Continous Learning for Adults

with Needs
(CLAN)
Prepared by: Nahide Yaman, Sevilay Yıldız
NURSING AS A JOB

LITERATURE SCAN

NATIONAL PROVINCE DIRECTORATE

BOLU – 2008

CLAN – Continuous Learning for Adults with Needs

134649-LLP-1-2007-1-IT-GRUNDTVIG-GMP
Grant Agreement 2007-3569/001-001
This project has been funded with support from the European Commission.
This publication reflects the views only of the author, and the Commission cannot be held responsible for any use
which may be made of the information contained therein

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 NURSING AS A JOB

Since the very early beginning of the history, health has been on of the most
indispensable aspects of life. According to modern public health
conception, preserving the good health before it gets worse is
among the initial targets. That is why the reforms on health
field and the expectations and complaints of the health
personell are getting more and more importance day by day.

Health, for the individuals, is one of the basic needs which is

compulsory, indispensable and preserving the level of its importance throughout the each
periods of life.

A nurse is a female person who ,after getting certain education, takes care of the
sick, gives health service at the clinics and assists to the doctor. Various definition has
been made throughout the history, for example; in the 19th century Florence Nightingale
defined it as “in order to recover the sick from his illness, the act of bettering and
ordering the environment of the sick”. In he 20 th century, Handerson defined it as “a
dynamic power to achieve the sick’s health and independence” The Union of International
Nurse Community approved this definition. In 1980, The Union of American Nurses
defined the nursing as “a profession that offers help” and the act of nursing as “the
diagnosis and the treatment of man’s reactions against the existing and the potential
health problems” (http://www.blogcu.com).

Nursing is tough job which involves hard working conditions and which includes
self-commitment, self-sacrifice, patience and tolerance. Nursing, likewise the other
professions, has arisen from social needs, and is very much related to human life. It
involves good skills on cooperation, manuel aptitude and pace, moreover in its core,
there lies respect and love. A nurse, without having any discrimination such as religion,
language, nationality, tries to do her best in order to make the individual, the family and,
the society recover from their illness’. Because of that it is impossible for a person that
lacks love, compassion, discipline and solemnity, to carry out this job. Because, the nurse
gives service to the people that are destitute of health and needing nelp. Form this point
of view, it is obvious that the nurses should be backed up with psychological, social and
financial aspects(http://www.hemsireler.org).

The nursing which has got deep historical roots, had been carried out in Ancient
Egypt, India, Greece and Rome not as much as it is done today. Florance Nightingale who
is the founder of modern nursing, opened the first nursing school in London in 1962. In

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Turkey, the first nursing courses go back to an institution named “Hilal-i Ahmer Cemiyeti"
(Kızılay) in 1911. The ones who finished these courses, took care of the wounded of
1912-1914 The Balkan Wars and 1st World War. After the foundation of the modern
Turkish republic, the first nursing school was opened in Istanbul which was followed by
the opening of the nursing school in Ankara in 1939. This schools give education as three
years with the level of a primary school and four years with the level of a high school.
Nowadays, they are health high schools with four year education. Also two year
occupational high schools are available for high school graduates
(http://www.hemsireler.org).

Presentation of Society Service

Nursing, after the doctors, is the oldest health profession. We could analyze the
functions of nursing under four headings.

1st function; is the method of transporting the protective, developer, recovering or

rehabilitating nursing services to the society.

2nd function; the training of the sick, service receivers and health maintenance
personell.

3rd function; working as an effective member of health maintenance outfit.

4th function; developing the nursing applications by way of critical thinking and
research.

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 Nursing in Turkey

The nursing in Turkey, despite having a great importance

as one of the outfits giving health services, are not
esteemed enough. A nurse is usually considered as the
assistant to a doctor and despite the fact that it is stressed
that health service is achieved only by a well-organized
cooperation, however in practical that is not the case.

Main Problems of Nursing in Turkey

Getting educations with different levels: In our country, there are five levels of
nursing education. They are 4 year college, 2 yer college, open-university, high-school,
and 18 month course after high-school. This variety affects the profession negatively. The
difference at education level are not reflected at the authorization and responsibility at
the workplace. The health high schools which were closed in 1996, were reopened in
2001. The nurse’s request for university education wasn’t taken into consideration.
However, there is no country that satisfies with high school education nowadays.

The Law of Nursing 6283 numbered and 1954 dated Nursing Law doesn’t reply the
needs of the changing roles and responsibilities of the nurses. While some laws in
accordance with the EU laws are putting into practice, a nursing law isn’t planned and
existing laws doesn’t reply the problems of health sector today.

The Employment of Nurses: Some politics named the conversions at the health sector,
have badly influenced the health personell especially the nurses and are still influencing
badly. These politics that are aiming at getting profit from health sector, are bringing an
umemployment problem for the nurses into the light since they are based upon
recovering health service not upon protecting health service. 90% of the total 80.000
nurses of our country are working for recovering health service which indeed is the half
of needed nurse number. For instance, if a hospital of 400 beds, even though it is stated
that 400 nurses are needed, generally you could see 150-170 nurses. Under such hard
conditions, nurses are facing the problem of leaving the care activities to some other
people. This situation affects the quality of the job badly and causes some ideas such as
a nurse is someone who acts accordingly by the orders of the doctor.

Seperating into branches: In our country, except for the scholar life, there cannot be
seen separating into branches (such as Operation room nurses, intensive care unit

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nurses, oncology nurses etc.) Some nurses who worked for oncology clinics for years can
be transferred to some other sectors.

Sex: the most important sociological characteristic is the sex. There are very few male
nurses in our country. Since nursing as a job has always been attributed to the female
sex, it affects the development of profession badly. Since in an patriarchial society, a
woman is expected to yield to the man, this situation is truly reflected in health sector.
According to the survey which was carried out by Turkish Nurses Association in 2000
and which consists of the nurses, midwives, and health civil servants; it has been
observed that 41,9% of the nurses are content eith their profession whereas 58,1% of
the nurses are discontent with their profession. Some reaons for this discontent are:

1. Deficiency of money,
2. Uncertainty at duties and responsibilities,
3. Having too much risk,
4. Being appointed to some tasks out of profession,
5. Not being able to make an advancement at the profession,
6. Negative approach of the society to the profession,
7. Intensive working conditions,
8. Being accepted as an assisting person,
9. Over-working
10. Not being able to work under the wanted branch.

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 When making plans on health sector in our country, nurses’ not being represented
enough is seen as one of the reasons of the profession’s not having autonomy.
Nursing is a professional kinda activity. Even though it has achieved its professional
development in the developed countries, it has not been achieved in Turkey enough
because of the reasons above.( http://gazi27.blogcu.com ).

Ataturk, who thought that a modern society is only

achieved by good education for both men and
women, expressed his idea: “It is compulsory that
both men and women must take proper education
on science.” Women got their almost all the rights
under the light of Ataturk’s these ideas. It has
always been stated that the women of our country
got their rights without struggle. But, this is not the case in health sector. Unfortunately,
the sexual discrimination is still going on in the health sector. Nowadays, there are still
people who are thinking that higher education is not necessary for the nurses. They
believe that nursing doesn’t demand much information and skill. They think that being
lovely, cheerful and self-committed are enough for being a good nurse. As a matter of
fact, in the higher health convention in 20th of October, 2007, the decision on opening
nursing high-schools shows us that this idea is still on.
As of summarizing the development of nursing: the history of nursing starts with
the curing role of woman. But, a modern approach to nursing as a job starts with
Florance Nightingale (1820-1910) who gave health service in Istanbul during the
Crimmean War (1854-56). That is to say, Turkey witnessed the birth of modern nursing.
Turkish Nursed Association organized the room in which Nightingel worked as a museum
in 1954. Florance Nighingale is one of the initiators of Human Rights. According to her,
someone who has got a creative thinking can change the destiny of human being and
shape the future. Dr. Besim Omer Pasa (1962-1940) is founder of modern nursing who
attended the nursing conference in London in 1907 and met Florence Nightingale there.
He, being aware of the fact that nursing is of great significance, trained the “ladies” of
the important families of Istanbul himself. Only after that was it possible for the Muslim
women to attend the Balkan War (1912) and

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Dardanos War (1915-16) and give health service to the wounded.
(http://www.saglikbilgisi.com).

Legal Regulations
Today, all the legal issues are being considered under the 6283 numbered and
1954 dated nursing services law. In this law, nursing is defined as a profession that is
acquired by a high school education, is bound to the responsible doctor, and a female
profession as well. This law is quite out of fashion today. In 1992, The Ministry of Health
launched some reforms on health field and prepared a draft on “Nursing and Turkish
Nursing Association” in which it is stated that nursing is a profession that is acquired by
four year college education and suitable for both sexes. This law draft which took a place
in the agenda of the 55th government (12/01/1999) was neglected because of the fact
that the 55th government was brought down.

Occupational Organizations
The first nursing organization in Turkey was founded by volunteer nurses in 1933
under the name of “Turkish Sick Carers Association”. This association was reorganized in
1943 and the board was replaced by educated nurses and renamed “Turkish Nursing
Association”

Today, what the nurses demand is that they want equality and cooperation with
other health personell such as doctor, pharmacist, physical-therapist and become an
autonomous profession. Several factors had roles in professional enlightenment. Some
social, political and financial developments in Europe in the last 25 years, the efforts of
EU, some developments in science and technology left some problems facing the health
sector. The expenses for health service rose quite high and there happened a need for a
cheaper but more qualified health service. In this new approach, the actual health staff
is expected to play the lead. WHO defined the nurses and midwives as the most
important figure in order to give cheaper but qualified health service. Those recent
developments necessitated a change in nursing. Some organizations such as ICN, WHO,
Europe Nursing Office, EU Nursing Perpetual Committee played important roles in legal
changes in nursing profession. With the helps of these organizations, some books and
study materials have been prepared for all the national nurses. One of the most
important activity for strengthening the nursing profession is the European Nursing
Conference held in Vienna in 1988. The decisions took in this conference have been
unanimously accepted by the participants. The main decisions are as follows
(http://www.hemsireler.org):

 All the educational programmes must be reorganized.

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  Nursing education must be reorganized as being a four year college education.
 Only the nurses themselves must be responsible for the education of the nurses.
 The laws on nursing must be reorganized as leaving the development and
management of the profession to the nurses themselves.

RELATED RESEARCHES
In this section, there are samples of some researches on nursing in Turkey.
Metin and Ozer (2007) in their work named “The Setting out the Level of Nurses’ Being
Exhausted” have set out the level of nurses’ being exhausted in Denizli SSK Hospital. 87
nurses working at Denizli SSK Hospital made up the universe of the research. The
universe has been directly studied without choosing a sample (n=64). The interviews
have been executed between 8th March and 19th March, 2004. The average age was
32.45±6.46.
71,8% of the nurses are graduates of two-year degree.
76,6% of the nurses are married.
85,9% of the nurses are having nuclear family.
71,9% of the married ones are having children.
It has been observed that desensitization point average is higher in the ones that
are having nuclear family or having a kid and the average points of desensitization and
being emotionally exhausted are higher in the ones that are thinking of changing the
profession. It has been also observed that as the years pass the level of being emotionally
exhausted decreases.

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Karadağ and his friends have spotted that the nurses that are having an experience of less
than 10 years have got a higher level of desensitization whereas the ones that are working
for more than ten years are more dwelling upon the individual success (2002).
Güneş (2007) has got a MA named the “The Factors that are Effecting the Nurses
Who are working at the University Hospitals”. This research which was fulfilled on 407
nurses who are working at the two university hospitals has stated that the nurses that
are working at the daytime and are having day-offs at the weekend have got a higher
degree of professional satisfaction and efficiency. Gunes, stating that in the past, the
satisfaction of the nurses was effected by the number of the sick, regular turns etc.,
states that nowadays things like commitment to the institution, self-development are on
the ground. Güneş says that 60% of the nurses emphasized the commitment to the
institution. He also says that as the level of being educated rises, the expectations follow
a different path. Among the mostly disturbed factors by the nurses are ambiguity on
roles, ambiguity on duties and some conflicts between the outfits.

Yildirim and others made a research in 2007 called “the setting up the level of
nurses’ using cognitive strategies for coping with the stress and effecting factors” 150
nurses who are working at Erzincan State Hospital made up the universe of this research
which was held between 1st February and 14th February 2005. In this research, it was
found the as the years pass the level of learned strength rises; the level of education, the
unit to be worked, and the working style have got nothing to the with learned strength. It
was also founded that the nurses haven’t got the wanted level of learned strength.
Ozaltin and Nehir (2007) did a study on the stress factors for the nurses of the
intensive care unit of the hospitals in Ankara and the way of their coping with that stress.
In this research, it has been seen that most of the nurses are single, between 20 and 30,
and are graduates of four-year degree and MA degree, are dissatisfied with the payment.
In thi study, it has also been seen that the most important factors of stress are taking
care of the most critic sick persons and their relatives. The ones who are working at the
insurance hospital, over 31, married, reluctantly working at the intensive care units,
lacking the necessary eduction, are having more stress than those ones.

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Moreover, they stated that they look for social back up in order to cope with stress. It is
also recommend that some modifications should be put into practises in order to better
the working conditions for the nurses so that this modifications should help them for
coping with the stress. A cooperation with the psychiatry section is also recommended.

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BİBLİOGRAPHY
Arcak, Rojan ve Evin Kasımoğlu.” Diyarbakır Merkezdeki Hastane ve Sağlık Ocaklarında
Çalışan Hemşirelerin Sağlık Hizmetlerindeki Rolü ve İş Memnuniyetleri” Dicle Tıp
Dergisi, Diyarbakır: 2006 Cilt:33, Sayı:1, (23-30)

Güneş, Nuray. “Üniversite Hastanelerinde Çalışan Hemşireleri Etkileyen Etmenlerin

Belirlenmesi” Yayımlanmamış Yüksek Lisans Tezi. Dokuz Eylül Üniversitesi Genel
Cerrahi Ana Bilim Dalı , İzmir: 2007 (Hürriyet 12 Kasım 2007)

Metin Ögür ve Fadime Gök Özer. “Hemşirelerin Tükenmişlik Düzeyinin Belirlenmesi”

Atatürk Üniversitesi Hemşirelik Yüksekokulu Dergisi, Erzurum:2007; 10: 1
Özaltın, Gülten ve Sevgi Nehir. “Ankara İlindeki Hastanelerin Yoğun Bakım
Ünitelerinde Çalışan Hemşirelerin İş Ortamındaki Stres Etkenleri Ve Kullandıkları
Başetme Yöntemlerinin Belirlenmesi” Atatürk Üniversitesi Hemşirelik
Yüksekokulu Dergisi, Erzurum: 2007; 10: 3
Taş, Fatma ve ümran Çevik.” Konya İlindeki Pediatri Hemşirelerin Şiddete Maruz Kalma

”
Durumları “ Atatürk Üniversitesi Hemşirelik Yüksekokulu Dergisi Cilt: 9 Sayı: 3
2006
Uğur, Esra ve Süheyla Aban. “Hemşirelerin Iş Yaşamı Kalitesi Ve Etkileyen Faktörlere
Ilişkin Görüşleri” Tıp Bilimleri Dergisi, Ankara: Yıl: 2008 Cilt: 28 Sayı:3

Yıldırım, Arzu; Hacıhasanoğlu, Rabia ve Papatya Karakur. “Hemşirelerin Stresle Başa

Çıkmada Bilişsel Stratejileri Kullanma Düzeylerinin Ve Etkileyen Faktörlerin
Belirlenmesi” Atatürk Üniversitesi Hemşirelik Yüksekokulu Dergisi,
Erzurum:2007; 10: 4

http://www.blogcu.com

http://www.hemsireler.org

http://gazi27.blogcu.com

http://www.saglikbilgisi.com

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