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Changing Role of Nursing

Today is not yesterday,
We ourselves change,
How then can our works and thoughts,
If they are always to be the fittest,
Continue always the same.
Change, indeed, is painful, yet ever needful:
And if memory have its force and worth,
So also has hope.

Thomas Carlyle

The role of nursing has undergone enormous changes over the past decade and continues daily.

The nurse has had to change her perception of what works and what is. The world and people have changed and to be able to help them, the nurse has to be flexible. Issues involving cost, quality and access of health care have created an increasing need for nurses to assume many roles.

Each nurse chooses her own special type of nursing. Some prefer the hospital, some like to work out in the community. Some even like to work with inmates in jail, others with school children. Whatever kind of nursing the nurse chooses, she will find changes have occurred in each field.

The Hospital
A young child may not be able to articulate the pain of his psychic state, but he is aware of it. It is the task of the nurse who comes in contact with an injured child to make him understand that help is available to him.

When a child is admitted to the hospital, the nurse has to assess the type of injury and be alert to the possibility of abuse.
When the child is in the hospital, he may be threatened by the newness of the experience. It is the nurse’s role to help the child feel at ease.

Karen: “I give every child that I admit, a teddy bear. The child may be able to talk through the play animal easier than he can talk to the doctor or nurse. He relates to the teddy bear.”

Teresa: “I have been a nurse in the emergency room for fourteen years, and I have witnessed great changes. People’s lives have changed, the world has changed and there is much despair.

“Our hospital receives many families who are homeless, and there are times we have to separate families. If a child comes in who has been injured, the social worker is obligated to make sure the child is taken to a safe environment. This may mean the child is taken to a receiving home and then sent to a foster home as long as the parents remain homeless.”

Many of these children think that this world is unfriendly, and is not for them. They have lose all hope and dread a separation from the only person they know, their parent. The fear of abandonment is their worst fear. The nurse has to try to explain this impossible situation to a child.

Even the child who has been abused loves his parents and doesn’t want to leave them. The hospitalized child can become passive and may revert to dependent levels of development. He will feel very helpless, and the level of helplessness depends on the age of the child.

When a mother has been hospitalized because of abuse, it takes a tremendous toll on the children. It can result in poor school performance and discipline problems. The child may also have trouble getting along with other children.

The nurse needs to observe all this and ask for the correct help. When a girl sees abuse, she may become passive; when a boy views abuse he may get the message that this is the way to deal with frustration. The girl can also get the same message. Thirty percent of children who are abused grow up to be abusers.

Violence affects some children more than it does others. Some children are remarkably resilient and are able to escape being traumatized. A child who has someone to talk to has a better chance of survival.

Mindy: “Being homeless is terrible. I want my own room and television. I want my own clothes and things. I want to finish school and be able to get a good job.”

Adolescent mothers are choosing to remain pregnant and keep their babies. Advantages and disadvantages of adolescent mothers:


•  easier pregnancies
•  spontaneous labors
•  spontaneous births
•  less fatigue
•  less depressed
•  fewer childbirth complications


•  less prepared for pregnancy
•  infant’s weight is lower
•  infants have more illnesses
•  less verbal and responsive to infant
•  have more stress after birth of infant

The nurse must know all the options and resources that are available in the community for the young parent.

The nurse assesses the bonding of the teenager with her child. Because the young girl mostly has the help of her mother, there may be a tendency to confuse responsibility for the infant. It is important for the nurse to get the mother off on the right start, and ensure the infant’s development.

The nurse needs to tell the teenager how important it is to talk to the baby. In order to raise a healthy baby the mother needs to feed the child in a quiet environment and to keep the baby clean. The young mother needs to be told that the only way the baby has to respond is by crying and that holding the baby will not spoil it.

The nurse who chooses obstetrics is an expert in teaching the young mother how to massage her infant in a way that will relieve gas and stimulate the nervous system. This is the time for the nurse to give information about what a positive parenting skill massage is.

The nurse should tell the teenager how important it is to talk to the baby. In order the raise a healthy baby, the mother needs to feed the child in a quiet environment and to keep the baby clean. The young mother should also be told that the only way a baby has to respond is by crying and that holding the baby will not spoil it.

To make the child’s stay at the hospital more agreeable:

•  explain all procedures if appropriate for age of child.
•  assure him he has been not abandoned by his parents.
•  tell him his illness is not meant as a punishment.
•  answer all questions truthfully.
•  acknowledge his emotional discomfort.

Another task the nurse has to deal with is the death of a baby. A young mother may deny that a certain substance will harm her child or cause death. However, the death of her baby may bring her back to reality. This young mother may feel sorry and will need help dealing with guilt. She will also need to understand what happened to create this sorrow.

One way a mother deals with the unwanted infant is to leave it in the nursery at the hospital, a “boarder baby.” These children have been placed on “social hold” by the local Division of Youth and Family Services for various reasons. It is a phenomenon which is increasing in hospitals every year.

It is the nurse’s ability to work with people who are not able to take responsibility for themselves that makes her so special. The nurturer is probably the nurse’s most important role, and it provides the greatest satisfaction.

School Nursing
The school nurse needs more than nursing skills to survive in today’s climate. She is also legally required to report any suspicion of child abuse to the authorities. She has to be a friend and advisor to all the children at that school.

Today the school nurse is probably the first health care professional to respond to a stabbing or shooting at her school. School administrators have banned from school facilities all guns, knives, metal detectors, and anything that can be used as a weapon.

Lucy: “I have been a school nurse for over twenty years and was surprised when we had our first fatality on the campus. Today I am not surprised by anything. It is constant vigilance.”

There is still trouble on some campuses. All students must agree to the rules of nonviolence at this school of learning. The principal is quicker to expell a student who is a nonconformist.

A crisis intervention team of mental health professionals, counselors and school nurses was necessary after a murder occurred at a local high school. A thirteen year-old boy was stabbed with a pocketknife by a fourteen year-old boy, and the school had to be prepared to act quickly. The boys pulse was irregular and he was bleeding profusely. One of the school staff called 911, another phoned both boys’ parents and the police were notified. However, even the quick action of everyone involved could not save the victim. Fire department paramedics arrived on the scene within four minutes, but the boy died on the way to the hospital.

School nursing is an ever-changing field, especially today as public schools are not well-funded and one of the school nurse’s duties is to write proposals for grants for health programs. The school nurse is not only concerned with the health of the students but is interested in improving the atmosphere of the school.
Cross-cultural understanding and nonviolence among students needs to be promoted. The breakup of the family and the varied perspectives of diverse peer groups contribute to many lifestyles. Of the many skills students are encouraged to learn, they are being taught that mediation is better than violence.

Save the Children
Save the Children is an organization dedicated to saving and improving the quality of life of children in underdeveloped countries. The nurse who chooses work of this type is special, and her skill becomes the biggest asset in this situation.

Young infants in all parts of the world are at the mercy of adults, and these adults are placing children in situations entirely unfit for children. In Mogadishu, Save the Children makes sure 4,500 children are fed every day. Refeeding of the malnourished child has to begin at a slow rate so as not to deplete the child’s store of minerals. Minerals are needed to metabolize food, otherwise the child is at risk for a heart attack. These young nurses enlist with organizations or missions dedicated to helping children in undeveloped countries in all parts of the world. The work is mostly done under primitive conditions.

Forensic Nursing
Forensic nursing is a growing field that is becoming popular its science used more in today’s world. The forensic nurse is an expert at collecting various legal evidence from victims of violent abuse.

There will be a forensic nurse in every emergency unit at some future time. The forensic nurse is especially trained as an expert witness to testify in court. She has the task of teaching and educating a jury about her findings. She is able to defend her conclusions under cross-examination.

To train for this new field, the nurse can work with another experienced nurse or with law enforcement. Forensics is becoming integrated into all parts of nursing with cases requiring the use of forensics occurring throughout the hospital.

The forensic nurse is especially trained to examine child abuse issues. The nurse understands that the more times a child tells his story, the more likely it is to be changed.

If a child abuse case goes to court, the nurse may be called to testify as to the evidence that was visible. She is able to describe the possible physical position a child may have been in when a sexual assault occurred. She relies on the nature of the damage and the injuries that are noted. Nurses’ ability to understand the signs and symptoms of the natural disease process aids in recognizing signs of trauma.

Forensics is becoming an important field and some nurses have switched professions to serve as death investigators in medical examiner offices.
In court case, whenever a nursing procedure to be clarified, attorneys will hire a nurse who is an expert in the concerned field. For example, a nurse is often asked to describe something that is not common knowledge to a jury. The nurse is qualified as an expert only when she is proficient in her field.

Roberta: “When I became a registered nurse, I chose to work only in the pediatric unit. I have an A.M.S. in Nursing specializing in pediatrics. I am especially concerned with child safety and the development of the child.”

Roberta has been called upon many times by attorneys to explain to a jury a special skill as well as the appropriate behavior of a child at a certain age.

She is frequently called upon to describe the nursing care at issue and to testify whether it complies with the standard of care. This is a field that appeals to many nurses.

Life today seems fast and furious at times. The nurse, working in the hospital or the emergency clinic, will come in contact with grieving families. It is more comfortable for them if they have an understanding of the grieving process.

There are many cultural differences in the grieving process that the nurse needs to be aware of. Each person heals at his own pace, and some people are very private about their grieving. A nurse should never minimize a person’s loss. If he wants to talk about death, the nurse should be there to listen to him.

In today’s world, mothers lose their children through traumatic means. Teenage suicide, drive-by shootings and other such traumas can tragically take away young lives without any warning.

People sometimes turn to the nurse for reassurance. They want to hear that the death of their loved one had some meaning. At this time, a person has many emotions with shock being the first and most intense response. A mourning ritual such as a funeral or memorial service will ease the stress of the griever. However, it is normal for the grieving person not to accept immediately the reality of what has occurred. Usually the person will go through the five stages of mourning in this order: denial, anger, depression, bargaining and acceptance. When the person is encouraged and supported in this process, the survivor will accept the loss and invite new changes into his life.

Some nurses choose to work in jails or correctional facilities. Many jails contain acute psychiatric hospitals for the nurse who desires challenge.

Many inmates are awaiting trial for child molestation or child assault charges. The nurse who works in this environment must not be judgmental of such individuals, as the nurse is often the only link these people have with reality, or with other people. An informed, sensitive and empathetic nurse has many opportunities to give a person a new way of thinking so that he may change his life.

The role of the nurse has changed in the past decade and grows daily; each nurse chooses her own special type of nursing.

Life is changing and there is much despair among people.

The social worker is obligated to put the child in a safe environment.

Children are frightened when their mother is hurt.

Violence affects some children more than it does others.

Nurses assess the bonding between mother and infant.

The school nurse needs to respond quickly in case of violence. More than nursing skills are necessary in today’s climate.

Forensic nursing is a growing field. The forensic nurse is expertly trained to examine children who have been victims of abuse. She is also an expert witness and qualified to testify in court.

Every nurse should understand the process of grief.

Children who are hurt look to the nurse for reassurance.

The nurse who is an expert witness is asked to describe something that is not common knowledge to the jury.