Contact Hours: 75

Module Unit Description: This unit equips students with knowledge and understanding of ethical standards of nursing, infection prevention and control, and skills in basic nursing care, bed making, vital observations, and patient hygiene.

By the end of this unit, the student shall be able to:

• Apply ethical standards in nursing.
• Take vital observations from patients.
• Carry out basic nursing care, prevent and control infections.
• Differentiate normal from abnormal anatomy.
• Carry out effective disinfection and sterilisation.

Nursing has been called the oldest of the arts and the youngest of the professions.

The term ‘nurse’ evolved from the Latin word nutrix which means ‘nourishing’ and the word nursing comes also from the Latin word nutrix meaning to ‘nourish’ or ‘cherish’. Nourish means to ‘supply that which is necessary for life’.

Today nursing emerged as a learned profession that is both a science and art. Science is the observation, identification, description, experimental investigation and theoretical explanation of natural phenomena (it is a body of knowledge). Art is the application of knowledge and skill to individualized action.

Nursing originated with the desire to nurture, nourish, to provide comfort, care and assurance to the sick children, the ill family and eventually entire tribes. Long before hospitals existed, caregiving was an instinctive, family centered activity passed down through generations, utilizing herbal remedies and holistic comfort measures.

Before the foundation of modern nursing, nuns and the military often provided nursing like services. During the Crusades and medieval periods, military religious orders, such as the Knights Hospitaller, built hospitals to care for sick and injured pilgrims. The Christian churches have been long term patrons of nursing and influential in the development of the ethics of modern nursing, establishing the concept of nursing as an act of charity and selfless service.

Elsewhere, other nursing traditions developed such as in Islam. During the time of Prophet Muhammad, women like Rufaidah bint Sa'ad served as the first female Muslim nurses, setting up tents during battles to treat the wounded, which mirrored early military nursing.

Early nursing was not recognized and respected but the declaration of Christianity as accepted religion in the Roman Empire drove an expansion of the provision of care which led to its recognition. The church mandated the construction of hospitals (xenodochia) in every cathedral city, shifting nursing from isolated family care into a publicly recognized, institutional duty.

The mid 19th century marked a revolutionary turning point for the profession. In 1852, Florence Nightingale started nursing in hospital setting due to wars and prevailing unemployment for the women in UK. She recognized that the marginalized status of women could be elevated through structured, noble work.

In 1853, Nightingale, founder of modern nursing, was associated to the beginning of nursing because she was instrumental in establishing sanitary conditions and reducing mortality rates during the Crimean war at the barracks hospital in Turkey from 42.7% to 22% in 6 months. Armed with statistics and a profound understanding of environmental hygiene, she introduced handwashing, clean linens, and proper ventilation. Florence Nightingale believed that nursing was started in 1810s before that there was poor knowledge of medical and surgical infection and prevention. Surgery was confined to emergency amputation and this had a terrible mortality rate due to poor conditions, often referred to as the "Dark Age of Nursing" where hospitals were places of death rather than healing.

In 1855, she put her theory of nursing and hospital experience into writing so that her system could be continued and therefore Nightingale introduced reforms that changed the care of the sick throughout the world. Her famous text, "Notes on Nursing: What it is, and What it is Not," became the cornerstone of nursing education.

• Educational Revolution: In 1860s, she opened the Nightingale training school for nurses in London at St Thomas hospital. She was able to train them with the books and notes she wrote on nursing and hospitals during her experience. This established nursing as a formal, respectable career rather than a menial task.
• Global Expansion: This inspired the opening of the US schools based on her model and all countries adopted the Nightingale format, ensuring that formalized nursing education spread globally.

As the Nightingale model spread globally, it arrived on the African continent through medical missions. Helped by missionaries, nursing found its way into Africa and to Uganda by Lady Catherine Cook.

Note: Florence Nightingale felt that she was leading a religious movement therefore a nurse must be dedicated in a religious way as it is a calling. She demanded strict moral discipline, absolute dedication, and continuous self sacrifice from her students. She inspired such a spirit of devotion up to now in her followers. Because she targeted respectable young women to elevate the profession's status, the group was entirely female and so the general public has thought of nursing as a woman’s work ever since.

Despite the modern stereotype of nursing being female dominated, men have a deep historical root in the profession, dating back to ancient military and religious orders. However, a darker period existed. Male nurses were 1st documented in practicing primitive nursing during the 17th century. It was during this time in history that men and women provided nursing care while serving punishment. During plagues and times of high mortality, courts would often force criminals and people of ill repute to perform the hazardous, undesirable work of nursing the highly contagious, drastically lowering the public perception of the role before Nightingale's era.

While Nightingale established the educational foundation, the legal and professional regulation of nursing was championed by another visionary. Mrs. Bedford Fenwick realized that there was a distinct knowledgeable body she believed that she could turn into profession. Ethel Gordon Fenwick (Mrs. Bedford Fenwick) campaigned tirelessly for the State Registration of Nurses, arguing that nursing was not just a religious calling or a domestic duty, but a distinct scientific discipline requiring statutory regulation.

She also believed that those who trained a qualified standard would allow nursing to evolve as a profession, protecting the public from untrained practitioners. Thus up to today, worldwide one must undergo prescribed syllabus of theory and practical education to be recognized as a nurse, complete with national licensure exams, professional councils (such as the Uganda Nurses and Midwives Council), and continuous professional development.

''I solemnly pledge myself before God
And in the presence of this assembly
To pass my life in purity
And to practice my profession faithfully
I will abstain from whatever is
Deleterious and mischievous
And will not take or knowingly
Administer any harmful drug.
I will do all in my power to maintain
And elevate the standard of my profession
And will hold in confidence. All personal
Matter committed to my keeping
And all family affairs coming to my
Knowledge in practice of my calling
With loyalty I will endeavour to aid
The physician in his work
And devote myself to the welfare
Of those committed to my care.''

Here are some key terms you will encounter in nursing:

• Nursing: Is defined as the unique function of the nurse to care and nurture the individual, sick or well in the performance of those activities contributing to health or its recovery or peaceful death, that s/he would perform unaided if s/he had the necessary strength, will or knowledge to do so. (international council of nurses, 1973)
• Nurse: Is a person who is qualified in the art and science of nursing and meets certain prescribed standards of education and clinical competence. Or Is a trained person to look after the sick or well individuals to perform those activities they cannot do on their own.
• Health: Is a dynamic state in which an individual adapts to internal and external environment so that there is a state of physical, emotional intellectual, social and spiritual well-being. Or Is a state of physical, mental, spiritual, emotional, economical and social well-being and not merely in the absence of disease or other disorders (infirmities.)
• Ethics: Is a code of moral principles that govern proper conduct of a profession. The ethics serve to protect the rights of human beings.
• Etiquette: These are rules set to govern a specific profession and they vary from one profession to another.
• Illness: Is a state in which a person’s physical, emotional, intellectual, social, developmental or spiritual functioning is diminished or impaired compared with that person’s previous experiences.
• Disease: Any deviation from or interruption of the normal function or structure of any part, organ or system of the body manifesting with a characteristic set of signs and symptoms.
• Profession: Is an occupation with normal principles that are devoted to the human and social welfare. The service is based on specialized knowledge and skills developed in a scientific and learned manner.
• Hospital: Is an organized institution which promotes the comfort and the health of the patients.

Ethical standards or principles are higher than those standards made by law. For example, to steal is wrong by law and it’s punishable by law. To tell lies is not wrong by law but is wrong by the ethical standards of behavior. The following are the ethical standards of principles:

• Discipline
• Intelligent obedience
• Punctuality
• Tactful understanding and patience
• Respect for persons
• Respect for autonomy that individuals are able to act for themselves to the level of their capability
• Respect for freedom
• Respect for beneficence
• Respect for non-maleficience
• Respect for veracity truth telling
• Respect for justice fair and equal treatment
• Respect for rights
• Respect for fidelity fulfilling promises
• Confidentiality protecting privileged information
• High sense of responsibility

Nursing as other professions has its standard of right behaviours that all nurses must adhere to. Some of the nurses’ ethics are as follows;

The fundamental responsibility of a nurse is a three fold:

• To conserve life
• To alleviate suffering
• To promote health

• The nurse must at all times maintain the highest standard of nursing care and of professional code.
• A nurse must maintain his/her knowledge and skills at constantly high level.
• Religious beliefs of patient must be respected.
• Nurses must recognize not only their responsibility but also the limitations of their professional functions.
• Nurses must hold confidence in all personal information entrusted to them.
• The nurse is under the obligation to carry out physicians’ order intelligently with loyalty and to refuse to participate in unethical procedures e.g. abortion, mercy killing etc.
• A nurse is entitled to just remuneration and accepts only such compensation as the contract, actual or implied provides.
• Nurses should no permit their names to be used in connection with advertisement of products or any other form of self advertisement e.g. going in public with a uniform.
• A nurse co-operates with and maintains harmonious relationships with members of other professions and with his/her professional colleagues.
• A nurse should participate and share responsibility(ies) with other citizens and other health professions in promoting efforts to meet the health needs of the public, local, district, national, international component.

Nurses work as a team which comprises of nurses, doctors, occupation therapists, social workers, physiotherapists, nutritionists and many others. The following are some of the roles of a nurse:

• Care giver: Care giving encompasses the physical psychological, developmental, cultural and spiritual needs.
• Patient’s advocate and protector: The nurse must represent the client’s/patient’s needs and wishes to other health professionals e.g. client’s wishes for information to the physician.
• Communicator: A nurse should identify patient’s problems and then communicate these verbally or in writing to other members of the health team.
• Teacher: As a teacher, the nurse helps patients/clients, their relatives, colleagues and the community to learn about their health and the healthcare procedures they need to perform to restore or maintain their health.
• Counselor: The nurse counsels health individual with normal adjustments, difficulties and focuses on helping the person to develop new attitudes, feelings and behaviours by encouraging the client to look at alternative behaviours, recognize the choices and develop a sense of control.
• Nurse educator: Some nurses take up teaching of nursing as their profession for example as tutors, clinical instructors, lecturers and professors. They maintain their clinical skills and facilitate the development of nursing skills in students.
• Manager: Management in nursing is the co-ordination and facilitation of nursing services; nurses are involved in the management of the nursing care by communication i.e. Directly with hospitalized patients, Within the nursing team, Within the wider health team (including doctors and paramedical staff).
• Decision maker: The nurse observes the patient continuously and makes decision regarding nursing diagnosis of the patients and the steps of the nursing process.
• Rehabilitator: In the physical medical department, the nurse helps patients in rehabilitation. This is also done in psychiatric department.

• Good physical and mental health.
• Truthful and efficient in technical competence.
• Cleanliness, tidy, neat and well groomed.
• Confidence in others and her/himself.
• Intelligence.
• Open minded, co-operative, responsible and able to develop good interpersonal relations.
• Leadership quality.
• Positive attitude.
• Self-belief towards human care and cure.
• Conveys co-operative attitude towards co-workers.

Some of the functions of a nurse include the following:

• Receiving of patients in out patient department and giving them guidance.
• Admission of patients on wards, ensuring comfort and reassurance to them.
• Perform duties such as bed making, dump dusting etc.
• Administer medications to the patients and monitoring the side effects.
• Taking of vital observations i.e. pulse, respirations, blood pressure, oxygen saturation and level of consciousness and record them to the patient’s charts.
• Co-ordinates patients with special services such as physiotherapy, radiotherapy psycho-social support etc.
• It is also the duty of a nurse to co-ordinate patients to the special clinics like diabetic, cardiac, T.B, skin, cancer institute etc.
• Provides health education, immunization both in the units and out reaches.
• Reinforces and repeats doctor’s explanations to the patients in layman’s language (local language or in simple terms.)
• Knows the number of the patients at her/his unit and their conditions.
• Keeps the ward/unit inventory on daily basis, weekly, monthly and annually.
• Makes reports about his/her unit per shift.

• Punctuality: This is vital for smooth running of the hospital and speedy recovery of the patients, so a nurse is required to be punctual while performing all duties.
• Confidentiality: A nurse is to ensure that the patient’s diagnosis, problems and condition are not discussed with outsiders who are not involved in the patient’s health care. The information should only be released to the relatives and friends with the patients consent.
• Fidelity: Obligation to remain faithful to ones commitments.
• Empathetic: Awareness of and insight into feelings, emotions and behavior of another person and their meaning and significance.
• Resourcefulness and initiative: The nurse should be able to act immediately during emergency by using her/his common sense, knowledge and with ability to use the available resources or equipment for the benefit of the patients. S/he should execute nursing care with in her/his professional level of responsibility.
• Alert and observant: It is the power to see, hear and appreciate what is being done and act accordingly and intelligently.
• Tactifulness (creativeness): A nurse must be careful to say and to do the right thing with greatest consideration for the other person’s feelings.
• Faithfulness: The nurse should remain true or loyal to the patients always while executing her duty. Also to the colleagues and any other thing entrusted to her.
• Loyalty: A nurse must be loyal to her patient colleagues, superiors for the good of the patient.
• Truthfulness and genuineness: A nurse must be honest in word and deed to her patients, fellow workers, with self and the entire community. This is the most important, vital virtue and of special value to nursing profession. She should also be able to admit her mistakes whether discovered by herself or by someone else.
• Speed and gentility: The nurse should always act fast and in a responsible and polite manner while carrying out her/his procedures especially during the emergencies.
• Accuracy (in decision making): The nurse should be correct and precise in whatever she does because the life of the patient is in her hands.
• High sense of responsibility: to promote health, restores health and alleviates suffering.
• Respectful: The nurse should show respect to self, patient, seniors, juniors and all people in authority.
• Courteous: It costs nothing to be polite and considerate to others. S/he should be straight forward in all s/he does.
• Integrity: S/he should adhere to moral principles of the profession and be honest to the patients/clients.
• Justice: All individuals will have equal and fair access to health care, resources available according to an individual’s need.
• Caring: It is the obligation of the nurse to give service of care to the sick person as her calling meeting the patient’s physical, spiritual and psychological needs.
• Co-operative: The nurse should have a sense of working with others, so as to be able to give adequate and quality care to the patients and entire community.
• Accountable: A nurse must be responsible for any action done either to the patients or for the hospital.
• Responsiveness: S/he should be able to react quickly to the situation at hand e.g in emergencies.
• Being considerate: A nurse should be thoughtful or kind to the patients when rendering health services to them.
• Poise: S/he should be composed or show dignity of manner while carrying out her/his duties.
• Intelligent: The nurse should show high sense of knowledge during performance of the procedures to the patients.
• Control of emotions: A nurse should be good tempered and able to control or cope with emotions such as anger, irritation, love or hatred. The nurse needs to develop emotional maturity in order to manage the problems and different behaviours of the patients, caretakers and fellow colleagues.
• Tolerance and understanding: A nurse must realize that the patients are physically, emotionally, psychologically sick and worried about their health, disease, homes and family. Therefore human understanding, sympathy together with technical knowledge and efficiency are foundation on which a true profession nurse must build her career.
• Cleanliness: Personal and environmental cleanliness and tidiness are essential to quick recovery of the patients and the nurse herself. Apart from other infection control methods, orderliness plays a role in the prevention of disease and infections.

N.B: Nurses learn about professional values both from formal institutions and from informal observation of practicing nursing staff and gradually incorporates professional values into their personal value system. Some of the values are non-moral and others are moral. Example of non-moral values include the following:

• Hairstyle
• Uniform
• Colours
• Fashions of shoes etc.

There are two principles under-minding ethical practices in nursing and health care i.e. beneficence (the obligation to do good) and non-maleficience (obligation to do no harm). The two are related but distinct and if the distinction is recognized, it helps to guide moral conduct of a nurse.

• To help save life.
• To help prevent further suffering.
• To help prevent disease and improve the health of the fellow men.
• To assist the individual by performing those activities or duties which he would if able to and knowledgeable by himself.

• N Nobility/Knowledgeable
• U Usefulness/Understanding
• R Responsibility
• S Simplicity/Sympathy
• E Efficiency/Equanimity

• Interest: As a nurse/health worker to be, one should show interest in people and the profession.
• Instinct of parental love and care: Since the nurse is the care giver to the patient, s/he must show love and care for the sick individuals during their stay in the hospital.
• Liking of people: so that service is not offered coldly but with warmth and tolerance that makes it easy for social interaction.
• Empathy: is called for rather than sympathy.
• Physical fitness: nursing involves physical work that is quite heavy and in an environment of many infections.
• Trustworthy: a nurse should be truthful and dedicated to her/his work at all times.
• Intelligence and adequate education: so as to cope with the scientific terms used in the medical profession (knowledge in technique, drugs skills etc.)
• Integrity and self respect: must be maintained in all circumstances with faithful assurance.

Is the way how one must behave towards his/her clients/patients, institution and the entire community which is acceptable professionally and publically. The code of conduct is as follows:

• Self: Report any conduct that endangers client/patients. Stay informed of current nursing practices, theory and issues and make judgement based on facts.
• Client/patient: Provide clients/patients with accurate information about care and conduct nursing in a manner that ensures clients’ safety and well being.
• Professional: Maintain ethical standards in practice. Encourage other professional peers to follow the same ethical standards. Report colleagues with unethical behaviours.
• Employment institution: Follow practices and procedures defined by the institution.
• Community/society: Maintain ethical conduct in the care of all clients in all settings. Every health worker must conduct him/herself in a manner that is acceptable professionally and publically at all times.

Article 29. Code of conduct: This part of the act shall constitute a code of conduct and shall be observed by all health workers.

• A health worker shall hold the health, safety and interest of the patient to be first consideration and shall render due respect to each patient at all times and in all circumstances.
• Ensure that no action or omission on your part or sphere of responsibility is detrimental (endangers) the interest or condition or safety of the patient.
• A nurse shall provide a patient with relevant, clear and accurate information about his/her health and the management for her/his condition.
• Treatment and other forms of medical intervention to a patient who has capacity to consent shall not be undertaken without the patient’s full free and informed consent except in emergencies when such intervention may be done in the best of the patient. Incase of minor or other incompetent patients, consent shall be obtained from apparent/relative/guardian or the head of the hospital.
• The nurse shall respect the confidentiality information relating to the patient and his family; such information shall not be disclosed to anyone without the patient’s consent or appropriate guardian, except where it is the best interest of the patient.
• A health worker who attends to a person held in detention shall do so in the interest of the detainee and strict confidentiality must be observed just as with other patients.
• A health worker shall not take, ask or accept any bribe from the patient or relatives.
• Maximum care shall be taken not to compromise the confidentiality and interest of the patient when carrying out an examination or supplying a report at the request of an authorized person.
• A health worker shall no abandon a patient under his/her care.

• The nurse should ensure that no action or omission on her/his part or sphere of responsibility is detrimental (endangers) the interest or condition or safety of the public.
• A health shall promote the provision of effective health services and shall notify the health team and other authorities whenever he/she becomes aware of the hazard to the community e.g. outbreak of cholera, dysentery, bola etc.

• The health worker shall abide by the rules and regulations governing the place of work and shall confirm to the expectations of the health unit, and strive to fulfill the mission of the institution.

• A health worker shall observe law; uphold the dignity of his/her profession and accepted ethical principles.
• A health worker shall not engage in activities that discredit his/her profession or delivery of health services and shall expose without fear or favour all those who engage in illegal or unethical conduct and practice e.g. stealing, poor dressing code etc.
• The health worker shall respect the confidentiality of information relating to the patient and his/her family, such information shall not be disclosed to anyone without the patient’s or appropriate guardian’s written consent except where it is required by law.
• A health worker shall keep a high standard of professional knowledge and skills in order to maintain a high standard of professional competence through continuing medical education program.
• A health worker shall not directly or indirectly advertise his/her professional skills or allow him/her to be advertised directly or indirectly and shall not entice patients from his /her colleagues except h/she shall notify the public of the services available in the health facilities.
• A health worker shall not indulge in dangerous life styles such as alcoholism, drug addiction, that discredit the profession.
• The health worker shall no support or become associated with cults or unscientific practices professing to contribute to heath care.
• A health worker shall be registered with his/her relevant professional council to be a member of the national association.
• Nurses shall acknowledge any limitation in their knowledge and competence and decline any duty or responsibility unless able to perform them in a safe and skilled manner.

• A health worker shall co-operate with his/her professional colleagues, recognize and respect each others expertise in the interest of providing the best possible holistic care as a health team.

• In your own words, explain the meaning of the word 'nurse'.
• Describe the key differences between nursing as a science and nursing as an art.
• Who is considered the first known nurse mentioned in historical texts, and what was her role?
• Briefly explain how nursing training started in Uganda.
• What are the three main responsibilities of a nurse according to the ethical principles?
• List at least five ethical standards or principles that guide a nurse's behavior.
• Why is confidentiality important in nursing, and when can patient information be shared?
• Give two examples of negligent actions that can result in harm to a patient.
• What is the purpose of patient rights?
• Explain the difference between criminal law and civil law in the context of nursing practice.

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