20071011

Nursing

Nurses have cared for the sick, the weak, and the disabled for at least as long as humans have kept records. In earlier times, nurses were generally untrained, learning only what was needed for the specific situations in which they worked. They washed and fed patients, massaged their bodies, helped them walk, made their beds, and performed other basic tasks. These nurses were almost always men, often members of military groups or religious orders.

Nursing as a modern profession can be traced back to the mid-19th century, to the remarkable Englishwoman Florence Nightingale (1820–1910). Her care of wounded British soldiers during the Crimean War dramatically demonstrated the efficacy of skilled nursing. In 1860, the first nursing school, based on Nightingale's methods, was founded in affiliation with Saint Thomas' Hospital in London. In 1863, women physicians founded the New England Hospital for Women and Children in Boston. In 1872, the hospital established the first U.S. school of nursing. The following year, the hospital awarded a nursing diploma to Linda Richards (1841–1930), the first trained nurse in the United States. Richards went on to found several schools for nurses, including one in Japan. The growing focus on education gradually led to the setting of standards and certification requirements, which helped give nursing a professional status.

In the ensuing years, the overwhelming majority of nurses were women. Society came to expect much of nurses, but these expectations were not matched by status or esteem. As career opportunities for women improved during the 20th century, many women interested in medicine studied to be doctors rather than nurses. Simultaneously, however, the responsibilities of nurses increased, and new employment opportunities arose. Recognition of the importance of nurses has grown, and with this has come greater respect and appreciation for the profession. Today, the field attracts both women and an ever-increasing number of men.

What Is Nursing?

The word "nurse" comes from the Latin term nutricius, meaning "to nourish." At the core of nursing is a concern for the welfare of others. As professionals, nurses are dedicated to preventing illness, educating people on good health practices, and caring for those who are sick or in need of rehabilitation.

Nursing covers a wide gamut of duties, all designed to ensure that a patient's basic physical and safety needs are being met. These responsibilities can include conducting physical examinations, administering injections, treating minor injuries, monitoring a patient's vital signs (blood pressure, heart rate, respiration, and temperature), offering counseling, monitoring pregnancies, and even delivering babies. The activities of any individual nurse depend in large part on the setting in which he or she works. Nurses work in hospitals, outpatient clinics, doctors' offices, homes, schools, factories, nursing homes, and other facilities. Typically, they coordinate their efforts with physicians and other members of the health-care profession.

Types of Nurses

In most countries, people interested in nursing careers must fulfill specified educational and training requirements. In the United States, there are three basic nursing-related career options.

• Registered nurses (RNs) are registered and licensed by a state to care for the sick and to promote good health. They have completed a rigorous educational program, receiving either an associate's degree in nursing from a community or junior college, a bachelor of science degree (B.S.) in nursing from a college or university, or a diploma from a hospital-administered nursing program. The daily duties of an RN generally include assessing and recording patient health, assisting physicians during examinations and treatments, administering prescribed medications, developing nursing-care plans, and educating patients and their families in proper care. Many RNs concentrate on a particular field or specialty, which requires additional training. Some continue even further, becoming advanced-practice nurses allowed to perform a number of tasks traditionally restricted to physicians. Such duties might include treating select common illnesses and injuries and, in some circumstances, prescribing certain medications.

To maintain and renew their licenses, RNs are required to regularly complete continuing-education courses. This ongoing training helps to ensure that nurses are familiar with the latest medical technologies, treatments in patient care, and avenues to disease prevention.

• Licensed practical nurses (LPNs)—called licensed vocational nurses (LVNs) in certain states—must also be licensed by the state in which they work. They are generally required to have high-school diplomas, followed by completion of a practical-nursing program at a state-approved school. Most such programs, one year in length, are offered either by vocational and technical schools or through a hospital-associated nursing school. LPNs work under the supervision of physicians and RNs, usually in nursing homes, hospitals, clinics, and physicians' offices. They administer routine patient care: recording vital signs (such as temperature and blood pressure); collecting urine and other samples for testing; dressing wounds; dispensing some medications and injections; assisting with bathing and other hygiene-related issues; recording and reporting changes in a patient's condition; and performing a variety of other essential patient-care tasks.

• Nursing assistants (NAs) are also known as nurses' aides, geriatric aides, or hospital attendants. They generally have high-school diplomas and have completed a short training course, either at a community college or vocational school; most undergo training at the facility where they are employed. Licensing is not required for NAs employed by hospitals, but it is mandatory for those working in nursing homes. NAs work under the supervision of RNs and LPNs, handling many routine but necessary tasks of patient care: bathing, toileting, dressing, eating, exercising, assisting patients in and out of beds and wheelchairs, and so on. They keep the nursing or medical staff informed of any changes they observe in a patient's physical, mental, or emotional condition.

Closely related occupations with similar responsibilities are psychiatric aides and home-health aides. Most psychiatric aides work in hospitals, mental institutions, or community health centers. Home-health aides are primarily employed by visiting-nurse associations, home-health agencies, social-services agencies, and residential-care facilities.

Nursing Specialties

There is a long list of areas in which nurses can specialize. Each involves unique responsibilities, and calls on specific behavioral and emotional characteristics. For example, emergency-room (ER) nurses deal with trauma, shock, and other medical crises on a daily basis. The work is fast-paced and stressful, often highly technical, and involves patients of all ages; although patient-nurse relationships are short term, helping people in dire situations often provides a rewarding experience. A hospice nurse, who works with dying patients and their families, also faces a certain kind of stress, but in a somewhat less pressured environment, and may develop long-term relationships that offer their own rewards.

Pediatric Nursing

Pediatric nurses provide care to children, teenagers, and their families in hospitals, clinics, doctors' offices, and other settings. A related specialty is perinatal nursing, which focuses on the care of women and their infants, from the beginning of pregnancy through childbirth and the first month of a newborn's life.

Closely allied with pediatric nurses are certified nurse-midwives (CNMs), who are educated in both nursing and midwifery; they offer perinatal care and supervise labor and delivery in hospitals, birthing centers, or private homes.

Trauma Nursing

Trauma nurses work in hospital ERs and other emergency-medical settings. Their patients can be newborns or the elderly (and any age in between), with problems resulting from accidents, shootings, stabbings, illnesses, drug overdoses, and so forth. They must respond quickly to assess the situation and stabilize the patient. They work closely with physicians, assist in surgical procedures, and are skilled in the use of intravenous-feeding systems, ventilators, cardiac monitors, and other equipment.

Operating Room (OR) Nursing

OR nurses, also known as scrub nurses, are RNs who assist physicians during surgery. They may visit the patient prior to the operation; describe the procedure; and explain what he or she might anticipate during the postoperative period. They review patients' medical charts and make certain that all paperwork is complete. In the OR, they position and cover the patient; help doctors put on sterile gloves; and pass instruments to the surgeons. Some OR nurses specialize in a particular discipline, such as neurosurgery or organ transplantation.

Oncology Nursing

Nurses in this area of specialization care for patients who have cancer. They usually work in hospitals, medical offices, or clinics. Their duties can include educating patients about their disease and their options for treatment; administering chemotherapy; and helping the patients cope with the illness and its treatment.

Rehabilitation Nursing

Rehabilitation is designed to help individuals whose ability to lead normal, independent lives has been temporarily or permanently disrupted as a result of illness, injury, or substance abuse. Rehabilitation nurses work with other specialists—including physicians, physical therapists, occupational therapists, and psychotherapists—to assess the extent of a patient's condition and develop a treatment program. These nurses also administer the specialized care that many people with disabilities require.

Psychiatric Nursing

Psychiatric nurses help people who suffer from mental illnesses, including psychoses, neuroses, personality disorders, and problems resulting from physical abuse and substance abuse. In addition to providing physical care and administering medications, the nurses help patients understand and modify deviant behaviors. They usually are employed by hospitals, outpatient facilities, long-term-care centers, and health departments.

Long-term-care Nursing

People with AIDS, terminal illnesses, and other chronic physical or mental disorders require care on a recurring or continuing basis—generally in hospitals, nursing homes, or private homes. Care may involve physical examinations, use of ventilators, intravenous infusions, tube feeding, repositioning immobile patients every few hours to prevent bedsores, and a host of other medical skills. The nurses develop long-term relationships with patients and families, and communicate regularly with other health-care professionals involved in the case.

Office Nursing

Office nurses manage physicians' practices, and care for outpatients in clinics and emergency-medical centers. In a physician's office, they prepare patients for examinations, assist in minor surgical procedures, administer injections, carry out routine laboratory tests, maintain office records and files, and perform a number of other essential tasks.

School Nursing

Nurses who work in schools focus on the health of students. They conduct hearing tests, vision checks, and other health screenings, give physical examinations, treat minor injuries, provide first aid and other emergency assistance, and arrange for any needed additional care. An important part of their job is educating students and parents about human growth and development, good health practices, safety issues, and the dangers of drug abuse.

Occupational Nursing

Also known as industrial nurses, occupational nurses provide care in offices, factories, and other work sites. They treat minor injuries and illnesses, provide emergency care, and arrange for any additional medical needs. They also teach wellness, offer health counseling, conduct examinations and inoculations, and identify potential health and safety problems in the work environment.

The information provided should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed physician should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies.

Copyright Information: Public domain information with acknowledgement given to the U.S. National Library of Medicine.

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