CHAPTER ONE

INTRODUCTION TO NURSING PROFESSION

1.1. History of nursing

A. Early Definitions of Nursing

A nurse is a person who nourishes, fosters, and protects—a person who is prepared to care for the
sick, injured, and aged.
 In this sense, “nurse” is used as a noun and is derived from the Latin nutrix, which means
“nursing mother.”
 The word “nurse” also has referred to a woman who suckled a child (usually not her own)—
a wet nurse.
 Dictionary definitions of nurse include such descriptions as “suckles or nourishes,” “to take
care of a child or children,” “to bring up; rear.”
In this way, “nurse” is used as a verb, deriving from the Latin nutrire, which means, “to suckle
and nourish.” With such an origin, it is understandable that people generally have associated
nursing with women.
B. Modern definition by theorists
1. Florence Nightingale (1820-1910)
(1859), wrote in detail about the concept of the aesthetic and seemed to realize the relationship of certain
qualities as health and beauty.

She suggested that: "Nursing is an art, and if it is to be made an art, it requires as exclusive
devotion, as hard a preparation, as any painter’s or sculptor’s work, for what is having to do with
the living body - the temple of God’s spirit? It is one of the fine Arts; I had almost said the finest of
the fine Arts". (Cited in Donahue 1996:501)

2. Mallison (1993:7) emphasizes in the difficulty to express by writing the multidimensional whole of
nursing as she suggests that:
“Nursing like dance or painting is not primarily an art of the written word. It is partly Kinaesthetic
- transmitted in facial expressions, posture, touch, silences, gestures, timing, intent. Attempts to pin
it down with language is like chasing butterflies: It's most beautiful in motion, flitting freely outside
the net of words".

3. Henderson (1966:39) stated that:

"the unique function of the nurse is to assist the individual sick or well, in the performance
of those activities contributing to health or its recovery (or to a peaceful death) that he
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 would perform unaided if he had the necessary strength, will or knowledge, and to do this
in such a way as to help him to gain independence as rapidly as possible"and she went on
to describe what are these activities. (cited in Lister 1997).

Definition of nursing by American Nursing Associations (ANA)

Nursing is the protection, promotion and optimization of health and abilities, prevention of illness
and injury, alleviations of suffering through the diagnosis and treatment of human response, and
advocacy in the care of individuals, families, communities, and populations(ANA,2003).
 Nursing is an art and science. This means that a professional nurse learns to deliver care
artfully with compassion, caring and a respected for each client dignity and personhood. As a
science, nursing is based upon a body of knowledge that is always changing with new
discoveries and innovations. When nurse integrate the science with art of nursing into their
practice, the quality of care provided to clients is at level of excellence that benefits a clients
in innumerable ways
C. History of nursing in Ethiopia

Modern nursing in Ethiopia started in the later part of the 19th century by Swedish Missionaries
who came to Eritrea in 1866. Years later the nursing service was extended to other parts of the
country still by expatriate nurses from Sweden, Russia, and France. During this time some
clinics and hospitals were opened in some parts of the country. Thus the need for nurses was
felt more than ever. Around 1928 elderly women were recruited and were given short term
training to serve as nurses and midwives. In 1949 the first School of Nursing (The Ethiopian
Red Cross) was opened in the former Haile Selassie I Hospital (Now Yekatit 12 Hospital
beginning of the modern nurses’ education). Students were recruited from 8thgrade and the
training duration was 3 ½ years. In the following years other schools of nursing were opened.
One of the schools (Gonder) was training community nurses who were basically working in
the community while the other schools train bed side nurses who work mainly in hospital
settings.
 In 1977, three years after the downfall of the Emperors regime, the nurse training was revised
at a national level and a decision was made to train one category of nurse namely
"Comprehensive nurse" who can function at all levels of health institutions. Thus the training
of community nurses was discontinued. The academic entry requirement at this time was raised
to 12th grade completion and the duration shortened to 2 ½ years. After the dawn fall of the

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 Derge regime, since 1991, the training duration reduced by ½ years to only 2 years and the
comprehensive form of training changed to specialized form of training.
 The training of different types of nurses then started for two years in most training institutions
and begins to train clinical nurses, public health nurses & midwives. However this fragmented
form of training is not appreciated by most faculty members of the respective institutions.
 A remarkable event to be mentioned in the history of nursing in Ethiopia is the launching of
post basic baccalaureate program in nursing in1994 in the former Jimma institute of health
science (now Jimma University). The annual average output of baccalaureate program trainees
were not more than 30 and deployed in schools and management positions.
 At present, there are a number of governments owned and NGO and private owned
Universities/schools/Colleges offering nursing education in the country in Level II, IV,BSc
and MSc level. At the end of the training period, regional health bureau of respective region
registered and licensed them to practice the profession in the country through the health
professionals' council and COC exam.

1.2. Nursing Processes

Nursing Process is a method of organizing through process for clinical decision making and
problem solving. Using nursing process, the nurse can focus on the unique responses of patient to
actual or positional health problems.

Characteristics of nursing process

1. Based on scientific problem solving
2. Systematic
3. Client centered
4. Continuous
5. Dynamic

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There are five steps, or phases, in the nursing process: assessment, diagnosis, planning,
implementation, and evaluation. These steps are not distinct; rather, they overlap and build on each
other. To carry out the entire nursing process, you must be sure to complete each step accurately
and then build upon the information in that step to complete the next one.
A. Nursing Assessment
The first step, or phase, of the nursing process is assessment. During this phase, you are collecting
data (factual information) from several sources. The collection and organization of these data allow
you to:
1. Determine the patient’s current health status.
2. Determine the patient’s strengths and problem areas (both actual and potential).
3. Prepare for the second step of the process—diagnosis.
Subjective Data
 What the patient tells you
 The history, from chief complaint through Review of Systems
 Example: Mrs. G is a 54-year-old hairdresser who reports pressure over her left chest “like an
elephant sitting there,” which goes into her left neck and arm.
Objective Data
 What you detect on the examination
 All physical examination findings
 Example: Mrs. G is an older white female, deconditioned, pleasant, and cooperative.
 BP 160/80, HR 96 and regular, respiratory rate 24, afebrile.
Methods of assessment are:-
1. Nursing health history
2. Physical assessment
3. Diagnostic evaluation

B. Nursing Diagnosis
Diagnosis means reaching a definite conclusion regarding the patient’s strengths and human
responses. This diagnostic process is complex and utilizes aspects of intelligence, thinking, and .

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Nursing diagnosis is a clinical judgment about individual, family, or community responses to
actual or potential health problems/life processes. Nursing diagnoses provide the basis for selection
of nursing interventions to achieve outcomes for which the nurse is accountable.
C. Nursing planning
Planning involves a series of steps in which the nurse and the client prioritize problems and set
goals or expected out comes to resolve or minimize the identified problems of the client
D. Nursing implementation
Implementation refers to the action phase of the nursing process in which nursing care plan is put
into action.
It is focused on resolving the patient’s nursing diagnoses and collaborative problems and achieving
expected outcomes, thus meeting the patient’s health needs.
E. Evaluation
Evaluation simply means assessing what progress has been made toward meeting the expected
outcomes; it is the most ignored phase of the nursing process.

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 Summary of nursing process steps
Assessment
1. Conduct the health history.
2. Perform the physical assessment.
3. Interview the patient’s family or significant others.
4. Study the health record.
5. Organize, analyze, synthesize, and summarize the collected data
Diagnosis
1. Nursing Diagnosis
a. Identify the patient’s nursing problems.
b. Identify the defining characteristics of the nursing problems.
c. Identify the etiology of the nursing problems.
d. State nursing diagnoses concisely and precisely.
2. Collaborative Problems
a. Identify potential problems or complications that require collaborative interventions.
a. Identify health team members with whom collaboration is essential
Planning
1. Assign priority to the nursing diagnoses.
2. Specify the goals.
o Develop immediate, intermediate, and long-term goals.
o State the goals in realistic and measurable terms.
3. Identify nursing interventions appropriate for goal attainment.
4. Establish expected outcomes.
o Make sure that the outcomes are realistic and measurable.
o Identify critical times for the attainment of outcomes.
5. Develop the written plan of nursing care.
o Include nursing diagnoses, goals, nursing interventions, expected outcomes, and critical times.
o Write all entries precisely, concisely, and systematically.
o Keep the plan current and flexible to meet the patient’s changing problems and needs.
6. Involve the patient, family or significant others, nursing team members, and other health team members in all
aspects of planning
Implementation
1. Put the plan of nursing care into action.
2. Coordinate the activities of the patient, family or significant others, nursing team members, and other health
team members.
3. Record the patient’s responses to the nursing actions.
Evaluation
1. Collect data.
2. Compare the patient’s actual outcomes with the expected outcomes.
3. Determine the extent to which the expected outcomes were achieved.
4. Include the patient, family or significant others, nursing team members, and other health care team members
in the evaluation.
5. Identify alterations that need to be made in the nursing diagnoses, collaborative problems, goals, nursing
interventions, and expected outcomes.
3. Continue all steps of the nursing process: assessment, diagnosis, planning, implementation, and evaluation .