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STATE INSTITUTE OF NURSING AND PARAMEDICAL

SCIENCES, BADAL

SEMINAR
ON
PROFESSIONAL EDUCATION
&
TRENDS IN DEVELOPMENT OF NURSING
EDUCATION IN INDIA

SUBJECT- NURSING EDUCATION

SUBMITTED TO:
RESP. SIR MR. SUNIL KUMAR GARG
LECTURER
SINPMS, BADAL
SUBMITTED BY:
RAMANDEEP KAUR
M Sc.NURSING 1ST YEAR
ROLL NO.-21

SUBMITTED ON: MAY 14, 2014


PROFESSIONAL EDUCATION
Profession
The word profession is derived from ‘Profess’ which means ‘To proclaim
something publicly’.

According to Oxford dictionary- “Profession is a paid Occupation, especially one that


involves prolonged training and a formal qualification”.

It can also be defined as an occupation which helps a person to build his/her skills and
develop his/her expertise in a field which interests him/her.

Education

The meaning of education is “delivery of knowledge, skills and values from teachers to
students”. This meaning of education is incomplete because education is not merely the
delivery of knowledge and skills to the students; rather it is the process of becoming an
educated person.

Professional education
Professional education includes any programs that improve the knowledge, skills, attitudes,
or behaviors of health care providers.

Profession education in nursing in india

There are six levels of nursing education in India today. They are :

1. Multi Purpose Health Worker Female training (ANM or MPHW-F)


2. Female Health Supervisor training (HV or MPHS-F)
3. General nursing and midwifery (GNM)
4. BSc. Nursing
5. MSc. nursing
6. MPhil and PhD

The ANM, HV, and GNM are conducted in schools of nursing. The last 3 are university level
courses and the respective universities conduct examinations. Beside there are several
certificate and diploma courses in specialties.

TRENDS IN DEVELOPMENT OF NURSING EDUCATION IN


INDIA
Trends in Nursing Education
As a profession, nursing requires that’s its members processes a significant amount of
education. Most nurses agrees that nursing education is important to practice and that it must
respond to change, in health care created by scientific and technological advances. There are
various education preparation for the registered nurses.

Nursing
Nursing is an art and science. As an art, professional nurse learns to dignity and personhood.
As a science, nursing is based upon body of knowledge that is always changing with new
discoveries and innovations.

Nursing education
Nursing education is a professional education which is consciously and systematically
planned and implemented through instruction and discipline and aims the harmonious
development of the physical, intellectual, social, emotional, spiritual and aesthetic powers or
abilities of the students in order to render professional nursing care to people of all ages, in all
phases of health and illness, in variety of settings, in the best or highest possible manner.

Development of Nursing Education


Basic General Nursing and Midwifery Education

1. Training of Dias (birth attendant)

The Dai training continued past independence. The goal was to train one Dai in each village
and ultimate goal was to train the entire practicing Dais in country. Duration of training was
30 days. No age limit was prescribed, training include theory and practice, more emphasis on
field practice. This training was done at sub centre and equipments provided by UNICEF.

2. Auxiliary Nurse Midwife

In 1950 Indian Nursing Council came out with some important decisions relating to
future pattern of nursing training in India. One of the important decisions was that there
should be only two standards of training nursing and midwifery, subsequently the
curriculum for these courses was prescribed.

The first course was started at St. Marys Hospital Punjab; 1951. The entrance
qualification was up to 7/8 years of schooling. The period of training was 2 years which
include a 9 month of midwifery and 3 months of community experience.
3. Lady Health Visitor Course

Training of LVH course continued post independence. The syllabus prepared and
prescribed by INC in 1951. The entrance qualification was matriculation. The duration
was two and a half years which subsequently reduced to 2 years.

4. General Nursing and Midwifery Programme

The general nursing and midwifery course is conducted in 2178 centers in the country. The
syllabus of General Nursing and Midwifery has undergone many revisions according to the
change in the health plans and policies of the Government and changing trends and
advancements in general education, nursing health sciences and medical technology.

 The latest revision of syllabus by INC in 2004 has increased the duration of the
course from three year to three and half year.
 The basic entrance has become intermediate or class 12 instead of earlier class 10.
 Both science and arts students are eligible.
 The focus of general nursing education is the care of sick in the hospital.
 Schools of nursing are generally attached to hospitals.
 Three Board examinations are conducted, one at the end of each year. On passing
the candidates are registered as registered nurse and mid –wife by the respective
state nursing councils.

Eligibility for admission

1. Age for the entrance shall be 17 years to 35 years.


2. Minimum education, all students should pass 12 classes or its equivalent, with arts
or science subjects
3. Admission of students shall be once a year.
4. Students should be medically fit.

The selection committee should comprise tutors, nurse administrators, and


educationalist/psychologist. The principal of the school shall be the chairperson.

Training programme

The course in general nursing shall be of three and half years duration as follows, ---

 Two years practice in general nursing ,


 One year community health nursing and midwifery and
 Six months internship which includes nursing administration and nursing research
classes.

Objectives

• Demonstrate awareness of and skills required in the nursing process in the provision
of health care and nursing of patients
• Apply relevant knowledge from the humanities biological and behavioral sciences in
carrying out health care and nursing activities and functions.
• Show sensitivity and skill in human relationship and communication in his or her
daily works
• Demonstrate skill in the problem solving methods in nursing.
• Gain knowledge of health resources in the community and the country
• Demonstrate skill in leadership
• Demonstrate awareness of necessity of belonging to professional organizations.
• Promotion of health, precaution against illness, restoration of health and rehabilitation

5. Bachelor of nursing course (b.sc. Nursing)

Graduate nursing education started in India in the year 1948 in CMC , Vellore and in the
RAK college of nursing at Delhi university. At present several universities in India offer the
course.

Eligibility for admission

A candidate seeking admission should have:

 Pass the 2 year of pre-university exam or equivalent as recognized by concerned


university with science subjects i.e. Physics, biology and chemistry.
 Obtained at least 45%of total marks in science subjects in the qualifying exam, if
belongs to a scheduled caste or tribe, should have obtained not less than 40 % of total
marks in science subjects.
 completed 17 years of age at the time of admission or will complete this age on or
before 31st December of the year of admission
 medically fit

Course of study

 The course of study leading to bachelor of nursing degree comprises 4 academic


years.

Objectives of study

The programme is designed:

1. To provide a balance of professional and general education


2. To enable a student to become a professional nurse practitioner who has self-direction
and is a responsible citizen.
3. Through planned guided experiences students are provided with opportunities to
develop a broad concept of the fundamental principles of nursing care based on sound
knowledge and satisfactory levels of skill in providing care to people of all ages in
community or institutional setting
4. Understanding of the application of principles from the physical, biological and social
sciences for assessing the health status
5. Ability to investigate health care problems systematically
6. Ability to work collaboratively with members of allied disciplines towards attaining
optimum health for all members of the society
7. Understanding of fundamental principles of administration and organization of
nursing service
8. Understanding of human behaviour and appreciation of effective interpersonal
relationship with individuals families and groups
9. Ability to assume responsibility for continuing learning

6. Bachelor of Nursing Course (Post Certificate) For Qualified Nurses

It was started in 1962. The need for higher training for nurses was stressed by Mudaliar
committee.

Eligibility for admission

The candidate seeking admission must:

1. Hold a certificate in General nursing and midwifery.


2. Be a registered nurse
3. Be medically fit
4. Have a good personal and professional record
5. Have working knowledge of English

Programme of study

Duration –The course of study comprises 2 academic years

Objectives

The goal of the post certificate programme leading to the bachelor of nursing is the
preparation of the trained nurses as a generalist who accepts responsibility for enhancing the
effectiveness of nursing care.

 Administer high quality nursing care to all people of all ages in homes , hospitals and
other community agencies in urban and rural areas
 Apply knowledge from the physical, social and behavioural sciences in assessing the
health status of individuals
 Make critical judgment in assessing the health status of the individuals and make
critical judgment in planning ,directing and evaluating primary, acute and long term
care given by themselves and others working with them
 Investigate health care problems systematically
 Work collaboratively with members of other health disciplines
 Teach and counsel individuals , families and other groups about health and illness
 Understand human behaviour and establish effective interpersonal relationships
 Teach in clinical nursing situations
 Acquire professional knowledge and attitude in adapting for leadership role.
7. Degree of Masters of Nursing

The master of nursing programme is offered by institution of higher education. The


programme prepares nurses for leadership position in nursing and other health fields and
encourages accountability and commitment to lifelong learning which fosters improvement of
quality of care.

 First two years course in masters of nursing was started at RAK College of Nursing
in 1959.and in 1969 in CMC Vellore.
 At present there are 401 colleges imparting MSc Nursing degree course in different
specialties.

Eligibility

 Have passed BSc. Nursing/post certificate BSc, or nursing degree of any university.
 Have a minimum of one year of experience after obtaining BSc, in hospitals or
nursing educational institutions or community health setting.
 The candidate shall be selected on merit judged on the basis of academic
performances in BSc nursing, or post certificate B.Sc. nursing and selection tests.

Objectives

Graduates of master of nursing programme demonstrate:

 increased cognitive ,affective and psychomotor competencies and the ability to utilise
the potentials for effective nursing performance
 Expertise in the utilization of concepts and theories for the assessment, planning and
intervention in meeting the self-care needs of an individual for the attainment of
fullest potentials in the field of specialty.
 ability to practice independently as a nurse specialist
 ability to function effectively as nurse educators and administrators
 ability to interpret the health related research
 ability to plan and initiate change in the health care system
 leadership qualities for the advancement of practice of professional nursing
 interest in lifelong learning for personal and professional learning advancement

Specialties

Candidate will be examined in any of the following branches—

1. Medical Surgical Nursing -Cardio Vascular & Thoracic Nursing


2. Medical Surgical Nursing–Critical Care Nursing
3. Medical Surgical Nursing –Oncology Nursing
4. Medical Surgical Nursing - Neurosciences Nursing
5. Medical Surgical Nursing - Nephro- Urology Nursing
6. Medical Surgical Nursing -Orthopaedic Nursing
7. Medical Surgical Nursing - Gastro Enterology Nursing
8. Obstetric & Gynaecological Nursing
9. Paediatric (Child Health) Nursing
10. Psychiatric (Mental Health) Nursing
11. Community Health Nursing

8. Masters of Philosophy Programme in Nursing

Nursing shares with the whole university a main focus of preparing its students for service
and assisting them to achieve a meaningful philosophy of life. The student is encouraged to
develop judgment and wisdom in handling knowledge and skills and achieve mastery of
problem solving and creative skills.

In 1980 RAK College of nursing started an MPhil programme as a regular and part time
course. Since then several universities started taking students for the MPhil course in nursing.

Objectives

The objectives of M. Phil degree course in nursing are:

 to strengthen the research foundations of nurses for encouraging research attitudes


and problem solving capacities
 to provide basic training required for research in undertaking doctoral work

Duration:-Duration of the full term M. Phil course will be one year and part time course will
be two year.

Course of study

At the time of admission each candidate will be required to indicate her priorities in regard to
the optional courses. A candidate may offer one course from M Phil programme from the
department of Anthropology, education, sociology and physiology or any suitable
department. The M. Phil studies will be into two distinct parts, part1 and part 2.

Part1-it consist of 3 courses, i.e. research methods in nursing, major aspects of


nursing, allied disciplines

Part2-after passing the part1 examination, a student shall be required to write a


dissertation. The topic and the nature of the dissertation of each candidate will be
determined by the advisory committee consist of 3 members. The dissertation may
include results of original research, a fresh interpretation of existing facts, and data or
a review of article of critical nature.
9. Doctorate Of Philosophy In Nursing (Phd In Nursing)

 Earlier Indian nurses were sent abroad for Ph. D programme.


 PhD programmes in nursing was first started in India in 1992.

Eligibility criteria

 The candidate should be post graduate in nursing with more than 55% of aggregates
of marks
 Should have research background
 May or may not published articles in journals
 The course duration is far regular PhD course is 3 years and for part time is 4 years

10. Post Doctoral Degree In Nursing

The Post- Doctoral Programs provide advanced research training for nurses who hold
doctoral degree.

The major goal of the Post- Doctoral Program is to develop a cadre of clinical nurse
researchers who will be able to :-

 Conduct clinical nursing research


 Secure funds for clinical studies through grants
 Foster the communication of clinical research findings through presentations and
publications
 Promote integration of significant research findings into the clinical area of patients.

Current education pattern in India


1. Non University Programme
Basic-ANM-GNM
Advanced-post-certificate diploma

2. University Programme
Basic- B.Sc (N)
Post-Basic B.Sc (regular)
Post- Basic B.Sc (N) IGNOU
Advance’s (nursing)
M. Phil
PhD

Development of Nursing education in India: Pre-independence


Nursing originated independently, existed many centuries without contact with modern
medicine. Evolution of medicine, surgery and public health into complicated technical area
requiring many procedures by trained person and who is having understanding of scientific
principles, which brought two profession closer and together.

1. Nursing in Pre-historic Times

There is no historical evidence available on ancient history on nursing care of sick in


primitive times discovered through myths and archaeologist. To get rid “evil spirit”
unpleasant conditioning like beating, starving, magic rites, nauseous medicine, loud noise
and sudden fright are used methods. Primitive man had the skill of massaging,
fermentation bone setting, amputation, hot and cold bath, heat to control haemorrhages.

2. Nursing- Vedic Period (3000 B.C-1400 B.C)

Indian medicines are found in the sacred books of “Vedas”. The ‘Ayur-veda’ is thought to
have been given by Brahma. 1400 BC Sushruta, known as ‘Father of Surgery’ in India
wrote a book on surgery years later. ‘Charaka’ wrote a book on internal medicine. By this
writings we can learn that those days surgery had advanced to a high level, also have 4
wings of treatment ‘Chatushpada Chikitsa’.

 Physician- Bhishak
 Nurse- Upacharika (Attentdant- Anuraktha)
 Therapeutic drugs- Dravya
 Patient-Adhyaya

Characters of Upacharika (nurse)

 Shuchi- pure or clean in physical appearance and mental hygiene


 Daksha- competency
 Anurakhta- willing to care
 Buddhiman- co-ordinator with the patient and doctor/intelligent

3. Nursing Post Vedic Period (600 BC – 600 AD)

Medical education introduced in ancient Universities of ‘Nalanda’ and ‘Thakshashila’.


King Ashoka (272-236 BC) constructed hospital for the people and animals. Prevention
of disease was given first importance and hygienic practices were adopted. Doctors and
midwives were to be trust worthy and skilful. Religious ceremonies and prayer precede
co-operations. Other religious restriction and superstitious practices probably declined the
development of nursing

4. Nursing in Mogul Period (1000 AD)

‘Unani’ system of medicine developed during the Arab civilization. It was practiced in
Indo-Pakistan subcontinent. The basic framework are consists of blood, phlegm, yellow
bile and black bile. Temperament, strengthening of body and nature are the real
physician.

Not believed in eradication of disease greatly depend on defence mechanism of the body
and self-care and positive health habits.

5. British period (16th century onwards)

After the Mougl period the nursing in India hindered due to various reasons like low state of
women, system of “Pardha” among Muslims, caste system among Hindus, illiteracy, poverty,
political unrest, language differences and nursing looked upon as servants work.

During the 16th century, nursing development in India taken three dimensions

Civilian nursing:- During 1664 (British raj), civilian nursing was started in govt. general
hospital at Madras. In 1854, certificates of diploma in midwifery for passed students and
sick nursing for failed students was granted by midwives training school. In1871, the
civilian nurses were trained for hospitals and first batch of nurses came out as diploma in
midwifery nursing.

Military nursing:- During 1st World war, military nursing was developed when British
officers informed need of nurses to take care of British officials and soldiers. On 21st
February 1888, 10 fully certified nurses from Florence Nightingale arrived to Bombay to
lead nursing in India. In 1927, Indian Military Nursing services formed with12 matrons,
18 sisters and 25 staff nurses. After 2nd World war, Nursing services in India and overseas
were expanded. 3 year training programme was carried out in preliminary training
schools in selected military hospitals. Those who successfully completed training were
granted certificates as ‘Registered Nurse’ and considered members of Indian military
nursing services and Auxiliary nursing services.

Missionary nursing:- It get started with training of Indian nurses. Various other
countries supported this move. This brought fully qualified Indian nurses. In those days,
girls were not allowed to do work, Muslim girls were held under pardha system and
Hindus girls were hold back due to deep rooted caste system. So, Christian girls were
encouraged to undergo training and were trained first.

Development of nursing education in India: post- independence


On 15th August 1947 India became independent and self govermentation. Social changes
were taking place rapidly but an alarming absence of public health and sanitary measures
continued. The ratio of nurse to patient remained dangerously low.

The opening of nursing schools associated with collage gave nursing profession a higher
social and economic status, than it had previously known. The formation of many
commission and committee, establishment of INC and tremendous work of TNAI brought
about change in nursing education post independence.
Trained Nurses Association of India

The trained nurses association of India is national body of practitiotiners of nursing at


various levels. The main idea behind the establishment of the association in 1908 was to
uphold in every way to dignity and honor of the nursing profession and to promote team
spirit, high standards of health care and nursing.

Objectives

 To uphold in every way the dignity and honor of the nursing profession and to
promote a sense of esprit de corps among all nurses.
 To promote high standards of health care and nursing practice.
 To advance professional , educational, economic and general welfare of nurses

Activities performed by TNAI

1. Conferences: - the TNAI holds its national biannually .it was planned in 1972 to hold
these conferences quadrannaully .
2. Continuing Education Programme:- The association organizes continuing
education programmes for nursing personnel oriented to different aspects of education
and administration
3. Publications: - the association brings out monthly magazines, the nursing journal of
India. Some books on aspects of nursing practice and education at low prices.
4. Socioeconomic welfare programme: One of the objectives of the TNAI is to provide
socio-economic welfare to nurses in country.
5. Nursing regulation project:- Another objective of the education is to raise the
standards of nursing education and practice through necessary legislations

Indian Nursing Council


The INC was constituted to establish a uniform standard of education for nurses, midwives,
health visitors and auxiliary nurse midwives. The INC act was passed on December 31st
1947. The council was constituted in 1949.

Aims and Objectives

The basic Aims, Objectives and functions of Indian Nursing Council are as follows:

 To establish and monitor a uniform standard of nursing education for nurses by


inspection of the institutions.

 To recognize the qualifications under section 10(2)(4) of the Indian Nursing Council
Act, 1947 for the purpose of registration and employment in India and abroad.

 To give approval for registration of Indian and Foreign Nurses possessing foreign
qualification under section 11(2)(a) of the Indian Nursing Council Act, 1947
 To prescribe the syllabus & regulations for Nursing programs.

 Power to withdraw the recognition of qualification in case the institution fails to


maintain its standards.

 To advise the State Nursing Councils, Examining Boards, State Governments and
Central Government in various important items regarding Nursing Education in the
Country

Functions:

 Inspect and accredit schools of nursing in their state.


 Conduct the examinations.
 Prescribe rules of conduct.
 Maintain register of nurses, midwives and ANM and health visitors in the state.

Challenges in Nursing education


 Nursing education prepares nurses to practice in a variety of settings.
 The impact of modernization, globalization and liberalization on the society has
brought tremendous changes in general and nursing education.
 The significant trends in modern education are creativity, changes in teaching-
learning process and advanced educational technology.
 The scientific and technological advances in medicine along with social changes have
resulted in emergence of new disease and the development of specialists and super
specialists.
 Advanced nursing practice enables nurses to practice in new role such as nurse
practitioners and clinical nurse specialists.
 Nursing profession ensures a promising career in India with job opportunities abroad.
 Large number of private nursing educational institutions has been set up, which
require faculty with postgraduate education.
 Degree nursing courses are offered through distance education by different methods
such as print media, video conferencing, off campus programme and academic or
continuing education courses on the World Wide Web.
 Improved teaching strategies such as programmed instruction, problem based
learning, computer assisted learning and online learning is few examples of newer
learning strategies available in nursing education.

With large number of graduates passing out every year, it is a challenge to maintain quality in
nursing education. Good infrastructure, clinical facilities and adequately prepared faculty are
important. Linking of nursing education and practice encourages well prepared graduates for
better patient care.
Evolution of Nursing Education in India
 1854: Nightingale established nursing school at St. Thomas Hospital, London.
 1865: Miss Florence Nightingale provided suggestions on a system of nursing for
hospitals in India.
 1867: St Stephens hospital in Delhi started training of nursing to the Indian girls.
 1871: The first school of nursing was started in government general hospital, Madras
with 6 months Diploma Midwives program.
 1886: School of nursing was started in J.J. hospital, Bombay.
 1888: Ten fully qualified certified nurses from Florence Nightingale arrived to
Bombay to lead nursing in India.
 1894: Regular system of training for orderliness (men for hospital work) was started.
 1901: Men were banned to serve as nurse in Military Nursing of USA.
 1908: Trained Nurses Association of India (TNAI) was established.
 1910: Nursing Journal of India started publishing from the TNAI. United board of
examination was organized to conduct examination for nurses in India.
 1911-12: South India and North India Examining Board were created to conduct
examinations of nursing.
 1918: Training schools were started for health visitors and dais at Delhi (India) and
Karachi (Pakistan).
 1926: First registration council for nurses was formed at Madras presidency.
Midwives Registration Act was also formed to ensure better training of midwives.
 1935: Bombay nursing councils were established.
 1943: School of Nursing was established at Rajkumari Amrit Kaur College, New
Delhi. Diploma programme in nursing administration was also started in New Delhi.
 1946: Four year basic Bachelor Degree programs were established at the RAK
College of Nursing (1946) and CMC Vellore (1947) as per the recommendation of the
Bhore committee. Nursing education was integrated into the system of university
education as per the recommendation of University Education Commission headed by
Dr Radha Krishanan.
 1947-49: The Indian Nursing Council act was passed by ordinance on December 31st
1947. The Indian nursing council (INC) was constituted in the year 1949.
 1951: The syllabus was prepared for lady health visitor course by INC and duration of
the course was reduced to 2 years from 2.5 years. The first ANM course in India was
started at St. Mary’s hospital in the Punjab. One year duration course in public health
was started at RAK College of nursing Delhi. Indian Nursing Council also prescribed
syllabus for general nursing and midwifery course in the year 1951 and a special
provision was made for the admission of male in GNM course in 1954.
 1953-54: First organized course in psychiatric nursing started at All India Institute of
Mental Health.
 1954: Shetty committee recommended improvement in conditions of training of
nurses. Minimum requirement for admission was suggested to be in accordance with
regulation of the INC.
 1959-60: Master in nursing degree course was started at the RAK College of Nursing,
Delhi. Later on in the year 1968-69 College of Nursing Christian Medical College,
Vellore also started the same programme.
 1961: Mudaliar committee recommended minimum entrance qualification for GNM
and B Sc Nursing programme. Matriculation was prescribed as minimum
qualification for admission in to GNM programme, similarly; higher secondary was
prescribed as minimum qualification for admission in to degree course of nursing.
 1962: Diploma in pediatric nursing was established at J. J. Group of Hospitals,
Bombay.
 1963: School of Nursing in Trivandrum started the first two years post certificate
bachelor degree program. First revision of GNM course was done in the same year. In
the year 1964-65 psychiatric nursing was included in curriculum.
 1973: Kartar Singh committee recommended multipurpose health worker scheme and
change in designation of ANM and LHV.
 1985: M. Sc Nursing course started in College of Nursing CMC, Ludhiana (Punjab).
 1986: M. Phil nursing programme was started in RAK College of nursing Delhi.
 1988: M. Sc Nursing programme was started at National Institute of Mental Health
and Neurosciences, Bangalore.
 1990: Sarojini Varadappan committee recommended that Masters in nursing
programme to be increased and strengthened and Doctorate in nursing
programme should be started in selected university. Continuing education and staff
development for nurses was also emphasized.
 1991: Working group on nursing education and manpower recommended that by the
year 2020 the GNM programme should be phased out from India and curriculum
of B. Sc nursing to be modified.
 1992: Post Basic B. Sc Nursing programme was launched by Indira Gandhi National
Open University (IGNOU) New Delhi. Ph.D programme was started in RAK College,
New Delhi.
 1994: M. Sc Nursing programme was started at MAHE, Manipal.
 1996: M. Phil and PhD Nursing programmes were started at MAHE Manipal.
 2004- College of Nursing, All India Institute of Medical Sciences, New Delhi started
super specialty master courses in nursing (Cardiological & CTVS, Nephrological,
Neurological, Critical care and Oncological nursing).
 2005- Ph D in Nursing was established under the leadership of the Indian Nursing
Council, seven leading nursing institutions of India, World Health Organisation, and
the Rajiv Gandhi University of Health Sciences, Bangalore.

Conclusion
Nursing is one of the health professions which functions in conjunction with other
health care agencies assisting individuals, families and communities to achieve and maintain
desirable standards and maintain desirable standard of health.

Bibliography
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India; Pp 1-22
 Kay Kittrell Chitty: “Professional Nursing Concepts and Challenges”; edition 4th,;
Published by- Elsevier Saunders; Pp-2-27.
 Leddy Susen and Pepper J. Mac: “Conceptual Bases Of Professional Nursing” ;edition 4th,
Published By- Lippincott; Pp-4-11.
 Potter and Perry “Fundamentals of Nursing”; edition 5th, Vol. 1st; Published By- Mosby
Harcourt India ;Pp-376-380.
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