It appears as if there has not been an instance, at least in our current time, when the character of nursing and the task or role of the registered nurse have not been the focus of argument and disputation. By tradition nursing has been seen as a dependent occupation, the nurse being expected to be the ears and eyes of the doctor, loyally carrying out instruction and faithfully reporting back. A nurse was expected to be ‘punctual, good tempered, obedient, and loyal to all rules as the foundation of her work’.
She should also remember ‘what is due to authority’ and ‘must ever remember that discipline and obedience are the keynote to satisfactory and efficient work in life’. Among other things the nurse should ‘dust the sick room, wash and cleanse all utensils used by the patient, and never... refuse to do domestic work in exceptional cases of extreme illness, infectious disease or straitened circumstances’.
The consideration on some aspects of the nurse’s role is then disregarded.Within this context we would discuss the development of nursing as a profession with claims to an increasingly independent function, notions of role extension, expansion and the scope of the professional practice (Hunt & Wainwright, 1994). The Nature of Nursing Work Nursing as we know it today has its origins in the early 19th century, although we can trace it further back to the Middle Ages. Nursing as an occupation developed as an extension of the work women were expected to do in the home, with nurses viewed as relatively unskilled doctors’ helpers.Right up to the present nursing has been seen as subordinate to and dominated by medicine, to the extent that for many years doctors had a key role in deciding the content of the nursing curriculum and in the appointment of nursing staff; it is still quite common to hear consultant medical staff talking of ‘my nurses’ (Walsh, Crumbie, & Reveley, 1999). As medicine became more technical and more scientific, nurses increasingly took in skills and procedures that had once the preserve of doctors, and doctors came to appreciate the value of ‘patient, obedient helpers who could in no way be seen to be competing in the medical field’.
However, the dependence of nursing on medicine to take the main responsibility for decision making continued. Nurses had become adept at suggesting a course of action to a doctor in a way which allowed him to think that he had initiated it. However, the very fact that nurses used such strategies suggests that there was no great desire to challenge medical authority or to seek autonomy (Hunt & Wainwright, 1994). The Role of the Registered NurseExamination of the role of the registered nurse reveals several principles that apply across all areas of practice and specialization. A review of the philosophies of various programs of nursing education across the country, as revealed in self-evaluation studies prepared by nursing education programs prior to accreditation site visits, likewise demonstrates agreement on several concepts basic to nursing.
These are reverence for life, a respect for the dignity and individuality of each person, and a determination to act on beliefs.These philosophies portray the patient as a holistic being with physical, psychological, socio-cultural, and spiritual dimensions. The objectives of the registered nurse with respect to patient care are achieved through effective interpersonal interactions within caring relationships with patients (Hood & Leddy, 2005). Nursing is defined by the American Nurses Association as the “diagnosis and treatment of human responses to actual or potential health problems. This broad statement encompasses older definitions of nursing that specifically refer to body, mind, and spirit.
The concept of spirit refers to the sense of meaning and purpose, the drive toward achieving maximum potential as a human being. It may be understood within a religious, philosophic, or humanistic context. An important emphasis of all quality nursing care is the understanding that each individual must be understood as a unified whole in constant interaction with the environment (Walsh et al. 1999). Summary and Conclusion The universal view of the role of the registered nurse includes philosophy describing the individual holistic and multidimensional; a respect and value for life; a responsibility to assist the individual in the promotion and restoration of health, prevention of illness, and attainment of a peaceful death; and maintenance of therapeutic environment in which to achieve these goals (Hunt & Wainwright, 1994).
While there seems to be agreement regarding the definition of nursing and the role of the nurse, the fact remains that the needs of two separate and distinct patient populations within a single setting may require the registered nurse to change roles as she moves from one activity to another. Such transitions will result in role conflict of the role expectations are contradictory or mutually exclusive (Walsh et al. , 1999).The nurse simultaneously fights death with the acutely ill and cares for the dying.
This setting, containing two sets of disparate concepts, may render any universal view of nursing ambiguous. Do these disparate concepts result in contradictory role expectations for nurses? The nurse assumes various roles, depending upon the stage of therapeutic relationship development. Because the stages of therapeutic relationship overlap, the roles assumed by the nurse vary.Success of the therapeutic relationships relies on nurse consistency in demonstrating deep respect, listening intently, and affirming client thoughts, concern, and needs throughout all phases.
As the relationship unfolds, client dependence on the nurse decreases, and the professional nurse role changes primarily to one of offering support. The relationship ends when the client assumes dependence, responsibility and accountability for meeting his or her own health care needs (Hood & Leddy, 2005).
