The document discusses the concept of profession, defining it as an occupation that requires specialized education, self-regulation, and a commitment to serving the community. It details the criteria for nursing as a profession, including the establishment of a well-defined body of knowledge, a code of ethics, and standards for professional autonomy and accountability. Additionally, it explores trends, issues, and the evolving scope of nursing in Nepal, emphasizing challenges such as underfunded education and a gap between theory and practice.

2. Profession
• Profession is a type of occupation that meets certain criteria that raises it to a
level that of an occupation.
• A profession is defined as a calling that involves some branch of advanced
learning or science. The essence of professionalism is both having unique or
special knowledge and the self imposed obligation to serve the community
(Wynd, C., 2003)
• Profession can be defined as a prestigious occupation with a high degree of
identification among the members that requires lengthy and rigorous education
in an intellectually demanding and theoretically based course of study that
engages in rigorous self-regulation and control; that holds authority over
clients; and that puts service to society above simple self interest. (Schwiran,
P.M.)

3. Occupation
• Occupation: An occupation is a job or carrier. An occupation is a
group of jobs that are similar in type of work and are usually found
throughout an industry or work environment.

4. • Professionalization: It is the process by which profession move up the
occupation-profession continuum. Aranson described it as a dynamic
process whereby many occupations can be observed to change certain
crucial characteristics in the direction of profession- an exchange
process between society and an occupational group striving for
professional status.

5. Professionalism
• Professionalism means qualities or characteristics of a profession or a
professional person.Profession is developed and guided by a code of
ethics that describes expected behaviors to reflect professionalism
among its members. In nursing, International Council of Nursing
(ICN) Code of Ethics describes the expected behavior of nurses and
every nurse must follow that code everywhere.

6. Professionalization
• Professionalization is the process by which an occupation achieves
professional status. It is an exchange process between society and
occupational group struggling for professional status. It is the dynamic
process moving from occupations to the profession. There is
occupation-profession continuum with different characteristics/ event
that goes through occupation to profession end. From this continuum,
occupations can be observed to change certain essential characteristics
in the direction of the profession. The status of nursing as a profession
is most important because it reflects the value given by the society
because of the work of nurses that benefits society.

7. Criteria of Nursing Profession
• Specialized Education
• Body of knowledge
• Code of Ethics
• Autonomy
• Service Oriented
• Ongoing Research
• Professional Organization
• Extensive period of Education
• High status and Reward
• Testing of Competence
• Licensed Practitioners

8. Specialized Education
• Nursing has developed into anidentifiable separate discipline,
aspecialized body of knowledgecalled as nursing science.
• •
• It was compiled through theresearch effort of nurses withadvanced
educational degrees. Although this body of specializedknowledge is
relatively small, itforms a theoretical basis for thepractice of nursing
today.

9. Body Of Knowledge
• Body of Knowledge As a profession, nursing is establishing a well-
defined body of knowledge and expertise. Conceptual frameworks
contribute to the knowledge base of nursing and give direction to
nursing practice, education, and ongoing research.

10. Code of ethics
• Like other professions, the nursing profession has its own code of
ethics which articulates its social responsibility and serves as a guide
for its members. Nursing has developed its own code of ethics and it is
the means to monitor the professional behaviour of its members.

11. Autonomy
• Professional autonomy means self-regulation, self-governing or self-
directing. A profession is autonomous if it regulates itself and sets standards
for its members.
• For nurses, autonomy means independence at work to complete their
responsibility and accountability for action carried out by them. From the
beginning, nurses are considered as assistant to physician/surgeon and they
only follow the instructions from the physician/surgeon.
• Now a day, in Nepal, nursing profession trying to get professional
autonomy that can be achieved or maintained from a position of authority,
evidence based practice as well as higher and specialization education in
nursing. For this reason, nursing research is integrated from bachelor level
curriculum to higher level curriculum.

12. • Nurses must be accountableand demonstrate a high levelof individual
responsibility forthe care and services theyprovide. The concept
ofaccountability has legal, ethicaland professional implicationsthat
include acceptingresponsibility for action takento provide client care
as well asaccepting responsibility for theconsequences of action
thatare not performed.

13. Service oriented
• Individual is the focal point ofall nursing models andnursing practice.
• Nursing has been viewed universally asbeing an altruistic
professioncomposed of selflessindividuals who place the livesand well
being of their clientsabove their personal safety.Dedicated nurses
providecare for victims of deadlydiseases with little regard fortheir
own welfare.

14. Ongoing research
• Ongoing Research: In the 1940s, nursing research in early stage of
development. In the 1950s, increased funding and professional
support, centers for nursing research established, directed at the study
of nursingeducation. In the 1960s, studies related to the nature of the
knowledge base underlying nursing practice. Since the 1970s, nursing
research focused on practice-related issues.

15. Professional organization
• Professional organization
• The nursing profession has its own organization. International Council
of Nursing (ICN) Nepal Nursing Council (NNC) and Nursing
Association of Nepal (NAN) are the profession organizations that
advance the nursing profession by fostering high standards of nursing
practice, promoting the economic and general welfare of nurses at the
workplace.

17. Extensive period of education

18. High status and reward

19. Testing of competence
• Nurses must pass a nationallicensure examination todemonstrate that
they are qualifiedto practice nursing.
• Only after passing the examinationthe nurses are allowed to practice.
• The granting of a nursing license is a legal activity conducted by
theindividual state under theregulations contained in the state’s nursing
practice act.

20. Licensed practitioners

21. Philosophy of nursing

22. Philosophy
• The word philosophy is derived from Greek word "phileo" means 'to
love', "sophia" means 'wisdom' therefore, philosophy means; search for
wisdom or love for wisdom.
• Philosophy is the investigation of the nature, causes of principles of
reality, knowledge or values, based on logical reasoning rather than
empirical methods.
• It also involves the critical analysis of fundamental assumptions or
beliefs.
• It is a set of ideas or beliefs relating to a particular field or activity. It is
a system of values which one lives

23. • A philosophy of nursing is a statement that outlines a nurse’s values, ethics,
and beliefs, as well as their motivation for being part of the profession.
• It covers a nurse’s perspective regarding their education, practice, and patient
care ethics.
• A philosophy of nursing helps you identify the beliefs and theories that shape
the choices you make on the job every day.
• Followings are important to construct your philosophy of nursing
• Define what nursing means to you.
• Add a personal story that expands on your values and skills.
• Include how you plan to impact society through nursing.
• Highlight any values and skills that are important to you.
Philosophy of nursing

24. Philosophies Influencing Nursing Values
• Asceticism
• Romanticism
• Pragmatism
• Humanistic existentialism

25. Asceticism
• Asceticism existed from nursing's inception (beginning) and strongly supported
during 'Pre-Nightingale Era’.
• The principle mainly focused on way of life was as self-denial, willing to sacrifice
life's comfort and safety for the sake of God (religion) or accept to bear hardship
of life.
• This era was closely identified with Christianity. Ascetic: one who tolerate severe
bodily hardship.
• In this era, nurses gave up home, family and futures and devoted themselves to
duty for the sake of God and orders were accepted as ascetics (Saints).
• Nurses often thought of themselves as the salves of God who were there to fulfill
the duty of serving the humanity on behalf of God.
• They were motivated by a spiritual objective of serving all people without
selfishness.

26. Asceticism
• In asceticism, the nurses devoted their entire life to serving the people without
expecting anything in return.
• Nursing was a selfless act of virtue.
• Nursing viewed as a calling, means calling for help.
• During Pre-Nightingale era, Asceticism was very strongly supported. During
Nightingale era, decreased emphasis on self-denial, & viewing clients as spiritual
being, here emphasis was increased on devotion to service (duty).
• Present value of ascetics
• 24 hour nursing duty hour.
• Self-discipline for professional growth.
• Devotion to duty.
• Quality care and service.

27. Romanticism (1890-1940)
• This was the period of natural and or logical transition for nursing philosophy.
• Thinking of hardship was derived to liberal thinking.
• Nurse's practice diverted to feeling of and attitude of romance, adventure, more
towards social expectation, being loyal to physician, to school of nursing and to the
client.
• Romantic title for Florence Nightingale:
• "The lady with lamp"
• Increase dependence on physician, decrease autonomy in nursing
• Support idealistic trait of WOMEN which affect strongly nursing value system
• Idealistic romanticized view of women is strongly attached with idealistic romanticized view
of nursing as soft, feminine or romantic.

28. Pragmatism (1940s onwards)
• Pragmatic (Greek word): acts, function, activities or business
• This philosophy directly based on its use, function, and its practical
consequences of the facts or ideas.
• Increased need of more nurses to work, shortage of trained nurses
increased need of more manpower to provide care for the sick persons.
• Therefore, there were need for the preparation of various categories of
nursing groups such as, nursing assistance, nursing aids, practical nurses,
emergency nurses and in other areas of caring the sick as war victims.

29. Pragmatism (1940s onwards)
• Decision was still remained under physician need, not for patients need.
• Focus was on problem, disease, disability and diagnosis. NOT TO
PERSON, his family, his need or his humanity, But for its use and its
functions.
• Specialized units opened to provide intensive nursing care for critically
ill patients: intensive unit, ambulatory unit and rehabilitative units.
• Need of nursing specialists influenced in the nursing value system.
• Then onwards a beginning of humanism in nursing brought significant
different in quality distribution affective

30. Humanism (1980-……)
• Nursing values focus towards the patient as a wholesome not towards physicians
or the institution.
• A great change or transition in nursing service is noted in this era. i.e. it moved to
non-hospital setting in community for individual, family and neighborhood.
• Humanistic Existentialism (The modern philosophic term)
• Initially stared after World War II
• Belief: person is unique and inexplicable (impossible to understand).
• Holistic philosophy: whole of a human being is different from his parts.

31. Humanism (1980-……)
• SCIENCE studies different parts of human being BUT can not explain and
understand human being as thinking beings with freedom to choose or think and
accountable to self.
• Emphasis on: human value, ideas, existence, quality of life.
• This philosophy is a natural maturational philosophy for nursing. Basic priority is
given to people centered during nursing activities.
• This philosophy is made acceptable for each individual client to make personal
choice about nursing care, alternative healing method and way to achieve goals.
• Nurses become more accountable to client, more decision maker in planning
nursing care and autonomic in function.

32. Humanism (1980-……)
• We can summarize humanism as
• It’s a modern philosophy
• It believes that person is unique
• Holistic approached used
• Basic priority is given to people centered during nursing activities.
• This philosophy is made acceptable for each individual client to make personal
choice about nursing care, healing method.
• Nursing become more accountable, more decision maker and autonomy in function.

33. Trends, Issues & Scope Of Nursing in
Nepal

34. Trends Of Nursing
• Privatization
• Super specialization
• Changing scope in nursing
• Changing role in nurses
• Advancement in technology
• Specialized care
• Holistic care
• Globalization
•

35. privatization
• With the increasing demand of nurses, many nursing institutions were
established during the past fifteen years.
• This has provided opportunities to many citizens to study within the country;
however, the quality education has become a main issue.
• Along with privatization, the clinical area has been shrinking, very few
qualified educators are available, presence of persistent political instability
and lack of monitoring and evaluation by concerned authority has raised the
quality of the education provided.

36. Super specialization
• Nurses who specialize in a specific field could become experts in their fields
and influence practice, education and health care outcomes.
• Each specialty designation, though specific qualities and interests shape the
area in which a advances professionally.
• Pursuing a specialization is not only beneficial for career advancement but
also for shaping the future of the health care industry.

37. Changing scope of nursing
• With the advancement of health care system and technology, new areas of
nursing have been identified and broadened.

38. Changing role of nurses
• The nursing role is rapidly evolving as nurses are tasked with an even wider range
of health care responsibilities.
• Today's nurses aren't just caring for the sick; they're changing our very notion of
modern medicine and health care delivery.
• Nurses are giving TED talks (technology,entertaintment,desain), publishing
scientific research, developing mobile medical applications, and actively addressing
health care policy.
• They're collaborating with their colleagues, from social workers and oncologists to
hospital administrators and public safety personnel.
• The field is growing, and so are opportunities for nurse practitioners, PhD nurses,
nurse educators, nurse administrators, nurse-anesthetists, and nurse researchers.

39. Advancement in technology
• Advancement in technology-New health care technology is also creating
opportunities for nurses.
• More and more aspects of the profession are electronic: Test results, X-rays,
blood work, and ordering medication.
• An array of new technologies — mobile devices, electronic medical records,
cloud computing, and teleconferencing - invite nurses to be digitally
ambitious.
• Even basic medical instruments are getting smarter

40. Advancement in technology
• Increased access to technology has been among the most important nursing
trend in practices.
• Nurses can expect to see a continued reliance on portable and mobile
technology as well as an emphasis on telemedicine, particularly in rural and
underserved areas.
• Nurses need to be comfortable with constantly changing technologies so that
they can choose the best care options for their patients.

41. Specialized care
• With the advancement of medical field and challenges of new diseases, now
people seek for specialized care.
• Certain diseases and conditions also need specialized knowledge to take care
of.
• Trend now has shifted towards nursing care with some specialized knowledge
and hence quality service.

42. Holistic care
• Treatment now a days has been considered in holistic dimensions.
• The nursing care has also to be moved towards holistic approach since a
patient or relatives need a complete care package where they can feel
completely recovered which is not possible with treatment of disease only
• Holistic care includes whole physical and mental care which treats the disease
as well as let the patient feel the wellbeing.

43. Globalization
• With the advancement of transportation and information technology (IT), the
whole world has now been shrunken.
• Technology, knowledge and skill are now considered as global property.
• Nursing service is also globalized now and global placement of nurses are
now more evident.
• Knowledge, skills and technology are also transferred from one part of the
globe to another with various means.

44. Issues Of Nursing
• Under financing of nursing education
• Shrinking of clinical field
• Nursing curriculum
• Enrollment issues
• Gap between theory and practice
• Brain Drain
• Structural and managerial problem
• Emerging chronic diseases
• Nursing shortage
• Quality care

45. Under financing of nursing education
• The faster development of higher education needs a lot investment.
• The state funded universities namely TU is acutely facing the problem of cost recovery
highly influenced by the political intervention.
• The cost recovery position of other universities is also not at the satisfactory level.
• In this situation, the government of least developed countries like Nepal alone cannot meet
the financial needs for higher education.
• The present day demand is the social inclusion in higher education i.e., increasing access
women, dalits, indigenous and backward people to the higher education.
• That's why; higher education has now been treated as both social as well as economic
goods and both public and the partnership is required for financing the higher education.
• Ultimately, the private sector o finance the higher education. So, privatization emerged in
nursing education.

46. Shrinking of clinical field
• Although there have been legislations laid by concerned authorities to run
their own hospitals by the institutions, many institutions have not confined to
that legislations.
• The occupancy rate of hospital by the patients has been very low which
decreases the opportunity for the students to practice in the clinical settings.
• Specialized settings like Eye, ENT, Psychiatric, Neuroscience, Oncology,
ICU, CCU, NICU are almost not available in private hospitals which leads to
lack of skill in those areas.

47. Nursing curriculum
• Although nursing curriculum of Nepal has been revised periodically, it has
not met international standard.
• There have been various categories of nursing education which has set some
issues in professionalization.
• Bachelor in Nursing Science (BNS) and Bachelor in Science in Nursing (Bsc
Nursing) are graduate nursing program but the enrollment criteria, course
content and course duration differs a lot which raises the issue of the standard
of education.

48. Enrollment issues
• ANM, PCL Nursing, BNS, BSC Nursing have different enrollment criteria
and curriculum which has become an issue.

49. Gap between theory and practice
• There is discrepancy between what is taught in the classroom and how care is
actually given in practice.
• If theory is considered to be the basis for understanding the reality of nursing,
it would seem reasonable to assume that the content studied in the classroom
relates with what the student experiences on the ward.
• It should also follow that if a gap is identified between theory and practice,
efforts should be made to reduce it.

50. Gap between theory and practice
• Some participants described the nursing staff as doing things differently from the
way they, the students, were taught in the classroom.
• The main reasons cited were time constraints and familiarity with the job.
• The theory-practice gap is not only real, but it results in diminished patient care and
inefficient nursing practice.
• It also results in failure or excessive lag time in incorporating or deleting clinical
practices based on current evidence.
• Much of this gap exists by default related to a lack of awareness by nurses of the
theory that guides their practice.

51. Brain drain
• "Brain drain" refers to the departure of educated or professional people from
one country, economic sector, or field to another, usually for better pay or
living conditions.
• When nurses leave their home countries to work elsewhere, the home country
loses the return on the investment in their education.
• Furthermore, when large numbers of health workers emigrate, they leave a
shortage in the health workforce, which means an understaffed and
overburdened healthcare system.

52. Brain drain
• This snapshot of nursing "brain drain" in Nepal suggests that up to one third
of the nursing labour force may be lost to wealthier states through circular
migration.

53. Structural and managerial problem
• Nurses' middle management position in hospital organizations places them at
the center of learning and knowledge development processes that are essential
for acquiring competencies with a view to the quality of patient care.
• Nurse Managers act at the vertical and horizontal crossroads of information at
the hospitalization unit, which turns them into a communication linkage
between high administration and frontline workers.
• Thus, there is a need to stimulate team work and other social forms of learning
in order to develop human capital which then begins to share talent and
knowledge.
• Best structures are those that present fewer obstacles and, therefore, easier
transit, as I as those which allow, as far as possible, work directed to clients.

54. Emerging chronic diseases
• There is a significant increase in the number of chronic diseases, such as
diabetes, hypertension and kidney disease and nurse has to provide different
type of care and management of chronic and non-communicable disease.
• This flood of older adults with chronic diseases will strain hospitals as the
health care system shifts its focus from treating acute illnesses to managing
chronic diseases.
• Nurses will play more of a role in educating patients and caregivers on how to
manage and prevent chronic conditions.
• Nurses are expected to play an increasingly important role in managing chronic
diseases in general practice and primary health care more broadly.

55. Nursing shortage
• The 'shortage' of nurses is not necessarily a shortage of individuals with nursing
qualifications; it is a shortage of nurses willing to work in the present conditions.
• The causes of shortages are multi-faceted, and there is no single global measure of
their extent and nature, there is growing evidence of the impact of relatively low
staffing levels on health care delivery and outcomes.
• The main causes of nursing shortages are highlighted: inadequate workforce planning
and allocation mechanisms, resource constrained undersupply of new staff, poor
recruitment, retention and 'return' policies, and ineffective use of available nursing
resources through inappropriate skill mix and utilization, poor incentive structures and
inadequate career support.

56.  Acute Care Setting:
 Many cases special serious and emergency cases need special care in special setting like ICU,
CCU, NICU etc.
 Nurse Practitioner:
 A nurse practitioner can manage 80- 90% of the health problems that occur among hospitalized
clients.
 Clinical Nurse Specialist:
 Specialist prepared after master's level as a: educator, advocate, counselor, researcher and
consultant.
 Nursing Research:
 Research is the main source of information in which the nursing care should be based which is
also called evidence-based nursing.
Scope Of Nursing

57.  In-Service Educator/ Staff Developer:
 Nurses can serve as trainer, in-service education for overall human resource
development
 Counsellor and Health Educator:
 Patient and their family consultation is must as this is a challenging stage
 Case Management Nurse:
 Highly expert nurse is needed to assist in the management of specific problems e.g.
dialysis, chemotherapy.
 Home Care Case Management Nurse:
 Holisic care in the community.

58.  Certified Rehabilitation Nurses:
 Rehabilitation of needed patients need expertise due to its sensitivity.
 Telephone Advice Nurse
 Patients may need 24 hours consultation even in absence of professional.
 Administrator Director of Nursing Services
 In hospitals, nursing homes, care centers, hospice etc
 Court Investigation Nurse:
 In case of any legal case nurse can serve as expert.

59. Advocacy in Nursing
• Research is the main source of information in which the nursing care should be
based which is also called evidence based nursing.
• In recent years some advancement has been achieved and accountability has
been increased in the profession

60. Profession and occupation : DIFFERENCES