Introduction to Fundamentals of Nursing and Professional Roles

Historical Context and the Spirit of Nursing

Nursing has been an intrinsic part of human existence throughout history, rooted in the mutual care provided within families from birth until death. Since the dawn of humanity, the role of the nurse was largely held by mothers or female family members who provided care for children, the sick, and the injured. This care was characterized by love, bondedness, and compassion. As societies expanded, the need for care grew due to the emergence of epidemics, power struggles, and territorial expansions, leading to large numbers of injured individuals. During these times, selfless women continued to provide care out of mercy and kindness. Before formal education existed, nursing was learned through a process of apprenticeship or imitation, often referred to as "Do as I do," where learners followed the practices of those who had prior experience.

The formalization of nursing as a respected profession began with Florence Nightingale, an English lady who dedicated her life to pioneering nursing in a way that gained acceptance from physicians, patients, and the international community. Florence Nightingale defined nursing as the act of creating an environment that assists a patient in recovering from illness. She emphasized that nursing must involve providing the best possible environment to allow nature to act upon the patient, thereby facilitating the healing process.

Definitions of Nursing

There are various definitions of nursing provided by different scholars and institutions. Generally, nursing is defined as the assistance provided to those who are weak and unable to care for or protect themselves safely. This group includes pediatric patients, individuals with disabilities, and those with unstable mental or physical strength who must rely on others for support.

According to Thanomkwan Thaweeboon ($2550$), nursing is a process that helps individuals maintain optimal health across physical, psychosocial, and emotional dimensions. The goal is to enable individuals to assist themselves in performing daily tasks and living happily within society according to their conditions. This process is grounded in scientific principles and artistic application, with mercy and kindness serving as the foundation, alongside a readiness to help patients with self-sacrifice.

Prakob Boonsong (as cited in Thanomkwan Thaweeboon, $2550$) provided a specific breakdown of the word "NURSING" as follows:

N represents Nourish, meaning the maintenance, care, and physical and mental support provided to the patient.

U represents Understand, which refers to having a deep understanding and ability to work effectively within a team consisting of the service user, relatives, and colleagues at all levels.

R represents Right, which signifies providing correct, high-quality nursing care to service users while maintaining justice in one's duties.

S represents Safety and Security, meaning ensuring the physical and mental safety of the service user, their relatives, and their family, as well as maintaining career stability.

I represents Intelligence and Investigate, denoting a nurse who is smart, prudent, possesses initiative, and makes correct decisions.

N represents Nicety, referring to being meticulous, thorough, and refined in practice.

G represents Graceful and Gratitude, which means being gentle, polite, soft-spoken, and possessing gratitude as well as other fundamental virtues.

Legal Framework and Professional Standards

The Nursing and Midwifery Profession Act B.E. $2540$ ($1997$) provides the legal definition that all nurses must adhere to. It states that nursing is an action toward humans concerning care and assistance during illness, rehabilitation, disease prevention, and health promotion. It also includes assisting physicians in medical treatments. This practice relies on both the science and the art of nursing.

Professional nurses are responsible for the care of patients throughout a $24$-hour period. This is managed by dividing work into three successive shifts, each lasting $8$ hours: the morning shift, the afternoon shift, and the night shift. This continuous care is provided to patients of all genders, ages, illnesses, ethnicities, and religions. This includes patients with severe or chronic conditions that cannot be cured, as well as terminal patients. In end-of-life care, the nurse's duty is to ensure the patient can pass through the final stage of life with peace and happiness.

Core Attributes of a Nurse: The NURSE Acronym

Beyond basic moral qualities such as honesty, integrity, justice, and responsibility, a nurse must embody the deeper meaning of the word "NURSE":

N stands for Nobleness, meaning a person of high virtue and morality, embodying the Four Sublime States of Mind (Brahmavihara $4$): Metta (loving-kindness), Karuna (compassion), Mudita (sympathetic joy), and Upekkha (equanimity).

U stands for Unity, referring to harmony, readiness, and the ability to work together as a unified group.

R stands for Responsibility, which is the ability to carry out assigned duties with happiness and accountability.

S stands for Seniority and Social, meaning showing respect toward elders/seniors and being someone who can live happily within society.

E stands for Education and Example, referring to a person who possesses nursing knowledge, understands nursing theories and other sciences (such as social sciences, humanities, and economics), continuously seeks new knowledge, and serves as a role model for the profession.

Classification of Healthcare Service Recipients

There are several terms used to describe those who receive nursing services, each carrying a slightly different nuance:

Consumers refers to the general public who utilize health services available in hospitals and the community.

Patient refers to an individual who must receive medical treatment and care, such as medication or surgery. This perspective views the person as a recipient of a structured service.

Client or Customer refers to individuals who come to use services or receive health advice. Regardless of the term used, it is emphasized that these individuals must participate in and make decisions regarding their own health care alongside the service provider.

Communication and Observation Skills

To identify the problems and needs of a service user, nurses must utilize communication and observation skills. Observation involves the purposeful use of sight; for instance, when observing respiratory abnormalities, a nurse must look at the rhythm, the characteristics of breathing, and chest expansion to determine the impact on the patient. Beyond sight, nurses use other senses for perception: listening (audition), touching (tactile), palpating (feeling), smelling (olfaction), and occasionally tasting.

Maslow’s Hierarchy of Basic Human Needs

Nurses and patients share identical basic human needs, though the degree of these needs varies by individual and their current physical or mental state. Abraham Maslow organized these needs into five levels from lowest to highest:

1. Physiological Needs: These are essential for survival and include the need for food, water, air, rest/sleep, body warmth, waste excretion, movement, and exercise.

2. Security and Safety Needs: This involves both physical and mental safety, allowing a person to live securely and avoid danger. A strong body and mind can build immunity and prevent physical illness.

3. Belonging and Love Needs: The desire to be loved by others, to feel a sense of belonging, and to be a significant person to others. It includes the need for mutual understanding.

4. Self-esteem: The need for social acceptance as a member or leader in a family or community, and the desire for social status and respect.

5. Self-actualization: The pinnacle of needs involving learning, creativity, work, and achieving success in life. Examples in this context include being an outstanding nurse, a specialized nurse, or gaining professional recognition.

Furthermore, humans possess spiritual beliefs shaped by family and society, such as adherence to religious rules, concepts of sin and merit, or the law of karma. Nurses must respect these varying beliefs and avoid any actions that would negatively impact the patient's faith. Allowing patients or relatives to keep spiritual objects or perform religious rituals as appropriate can provide mental strength to fight against illness.

Scope of Nursing Duties

Nursing practice can be categorized into two distinct types based on the level of autonomy in decision-making:

1. Independent Nursing: This refers to the independent role where nurses use their knowledge and nursing science to provide care without needing a medical order. Examples include turning patients who cannot move, performing a tepid sponge to reduce fever, observing symptom changes, recording clinical signs, and monitoring vital signs when changes occur.

2. Dependent Nursing: This refers to the non-independent role where nurses work in collaboration with other professions or physicians. This ensures the service user receives correct and safe treatment. Examples include administering medications, starting intravenous ($IV$) fluids, preparing a patient for surgery, and preparing patients for special diagnostic tests.

Nurses must combine scientific knowledge and reasoning with the professional art of care to perform their duties effectively within these scopes.

Professional Roles of the Nurse

A nurse's role toward the patient and community centers on Patient-Centered Care, which addresses the physical, mental, social, and spiritual needs of the individual, known as Holistic Care. These roles include:

1. Alleviative or Palliative Role: Focusing on providing comfort. This is often an independent role, such as providing plenty of water and a tepid sponge for a high fever, or managing the environment (quietness, positioning) for a terminal patient.
2. Communication/Helper: Using communication skills to build relationships and trust with service users and colleagues.
3. Teacher: Providing health education and self-care skills to patients and the public for health promotion and rehabilitation.
4. Counselor: Offering health advice and leading groups to help individuals change their health behaviors.
5. Advocator: Protecting the rights of service users to ensure they receive quality care and helping them negotiate with the healthcare team to maintain their dignity.
6. Change Agent: Leading improvements in nursing services and problem-solving for patients and families.
7. Leader: Influencing others to enhance service efficiency and using appropriate power (moral, expert, reward, or positional) to develop the profession.
8. Manager: Managing people, nursing care, and the environment in their unit to ensure the nursing process is followed and professional standards are met.
9. Researcher: Often at a Master’s degree level, conducting research to improve clinical practice and applying findings for better patient outcomes.

Advanced Nursing Practice

The Nursing Council defines two levels of practice: General Nursing Practice (GN) and Advanced Nursing Practice (ANP). ANP requires deeper skills and competencies to manage complex patient problems and difficult coordination. These practitioners often have specialized training or a Master's degree and include:

1. Nurse Anesthetist: Manages anesthesia, acute pain management, respiratory assistance, and resuscitation.
2. Nurse Midwife: Possesses skills in prenatal, intrapartum, and postpartum care, including infant care and family planning.
3. Nurse Practitioner: Capable of comprehensive health assessments, providing pharmacological and non-pharmacological treatments, and evaluating outcomes.
4. Clinical Nurse Specialist (CNS): An expert in a specific clinical field of practice.

Conclusion: The $4$ H Principle

A committed nurse should understand their role through the principle of the $4$ H's:

1. Head (Intelligence): Having knowledge in nursing and other sciences, and using prudence before acting.
2. Heart (Compassion): Being full of mercy, knowing how to conduct oneself, and working well with others.
3. Hand (Skill): Possessing the ability to perform nursing tasks with a gentle touch and skillful power.
4. Health (Physical): Maintaining physical strength and an exemplary personality for health.