be done.
5. Evaluation of nursing care – nurses are given the answers whether –
and to which degree – the aims were reached, how is the client/patient
recovering, how is he/she reacting to the care given. The effectiveness of
the entire process and the model used is evaluated. Nursing process – in
every model – emphasizes individual steps which can be carried out in
different ways depending on particular models.
Summary
Nursing is a scientific discipline which differs from medicine by its focus on
human needs in health or illness. Nursing was already defined in the 19 th
century, the most frequently used definition comes from Henderson (it has
been slightly modified). As a discipline it involves all essential components
– subject and method of research, theory and philosophy. It is characterized
by active and individualized care, by stressing prevention, teamwork and
scientific approach.
Questions and tasks:
1. Specify the difference between nursing and medicine using a specific
example.
2. Give specific examples of individualized, active and preventive care.
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3. Apply metaparadigmatic elements to a real situation in practice.
Further reading related to the chapter:
ŽIAKOVÁ, K. a kol. Ošetrovateľstvo – teória a vedecký výskum. Martin: Osveta,
2009.
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2 HEALTH
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about
about
about
about
about
the essentials of the definitions of health according to WHO;
the development of the definitions;
relation between health and nursing;
holistic concept of health;
models of health and preventive orientation of the discipline.
Keywords:
definitions of health, models of health, state of health, holism, determinants
of health, prevention of illness, health support.
Definitions of health
Concept of health is changing and developing. For centuries health was
understood as the absence of illness. Until the end of the 19 th century the
main aim of the medical experts was to "deal with disease". In the recent
years, however, the emphasis is being put on health. Widely known concept
of health is based on the definition which has been since 1948 a part of
Constitution of the World Health Organization (WHO):
"Health is a state of complete physical, mental and social well-being and
not merely the absence of disease or infirmity."
Health is here defined by three dimensions of equal significance – physical,
mental and social. Using the three dimensions the concept of health was
liberated from the traditional biology-based view which seems to be
historically predominant in medicine. The definition of health understands
individuals as inseparable from the social environment. Illness is here
understood as disorder in the individual-environment system. It is the
potential of organism's functions to adjust in the course of life to the
requirements of one's environment. In recent decades illness has been
widely considered to have (like health) multifactorial, bio-psycho-social
basis. Illness is caused (or developed) not only by individual factors of the
environment (biological or social) but predominantly by their interactions
with human organisms and particular lifestyles.
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In 1984 WHO published following definition of health:
"The extent to which an individual or a group is able to realize aspirations
and satisfy needs, and to change or cope with the environment. Health is a
resource for everyday life, not the objective of living; it is a positive
concept, emphasizing social and personal resources as well as physical
capabilities."
This definition acknowledges multidimensional basis of health. People are
not healthy if they cannot realize their wishes and life aims, fulfill their
needs and cope with their environment. From this point of view we
understand health as reserves of physical and mental faculties and as ability
to adjust to the changing conditions. Nowadays it is not enough to remove
one's illness, we have to pay increased attention to the need of optimal
cultivation and utilization of one's beneficial biological, mental and
social faculties and abilities.
Holistic concept of health
Everything which concerns human beings is holistic – uniqueness of their
personalities, of their organisms, minds, lifestyles, of relation to their
environment, to other people and themselves. It includes human ability to
defend oneself against physical and emotional stress (ability of primary
prevention), to cope with it, to know the limits of one's abilities and to
utilize them appropriately. Health means bio-psycho-social balance.
Balance which keeps all elements (bio – physical and physiological state;
psycho – cognitive, emotional and spiritual; social – social environment,
intrapersonal and interpersonal relations) in equilibrium. Because of the fact
that all the elements interact, we denote their mutual relation as
psychosomatic. Mind and body interact. Information and energy are freely
interchanged between one's outer environment, his cells, mind and social
environment. The main "mediator" of this interchange is brain. Unbalance
of one element causes unbalance in the entire system. Organism then reacts
by developing an illness. Stress plays an important role in breaking
equilibrium – sadness, multiple changes in life, social isolation, pain and
other physical stress generators (stress factors). Stress decreases
"coherence" of the mentioned elements and organism's immunity against
illness. Human beings experience stress as physical and mental discomfort.
Mental unbalance causes physical unbalance and vice versa.
Basic terms and concepts of health
Our concept of health is social and culture bound; our view of health is
influenced by our experience of illness or by frequent contact with the ill.
Sociological health. Health is physical and emotional state which enables
individuals to reach desired values and enjoy them. Good sociological
health means to live normal, fully-fledged and active life according to one's
ideas.
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Psychological health. Health means a feeling of steadiness, peace and wellbeing; one experiences serene and peaceful mood, positive emotions, mental
well-being, harmonious interactions with society the individual lives in.
Public health. Public health means state of health of the populace which is
determined by the complex of natural, living and working conditions and by
lifestyle.
Health support and prevention of illness became important elements of
modern conceptions of public health care as its new, initial phases.
Prevention of illness involves effort to prevent illness by interventions, i.e.
immunization, decreasing of risk factors etc.
Health support on the other hand involves every effort to increase the
general level of health by supporting overall physical, mental and social
well-being and by increasing immunity against illness (32).
This approach understands prevention as action specifically oriented,
focused on certain illnesses, while health support is considered to be
nonspecifically oriented, focused against groups of diseases or against their
general causes. For people to be healthy and able to live fully the following
needs have to be fulfilled:
 They need support of others, need to feel safe, trust others and their
environment.
 They need opportunity to create a place in the society which supports
self-confidence and responsible behavior towards others.
 They need necessary skills and resources (health is one of the
necessary preconditions of meaningful life of an individual, community
and the entire society).
Conditions for gaining or maintaining health according to the WHO
program Health for All:
 peace and absence of fear of war;
 equal opportunities for everyone;
 fulfillment of basic needs (nourishment, elementary education, water
and sanitation, adequate housing, ensured job and place in society);
 political will and support of the public.
Models of health
Clinical model. People are presented as physiological systems with
adequate functions; health is defined as absence of signs or symptoms of
illness or injury. The opposite of health is illness or injury. Clinical model is
used by many general practitioners. If an individual does not have the
symptoms of the illness, physicians often think he/she has recovered.
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Ecological model. Is based on people's relation to the environment; it is
composed of three interactive elements:
host – an individual who can be at risk of illness;
agent – factors of environment which can cause illness;
environment (outer and inner) – which can influence onset of illness.
Social roles model. Health is defined as one's ability to play his/her social
and occupational roles. According to this model, people who can fulfill their
tasks are considered healthy even though they are clinically ill. Illness is
inability to work.
Adaptation model. This model understands health as creative process.
Individuals actively and constantly adapt to their surroundings and
environment. Illness is understood as failure to adapt. The aim of treatment
is to renew one's ability to adapt, i.e. to adjust.
Eudemonistic model. Health is understood as a state in the process of
fulfilling one's potential. Such fulfillment is the zenith of fully realized
personality. According to this model, illness is a state which prevents selfrealization.
Health and society – determination of health
Level of health is one of the measures of society's welfare, of its economic,
political and humane maturity. Health is determined by three factors:
1. Individual features of human beings, such as their inborn disposition to
health or illness. Life-style (human behavior) belongs to this category.
2. Social factors which determine conditions for health support, treatment
and prevention of illness. Mature society safeguards human beings
against many health risks (infections, industrial diseases, injuries), gives
them health education, provides ways to maintain their health
(recreational activities, sport, healthy food) and offers treatment.
3. Both groups of factors are active on the background of living
environment (e.g. climate, radiations, pollution).
State of Health
State of health means state of an individual's health in a given moment.
Views of health reflect one's momentary beliefs regarding health which can
be true or not. Factors influencing state of health: genetic set-up, race,
gender, age and development, mental and physical relations, life-style,
natural environment, living standard, cultural background, family, selfconcept, supportive net (friends), job satisfaction, geographic location.
Determinants of health
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1. Life-style is the most substantial one. Decrease in mortality rate in
countries with beneficial life-style was influenced mainly (by 50–60%) by
positive change of life-style. The most influential health hazards: smoking,
inappropriate nutrition, lack of exercise, high level of mental stress,
alcohol abuse, drug addictions, inappropriate sexual behavior.
2. Living and working environment – pollution of air, water, soil and
food, chemicalization of environment, unhealthy natural factors (noise,
radiation). These factors influence state of health by approx. 20%.
3. Health care – quality of health care influences health by approx. 10–
15%.
4. Genetic factors – chromosomal level, genofonds – by approx. 10–15%.
Healthy life-style
Healthy life-style is defined by activities aiming at understanding state of
health, at maintaining optimal health, at preventing illness and injury and at
achieving maximal physical and mental potential. Healthy life-style protects
against illness or gives opportunity for their early diagnosis.
Basic rules of healthy life-style:
 to know one's state of health as well as possible, to know health state of
one's close relatives, to live and act according to this knowledge, to pay
attention to information, instructions and suggestions of medical experts;
 to follow the rules of healthy eating, to eat appropriate amounts of food,
not to overeat or starve, to decrease fat consumption, to eat more
vegetables and fruits, to change structure of one's food;
 to bear in mind the importance of movement (exercise, sport, tourism)
and to spend more of one's free time doing these activities;
 to adjust one's approach to work and people to one's faculties and
abilities in order not to put oneself and others under stress;
 to learn to rest after work, to spend time on your hobbies, to sleep
enough;
 to avoid health hazards caused by smoking, abusing alcohol or other
addictive drugs, to behave with respect to risk of HIV infection;
 to use one's faculties and means to make life in your surroundings
healthier.
Prevention of illness and health support
Prevention of illness – preventing illness by means of interventions, such
as immunization, decreasing the risks of illness, environmental protection.
21
Health support – every effort to increase the level of health, to increase
physical, mental and social comfort and general immunity of organism.
The majority of the most common illness can be to a significant degree
prevented by change of life-style. Exposure to the majority of substantial
factors (e.g. smoking, inappropriate food, alcohol abuse, lack of movement,
inappropriate sexual and reproductive behavior) is usually voluntary and can
be reduced or eliminated.
There is a wide range of intervention measures which can be used: state
health policy, education to healthy living, community programs focused on
improving conditions for healthy living, searching for patients with
increased risk factors and in asymptomatic state of illness and their
treatment.
Preventive strategy can be oriented on the entire population or on
individuals. After certain global experiences in the recent years the
programs oriented widely on entire populations are no longer preferred.
Effective prevention have to be oriented on clearly defined risks and
groups of endangered people.
It is vital for every individual to know that health is not the aim of one's
life, but the one and only means of living valuable life. Every individual is
primarily responsible for his/her health.
Summary
Nursing concentrates on the needs of individuals, especially the healthy
ones. Definition of health according to WHO acknowledges its
multidimensional basis. There are many models of health, the concept of
health, however, is based on holism. Health is determined by four basic
determinants, healthy life-style being the most important one.
1. Name the most substantial factors influencing state of health.
2. Think about the difference between health support and illness
prevention. Which is more effective?
3. What is the difference between the WHO definitions of health from
1948 and 1984?
BARTLOVÁ, S., MATULAY, S. Sociologie zdraví, nemoci a rodiny. Martin:
Osveta, 2009.
KOZIEROVÁ, B., ERBOVÁ, G., OLIVIEROVÁ, R. Ošetrovateľstvo Vol. 1 & 2.
Martin: Osveta, 1995.
22
3 ILLNESS




about the basic theories of illness and their essentials;
about the causes and risk factors of illness;
about stages of human behavior in illness;
about attitudes of ill individuals and about the factors influencing
illness.
Keywords:
theories of illness, human behavior in illness, attitudes of the ill,
experiencing illness, psychosomatic illness, compliance.
Theory of genesis of illness
The influence of culture and scientific thinking of the times is vital – e.g.
illness understood as a form of demon possession or as punishment for
sins. The germ theory of illness genesis became influential in the 19th
century (L. Pasteur) – it suggests that every illness is caused by a specific
microorganism (e.g. plague, cholera). Biomedicine understands illness as
dysfunction of organs or cells. It concentrates on biological and
physiological processes which cause pathologic damage of tissue or
dysfunction of organs. Psychosocial aspect of illness is not paid attention to.
Nowadays, life-style, behavior of individuals and living environment are
considered to be essential.
Holistic theories view illness genesis outside the range of pathologic
processes, they concentrate on interaction of human beings with
environment and the effect of the interaction on mental and physical health.
A. Homeostatic theories of illness
Refer to self-adjusting processes of body and ways of maintaining their
equilibrium. Illness is viewed as dysfunction of the processes or as failure of
homeostasis.
 Illness as dysfunction of homeostasis
Health depends on the ability of organism to maintain inner environment
of organism in equilibrium. Illness is caused by dysfunction of inner
environment of body, by failure of organism to communicate with outer
environment (C. Bernard, W. Cannon).
23
 Illness as failure to adapt
Stress is a medical term referring to a wide range of outer stimuli
(physiological and psychological) which can cause a physiological reaction
of organism called general adaptation syndrome (first described by Hans
Selye in 1936). Selye supposed that stress in not only a physiological
process of adaptation, but also a syndrome which can cause illness (failure
to adapt to stress). He noted that some patients suffered physical
manifestations not caused directly by illness or their state of health. Failure
to adapt to stress means inadequate reaction of body to stress; adaptation
illness.
B. Psychosocial theories of illness
The theories try to explain illness genesis by integrating physiological,
psychological and social factors. They concentrate on the effect of mental
life on one's health.
 Theory of stress, maladjustment and illness
Ineffective adaptation can lead to failure of homeostasis and illness – illness
is often caused by attempts to adapt and restore homeostasis. The
representative of this theory is Harold Wolff (psychiatrist) who noted that
one's mental state influences his physical state, that people react to
frustration repeatedly by different systems (gastric mucosa – ulcer; pituitary
membrane – rhinitis).
 Illness as way of life
The representative of this theory is Stewart Wolf who concentrated on the
role of brain in regulating physical processes and in illness genesis (e.g.
physiological reaction on negative thoughts). One's ability to react to
symbols in fact determines whether one stays healthy or becomes ill.
 Theory of life changes
Change in life is a form of stress one has to adapt to physically and
mentally. Having to cope with many significant changes in a short period of
time can lead to overstrain and illness genesis. The representatives of this
theory are Thomas Holmes and Richard Rahe (social adjustment scale –
significant life events).
C. Biobehavioral theory of illness
Biobehavioral theory of illness genesis tries to specify behavior of
individuals and its relation to illness. It relates behavior, life-style and stress
to illness. Friedman and Roseman (U.S.A, from the 1950s) explored relation
between certain types of personality and their predisposition to illness. They
divided individuals into two types according to their behavior and reactions
in stressful situations – type A personality (the personality and life-style
make one predisposed to cardiac failure; such people always seem to be in
hurry, tend to perfectionism, they are often overworked, they are doing
more things at once, they are not able to rest, are impatient, competitive,
24
aggressive, hard-working; they often become addicted to stress hormone
noradrenaline they produce – risk of cardiovascular disease); type B
personality (such people are moderate, calm and relaxed; not so much
inclined to the risk of stress or predisposed to cardiac failure – often suffer
from GIT disease).
ILLNESS
Illness – originally meant "bad". We define illness as a state of organism
caused by inner or outer conditions which disrupt its proper functioning and
balance. Malfunctioning and disorder of organs lead to symptoms of illness
and other effects. Illness is a complex of reactions of organism to the
disrupted balance between itself and environment. It also affects the
surroundings of the ill (changes the rhythm of life of family, can cause
economic problems – i.e. social definition of illness). Illness is deviation
from health; we can trace objective changes, but not necessarily; it is usually
accompanied with subjective feelings (individual experiences).
Basic terms
Illness is a personal relation; an individual is not feeling healthy; subjective
view of state of health (pain, fear, weakness, depression) – „mental
dimension“.
Sickness – a state usually connected with illness, but it can also appear
independently; social activity (according to age, gender, occupation) –
„social dimension“.
Disease is a medical term which refers to disorder in physical and mental
functions leading to decreased effectiveness or shortened length of life;
objective state (biological malfunction) – „biological dimension“.
Cause of illness (etiology). Illness is caused by: genetic or family
predisposition, influence of environment, biological agents, natural agents,
chemical agents, substances inducing antibody formation, harmful chemical
or metabolic processes, constant stress.
Risk factors – phenomena increasing sensitivity of individuals to illness or
injury; there are 5 interconnected categories: genetic set-up, age,
physiological factors, life-style, environment.
Stages of human behavior in illness
Human behavior in illness is influenced by various factors, such as age,
gender, occupation, socioeconomic state, religion, nationality, mental
stability, personality, education and compliance.
25
1. Realization of symptoms. It is a transitory state at which individuals
realize that something is wrong. The stage has three aspects: physical
experience of symptoms (e.g. pain), cognitive aspect (explaining symptoms)
and emotional response (fear, anxiety). At this stage individuals discuss
their feelings and symptoms with the close relatives.
Fig. 2 Stages of human behavior at appearance of the first symptoms of illness (Bartlová,
1996)
2. Adopting the role of the ill. Second stage signals acceptance of illness.
Subjects consider whether the symptoms are serious enough to assume
illness. At this stage individuals are scared, they are willing to abandon
certain activities and seek medical aid.
3. Contact with medical care. The ill seek medical aid, willingly or on
advice of others. At this stage they request three types of information:
confirmation of illness, explanation of symptoms, assurance that they will
recover (or prediction of consequences).
4. Role of dependent ill. When a medical expert confirms illness,
individuals become dependent on his aid. Responsible role (e.g. provider for
family, father, mother, student, sportsman) complicates one's decision to
renounce independence. The majority of individuals, however, accept their
dependence on medical care, even though they to try to maintain control
over their life. At this stage individuals often become passive recipients.
26
5. Recovery or rehabilitation. At this stage patients learn to renounce the
role of the ill and to return to their previous roles and functions. If
individuals suffer from acute illness, the role of the ill is not played for long
and recovery is usually speedy. Patients suffering from prolonged chronic
illness who have to adjust to a new life-style can consider recovery harder.
Compliance. Is the degree to which behavior of individuals complies with
advice of medical staff. Whether an individual complies with course of
treatment depends on many factors (e.g. age, education, expenses, patient's
evaluation, discomfort one has to endure). The compliance research states
that more than 30% of individuals refuse to comply (noncompliance). To
enhance compliance nurses can: be empathic and caring, enhance healthy
behavior by heartened suggestions, find out the reason why patients resist
treatment, use educational aids, make nursing as liberal as possible, induce
mutual understanding and responsibility (paternalistic Vs partnership
relation).
Attitude towards illness
1. Normal attitude – corresponds with the actual state. The ill is adequately
adapted to illness.
2. Downplaying attitude – the ill underrates illness, is not willing to
undergo treatment, to rest, to follow suggestions (e.g. underrating, fear).
3. Repudiating attitude – repudiation of illness. The ill is not paying
attention to illness, is not willing to seek medical aid.
4. Dissimilative attitude – the ill deliberately distorts his problems or
denies them (e.g. is not willing to take sick leave).
5. Nosophobic attitude – irrational fear of illness. The ill wants to be
repeatedly examined by various medical professionals; the ill overrates
problems (e.g. carcinophobia).
6. Hypochondriac attitude – the ill is convinced that he/she is seriously ill
or experiences problems connected with less serious illness profoundly.
7. Nosophilia – the ill feels certain satisfaction in being ill, likes pleasant
aspects of illness (e.g. not having to fulfill his/her responsibilities, being
taken care of).
8. Purposive attitude – enhanced nosophilia (e.g. appeal to pity, escape
from an unpleasant situation).
Factors influencing the personality of the ill
1. Process of illness – some diseases can cause changes in personality (e.g.
head injury, mental illness).
2. Secondary features of illness – length of illness, its progress,
painfulness, consequences of surgical procedures, amputations (vital values,
emotional experience).
3. Premorbid personality (personality prior to onset of illness) –
personality influences the way one experiences illness; every individual
approaches illness with different assumptions (temper, emotional reactions,
27
view of surroundings – sociable individual or loner, education,
consciousness).
4. Group features and age – typical for certain gender, age or social and
cultural surroundings (e.g. men are expected to bear pain better that women,
the middle-aged are expected to provide for family).
5. Other features of the mentality of the ill – some of the ill mask their
inner feelings (calm and quiet or not coping with illness well).
Some special personality traits influencing progress of illness:
- suggestibility – enhanced sensitivity; embracing information from
surroundings uncritically (pessimism, submissiveness);
- selfishness – suspecting (considering every circumstance significant, even
though it is in no relation to the patient);
- egocentrism – concentrating on oneself and one's problems;
- sensitiveness – caused by weakened nervous system (prolonged pain,
fear, insomnia);
- problems with adaptation – mainly seniors (insecure, disquiet,
disoriented, confused);
- regression – descend or return to the previous stage of personality.
Division according to types of illness




acute form – prior to onset of illness the patient was healthy (injuries,
colicky pain, life-threatening conditions);
chronic illness – prolonged illness, moderate progress, can lead to mood
swings, depression or total exhaustion of organism;
permanent defect (sensory and somatic) – the time when defect was
suffered is essential (birth, early childhood, youth, adulthood). Children
adapt more quickly (upbringing and education in specialized institutes);
seriously ill who do not know about illness – not seeking aid of
medical professionals, not informed.
Experiencing illness in time
1. Premedical stage – first symptoms and problems of organism, one asks
laymen or healers for advice, self-treatment.
2. Stereotype change – more serious illness connected with sick leave or
hospitalization (hard to bear for workaholics and hypochondriacs).
3. Active adaptation – adapting to illness and related problems, trust in
speedy recovery (the ill cooperates with medical professionals).
4. Mental decompensation – depends on patient's state, progress of illness,
patient's personality (when active adaptation fails – patient feels sorry for
himself, is impatient, irritable, uncritical).
5. Passive adaptation – resignation (patient isolates him/herself from
surroundings, accepts unfavorable state, resigns, stops struggling, it can
lead to patient's death).
28
Relations between physical and mental aspects of illness –
psychosomatic illness
Physical and mental development of human beings is inseparable. Every
illness has physical and somatic aspect:
- somatophysical aspect – illness and damage of body cause mental
reaction (almost every more serious illness brings fear, anxiety, insomnia
and nervousness);
- psychosomatic aspect – mental irritation causes physical illness (e.g.
prolonged stress – heart attack, gastric ulcer, hypertension); such illness is
denoted as psychosomatic.
Genesis of psychosomatic illness is influenced by: repeated stressful
situations, hereditary predisposition, age, immunologic processes, previous
illness, social environment. Treatment of psychosomatic illness requires
complex approach – physical and mental aspects of individuals have to be
treated. In recent years psychosomatic illness is being paid extensive
attention to because of the rising problems related to the development of
civilization and to the life-style change of the current population.
Summary
Views of illness were developing for centuries; nowadays holistic theories
of illness genesis are the most influential ones. Individual experience of
illness can be divided into five stages. Attitudes towards illness depend on
experience and behavior of the ill. Nurses try to enhance compliance. Every
illness has physical and mental aspect. Psychosomatic illness is more
frequent in the highly developed civilizations and it requires complex
approach.
1. Give examples of several psychosomatic diseases related to the level of
social development.
2. Think about the possibility of prevention of psychosomatic and
civilization diseases.
3. Give specific examples of illness or state of heath change of children
connected with terms "illness", "sickness", "disease".
Osveta, 2009.
KOZIEROVÁ, B., ERBOVÁ, G., OLIVIEROVÁ, R. Ošetrovateľstvo Vol. 1 & 2.
29
4 HISTORY OF NURSING




about historical beginnings of the development of nursing and about
its connection to the development of medicine;
about the roots and representatives of modern nursing;
about history of the development of nursing in the Czech lands;
about history of the development of nursing education.
Keywords:
history, development, nursing, medicine, education in nursing.
The beginnings of nursing
Primitive life of settlers in the ancient times was accompanied by diseases
and epidemics. Illness was fought with knowledge gained from observing
effects of herbs, water and sun on human organism. This knowledge was
passed on to following generations. When Christianity spread in Europe,
nursing became a part of medicine. The development of nursing in various
countries shares certain features, some of its aspects are, however, different.
Nursing was always under influence of religious, cultural, social and
political factors, it was influenced by wars, scientific discoveries and by
distinguished personalities. Primitive people did not understand causes of
illness; the first attempts at treatment were based on the assumption that
magic can prevent illness. Medicine-men developed various rituals to treat
illness. Therapy used mostly herbal remedies and massage. Later, the ill
visited temples where priests were praying for their recovery or were trying
to placate the angry gods who were causing illness. Priests were known as
priests-healers. Nursing at home was provided by mothers or other
members of family and by slaves. The development of medicine in Europe
was vitally influenced by Ancient Greek medicine which originated in the
second millennium B.C. Hippocrates – "the father of medicine", the author
of typology, the teacher of the authors of the Hippocratic Oath – lived in the
5th and the 4th century B.C. Another of the most outstanding personalities of
the Ancient Greek medicine was Galen (the 3rd and the 2nd century B.C.)
whose works were influencing medicine for centuries.
Christian belief that service provided to man is, in fact, service to God led
in the 1st century A.D. many philanthropic individuals to visit and nurse the
ill. In the 4th century A.D. the first convents fulfilling these purposes were
30
established; many Roman women of noble origin participated in nursing the
ill. For several following centuries religious orders were establishing
convents and monasteries where monks and nuns nursed the physically and
mentally ill. In their activities (providing shelter and nourishment, physical
care and spiritual support) the first attempts at fulfilling physical, mental
and social needs can be recognized. While the Catholic Church suggested
the ones in need should be taken care of in convents, monasteries and
infirmaries, the Protestant Church concentrated on helping individuals in
families and communities. The ill in the protestant lands were nursed by
deaconesses. They nursed individuals in their homes and also in hospitals
(when invited). They were theoretically and practically prepared by medical
professionals and had to pass an exam in pharmacy. They were not paid, but
their basic needs were provided for, even in old age. Christian churches
significantly influenced the development of health care, however, they did
not support examination of physical processes to identify causes of illness,
which was sometimes even punished as sinful.
Medicine and nursing
The birth of medicine as scientific discipline dates back to 1300-1450 B.C.
Until the end of the 19th century scientific diagnostics, treatment and
surgical methods were limited. At the beginning of the 20th century
medicine and medical technology started to develop quickly. Hospitals did
not serve only to treat patients but also as educational centers for medical
experts and for medical research. At the beginning of the 19 th century
patients mostly stayed at home and were nursed by family, servants or
custodians who were treated only slightly better than servants. Their salary
was low, as well as their social position. They gained knowledge in practice
from the senior colleagues. The custodians (and later nurses) were expected
to assist physicians and to follow their orders. Emphasis was on treatment
of physical illness. The first lectures for nurses were not organized sooner
than at the end of the 18th century. These lectures took place in mental
institutions and can be considered the first attempts at organized education
of nurses.
Changes in quality of nursing the ill
Wars were influencing the development of nursing significantly. Huge
numbers of soldiers, mass infections brought by poor hygiene in military
hospitals and insufficient knowledge of medical staff caused the increased
need for medical and nursing care. More soldiers were often killed by
diseases than by enemy. In Antiquity the ill and wounded were taken care of
by slaves. During the crusades in the Middle Ages the well-organized
military nursing orders taking care of the crusaders were founded. Many
nursing traditions originated in military nursing which goes back to the
times of the Holy Wars, e.g. strict morals, ward rounds, structure of nursing
units (large rooms for patients with slight injuries, side rooms for seriously
ill patients, cabinets for patients in critical condition).
31
The quality of nursing is supposed to have changed in the time of Crimean
War (1854–1856). The idea to use women as nurses in battlefields was
utilized by Nikolay I. Pirogov (1810–1881), a Russian surgeon who trained
thirty Russian volunteering nurses for the Russian front in Crimea in 1854.
He stressed that the hygienic rules should be strictly followed in order to
prevent epidemics of infectious disease which caused more deaths than
wounds of war. Nursing care of wounded soldiers was also significantly
shaped by Henry Dunnant, a Swiss businessman who happened to
participate in a battle near Solferino between the French and Austrian army
in 1859. He found the experience very painful. He outlined rules of
proceeding in such situations which suggested the wounded should be
serviced by civilians. Dunnant's efforts led to the founding of the
International Committee of the Red Cross in Geneva in 1854. Nowadays
the organizations united in the International organization take care not only
of those who were affected by war, but also of victims of floods, famine,
earthquake and other such events (36).
The roots of modern nursing
Nursing was reformed by the work of British nurse Florence Nightingale
(1820–1910). She was well-educated, came from wealthy family and had
influential friends. Her family did not allow her to work as nurse at a local
hospital because nursing was not considered respectable enough for a young
lady from an upper-class family. In spite of this she visited the ill in
hospitals and studied health care in Europe; she was in contact with
hospitals in England, France and Germany. She used her knowledge and
experience gained from managing a small nursing institute in Crimean War;
she came to Crimea a year later than Pirogov. She took with her a group of
forty English nurses she herself trained. Florence Nightingale, the Anglican
nurses and local nurses managed to significantly decrease the number of
soldiers who died of wounds or infection. Under her management they
opened laundry, dietary kitchen and hygienic conveniences; sufficient
supply of clothes and food for personnel and soldiers was secured. Her
interventions in nursing management decreased mortality of wounded
soldiers from 50 to 22%. Her reforms laid foundations for independent
professional nursing which stresses thorough training of nurses; her work
substantially influenced modern nursing. Having returned from Crimea,
Florence set up the Nightingale Training School at St. Thomas' Hospital
in London in 1860; it was the first school training nurses in the world and it
provided model for nursing education institutes in other countries. She
outlined the first conception of nursing which was based on charitable
approach to nursing the ill and it stressed humane motivation of nursing.
No sooner than in her time were nurses systematically trained and educated
in hospital and home care. Thanks to Nightingale's efforts nursing was
transformed from charitable service into professional and profoundly
humane occupation. The development of nursing was significantly
influenced by her book Notes on Nursing (1860). In 1874 it was translated
into seven languages including the Czech. The book is still topical; it
contains instructions to satisfy patient's needs for hygiene, nourishment,
fresh air, rest, comfort, stimulating and pleasant environment. Florence
32
Nightingale realized the difference between nursing and medicine and
envisioned nursing as independent profession.
However, education and work of nurses was to remain controlled by the
needs of hospitals and medical professionals for a long time. Nightingale
turned nursing into respectable civilian occupation for middle-class women.
She popularized the idea of systematic education of nurses and introduced
the function of matron as the head of nursing professionals in hospitals. The
training school in London became model for nursing education institutes
founded in a relatively short time in other major European cities and in the
United States. Professionally trained nurses quickly increased quality of
nursing, especially of hospital care. In individual countries nurses began to
associate and establish national professional organizations uniting graduates
of nursing institutes. At the end of the 19th century, in 1899 the first nursing
organizations united and founded International Council of Nurses (ICN)
which is still operational.
History of Czech nursing
The roots of organized nursing of the ill in the Czech lands can be traced
back to the 10th century to the rule of Boleslaus I (935–967). The first
hospices were founded in the region of Prague; they were, in fact, shelters
for the poor and the ill – serviced by nurses – whose basic needs were met
there. Similar role was served by some religious orders and congregations
whose mission was to help the suffering and people in need. Apart from
monasteries and convents, the orders and congregations were also founding
infirmaries which were giving the ones in need shelter, food, bed and the
warmth rather than providing treatment. The first one was founded in Týn
(where the Old Town Square is located today); it housed twelve ill nursed
by seven women. Other infirmaries founded later in the Czech lands were
usually connected to a chapel, church or monastery. Nursing was
understood as secular service to the suffering, it was seen as a highly
humane activity. Nurses had no professional training, they were drawing
only on experience of their predecessors. The outstanding personality of the
beginnings of Czech nursing was Agnes of Bohemia, sister of Wenceslaus I
of Bohemia. She founded several friaries – the one she founded in 1233 ("U
sv. Haštala") included infirmary. She also founded the order of the Knights
of the Cross with the Red Star which followed her own instructions in
nursing the ill and providing for the poor. Later she was considered the
founder of nursing in the Czech lands; finally, at the end of the 20th century
she was canonized. Among other orders dedicated mainly to nursing and
caretaking were Missionaries of Saint Charles Borromeo, Order of Saint
John, Sisters of Saint Elizabeth, Brothers of Mercy (infirmaries in Prague,
Brno, Letovice, Valtice and other towns and cities founded mostly in the
17th century).
In hospitals the ill were serviced also by trained barbers,
bath attendants, midwifes, herbalists, itinerant surgeons and others.
Deaconesses (the 15th century) were not working only at hospitals and
infirmaries but also in the field. They were visiting the ill in their homes
where they were nursing them especially in case of infectious disease. The
area called "At St. Francis'" ("Na Františku") in Prague was known for
charitable services (especially caretaking) provided there from 1620 by
33
Brothers of Mercy. They were taking care of physically and mentally ill,
mainly of the poor, but they were not distinguishing the patients according
to the social status, nationality or religion. In the second half of the 18 th
century the first general hospitals were founded; in 1785 in Brno, in 1787 in
Ostrava, in 1790 in Prague. Untrained caretakers were nursing the ill and
cleaning the entire institute. Nurses were gradually given another task – to
assist physicians. Such role called for professional training; the first training
schools for nurses were established in the second half of the 19 th century.
The first Czech training school for nurses
The work of Florence Nightingale significantly influenced the development
of nursing in Austro-Hungarian Empire. The first training school for nurses
was founded as early as 1874 in Prague. It was a Czech school; it was
shaped by the Czech author Karolína Světlá; she was a Czech patriot who
led the women's movement and defended women's rights. The Czech
training school educated nurses in theory and practice; teachers were Czech
medical professionals, mainly from the Medical Faculty of Charles
University. Caretaking gradually transformed into nursing. Women studying
nursing were drawing on Nightingale's book Notes on Nursing which was
translated into Czech in 1874 by Paulína Králová as Kniha o ošetřování
nemocných. The graduates of the first Czech training school for nurses
worked as caretakers in private households. For hospital service nurses were
trained in hospitals (so-called apprenticeship). Students of nursing courses
had to pass an exam after which they were awarded the degree. Even though
the school was closed after seven years, it played – as the first training
institute of its kind in Austro-Hungarian Empire – a significant role in the
development of Czech nursing.
The Czech Provincial School of Nursing (Česká zemská škola pro
ošetřování nemocných)
In May 1914 the Austro-Hungarian Department of Home Affairs issued a
decree no. 139 dealing with nursing as occupation. The decree legalized
establishing training schools for nurses, outlined the structure of their
organization and defined their functioning. One of the most important
regulations of the decree allowed training schools for nurses to be
established only at hospitals which would train students practically in the
most important subjects. The new Czech (Provincial) School of Nursing
(Česká zemská škola pro ošetřování nemocných) was opened as late as
during the First World War, in 1916. The training school remained
operational in the newly established Czechoslovakia and it became a model
for other Czech civilian and even clerical nursing schools which were being
founded in the young republic. The quality of the training was excellent;
three experienced American nurses were invited to Prague in 1918 to work
out the theoretic and practical conception of education and train the first
graduates as practical instructors. Sylva Macharová – one of the few
professionally educated Czech nurses who was trained in a nursing institute
in Vienna – became the first Czech school headmaster in 1923. In the first
years 10–15 registered nurses graduated from the school. Thus, for a long
time on there were – apart from clerical nurses – two types of civilian
nursing staff working side by side in hospitals: Registered nurses –
34
graduates from the Czech School of Nursing; auxiliary nurses trained in
particular hospital departments. Social status of both was very low.
Auxiliary nurses were paid poorly and were housed in hospital rooms.
Nursing between the two World Wars
The first graduates of the school of nursing founded as early as 1921 the
Association of the Graduates of Nursing School which in 1928 became the
Association of Registered Nurses. The first lodging houses for nurses were
founded; the working conditions, labor hours and leave of absence were
regularized. The Association organized lectures and courses for the
advanced and helped in founding other training institutes for nurses. It
cooperated with foreign nursing organizations. In 1933 the Association
became a member of the International Council of Nurses. In 1937 it started
to publish its first magazine Diplomovaná sestra (Registered Nurse). The
quality of nursing, its organization and education of nurses were rapidly
increasing. Czech nursing in the interwar period was not oriented only on
the development of hospital care. As early as 1918 the Social College was
opened in Prague which trained social workers in one-year study programs
and later trained mainly registered nurses for independent fieldwork. The
nurses established and conducted advisory services for mothers and children
and health stations with dispensatory for patients suffering from tuberculosis
or venereal disease. In 1918 the Czech branch of the Red Cross established
in Prague the organized nursing and health care service in family; nurses
worked independently and were paid by health insurance companies.
Fieldwork of nurses focused on health education of the economically
disadvantaged and included promotion of responsible parenthood and
distribution of information on preventing dangerous infectious disease.
Independent nursing fieldwork ceased to exist after 1948; relatively
independent nurses appeared again no earlier than the 1970s (visiting
geriatric nurses).
Czech nursing after World War II
During the war but mainly after its end there was an urgent need for
qualified nursing staff. In 1946 the Nursing College was opened in Prague
which trained nurses for teaching in training schools for nurses and matrons
in nursing management. After 1948 nursing schools were united with family
and social schools into secondary medical schools for training of all types
of medical staff. Students entered the school aged 14–15; the length of study
was 4 years. Further professional education was provided by the Institute
for Further Education of Medical Personnel (Institut pro další vzdělávání
středních zdravotnických pracovníků) which was established in 1960 in
Brno and Bratislava. In the same year the Philosophical Faculty of Charles
University in Prague opened a five-year study program for
nurses/instructors; nursing could be studied there in combination with
psychology and later on with pedagogy. Czechoslovak nurses published
magazine Zdravotnická sestra (Medical nurse) which is now published
under the title Sestra (Nurse). In 1992 universities started offering Bachelor
– and later on Master's and doctoral – study programs in nursing which
35
allow nurses to advance their professional education further in academic
environment. Since 2001 (resp. 2004) the pre-gradual education of Nurses
in the Czech Republic can be obtained at colleges and universities.
Summary
Nursing as aid and care was developing since the beginning of mankind. As
occupation it is closely connected with the expansion of Christianity and
churches; it was always to a significant degree influenced by wars.
Conception of nursing changed with the development of medicine from
caretaking to assisting and providing technical aid. The most important
personality of nursing was Florence Nightingale who shaped the
development of nursing in the entire world. Czech nursing is historically
tied to Agnes of Bohemia and to clerical orders. Nursing education in the
Czech lands develops from the end of the 19 th century.
1. Read the article on Florence Nightingale (from the book listed below) and
summarize her contribution to the development of nursing.
2. Search the electronic databases for the Czech nursing magazines;
characterize orientation of individual magazines.
3. Explain the circumstances of the founding of the first Czech training
institute for nurses in 1874.
4. Which elements of the current state of nursing still reflect the historical
development of the discipline in the Czech lands?
PLEVOVÁ, I., SLOWIK, R. Vybrané kapitoly z historie ošetřovatelství. Ostrava:
Ostravská univerzita v Ostravě, 2008.
36
5 INTERNATIONAL NURSING ACTIVITIES





about WHO, its role and health oriented programs;
about relation between nursing and WHO;
about international nursing organizations and their activities;
about the Czech Association of Nurses and its activity;
about important conferences of WHO which shaped roles and
competences of nurses.
Keywords:
WHO, health programs, primary care, role of nurse, ICN, WENR, ČAS,
EFN, Sigma Theta Tau.
WHO – World Health Organization
World Health Organization (WHO) is directing and coordinating
organization for international cooperation in health care. In was founded on
the 7th of April 1948 in New York; currently it works with 193 member
states, each one has one vote. Its aim is defined by its status – WHO works
for the attainment of the highest possible level of health by all peoples .
Governments of individual member states are responsible for achieving this
aim, they guarantee the right of the citizens to care and health. World Health
Organization is the international coordinating authority for health. Its
mission is to assist all governments in fulfilling the responsibility for health
of their citizens, to vitalize the involvement of all resorts in following
individual health programs, to increase the active involvement of the public
in health care. Nurses can be vitally engaged in working for WHO (nursing
education, public health care, nursing care), especially in developing
countries or when a natural disaster occurs. Main responsibilities of WHO:
providing leadership on global health matters, setting global health norms
and standards, providing technical support to countries and monitoring and
assessing health trends.
WHO organizes irregular assemblies and conferences where the priorities of
international health policy and the strategic health programs are outlined
and defined. One of the most significant meetings of experts was joint
international conference of World Health Organization and United Nations
Children's Fund held in Alma-Ata (1978) which adopted the Alma-Ata
Declaration defining primary health care as the key to achieving the goal of
37
"health for all by the year 2000". This conference defined a new concept
of health care – primary health care; its goal was to implement basic
health care as an integral part of national health care in connection to other
resorts.
Current aims of WHO
 fighting against infectious disease
 providing professional assistance to governments (e.g. natural disasters)
 supporting health research
 educating and sending experts to wherever they are needed
 providing material and technical aid
 organizing conferences and assemblies
 assisting in education of medical professionals
 monitoring epidemiological situations (current data published on WHO's
web page)
 working out the unified methodology of global statistics
 defining international terminology
 awarding stipends and training medical professionals
 maternal and child health care
 public health education
 environmental care
 publishing
HEALTH 21 – Health-for-all policy for the twenty-first century (the
WHO global program)
The goal of this policy framework passed by the World Health Assembly in
April of 1998 is to achieve the "Health for All" vision declared by the AlmaAta conference. Global priorities and ten goals for the first two decades of
the twenty-first century were set aiming at creating global conditions for
attaining and maintaining health throughout life. The WHO European
Region policy framework Health 21 has four basic parts set out generally to
be realized in Europe. Individual states and governments concretize the
policy and apply it in specific local conditions and situations according to
their means (social, political, economic etc.); they define specific goals and
responsibilities for their achievement, choose means of application,
establish administrative and organizational conditions of realization.
Health 21 targets for the twenty-first century
1. Solidarity for health in the European Region;
2. Equity in health;
3. Healthy start in life;
4. Health of young people;
5. Healthy aging;
6. Improving mental health;
7. Reducing communicable diseases;
8. Reducing non-communicable diseases;
9. Reducing injury from violence and accidents;
38
10.
11.
12.
13.
14.
15.
16.
17.
18.
19.
20.
21.
A healthy and safe physical environment;
Healthier living;
Reducing harm from alcohol, drugs and tobacco;
Settings for health;
Multisectoral responsibility for health;
An integrated health sector;
Managing for quality of care;
Funding health services and allocating resources;
Developing human resources for health;
Research and knowledge for health;
Mobilizing partners for health;
Policies and strategies for health for all.
NEHAP – The National Plan of Activities for Health and Environment
(Národní akční plán zdraví a životního prostředí) – (application of the
WHO program in the Czech Republic)
The Health 21 program is applied in the Czech Republic as the National
Plan of Activities for Health and Environment (NEHAP) which was
approved by the resolution of the Government of the Czech Republic
(12/08/1998). Its aim is to improve health of the nation, to level undesirable
differences in state of health of individual population groups, to react to
economic and political changes after 1989, to minimize negative
environmental impact on population health, to harmonize the health and
environment protection policy with corresponding policies of the European
Union, to react to suggestions of recent significant international activities.
Based on an analysis of the causes of sickness and mortality rate and of
potential health threats of the Czech society the main health problems
were identified:
 heart and vascular disease
 tumor disease
 injury
 disturbance of natural population alteration
 pathologic immunity changes
 mental disorder
 drug addiction
 HIV/AIDS and other serious infections
 congenital and systemic infirmity of children
Having analyzed the risks related to high sickness and mortality rate the
life-style change was set out as priority. The life-style change means:
positive change of eating habits and diet, decreasing smoking prevalence,
limiting and managing excessive stress, increasing reproductive health,
decreasing consumption of alcohol, optimizing movement activities.
39
Main priorities of the current strategic program of WHO are two interacting
entities – state of health and state of environment.
WHO – The International Conference on PRIMARY HEALTH
CARE – Alma Ata 1978
The first definition of primary health care – Primary health care is essential
health care based on practical, scientifically sound and socially acceptable
methods and technology made universally accessible to individuals and
families in the community through their full participation and at a cost that
the community and country can afford to maintain at every stage of their
development in the spirit of self-reliance and self-determination.
Primary health care includes at least: education concerning prevailing health
problems and the methods of preventing and controlling them; promotion of
food supply and proper nutrition; an adequate supply of safe water and basic
sanitation; maternal and child health care, including family planning;
immunization against the major infectious diseases; prevention and control
of locally endemic diseases; appropriate treatment of common diseases and
injuries; provision of essential drugs.
Nursing becomes characteristic for individualized care based on
identifying and planning of fulfillment of needs of healthy and ill
individuals and for independent fieldwork of nurses (home care, but mainly
prevention).
WHO – First International Conference on HEALTH
PROMOTION (Ottawa Charter) – Ottawa 1986
To promote and improve health means to: build healthy public policy,
create supportive environments, strengthen community action, develop
personal skills, reorient health services.
Health promotion focuses on achieving equity in health. Specifically it
aims at ensuring equal opportunities, creating supportive environments,
improving access to information, developing life skills and opportunities for
making healthy choices in order to allow everybody to attain the highest
possible level of health.
WHO – European Conference on Nursing – Vienna 1988
The participants outlined the new role of nurse – nurses should act as
partners in interdisciplinary teams, they are becoming independent experts
specializing in identifying and fulfilling the needs of the ill. Nursing
practice has to be based on primary care.
40
According to the Declaration of Alma Ata, nursing should focus on:
supporting and maintaining health, prevention of illness, involving
individuals, families and communities in care and increasing their
responsibility for health, decreasing inequity in health care and in
fulfillment of the needs of the population (especially in case of individuals
who are not taken sufficient care of), cooperating on interdisciplinary level,
ensuring high standards of health care and appropriate use of technologies,
reshaping and reorienting nursing education in order to train nurses to
work in new conditions in secondary and primary care.
In the time of substantial reforms of health care and increasingly
challenging health problems, nurses and midwifes are frequently considered
to be the essential source of most strategies of reforming health care. Nurses
and midwifes present the most extensive part of medical personnel in the
European region of World Health Organization. They work at various
positions and their work is substantial in achieving the goals set out by the
member states in the Health for All policy for the twenty-first century.
Nurses and midwifes have to be educated in order to face the challenges of
the times: the need to disseminate information on illness prevention, work
for the development of communities, cooperate in interdisciplinary teams,
bring health care closer to people and stress equity in health. (WHO, 2000)
International nursing organizations
International Council of Nurses (ICN)
ICN is the oldest and the most significant professional organization of
nurses; it was founded in 1899 (by nursing organizations of U.S.A., Canada,
Netherlands, Australia, New Zealand, Denmark and South America). ICN is
a federation of national associations of nurses, such as ČAS (the Czech
Republic) or ANA (U.S.A.). In 2010 it represented 135 national associations
(i.e. more than 13 million nurses worldwide; in the Czech Republic there
were 105 000 registered nurses). Its aim is to create environment for
interpretation of interests and needs of nurses to the satisfaction of nurses
and the public. The ICN Board of Directors resides in Geneva. The mission
of ICN is defined by: international classification for nursing practice
(ICNP® ); advanced nursing practice; entrepreneurship; HIV/AIDS, TB and
malaria; women’s health; primary health care; family health; safe water;
regulation and credentialing; code of ethics, standards and competencies;
continuing education of nurses.
Main goals:
 to promote establishment of national nursing associations in
countries where none exist yet;
 to support nurses in achieving a high standard of education and
competency training;
 to assist nurses in improving standards of nursing;
 to develop theoretic and practical aspects of nursing and to support
nursing research;
41


to improve social position of nurses, to represent nurses and nursing
internationally;
to mediate and sustain cooperation and international communication
of nurses.
The first assembly of ICN was held in 1901 in Buffalo (U.S.A.); its seat was
alternately in London, Geneva and New York (1939–1948). The highest
representative of the organization is the president who is elected on
meetings which are held every four years. The Council of National
Representatives (composed of chairmen of national nursing organizations
and the ICN officers) meets every two years. The Council of National
Representatives sets policy, admits members etc. Between meetings of the
Council, ICN is governed by the Board of Directors composed of 11 elected
members which elects the vice presidents. The Czechoslovak nurses were
admitted to ICN for the first time in 1933 as members of the Association of
Registered Nurses; after 1945 the membership was interrupted, it was
restored in 1983 (the Czech Association of Nurses); after the separation of
Czechoslovakia the membership ceased to exist; in 1994 the Czech
Association of Nurses was admitted to ICN. ICN publishes three magazines:
International Nursing Review (peer-reviewed research journal), ICN Calling
(bulletin publishing information on the ICN activities) and ICN Newsletter
(focusing on current nursing news and information). Every two years ICN
organizes international congress of nurses (Japan – 2007; South African
Republic – 2009; Malta – 2011; Australia – 2013). ICN issues general
strategic statements related to nursing. The official global symbol of nursing
is the White Heart (since 1999, i.e. the 100 th anniversary of ICN). White
color represents all colors and associates with care, hygiene and comfort.
Workgroup of European Nurse Researches – WENR
WENR is an association of representatives of the individual ICN
organizations from 23 countries; it was established in 1978 (Czech nurses
were admitted in 1985).
Goals of WENR
 to organize collaboration of nurse researchers in order to develop
and enhance nursing research as one of the conditions of achieving
high standards of nursing care;
42
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


to create environment for communication and dissemination of
research findings in the European countries;
to promote the idea that nurses should be in national education
programs of individual countries trained also in nursing research;
to enhance dissemination of nursing research findings and their
discussion;
to enhance collaboration and communication among nurse
researchers across Europe, especially among the ones working at
universities and research institutes;
to achieve high standards of nursing care by applying nursing
research findings and scientific knowledge in everyday nursing care.
WENR organizes two-day Workgroup Meetings which are held annually
and in different European countries by invitation. It also organizes Biennial
Conferences where research findings related to a topic of the conference are
presented.
The Czech Association of Nurses (Česká asociace sester; ČAS)
The Czech Association of Nurses is an expert, professional, volunteer, nonprofit and non-political organization with legal subjectivity. It is the largest
professional organization of nurses and other health care professionals in the
Czech Republic. It is open to all nurses and other health care professionals
regardless of their nationality or religion, working in health care, social care,
education and in the private sector. It operates throughout the Czech
republic.
Main goals of ČAS
1. to support the activities focused on the realization of national and
international programs, whose aim is the training of nurses, midwives
and other health care professionals;
2. to participate on changes of the health care system in the Czech
Republic;
3. to cooperate with government authorities and other professional and trade
organizations to promote the free movement of workforce within the EU
and beyond;
4. to create effective tools to ensure the safety and quality of nursing
services in accordance with the needs of individuals, groups and
communities;
5. to support activities increasing the recognition of nurses and health care
professionals by the society;
6. to represent the providers of the home care nursing services and create
effective tools to enforce their rights.
Partial goals of ČAS
43
1. to motivate health care professionals to achieve the professional and
ethical goals of their professions, according to the principles of modern
nursing;
2. to shape education programs of pregradual, postgradual and lifelong
education of health care professionals;
3. to strengthen the role of the Czech Association of Nurses in shaping
health care and social care system of the Czech republic;
4. to regulate quality of health care in the Czech Republic by publishing
documents and developing indicators;
5. to enhance cooperation and stimulate communication between the Czech
Association of Nurses, other professions in the Czech Republic and nursing
organizations abroad;
6. to improve status of nursing and position of nurses, midwives and other
health care professionals in the Czech Republic;
7. to influence attitude of payers of home care fees.
ČAS was established in 1991 as the association of nurses of different types
and of other health care professionals (laboratory technicians, dietetic nurses
etc.). It is the strongest representative of the Czech nurses, its
representatives participate in important proceedings dealing with legislation
or issues related to activities and professional education of nurses. The
Association is divided into specialized sections and regional organizations.
The supreme body of the Czech Association of Nurses is the Forum of
Delegates, consisting of the associations' members. The Forum of Delegates
elects the 9-member Presidium and the Auditing Committee. The seat of the
Czech Association of Nurses is Prague. Its activities are defined by
regulations authorized by the assembly of delegates of specialized sections
an regions. It focuses on following areas:




development of the discipline – supporting realization of the
conception of nursing in nursing practice; participating in
developing the quality assessment framework of nursing practice in
health care centers; implementing nursing process as the essential
method of nursing practice; introducing appropriate nursing
documentation; promoting scientific research as a part of nursing
profession;
development of the profession – improving status and social
position of nurses; supporting transformation of nursing education;
supervising nursing education; organizing specialized seminars,
conferences;
supporting publication of specialized studies – membership in
editorial boards of specialized reviews and magazines; financial
support of translation of professional texts; translation and
publication of strategic materials for nurses;
cooperation with institutions shaping nursing in the Czech
Republic – with Ministry of Health (MZČR), Ministry of Labour
and Social Affairs (MPSV), Ministry of Education, Youth and
Sports (MŠMT), universities, unions, the Czech Medical Chamber,
Professional and Trade Union of Medical Workers of Bohemia,
Moravia and Silesia;
44

development of international cooperation – membership of ICN
and WENR (Workgroup of European Nurse Researches); specialized
sections of ČAS can become members of corresponding
international professional nursing organizations (nephrology nurses,
dietetic nurses etc.); organizing internships and professional visits
abroad.
According to professional orientation of nurses, ČAS is divided into
sections (e.g. section of home nursing, of wound healing, of primary care)
and regions (e.g. Prague, Moravian-Silesian Region).
ČAS has accepted the Code of Ethics for Nurses which defines basic
standard of nurse's conduct in relation to the ill, his/her family, community
and the public. It outlines rules which are based on a set of moral values
nurses acknowledge and respect. The International Code of Ethics for
Nurses was for authorized by the International Council of Nurses (ICN) in
1953. It has been revised and reauthorized several times since, the last
revision was made in 2000. Nurses in the Czech Republic acknowledge via
membership in the Czech Association of Nurses the Code of Ethics of the
International Council of Nurses (ICN) which was discussed by the
assembly of chairpersons of individual sections and regions of ČAS and
authorized by the Presidium and the Auditing Committee; it has been valid
since 29 March 2003.
The European Federation of Nurses Associations – EFN
EFN was established in 1970 and is considered to be the official
representative of nurses in the Council of Europe where it promotes interests
of nurses. Its members are the national nursing organizations of the
individual states of the European Union which are also members of ICN. It
issues recommendations related to nursing, aiming at enhancing
professional training of nurses in order to achieve high standards and mutual
comparability of nursing care to promote the free movement of workforce.
The EFN also aims to bring to the attention of the Council of Europe the
current collaboration of nurses and nursing to meet the health needs of the
population and create conditions for community nursing care.
Main goals of EFN
 to support nurses and nursing in the EU (the European Commission,
the European Parliament, the Council of Europe);
 to promote issues related to nursing and nursing care services in the
Council of Europe;
 to present in the Council of Europe the current and potential
collaboration of nurses and nursing to meet the health needs of the
population throughout the European Union;
 to represent opinions of nurses in the Council of Europe and to issue
recommendations related to nursing;
 to develop a database containing information on nurses and nursing
profession in the EU;
45

to mediate organization of collaboration between international
medical organizations, research institutes and the Council of Europe.
Sigma Theta Tau
The Honor Society of Nursing, Sigma Theta Tau International was
established in 1922; its seat is Indianapolis, Indiana. The Greek letters are
the initials of words Storgé, Tharsos and Timé meaning "love", "courage"
and "honor". The society unites universities; its activities are rather
professional than social. Membership is by invitation to professionals who
demonstrate academic achievements or to baccalaureate and graduate
nursing students worldwide. The society publishes a peer-reviewed
scholarly Journal of Nursing Scholarship; it runs its own on-line library
(research repository) Victoria Henderson International Nursing Library
available to members; it organizes conferences and educational courses,
funds research, awards scholarships.
Summary
WHO is an important international organization working for the attainment
of the highest possible level of health by all peoples. Nursing strategies and
activities are closely related to the activities of WHO, e.g. concept of
primary care, roles and competences of nurses, position of nurses in the EU,
regulation of the profession. Nurses present the largest professional
community in the world; there is a significant number of national and
international nursing organizations. The largest international nursing
organization is International Council of Nurses; the Czech nursing
organization ČAS is a member of ICN.
1. Search the web pages of WHO for the current strategic aims related to
nursing and nursing profession.
2. International Council of Nurses (ICN) publishes annual strategic report.
Find the current one on the web pages of ICN or Ministry of Health of the
Czech Republic and read it carefully.
3. Search the web pages of WHO for training and education programs
currently offered to nurses and midwifes.
International Council of Nurses. [retrieved 2012-05-25]. Available from WWW:
http://www.icn.ch/
World Health Organization. [retrieved 2012-05-25]. Available from WWW:
http://www.who.int
Sigma Theta Tau. [retrieved 2012-05-25]. Available from WWW:
http://www.nursingsociety.org/default.aspx
46
European Federation of Nurses Associations. [retrieved 2012-05-25]. Available
from WWW: http://www.epha.org/a/123
Workgroup of European Nurses-researches. [retrieved 2012-05-25]. Available
from WWW: http://www.wenr.org/
Česká asociace sester. [retrieved 2012-05-25]. Available from WWW:
http://www.cnna.cz/
47
6 SOCIAL ASPECTS OF NURSING




about
about
about
about
regulation of nursing;
legislation on nursing;
orientation of nursing and role of nurses;
role of the ill.
Keywords:
regulation, legislation, registration, license, role and function of nurse, role
of the ill.
Time needed for studying the chapter: 40 min.
Regulation of nursing
regulation – controlled intervention in order to sustain endurance, stability
of function and conduct of regulating system;
registration – entry into the (national) register, continuous logging;
license – a permit to practice specific activity.
Regulating system
Regulating system allows coordinating professional training and practice in
order to sustain and form identity, secure integrity and systematism in
education and practice. Regulation is applied mainly in professions
providing social services. Society expects to be provided specific services
by a corresponding profession. Representatives of society and profession
agree on regulation.
Nursing regulation aims at protecting the public by providing competent and
available health care. Regulating system of nurses and midwifes specifies:




range of activities conducted by nurses and midwifes
education requirements
control system of professional observance
system of disciplinary measures
The European Union also regulates medical professions; it issues guidelines
related to education, designation of professions and titles (77/452 EHS,
77/453 EHS).
48
Other regulations: professional
intergovernmental agreements.
and
systemic
guidelines,
various
1. Professional guidelines (guidelines of member states of the EU) –
relate to specific professional groups; they outline minimal professional
standards (conception, minimal content and duration of education and
training programs), they provide qualifications acknowledged by
individual member states (general nurse, midwife, physician, general
practitioner, pharmacist, dentist, veterinary).
2. General systemic guidelines – in case the profession is a regulated one,
an individual recognized as professional in one member state of the EU
has to be recognized as professional in other member states.
Nursing regulation also means defining a range (of education, nursing
practice, ethical and working standards). The aim of regulation is to secure
the appropriate nursing care (character and range of general and specialized
practice), protect the public, support development of the profession, enhance
responsibility of nurses, achieve appropriate social status of nurses and their
economic security.
1. Statutory regulation – nursing profession is regulated by outer entities
(conceptions related to the discipline, mandatory legal regulations). The
aim of the regulation – protection of the public.
2. Self-regulation – nurses regulate the profession themselves (on
individual level, in various working groups, collaborating on national
and international projects). The aim of this regulation – securing
coherence of high standards of nursing care, improving nursing practice,
developing theories of the discipline.
When the Czech Republic became a member of the European Union a
number of legal regulations was issued:
Act No. 96/2004 Coll. – New Act 105/2011 Coll. – regulation on conditions of
achieving and acknowledging competence to non-medical practice in health care
services and practice of health care related services (Act on non-medical health
care professions).
Regulation of Ministry of Health of the Czech Republic No. 424/2004 Coll.
– amended by 55/2011 Coll. – on practice of health care professionals and other
professionals.
Government Regulation No. 463/2004 – amended by 31/2010 – which defines
disciplines of specialized training and designations of health care professionals
with specialized practice.
Regulation of Ministry of Health of the Czech Republic No. 39/2005 Coll. –
which defines minimal requirements of education programs training non-medical
health care professionals.
– New Regulation 189/2009 – which modifies details of postgraduate
examination, certification for performance of medical profession without
49
professional supervision, final examination of accredited competence training
courses, qualifying examination and rules for the conduct of examinations .
– amended by 4/2010 Coll. – which defines the credits system of certification for
performance of medical profession without direct professional supervision.
The essential components of the regulatory process and system –
involved agents:
1. Government (corresponding department of Ministry of Health of the
Czech Republic) – conception of the discipline, regulations, guidelines.
2. Professional association (ČAS) – specific knowledge and skills of its
members are utilized in shaping governmental regulation; its purpose is
to represent interests of itself and its members.
3. Nurses – take part in regulation by conducting practice according to the
valid regulations and code of ethics, by trying to sustain or develop their
competencies according to the needs of the society.
4. Employer – defines requirements for employees and content of the
process of adaptation, follows regulations and standards defined by
government and professional organization.
5. Registration – process of evaluation and of achieving a professional
status according to defined criteria; in the Czech Republic – legal act of
certification for performance of medical profession according to Act No.
96/2004 Coll. on non-medical health care professionals (Registered –
abbreviation RS following a professional's name).
National system of registration (registering center) – issues Certification
for performance of health care profession which proves a professional meets
specific requirements; it defines limits of certain competences in nursing
practice (who can work without professional supervision), supports
continuing education, creates a basis for further development of the
profession and sustainment of high standards of practice (it allows to
monitor the number of nurses in individual regions, disciplines and
specialized competences, thus preventing the lack of professionals in
individual fields).
Registration – process of entering nurses and midwifes into the national
register (Ministry of Health of the Czech Republic – NCO NZO) according
to specific criteria (qualification, practice) defined by legal regulations.
Registration allows to be identified as professionals, nurses and midwifes
can use a professional title RS (RPA) following their names. In the legal
time limit (usually every six years) nurses and midwifes have to present
required materials to have the registration renewed.
License – allows nurses and midwifes to professional practice (e.g.
independent home care practice, community midwife). License is
compulsory for specific professional tasks.
Registration and license are means of regulation securing required
professional standards of nursing practice and preventing unqualified
50
individuals to provide professional services, thus safeguarding nurses and
midwifes and also receivers of health care – patients/clients.
Regulation (coordination, control) of nursing is dealt with by a number of
national and international organizations and governmental institutions –
especially by International Council of Nurses (ICN) which in 1992 defined
12 essential principles of regulation of nursing:
 functionality
 relevance (importance, significance)
 definition of the range of professional practice and responsibility
 balance of interests involved
 optimization (supervision and restriction)
 flexibility
 effectiveness
 universality
 justice
 equality
 professional compatibility
Nursing orientation – problems in the health care system
Fragmentariness of care – highly specialized sub-disciplines, specialized
nurses, biomedical technicians, expensive and fragmentary care.
Rising costs of health care services – technology, equipment, methods,
inflation, rising population, aging, educated client, rising number of health
care providers, competition.
Health care services for the homeless and uninsured – acute care,
alcoholism, drug addiction, chronic disease, infectious disease (e.g. AIDS),
malnutrition, injury.
Expensive secondary care – transfer of patients to primary care,
requirements of nursing training, higher competencies, individual evaluation
of nursing service (NANDA), communication, multi-cultural health
education, relation of nursing to the public.
ROLE OF NURSES
In every social group an individual plays a specific role. Every individual
fulfills several roles which can be classified as given (man, woman),
developmental (child, parent, working person) or temporary (hospitalized
ill). Society expects individuals to act according to the roles they fulfill.
ICN – Role of practice nurse
51
Health support and prevention of illness oriented on individuals regardless
of their age, on families and communities; planning and controlling health
care of individuals of all ages, of families and communities suffering from
physical or mental illness or with disability, of the ones in need of
physiotherapy in medical or community centre; health care oriented on the
aged.
 Providing health support for individuals, their families and groups of
people; preventing illness, assisting in illness, convalescence and
dying.
 Cooperating with family, educating, working in home environment.
 Fieldwork – primary and tertiary care.
 Working in secondary care – intensive care units, follow- up care;
state and private organizations.
 Working in health care stationary.
 Working in social services – nursing homes; social care services.
Nurses follow patterns specified for the role of medical practitioners:
functional specificity, universality, collective orientation and emotional
neutrality. The basic orientation of nurse's behavior differs according to the
professional content of conduct (competence).
The role of nurse changes with the development of nursing and its
orientation. The need for transformation is not caused only by development
of medicine and nursing itself, the discipline is being significantly
influenced by the humanities, mainly by psychological, pedagogical and
ethical findings. Nurses are becoming members of teams of professionals
able to work independently with ill and healthy individuals in the course of
hospitalization and also in family and community.
The essence of the role of nurses is defined by the following functionally
different activities: nursing and care; expressive, educational and
instrumental activities; health support and education; administration and
organization of care, etc.
Development of the role of nurse
Only a few occupations underwent in a relatively short period of time such a
substantial transformation. Nursing was originally formed in charitable
institutes – medieval hospitals – as charitable activity of religious basis;
the institutes provided shelter and basic care for the poor. In the second half
of the 19th century hospitals became centers of rational medicine, of medical
practice and knowledge. This development laid foundations for modern
nursing. Physicians needed assistance of skilled individuals able of
professional communication and rational conduct in health care.
The role of nurse was shaped by other events and factors: the work of
Florence Nightingale (active care of the ill, high standards of nursing
professionals), development of medicine based on natural sciences'
approach to health and illness (illness understood as isolated phenomenon,
52
the ill as passive objects of health care professionals), three functional
areas of hospital work (medical, nursing and administrative), two forms of
subordination: professional and personal (multiple subordination of nurses:
to physicians and nursing management), enlargement of hospitals (new
nursing activities, administrative overloading of nurses, distancing from the
ill).
Nurses are traditionally seen as team members providing patients with basic
health care. Nursing activities related to mental hygiene are being
emphasized recently, i.e. supporting patients recovering from illness or
coping with it. It also includes educational function of nurses and activities
related to enhancement of professional function of nurses in improving
standards of medical care and nurse's participation in the development of
nursing theory. The emphasis is being put on nurse's participation in
primary health care because innovated nursing care should be oriented
rather on health than illness. The role of nurse is being transformed
constantly. Achieving and sustaining standard of care requires nurses to
develop new skills, e.g. related to social problems accompanying illness or
health of individuals or groups of individuals.
Advanced nursing roles
General nurse – general term referring to nurses with basic pregradual
education defined by legislation of particular states; regulated occupation;
free labor market in the EU.
Practice nurse – also skilled in educating, trains nurses in primary and
community care; practical nurses have higher education (M.A. degree), can
work as visiting nurses, specialist nurses (e.g. geriatric nurse, children's
nurse) or in health care facilities (e.g. health care centers, general practice),
schools and nursery schools.
Nurse specialist – has higher education (usually M.A. degree) in specialized
areas of nursing (specializations), works as specialist (according to the
current legislation).
Clinical nurse specialist – provides basic nursing care to hospitalized
patients (hospitals); Bc. or DiS. degree.
The essence of nursing role is internally conflicted. Most activities
conducted in health care services are strictly regulated, health care
professionals, however, have to carry them out in specific situations.
Adopting the role, embracing new functions and responsibilities and new
patterns of behavior depends to a significant degree on social status of the
occupation.
Vocation and function of nurses
Social vocation of nurses is to help individuals, families and groups of
people fulfill and achieve physical, mental and social well-being in the
53
environment they live and work in. Nurses help individuals and their
families, friends and social groups participate actively in health care, by
doing so they support their self-confidence and independence.
Main functions of nurses
1. Managing and providing nursing care (supportive, preventive,
medical or assisting) to individuals, families and groups in the nursing
process.
2. Educating patients, clients and training health care professionals .
Checking skills and knowledge of individuals of sustaining and restoring
health; preparing and disseminating information of an appropriate level;
helping other nurses and co-workers achieve new knowledge and skills.
3. Taking an active part in teams of health care professionals in
cooperating, planning, organizing, managing and evaluating nursing
health care as an integral part of general health care service.
4. Developing nursing practice, critical thinking and research.
Applying new nursing methods in order to achieve better nursing
results; defining research areas to attain advanced knowledge and
enhance skills in nursing practice. Realization of ethical and
professional standards in nursing research.
Quality of nursing care is not defined only by nursing practice. From a
patient's point of view, it is to a significant degree influenced by a nurse's
behavior. Mutual relationship which is formed in such situations enables
close cooperation between nurses and patients and can thus accelerate
treatment and nursing process. Inadequate behavior of nurses, on the other
hand, can hurt a patient's feelings and complicate treatment and nursing
care.
ROLE OF PATIENTS
Theory of patient's role
Position of patients developed with the historical development of hospitals.
Medicine oriented on natural sciences understood patients solely from the
biological viewpoint. Patients were seen as independent of social conditions.
The process of illness was understood biologically; etiologic research was
restricted on exploring causes of illness in human organism. Since the
beginning of the 20th century, more attention have been paid to the subject
of the ill and mental and social conditions related to illness. Various theories
have been formulated. Structural functionalism represented by American
sociologist Talcott Parsons have been widely spread.
The ill, i.e. humans in contact with health care professionals, can be divided
into several groups:
54
1. the hospitalized ill who accept the role of patients in its utmost form;
also includes the ill in home care who retain certain roles they carried out
in health (e.g. the role of mother or father);
2. the ill able to work – people who while being treated continue working
and socializing, i.e. they fulfill their roles in work, family, etc.;
3. relatively healthy who also fulfill roles of patients; relatively large group
of people not seeking advice or treatment; they are relatively healthy,
however, they consult a physician;
4. people participating in prevention who do not accept the role of
patients; specific group of individuals coming for single or routine
preventive checkups;
5. problematic individuals – from the viewpoint of the role of patients this
group includes for example individuals suffering from addictive disorders
who fulfill roles of patients, however, they do not accept the responsibility
to prevent illness.
Specific group is represented by the pregnant, parturients and newborns
who need constant care of professionals with medical or psychological
training.
Position of the hospitalized patient
The hospitalized ill no longer belong to the society of the healthy. Their
position is of mental and social submission. Social position of health care
professionals and of patients is essentially different. In hospital environment
the ill have to accept a new role and comply to authority which is imposed
upon them to regulate their behavior. Nowadays, the contradiction
between technological advancements and real possibilities of fulfilling
the needs of patients appropriately and with dignity is felt in hospitals more
strongly than anywhere else. The ill is often seen only as a biological being,
his/her mental and social side is not understood appropriately. Medical and
nursing care in practice fell behind with applying findings of the humanities,
such as psychology and sociology. Patients also think more and are
better informed than in previous times. They are more willing to cooperate
in care for their health. They do not want to be passive objects of health
care.
Nowadays, patients can be divided into two groups:


population is rapidly ageing – there are more older patients;
the number of more educated patients is increasing; they are not willing
to accept a passive role in the patient-physician relationship.
In the 1980s and 1990s the role of patients in relation to the treatment
quality and its outcomes was emphasized. The ill and their opinions on
55
their needs and values are monitored and recorded. The knowledge received
is used to evaluate the final effect of treatment, i.e. its quality.
Nurse-patient relationship
Nurses remain the guardians of patient's concerns. Their contact with a
patient is more frequent and closer than the physician's. Nurses assist
patients in fulfilling their needs and substitute social relations. Nurse's
communication with a patient is controlled and cultivated in order to
identify a patient's needs and learn how to satisfy them in a way
acceptable for the patient. Nurses take professional care of patients and help
them cope with personal conditions connected with illness.
Medicine has been recently trying to change a traditional view of the role of
patient and his/her family. No longer passive consumers, patients are
becoming active participants in the teamwork of health care professionals.
Nurses should not view patients as objects of their activities, they are not
only working for their benefit, they very often work with them. Nurses
also function as mediators between patients and physicians. They sustain
natural relationship to patients and physicians and try to sustain such
relationship between patients and physicians. Nurses help patients trust
physicians, which is a part of their responsibilities. Physicians as controlling
agents are responsible for decisions related to a patients' treatment; when a
patient does not trust or understand a physician's decisions, treatment is
often less effective. Nurses create relationship of responsibility and sustain
harmonious relation between patients and physicians.
Summary
Nursing/practice nurse is one of the regulated professions in the Czech
Republic and in the EU. Regulation is achieved by registration and
eventually licensing. The regulatory organ of Ministry of Health of the
Czech Republic is Národní centrum ošetřovatelství a nelékařských profesí
(The National Center of Nursing and Non-medical Professions). Every
health care professional in the Czech Republic has to be registered in the
National Register and participate in lifelong learning.
1. Read carefully the requirements for registration of nurses at the NCO
NZO web pages.
2. Name the main functions of nurses and specify their activities.
3. State a specific example of nursing activities safeguarding a patient's
concerns.
Legislativa. [retrieved 2012-05-25]. Available from WWW:
http://www.nconzo.cz/web/vzdelavani/112/
56
Národní registr nelékařských profesí. [retrieved 2012-05-25]. Available from
WWW: http://www.nconzo.cz/web/registr
Směrnice E. [retrieved 2012-05-25]. Available from WWW: http://eurlex.europa.eu/LexUriServ/LexUriServ.do?uri=CELEX:31977L0452:CS:HTML
57
7 PROFESSIONAL EDUCATION OF NURSES

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
about
about
about
about
the
the
the
the
conception of nursing education in Europe;
conception of nursing education in the Czech Republic;
conditions of pregradual training of nurses;
curriculum framework of practice nurse education.
Keywords:
education of nurses, the European Union, guidelines, structure of education,
curricula.
The European Union
Main types of legislation:
 decrees – direct legal power;
 guidelines – issued by individual states as parts of the national
legislative; guidelines are valid for a specified period of time;
 decisions –legally binding for the member states;
 suggestions – statements which are not legally binding.
Recognition of professional qualification – professional guidelines
 recognition of education and qualification in the EU;
 minimal professional standards (the process of harmonization in the
EU);
 practice nurses, midwifes, dentists.
Nursing guidelines (77/452/EHS; 77/453/EHS)
 the member states require students to pass a final exam to be
awarded a degree; the final exam guarantees that students acquired
knowledge and skills defined by generally outlined thematic areas
and disciplines, including practice (nursing – ethics, general
principles of health, care of children, mother, mental health, elderly;
basic medical disciplines, social sciences, clinical training);
 guidelines define minimal period of study, its form, number of
lessons, content of education program.
58
Conception of education in Europe and its importance for nursing
The Czech Republic participates in creation of joint European university
education which is reflected in the education of nurses and midwifes – in the
conceptual and strategic documents and documents binding for the Czech
educational system which were authorized by the government. In 1998 at
the meeting of four ministers in Paris the need for joint educational system
in Europe was discussed which would promote and realize the conception
of lifelong education and the vision of international cooperation and
mobility of students and teachers and free movement of labor in the united
European area. Bachelor's degree programs were legalized by Higher
Education Act as a self-contained part of the university education. It is
highly probable that graduates of Bachelor's degree programs will in the
next years present the largest part of the university educated population (as
in most countries in the EU and in the U.S.A). Bachelor's degree programs
prepare students mainly for practically oriented occupations (professional
study programs). Graduates can continue in studying for a Master's
degree in corresponding programs. Since 2001, the structured educational
system has been applied also in education of nurses and midwifes. From
1993 students in the Czech Republic could study nursing at university,
however, the structure of study programs did not allow them to achieve a
new qualification. The university education of nurses significantly improved
quality of nursing and health care. Development of pregradual professional
study programs is also very important for achieving compatibility of nursing
education with requirements defined by the EU. Recently, Master's degree
(and advanced) study programs have been developed (since 2006; more
precisely: 2008); the number of students is in the Czech Republic rather
limited.
Education of nurses in the EU
1. Basic qualification (before registration) education – to achieve
professional competence; is obtained at colleges and universities or
institutes offering professional tertiary education.
2. Advanced post qualification (after registration) education – needed to
sustain and improve professional erudition of nurses. It includes:
- specialized study which concentrates on nursing in specific clinical
disciplines, forms of fieldwork, nursing in hospitals and nursing
management (e.g. nursing in intensive care, theatre nurse, children's
nurse);
- university post qualification study – Bachelor's or Master's degree in
general nursing,
management,
pedagogy; achieving specialized
functional competence;
- continuing (lifelong) education – the professional knowledge of nurses
must not fall behind with the current scientific knowledge; nurses
participate in organized forms of education, attend seminars of
professional organizations, study on their own.
59
Guidelines and suggestion of the EU
The Council of Europe worked out as early as in the 1960s guidelines for
joint education and qualification of nurses which were based on an
agreement of several states. The agreement was between 1967 and 1971
signed by 12 European states. In 1972 the guidelines were proclaimed in
Strasbourg as European agreement on instruction and education of nurses
no. 59. It is an official document of the Council of Europe which is still
valid. It was gradually acknowledged not only by all member states of the
EU, but also by every prominent international organization, e.g. World
Health Organization (1985, 2000), The International Council of Nurses
(1984, 1999) and The International Labor Organization (1986). The brief
document was in 1995 amended by a document of the Council of Europe –
The Role and Education of Nurses which specifies individual directives and
includes curriculum framework of professional training.
International requirements for qualification training of general nurses
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Nursing education institutes enroll students who finished their secondary
general education and are over 18 years of age.
In case the qualification education is not of university type, the level of
professional training has to allow nurses to be admitted at university.
Education is solely professional. The minimal duration of professional
training is 3 years. Theoretical part presents at least 35 to 50 percent of
education, practical part presents at least 50 percent.
This type of education trains general nurses; only graduates of
qualification education can achieve a specialized training.
Study plans and curricula concentrate on independent nursing care of
healthy and ill individuals, environment, health and illness, the most
common illness influencing everyday life. Subjects dealing with clinical
and community nursing emphasize the conception of individualized
care, communication and practical instrumental skills, history of nursing
and its development, nursing ethics.
Education includes assessment of nursing care and enhancement of
continuing education.
Theoretic subject matter also includes applied psychology, sociology
and communication. Professional practice includes care of disabled
people and practice in home care and fieldwork.
Education trains nurses in guiding patients/clients and their families to
actively participate and cooperate.
Graduates are able to accept greater responsibility, work independently
in hospital care and conduct fieldwork.
Principles of pre-registration nursing training


Nursing as a scientific discipline must be a part of the national
legislation (legal and sublegal regulations).
Nursing education is oriented on sustainment and promotion of health of
individuals, families, communities, groups of people and on
individualized and holistic care of the healthy and ill. Care takes into
60
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consideration the needs of the populace, it pays attention to the social,
cultural, political and economic orientation of individuals and society of
a given country. Nursing must comply with acknowledged standards of
quality of care.
Nursing education concentrates on healthy or ill individuals, their
families, partners, social groups and communities.
Content of nursing education is multi-professional and interdisciplinary
in order to prepare students for effective teamwork.
Basic professional education institutes enroll only graduates from
secondary schools who have passed the Maturita exam which allows
them to study at universities.
Academic level of qualification must correspond to a university degree.
Students are not employed during the education.
Education programs are not shorter than 3 years.
There is only one level of nurses. Only professionals who have achieved
education corresponding to the international requirements can claim the
title of nurse. Other professionals are denominated as health care
assistants.
Graduating from institutes of qualification training means achieving
professional competence to work as general nurses.
Qualified nurses are competent to work independently in hospitals and
in primary care centers.
Qualified nurses can achieve qualification in nurse-midwifery;
midwifery can also be studied in a self-contained study program.
Directives of the EU present minimal requirements for professional
education.
Status and title of qualified nurse can be achieved only by graduates of
nursing education programs which correspond with the principles of the
WHO/EURO Strategy.
Universities, institutes offering professional tertiary education of nurses
and midwifes and locations where practice training takes place must be
officially accredited and regularly evaluated.
Post-qualification (post-registration) nursing training
Specialized training concentrates on clinical disciplines and various forms
of hospital care and fieldwork. Nurses achieve advanced training in one of
the areas of their general qualification. The European Union issued general
directives for specialized training of nurses (89/48 EEC, 92/51 EEC) which
should be followed by all specialized nursing education programs.
Requirements:

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The program of specialized nursing education should be
authorized by the Accreditation Commission.
Education has to take place in the accredited institutes
professional tertiary education or at universities with its own
staff, teachers are nurse specialists.
Students have to pass an entrance procedure; they are required
taken a practice period of 1 year prior to admission.
61
officially
offering
teaching
to have

The minimal length of study is 12 months (560 lessons), it includes at
least 50 percent of practical training in a specialized discipline.
 Graduates are awarded a degree.
 Nurse specialists are organized in the professional nursing organization
according to their specializations.
Other forms of post-registration training of general nurses include certified
courses, innovative courses, education training courses, specialized
conferences, congresses or symposia and self-study of professional
literature.
General nurse

Full-time form of study with specific professional orientation, the
minimal length is 3 years, it includes at least 4,600 lessons of theoretic
education and practical training (from 2,300 to 3,000 lessons); the length
of other forms of study is not shorter, the level of education not lower.
 Theoretic education promotes knowledge of:
- disciplines which form the basis of general nursing care: anatomy,
physiology, pathology, microbiology (bacteriology, virology and
parasitology), biophysics, biochemistry, basics of radiation protection,
preservation of public health – including epidemiology, prevention of
illness, early diagnosis of illness, health education, pharmacology,
basic knowledge of medical supplies.
- nursing and clinical disciplines: history, character and ethics of
nursing, general rules of health care, community care, nursing related
to general practice and other medical disciplines, mainly to internal
medicine, surgery, pediatrics, care of mother and newborn,
gynecology, psychiatry, elderly care and geriatrics, intensive care,
dietetics and transfusion medicine.
- social sciences and related disciplines: basics of sociology, basics of
general psychology, psychology of the ill, evolutionary psychology,
basics of pedagogy and education, legal regulations related to social
issues, basics of information science, statistics and methodology of
scientific research.
 The study aims at developing nursing skills and knowledge related to
general medicine and other medical disciplines, mainly internal
medicine, surgery, care of children, pediatrics, care of mother and
newborn, gynecology, psychiatry, elderly care and geriatrics, intensive
and community care; it develops skills and knowledge allowing nurses
to train health care professionals and to draw on experience of other
professionals working in health care services; the skills are acquired
under supervision of qualified general nurses or – in specific cases –
other medical professionals competent to provide health care services
without professional supervision.
The professional training of nurses is in the Czech Republic provided
according to the minimal national standards (curricula) authorized by
Ministry of Health.
62
Graduate profile of „general nurse“ – basic functions of nurses
1.
-
Autonomous function
health promotion and prevention of illness;
disseminating information and health education;
supporting and assisting individuals in emergency situations.
2. Cooperative functions of nurses
- working in multidisciplinary and multiprofessional teams;
- conducting examination and treatment according to
instructions;
- cooperating with competent professionals.
physician's
3.
-
Research and development in nursing
critically assesses everyday practice and applies research outcomes;
participates in nursing research;
participates in sustaining quality of nursing care;
achieves professional advancement by means of lifelong learning.
4.
-
Planning, coordination and management
works in teams, cooperates with other professionals;
assesses, controls, and trains subordinate professionals;
participates in decisions concerning health policy and management
related to nursing.
Summary
Nursing is a regulated profession, nursing education is thus regulated as
well. Professional training of nurses takes place at institutes offering tertiary
education and is regulated by directives issued by the EU, the Czech
legislation and the national curricula which are binding for all schools. The
study program includes 4,600 lessons (2,300 lessons of practical training);
education is at least 3 years long and professionally oriented.
1. Read the study plan of general nurse education program and look up the
learning outcomes of practical training courses taught in the first year of
study.
2. Specify nursing activities in the context of basic functions of nurses.
3. What are the possibilities of postgraduate nursing education in the Czech
Republic?
63
8 CONCEPTION OF NURSING



about legislation of nursing profession and education;
about nursing conception of Ministry of Health of the Czech
Republic;
about nursing organization and management.
Keywords:
legislation, conception of nursing, nursing process, quality assessment,
management and organization, nursing team.
Nursing legislation
Act No. 105/2011 Coll. – regulation on conditions of achieving and
acknowledging competence to non-medical practice in health care services
and practice of health care related services (Act on non-medical health care
professions).
Regulation of Ministry of Health of the Czech Republic No. 55/2011
Coll. – on practice of health care professionals and other professionals.
Government Regulation No. 31/2010 – which defines disciplines of
specialized training and designations of health care professionals with
specialized practice.
Coll. – which defines minimal requirements of education programs training
non-medical health care professionals.
Coll. – which modifies details of postgraduate examination, certification for
performance of medical profession without professional supervision, final
examination of accredited competence training courses, qualifying
examination and rules for the conduct of examinations.
– which defines the credits system of certification for performance
of medical profession without direct professional supervision.
Conception of Nursing (Ministry of Health of the Czech
Republic)
64
Conception of nursing defines development of the discipline and in some
countries presents a system of legal regulations outlining quality
assessment, ethical nursing standards, level of qualification, specialization
and university education of nurses.
Nursing plays an irreplaceable role in health care. Nursing care means a set
of professional activities oriented on preventing illness and sustaining,
supporting and recovering health of individuals, families and people sharing
a certain social environment or suffering from similar health problems.
Nursing includes care of the incurably ill, alleviating their suffering,
providing for calm dying and respecting an individual's dignity in dying.
Nursing care is provided as a part of integrated care and of palliative care.
Nursing in residential, ambulatory and community care is defined by a
specific area of activities; nursing professionals here work more
independently. Nursing is characterized by individualized care based on
identifying and fulfilling needs of individuals related to their needs caused
or changed by illness. Nursing activities require sophisticated organization,
supervision and control of care. Modern trends in nursing include multistage
care which requires a team of nursing professionals with different
specializations and qualifications. Competencies of such professionals are
defined by their education and specialization. This conception of nursing is
based on Nursing Conception of the Czech Republic (1998), it respects
suggestions of the United Nations and World Health Organization,
guidelines of the European Union, suggestions of the European
Commission, the International Labour Organization, the International
Council of Nurses and the International Confederation of Midwives. The
documents outline the development and orientation of nursing and
midwifery in the 21st century. The conception emphasizes more demanding
and independent work of nursing professionals. It stresses the need to use
the method of nursing process which involves working out a detailed
medical documentation. It presents an methodic basis of working with
healthy or ill individuals, their families and social environment. It aims at
providing quality nursing care by defining nursing standards which outline
the criteria for providing and assessing nursing care. The conception utilizes
a system which authorizes non-medical health care professionals to practice
without professional supervision, names of such professionals are listed in
the National Register. Systematic application of the conception in practice
will lead to the improvement of the quality of general health care of the
Czech population, not only to the improvement of residential, ambulatory
and home care and to the implementation of the standards into integrated
and palliative care, but also to the improvement of the prevention and health
education in community health care. The nursing conception presents a
cornerstone of creating specific nursing conceptions of individual clinical
disciplines.
Definition, aims and characteristic features of the discipline
Definition of nursing
65
Nursing is an independent scientific discipline aiming at identifying and
fulfilling biological, mental and social needs of ill or healthy individuals to
care of their health. Nursing is oriented mainly on health promotion and
support, recovering and enhancement of self-reliance, alleviating suffering
of the incurably ill and providing for calm dying and death. Nursing plays
an important role in prevention, diagnostics, therapy and rehabilitation.
Nursing professionals assist individuals, families and groups of people to
become able to independently fulfill physiological, psychosocial and
spiritual needs. Nursing guides the ill to self-care, educates their relatives
and close ones to provide non-professional care. The ill who are not able or
willing to take care of themselves are provided with professional nursing
care.
Aims of nursing
The main aim of nursing is systematic and complex fulfillment of the needs
of individuals while respecting their individual quality of life; such
fulfillment leads to sustaining or recovering health and alleviating physical
or mental pain during dying. When trying to achieve the aims the nursing
professionals collaborate closely with the ill and medical and other health
care professionals. The aim of nursing is to promote and strengthen health,
assist in recovering, alleviate suffering of the ill, provide for calm dying
while respecting one's dignity.
Characteristic features of nursing: providing active nursing care,
providing individualized care using the method of nursing process, proving
nursing care based on scientific knowledge and research, holistic approach
to the ill, nursing care provided by teams of nursing professionals of
different qualifications.
The register of health care professionals authorized to practice without
professional supervision
Health care professionals are in the course of their careers registered in the
Register of health care professionals authorized to practice without
professional supervision. The Register is freely available (excluding one's
address and the national identification number) as a part of the National
Health Care Information System. It contains information concerning the
number and professional orientation of health care professionals
specializing in nursing care.
Authorization
(registration)
to
practice
without
professional
supervision
To be entered into the Register of health care professionals authorized to
practice without professional supervision motivates nurses to lifelong study
and it makes professional practice in member states of the European Union
easier. The registered health care professionals are given the official
66
certification which is valid for 6 years. The certification authorizes to
practice without professional supervision and to train and educate.
Professional identification card
Professional identification card contains records concerning the type and
duration of achieved professional training and other information connected
with the course of a professional career, i.e. examinations, lifelong study
programs.
Nursing process and its documentation
The main method of nursing professionals is the nursing process. It aims at
prevention, removing or softening problems connected with individual
needs of patients/clients. It is a rational method of providing and controlling
nursing care. It consists of a series of planned activities and mental
algorithms which are used by professionals:
1. to assess the state of individual needs of clients, families or
communities;
2. to identify nursing problems (nursing diagnosis);
3. to plan nursing care;
4. to realize nursing care;
5. to assess effectiveness of nursing care.
Nursing activities in the continuous work are organized by the following
systems of organization:
- system of charge nurses – a charge nurse takes care of a group of patients,
being responsible for the nursing process and medical documentation. Every
patient is personally handed over to a charge nurse working the next shift.
- system of primary nurses – when admitted to hospital, each patient is
given a primary nurse who is responsible for the nursing process throughout
the patient's stay and medical documentation. The work plan is realized with
the assistance of other nursing professionals. Leaving work, primary nurses
hand the patients over to nurses working the next shift; returning to work,
primary nurses are handed the patients over. Primary nurses also assist in
care for other patients.
The mentioned systems of organization require regular and sophisticated
sharing of information regarding patients which usually takes form of
briefings of nursing teams and of handing a patient over in his presence.
Students who are being trained for health care professions are integrated
into the nursing process. Nursing care of the ill is planned by primary or
charge nurses. Nursing process as a part of fieldwork requires close
cooperation with the medical professional of primary care. Nursing
documentation is a part of the medical documentation of every
patient/client; nursing documentation includes information regarding the
state and development of individual needs and nursing problems of
patents/clients, their families or close ones or the community.
67
Nursing management
The supreme institute regarding methodology of the discipline is the
Ministry of Health. The corresponding section of the Ministry methodically
controls and supervises nursing in the Czech Republic. It issues statements
concerning every significant professional, organizational, economical or
legislative arrangements which are connected with nursing and work of
nursing professionals in health and social care. It is authorized to create or
designate working groups and commissions which serve as advisory
committees assisting with solving professional problems and prepare
documents promoting further development of the discipline. The members
of working groups and commissions are the representatives of nursing
practice, professional organizations and educational institutes. Residential
care is supervised by deputies for nursing care or by nurse managers. The
structure of nursing supervision in an individual health care institute is
defined by its management.
Assessment of quality of nursing care
High standard of nursing care is the main aim of the contemporary nursing.
Quality of nursing care is defined by nursing standards which at the same
time define its measurable criteria. A nursing standard means an approved
professional norm of quality. Standards are in forms of legal regulations
(acts, regulations), methodical arrangements of the Ministry of Health of the
Czech Republic published in its newsletter or are worked out by health care
institutes, professional organizations, etc. Nursing standards regard
categories
and
qualifications
of nursing
professionals,
nursing
documentation, nursing procedures, technical equipment and nursing
personnel of the workplace. Health care institutes are required to follow
standards defined by legal regulations and to work out their own nursing
standards based on suggestions issued by the Ministry of Health of the
Czech Republic.
Supervising health care professionals are required to continuously assess
quality of provided nursing care, professionalism of the nursing personnel
regarding its attitude to the ill, organization of work of nursing professionals
and satisfaction of the ill with nursing care. Quality assessment utilizes
objective methods of evaluation.
Assessment of quality of nursing care involves:
 continuous assessment of care being provided;
 backward assessment of care provided based on analysis of nursing
documentation and other records.
Assessment and evaluation of quality of nursing care is also dealt with by
nursing professionals working as judicial experts. Health care professionals
providing nursing care are required to respect Convention on Human Rights
and Biomedicine and the Code of Ethics for Non-Medical Health Care
Professionals.
68
Community nursing
Nursing services provided as a part of community nursing are usually
realized outside of residential institutes and provide care for families,
individuals or groups of people. Community nursing is oriented on health
preservation, prevention of illness and health education. It also includes care
for the ill and rehabilitation, education of family members and close ones to
provide non-professional nursing care. Community nursing also focuses on
care for chronically and incurably ill and the disabled, including various
forms of home care. Health care professionals providing community nursing
care closely cooperate with medical professionals, government agencies,
local organizations,
non-governmental organizations,
etc.
Further
development of community nursing is the priority of World Health
Organization.
Nursing research
Nursing research is a part of medical research. It brings new findings which
directly or indirectly influence nursing practice. It allows nurses to provide
high standard of nursing care based on evidence. Nursing research is carried
out at research institutes, educational institutes and other educational
centers, in medical and social centers. It follows valid legal regulations and
international codes of ethics for biomedical research. Nursing research
focusing on the theory of nursing deals with systematic findings. It
identifies or explains regularities, universally observable characteristic
features, and verbalizes certain defined phenomena of nursing. This leads to
creation of nursing classifications which serve as the common professional
language of nursing professionals. Creation of nursing classifications
expands scientific basis of nursing with its identifications and defines new
areas of research:
 From the point of view of nursing practice, nursing research suggests
and validates models of nursing care. To carry out research and to
utilize its outcomes is one of the essential requirements for
development of nursing practice based on evidence.
 Nursing research leads to creation of educational programs focusing
on the methodics of scientific and research practice in accordance
with the European Union regulations concerning creation of
educational materials.
 Regarding management, nursing research focuses on various work
processes, especially quality assessment, workload of nursing
professionals, division of labor, relations between individual
categories of health care professionals. It aims at making health care
services more objective and effective.
Nursing research is financed mainly by science foundations. Every year
research projects dealing with any nursing topic can be submitted to achieve
financial support. Based on the public demand, the Ministry of Health can
publicly specify certain supported areas of research. New findings can also
be achieved by participation in international research projects, which is
made possible by the European Union, WHO or other international
organizations. Outcomes and findings of nursing research studies and
69
projects aiming at the development of theory and practice are published in
professional journals. Health care professionals are acquainted with them at
conferences organized by health care professional organizations on national
and international level.
Nursing organization and management
Nursing process
Nursing process is the essential methodic framework for achieving the
aims of nursing. It understands nursing as systematic and specific mode of
individualized approach to care for every ill/client in residential care or
outside of it.

Based on evaluation of the patient and in cooperation with him/her
nurses identify problems and needs of the ill and plan the fulfillment
by means of active nursing care.

Nursing process is realized in following phases: evaluating, diagnosing,
planning nursing care, realizing suggested actions, evaluating the effect
of care provided.
1. Evaluation (evaluation of the ill) – by means of interviewing, observing, testing and
measurement.
2. Diagnosing (identifying nursing needs, problems, diagnosing ) – nursing problems
diagnosed by nurses, problems felt by the ill, agreement with the ill concerning
sequence of urgency.
3. Planning (planning of nursing care) – identifying short-term and long-term aims of
nursing care, suggesting appropriate actions for their achieving, agreement with the ill
concerning sequence of urgency.
4. Realization (active individualized care) – realization of nursing actions which are
planned to help the patient achieve his/her aims.
5. Evaluation (evaluating the effect of provided care) – objective measurement of the
effect of care, evaluation of physical and mental comfort of the ill.
Even though each phase is self-contained, approach to nursing care must be coherent,
each step is dependent on the others. All steps of nursing process influence the others,
they are interrelated.

Nursing process is recorded in each patient's/client's specific nursing
documentation (nursing record and plan of nursing care) which is a part
of health care documentation.

Nursing care as a part of nursing process is planned by a nurse who is
specifically responsible for its realization throughout the hospitalization
or long-term fieldwork (primary nurse).

Nursing process in individual health care centers is supervised by nurse
managers who are responsible for its realization.

As part of their practical training of individualized nursing care,
students of nursing are integrated into the nursing process.
70
Work organization systems of nursing teams
In every department the ill are nursed by a group of health care
professionals – health care team. Health care teams consist of health care
professionals of all categories: medical professionals, nurses, physical
therapists, dietary nurses, nurse's aides, etc. One if its parts is nursing team
which provides nursing care. It consists of nurses with different
qualifications and nurse's aides. Forms of organization of nursing care can
differ. Older systems of organization were oriented mainly on division of
tasks between individual professionals in the course of working shifts.
Modern systems are based on the fact that nurses are responsible for care
for specific clients and are supposed to take care of every aspect of nursing
demanded. Nurses are fully responsible for the clients.
a) system of charge nurses
This method, also called "total care", belongs to one of the oldest systems. A
single nurse is responsible for a group of patients during a working shift.
Nurses provide all services demanded by treatment and nursing program.
b) functional system
Nurses are responsible for carrying out specific groups of tasks and
providing services for all patients. Functional system in nursing is more
economical, it is effective and allows centralization of management and
supervision, however, the care provided is fragmentary. Patients are
provided services by nursing professionals of different categories, thus
malpractice or nursing of low standard (i.e. insufficient fulfillment of
emotional needs) can be easily overlooked. The system is not paying much
attention to individuality of the ill; nurses are not specifically responsible for
groups of patients.
c) system of primary nurses
When admitted to hospital, each patient is given a primary nurse who –
with the assistance of other health care professionals – is responsible for
providing nursing care throughout the patient's stay. Every primary nurse
can be responsible for more patients. Model of primary nurses was created
in 1970 (Minnesota, USA) in order to give nurses greater individual
responsibility and to enable nurses to provide patients more extensive and
complex care. System of primary nurses is characterized by following
features:
 Every patient is nursed by an appointed primary nurse throughout his
hospitalization.
 Primary nurses provide their patients complex nursing care during the
working shift; when the primary nurse is not at work, the patient he/she
is responsible for is handed over to be nursed by a secondary nurse,
however, it is the primary nurse who remains responsible for the patient.
 Nursing care is based on a patient's life-style which is altered by illness;
the ill (eventually with the help of their families) are actively
participating in nursing care.
71

Health care documentation and regular briefings enable appropriate
exchange and sharing of information between individual members of
nursing and health care teams.
d) case management
Nurses are considered case managers responsible for a number of "cases".
Its form depends on chosen principle of organization: 1. case managers
work with specific medical professionals whose patients they nurse; 2. case
managers are appointed to nurse patients according to geographic criteria; 3.
case managers nurse patients according to their diagnose. The system is
based on principles of primary nursing and requires well-trained and
educated health care professionals (tertiary professional schools, Bachelor's
or Master's degree in nursing).
Multistage nursing care is based on division of labor between nursing
professionals of different training and education in nursing teams. Nurse
managers, ward sisters or charge nurses are responsible for providing
nursing activities and specify which professional is to carry them out
according to nurses' specializations and state of patients.
Multistage nursing care works with the following categories of nursing
professionals (nursing team):
a) Graduates of Bachelor's or Master's degree study programs in nursing.
b) Graduates of specialized study programs or registered nurses
(graduates of tertiary specialized study programs or tertiary professional
training).
c) Sisters, i.e. graduates of secondary nursing schools (until 2008), now
called health care assistants.
d) Nurses, graduates of the two-year study programs of lower vocational
schools, professional training schools or long-term hospital training.
e) Nurse's aides, graduates of short-term hospital training.
Health care team
Health care teams consist of nursing teams and other health care and nonhealth care professionals: medical professionals, pharmacists, physical
therapists, occupational therapists, nutritional therapists, radiologist
assistants, laboratory technicians, midwifes, emergency medical
technicians, social workers, psychologists, speech therapists, teachers, etc.
Multistage nursing is efficient only if individual members of nursing team
cooperate closely and precisely fulfill their responsibilities specified
according to their competencies.
Summary
Conception of nursing is since 1998 defined by
Czech Republic. It specifies nursing, its
supervision, orientation, philosophical basis, its
research and quality assessment. Nursing care
72
the Ministry of Health of the
organization, management,
agents and their education,
is realized by nursing teams
composed of health care professionals of different categories; a nursing
team is a part of a more extensive health care team. Nursing process is
organized by the system of charge nurses, primary nurses, case management
or functionally.
1. Specify the system of nursing care applied at the workplace where you
are obtaining your work experience.
2. Define activities of nurse researchers.
3. Look up sources and information concerning evidence based practice and
define it.
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75
APPENDICES
CODES OF ETHICS IN NURSING
Norm 1
Nurses value individuals as unique and dignified human beings regardless
of their gender, ethnicity, race, culture, religion or economic situation.
1. Nurses maintain a patient's privacy during examination, treatment and
recording of personal details.
2. Nurses utilize a specific method of identifying patients using their
names and corresponding information concerning clients' personality,
bed and the list of patients currently using the hospital unit.
3. Nurses utilize reliable methods of distress call.
4. Nurses give patients opportunity to express their thoughts and feelings
concerning their previous and current state of health.
5. Nurses accept clients in their current situation without judging them.
6. Nurses enhance patients' self-respect by allowing them to take part in
planning nursing care.
Norm 2
Nurses assist individuals, families and other groups of people and
communities in achieving and maintaining optimal state of health.
1. Nurses utilize findings of natural, physical and behavioral sciences to
interact with a client (individual, group, the public) seen as a unique
human being with a personal value and dignity.
2. Nurses take a patient's nursing history and carry out physical
examinations using appropriate tools, screening and evaluation.
3. Nurses record all information concerning a client. The record must be
made continuously and be appropriate for future use.
4. Nurses identify immediate, current and long-time needs of patients.
5. Nurses identify patients' reactions and responses to their current and
potential health problems.
6. Nurses identify a patient's cultural orientation and beliefs which
influence health and medical practice.
7. Nurses form a nursing diagnosis and make a nursing plan after having
consulted a client and (when needed) other professionals.
Norm 3
Nurses enhance feeling of safe environment to advance the level of
satisfaction, health and treatment.
1. Nurses collect and utilize previously collected information concerning
environmental danger in hospitals, households and municipalities.
2. Nurses identify actual and potential health threatening risks.
3. Nurses monitor risk environments.
4. Nurses instruct other professionals and personnel to practice minimizing
or eliminating health threatening environmental risks.
5. Nurses act to minimize or eliminate health threatening environmental
risks.
76
6. Nurses instruct clients how to change their ways of living to minimize or
eliminate health threatening environmental risks.
Norm 4
Nurses use scientific findings as a basis of decision making process in
nursing practice.
1. Nurses critically examine and challenge established models of practice.
2. Nurses apply new findings to modify and improve established models of
practice.
3. Nurses systematically collect information concerning problems of
nursing.
4. Nurses identify problems of clinical nursing and utilize the research
process to assist in solving them.
5. Nurses utilize research to take part in the process of realization of new
findings in nursing practice.
Norm 5
Nurses appropriately intervene and carry out nursing practice to reduce
suffering or discomfort in the period of disease, in recovering, or to
maintain dignity in dying.
1. Nurses utilize collected information concerning physiological and
psychological reactions of patients on illness to make decisions in
nursing.
2. Nurses make plans of managing nursing activities which enhance
therapeutic process and prevent complications.
3. Nurses carry out therapeutic interventions to advance physical and
mental recovery from illness and prevent complications.
4. Nurses initiate urgent actions and interventions to advance survival and
recovery from illness.
5. Nurses satisfy all biopsychosocial needs of clients required by their state
of health.
6. Nurses create a physical and psychological environment enhancing
recovery, regaining health or maintaining dignity in dying.
7. Nurses repeatedly assess and set priorities, reassess new aims and revise
plans of nursing care.
Norm 6
Nurses assess quality of nursing care provided according to subjective and
objective state of patients and to the results of nursing process.
1. Nurses utilize not satisfied needs of patients to set aims of nursing care
and plan nursing process.
2. Nurses predict results of nursing according to a client's reactions.
3. Nurses record nursing actions and a client's reactions so that the records
can be assessed systematically.
4. Nurses decide whether there are measurable proofs of advance towards
achieving aims.
5. Nurses revise and modify plans of nursing process according to the
differences between predictions and results.
Norm 7
77
Nurses assist clients to achieve and maintain balance between the need for
personal advancement and optimal functions.
1. Nurses assess patients' readiness to improve their ability to self-care.
2. Nurses teach clients the basic skills needed to improve their ability to
self-care.
3. Nurses teach clients how to realize changes of their state of health.
4. Nurses guide clients concerning questioning their health state in advance.
Norm 8
Nurses identify changes of health state and deviations from optimal
development.
1. Nurses collect basic information concerning health state and its
development.
2. Nurses identify marginal and significant physical and mental reactions to
changes of health state.
3. If needed, nurses change plan of nursing care in cooperation with a client
and other health care professionals.
4. To enhance treatment, nurses intervene according to physical and mental
reactions to changes of health state.
5. Once it changed, nurses monitor health state.
6. In case other health care professionals are involved, nurses coordinate
nursing care.
Norm 9
Nurses are required to educate themselves continuously, to improve the
level of their professional conduct and to advance professional improvement
of others.
1. Nurses are improving their knowledge by searching for findings and
contacts with other professional and cultural groups.
2. Nurses advance their professional improvement by using all available
means of continual education.
3. Nurses take part in activities of their professional organizations.
4. Nurses apply all new findings to practice and utilize them in their nursing
activities.
78
CODE OF ETHICS FOR NURSES
(ICN Code for Nurses: Ethical Concepts Applied to Nursing. Geneva Imprimeries
Populaires, 2000 )
Code of ethics for nurses defines basic standard of conduct of nurses
towards the ill, their family, community and the public (essential ethic –
moral principles of nursing). 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 2000.
Czech nurses in the Czech Association of Nurses (ČAS) avow The ICN
Code of Ethics for Nurses which was reviewed by the Presidium
Committee of ČAS and affirmed by the Ethics Committee and the
Presidium of ČAS. It is valid since 29 March 2003.
Code of ethics for nursing care
Nurses have four fundamental responsibilities:
1. to promote health;
2. to prevent illness;
3. to restore health;
4. to alleviate suffering.
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, creed,
culture, disability or illness, gender, sexual orientation, nationality, politics,
race or social status. Nurses render health services to the individual, the
family and the community and coordinate their services with those of
related groups.
Nurses and people
The nurse’s primary professional responsibility is to people requiring
nursing care. In providing care, the nurse promotes an environment in which
the human rights, values, customs and spiritual beliefs of the individual,
family and community are respected. The nurse holds in confidence
personal information and uses judgement in sharing this information.
Nurses and practice
The nurse carries personal responsibility and accountability for nursing
practice, and for maintaining competence by continual learning. The nurse
maintains a standard of personal health such that the ability to provide care
is not compromised. The nurse uses judgement regarding individual
competence when accepting and delegating responsibility. The nurse at all
times maintains standards of personal conduct which reflect well on the
profession and enhance its image and public confidence.
79
Nurses and society
The nurse shares with society the responsibility for initiating and supporting
action to meet the health and social needs of the public.
Nurses and co-workers
The nurse sustains a collaborative and respectful relationship with coworkers in nursing and other fields. The nurse takes appropriate action to
safeguard individuals, families and communities when their health is
endangered by a co-worker or any other person.
Nurses and the profession
The nurse assumes the major role in determining and implementing
acceptable standards of clinical nursing practice, management, research and
education. The nurse is active in developing a core of research-based
professional knowledge that supports evidence-based practice. The nurse is
active in developing and sustaining a core of professional values. The nurse,
acting through the professional organization, participates in creating a
positive practice environment and maintaining safe, equitable social and
economic working conditions in nursing.
80
GUIDELINES OF THE EU FOR EDUCATION OF NURSES
The Council of Europe worked out in the 1960s basic guidelines for joint
education and qualification of nurses which were based on an agreement of
several European states. In 1972 the guidelines were proclaimed in
Strasbourg as European Agreement on Instruction and Education of
Nurses no. 59. It is an official document of the Council of Europe which is
still valid; it was gradually acknowledged not only by all member states of
the EU, but also by every prominent international organization, e.g. World
Health Organization, The International Council of Nurses and The
International Labor Organization. The document was in 1995 amended by a
document of the Council of Europe – The Role and Education of Nurses
which specifies individual directives and includes curriculum framework of
professional training.
Strategy of World Health Organization (WHO) – Strategy NUR/WHO
EURO 2000
A WHO European program Nurses and Midwifes for Health 2000 contains
an important chapter European Strategy for Nursing and Midwifery
Education which recommends that the education requirements for nurses
should be unified and increased. The program was accepted by the Ministers
of Health of European states at the Second WHO Ministerial Conference
on Nursing and Midwifery in Munich (2000); it defines new roles and
aims of nurses and midwifes at the beginning of the third millennium and
outlines basic principles of qualification of nurses; it characterizes
educational institutes where nurses acquire professional authorization.
Principles of pre-registration nursing training (according to NUR/WHO
EURO 2000)
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Nursing as a scientific discipline must be a part of the national
legislation.
Nursing education is oriented on sustainment and promotion of health of
individuals, families and communities and on individualized and holistic
care of the healthy and ill.
Care takes into consideration the needs of the populace, it pays attention
to the social, cultural, political and economic orientation of individuals
and society of a given country.
Nursing education concentrates on healthy or ill individuals, their
families, partners, social groups and communities.
Content of nursing education is multi-professional and interdisciplinary
in order to prepare students for effective teamwork.
Basic professional education institutes enroll only graduates from
secondary schools who have passed the Maturita exam (12 years of
schooling) which allows them to study at universities.
The minimum academic level of qualification is Bachelor's degree in
nursing.
Students are not employed during the education.
81
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Education programs are not shorter than 3 years.
There is only one level of nurses. Only professionals who have achieved
education corresponding to the international requirements can claim the
title of nurse. Other professionals are denominated as health care
assistants.
Graduating from institutes of qualification training means achieving
professional competence to work as nurses or midwifes.
Qualified nurses are competent to work independently in hospitals and
in primary care centers.
Qualified nurses can achieve qualification in nurse-midwifery;
midwifery can also be studied in a self-contained study program.
Directives of the EU present minimal requirements for professional
education.
Status and title of qualified nurse can be achieved only by graduates of
nursing education programs which correspond with the principles of the
WHO/EURO Strategy.
Universities, institutes offering professional tertiary education of nurses
and midwifes and locations where practice training takes place must be
officially accredited and regularly evaluated.
Education programs must be officially accredited and regularly
evaluated.
Teaching staff
 Headmaster of a nursing education institute must be a qualified
nurse.
 Nursing subjects are taught by qualified nurses or midwifes.
 Teachers must have university degrees in subjects they teach
(Master's degree, Doctoral degree, equivalent to qualifications of
university teaching staff), pedagogic qualification, at least two-year
practice, specialization in the area they teach.
 Teachers teach only subjects they are specialized in.
 Teachers are responsible for practical training of students, they
cooperate with Clinical Nurse Managers who supervise students
during clinical practice (they are trained for such work, are
specialized
in particular disciplines and have pedagogic
qualifications).
 In case there are no academically trained specialists in nursing and
midwifery in a particular country, it is necessary to invite foreign
specialists and send experienced nurses and midwifes to study
abroad.
82
PATIENT'S RIGHTS
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
The patient has the right to receive health care services at an appropriate level of expertise, to be treated
with respect and understanding.
The patient has the right to know the full names of the health care personnel and other professionals
directly involved in providing the patient with healthcare services; to discreteness and respect for the
privacy of the patient in providing of the health care services – as appropriate to the nature of provided
health services; to receive visitors (family, friends) on a daily basis. Continuity of visits can be restricted
only for serious reasons.
The patient has the right to be informed by the health care professionals about his/her diagnosis, the
benefits and risks of each treatment, and the expected outcomes, so that he/she can make an informed
decision as to whether or not he/she would like to undergo it. The patient has the right to be told about
other possible treatment methods. The patient has the right to know the full names of the health care
personnel and other professionals directly involved.
The patient has the right to refuse treatment to the extent permitted by law and to be informed about the
medical consequences.
The patient has the right to expect full consideration of his/her privacy and confidentiality in care
discussion, examinations and treatments in ambulatory and hospital care. The patient has the right to
expect that all communications and records pertaining to his/her care are confidential and discrete. The
patient has the right to refuse the presence of other people who are not directly involved in the
procedure, which also applies in teaching hospitals, in case the patient has not chosen the particular
persons.
The patient has the right to expect that all communications and records pertaining to his/her care are
confidential and discrete. Security of information concerning patients must be maintained also in case of
computer data processing.
The patient has the right to expect that the hospital appropriately satisfies the patient's requests for care,
depending on the corresponding type of illness and possibilities of the hospital. If the medical condition
requires it, the patient can be transferred to a different facility. This facility has to agree with the transfer
and the patient has to be fully informed about the reasons and other alternatives.
The patient has the right to expect that his/her care will be continuous as well as to know which doctors
are available, where and when. The patient has the right to be involved in the discharge planning and to
receive information about follow-up care.
The patient has the right to agree to, or to refuse to, take part in medical research. The patient has the
right to be informed about the research in detail and in an understandable way. The patient may
withdraw at any time from the research, after he/she was informed about possible medical consequences.
A patient at the end of life has the right to receive respectful and compassionate care. The health care
professionals have to respect his or her wishes unless they are against the law.
The patient has the right and the responsibility to follow the hospital ru les. The patient has the right to
receive detailed information about his/her hospital bills, regardless of who pays for it.
The code of ethics "Patient's Rights" was proposed and after amendment
procedure formulated and accepted by the Central Ethics Committee of the
Ministry of Health of the Czech Republic. The code is valid from 25 th of February
1992.
83
This project is co-financed by the European Social Fund and the public budget of
the Czech Republic.
Name:
Fundamentals of Nursing
Authors:
Doc. PhDr. Darja Jarošová, Ph.D.
Edition:
first, 2012
Number of pages:
80
Projects:
Modernization – Diverzifikation– Inovation
Reg. number of the project:CZ.1.07/2.2.00/28.0247
Publisher:
University of Ostrava
© Jarošová
© University of Ostrava
84

Fundamentals of Nursing - Ostravská univerzita v Ostravě

Transcription

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